Medical Science 2025 Paper II 50 marks Differentiate

Q4

(a) (i) How do you differentiate between acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) based on peripheral smear and bone marrow findings? (ii) Describe the current standard of care for acute lymphoblastic leukaemia (ALL) in adults and children. 10+15=25 (b) Enumerate the various types of vaccines available in National Immunization Schedule (NIS) in children. Define adverse events following immunization. State the adverse events of any three vaccines. 6+3+6=15 (c) Discuss the diagnostic approach to and curative management of renovascular hypertension. 10

हिंदी में प्रश्न पढ़ें

(a) (i) परिसरिय आलेख तथा अस्थि मज्जा परिणामों के आधार पर तीव्र लसीकाकोशिकाप्रसू ल्यूकीमिया (ए० एल० एल०) तथा तीव्र मज्जाभ ल्यूकीमिया (ए० एम० एल०) के बीच कैसे भेद किया जाता है? (ii) वयस्कों तथा बच्चों में तीव्र लसीकाकोशिकाप्रसू ल्यूकीमिया (ए० एल० एल०) के वर्तमान देखभेख (उपचार) मानकों का वर्णन कीजिए। 10+15=25 (b) बच्चों के लिए राष्ट्रीय टीकाकरण सारणी (एन० आइ० एस०) में उपलब्ध विभिन्न प्रकार के टीकों (वैक्सीन) के नाम गिनाइए। टीकाकरण के पश्चात् होने वाली प्रतिकूल घटनाओं को परिभाषित कीजिए। किन्हीं तीन टीकों से होने वाली प्रतिकूल घटनाओं का वर्णन कीजिए। 6+3+6=15 (c) वृक्क-धमनी अतिरक्तदाब के प्रति नैदानिक अप्रोच तथा रोगमुक्तिकर प्रबंधन की व्याख्या कीजिए। 10

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Directive word: Differentiate

This question asks you to differentiate. The directive word signals the depth of analysis expected, the structure of your answer, and the weight of evidence you must bring.

See our UPSC directive words guide for a full breakdown of how to respond to each command word.

How this answer will be evaluated

Approach

The directive 'differentiate' in part (a)(i) demands systematic comparison, while 'describe' in (a)(ii), 'enumerate/define/state' in (b), and 'discuss' in (c) require comprehensive coverage. Allocate approximately 50% time/words to part (a) given its 25 marks (10+15), with 30% to part (b) (15 marks) and 20% to part (c) (10 marks). Structure: begin with morphological differentiation of ALL vs AML using FAB/WHO criteria, followed by age-stratified ALL management protocols, then list UIP/NIS vaccines with AEFI definitions and specific examples (DPT, measles, OPV), concluding with renovascular hypertension diagnostic algorithm and revascularization strategies.

Key points expected

  • Part (a)(i): Peripheral smear findings—ALL shows lymphoblasts (high N:C ratio, scant cytoplasm, no granules, TdT+); AML shows myeloblasts (Auer rods, myeloperoxidase+, Sudan black B+, CD13/CD33+); bone marrow blast threshold ≥20% for both; cytogenetic markers (Philadelphia chromosome in ALL, t(8;21), inv(16) in AML)
  • Part (a)(ii): Pediatric ALL—risk-stratified therapy using NCI/CCLG criteria, 4-drug induction (vincristine, dexamethasone, L-asparaginase, doxorubicin), CNS prophylaxis, maintenance with 6-MP/MTX; Adult ALL—hyper-CVAD or pediatric-inspired regimens, allogeneic HSCT for high-risk/Ph+ (imatinib/ponatinib), blinatumomab/inotuzumab for refractory disease
  • Part (b): NIS vaccines—BCG, OPV/IPV, Hepatitis B, DPT, Measles/MMR, JE, Rotavirus, PCV, Pentavalent; AEFI definition—any untoward medical occurrence post-immunization not necessarily causally related; specific AEFIs—DPT (sterile abscess, HHE, encephalopathy), Measles (febrile seizures, thrombocytopenia), OPV (VAPP)
  • Part (c): Diagnostic approach—clinical clues (onset <30 or >55 years, abdominal bruit, flash pulmonary edema, resistant hypertension), screening with Doppler ultrasound, confirmatory CTA/MRA, gold-standard renal angiography; curative management—percutaneous transluminal renal angioplasty (PTRA) with stenting for fibromuscular dysplasia, surgical revascularization for atherosclerotic disease, ACE inhibitors with caution in bilateral disease

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Precise morphological descriptors for ALL vs AML blasts (Auer rods exclusive to AML, TdT restricted to ALL); accurate blast percentage thresholds per WHO 2016/2022; correct vaccine schedules per India's UIP 2023; accurate renovascular hypertension pathophysiology (renin-angiotensin activation)Generally correct blast morphology but misses specificity of cytochemical stains; lists vaccines with minor schedule errors; describes hypertension workup without emphasizing screening testsConfuses lymphoid vs myeloid lineage markers; omits blast percentage criterion; significant errors in vaccine types or AEFI definitions; conflates renovascular with essential hypertension management
Clinical correlation20%10Age-specific clinical presentations (ALL: children with bone pain, hepatosplenomegaly; adults with higher WBC, CNS involvement); links AEFI severity to contraindications (DPT in progressive neurological disease); connects flash pulmonary edema/abdominal bruit to renovascular hypertensionMentions age differences without clinical nuance; lists AEFIs without severity stratification; notes hypertension resistance without specific clinical cluesNo age-stratified considerations; omits clinical relevance of AEFI surveillance; fails to mention abdominal bruit or asymmetric kidney size
Diagram / pathway20%10Flowchart for ALL vs AML diagnostic algorithm (morphology → cytochemistry → immunophenotyping → cytogenetics); NIS vaccination schedule timeline; renovascular hypertension diagnostic and management algorithm (screening → imaging → intervention)Describes algorithms in text without visual representation; attempts tables for vaccines without timeline clarityNo diagrams, flowcharts, or structured tables; purely descriptive without algorithmic presentation
Differential / staging20%10FAB and WHO classification for ALL/AML; risk stratification in ALL (standard vs high risk based on age, WBC, cytogenetics); differential diagnosis of secondary hypertension (pheochromocytoma, primary aldosteronism, coarctation); distinguishes AEFI types (program error vs coincidental vs injection reaction)Mentions FAB or WHO without elaboration; basic high/low risk without criteria; limited differential for secondary hypertensionNo classification systems; no risk stratification; no differential diagnosis for hypertension causes
Management / public-health angle20%10Pediatric ALL: 90%+ cure rates with risk-adapted therapy; Adult ALL: pediatric-inspired protocols improving outcomes; AEFI surveillance (AEFI committee, Causality assessment); renovascular: PTRA vs surgery based on lesion type (FMD medial fibroplasia vs atherosclerosis); mentions Mission Indradhanush for immunization coverageLists chemotherapy drugs without protocol context; mentions AEFI reporting without surveillance system; describes revascularization without selection criteriaOutdated chemotherapy regimens; no mention of targeted therapies (imatinib, blinatumomab); no AEFI surveillance; no revascularization indications

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