Medical Science 2025 Paper II 50 marks Describe

Q7

(a) (i) Describe the clinical features and diagnostic workup of a suspected case of peritonitis. (ii) Enumerate the principles of management of peritonitis. (iii) Enlist the important complications of peritonitis. 10+5+5=20 (b) 'Anaemia Mukt Bharat Programme' employs a multipronged approach. What are the interventions it focuses on to achieve its goals? What are the specific measures being undertaken under this programme? Which are the specific population groups that this programme targets? 5+5+5=15 (c) (i) Define infertility. How will you investigate the tubal factors of female infertility? (ii) Enumerate the assisted reproductive technology (ART) procedures. 10+5=15

हिंदी में प्रश्न पढ़ें

(a) (i) पेरिटोनाइटिस के संभावित मामले की रोगलाक्षणिक विशेषताओं तथा नैदानिक जाँच-पड़ताल का वर्णन कीजिए। (ii) पेरिटोनाइटिस के प्रबंधन के सिद्धांत गिनाइए। (iii) पेरिटोनाइटिस की महत्वपूर्ण जटिलताएँ सूचीबद्ध कीजिए। 10+5+5=20 (b) 'एनीमिया मुक्त भारत कार्यक्रम' बहुआयामी पद्धति अपनाए हुए है। अपने उद्देश्यों की पूर्ति के लिए यह कौन-कौन से हस्तक्षेपों पर केंद्रित करता है? इस कार्यक्रम के अंतर्गत क्या-क्या विशिष्ट उपाय किए जा रहे हैं? यह कार्यक्रम किन-किन विशिष्ट जनसंख्या समूहों पर केंद्रित है? 5+5+5=15 (c) (i) बंध्यता को परिभाषित कीजिए। महिलाओं में बंध्यता की डिंबवाहिनी नलिकाओं से संबंध कारकों की जाँच कैसे की जाती है? (ii) सहायक प्रजनन प्रौद्योगिकी अर्थात् असिस्टेड रिप्रोडक्टिव टेक्नोलॉजी (ए० आर० टी०) की क्रियाविधियों के नाम गिनाइए। 10+5=15

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Directive word: Describe

This question asks you to describe. 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 'describe' demands systematic elaboration of clinical features, diagnostic pathways, and programmatic details. Allocate approximately 40% of time/words to part (a) peritonitis (20 marks), 30% to part (b) Anaemia Mukt Bharat (15 marks), and 30% to part (c) infertility and ART (15 marks). Structure: begin with (a)(i) clinical features and diagnostic workup in sequence, followed by (ii) management principles and (iii) complications; then (b) interventions, specific measures, and target groups; finally (c)(i) definition and tubal factor investigation, closing with (ii) ART enumeration. Use diagrams for peritonitis pathophysiology and infertility workup flowchart.

Key points expected

  • (a)(i) Clinical features of peritonitis: acute abdomen with guarding, rigidity, rebound tenderness, absent bowel sounds, fever, tachycardia; diagnostic workup includes CBC, serum amylase, erect chest X-ray (free air under diaphragm), USG abdomen, diagnostic paracentesis (ascitic fluid analysis for PMN count, Gram stain, culture, amylase, bilirubin), and CT scan for localized collections
  • (a)(ii) Principles of management: NPO, IV fluids, NG tube decompression, broad-spectrum antibiotics (covering Gram-negatives and anaerobes), source control (surgery for perforated viscus, abscess drainage), organ support, and nutritional support; mention sepsis protocol
  • (a)(iii) Complications: septic shock, multi-organ dysfunction syndrome (MODS), intra-abdominal abscess, enterocutaneous fistula, adhesive intestinal obstruction, and death
  • (b) Anaemia Mukt Bharat: six interventions—prophylactic iron-folic acid supplementation, deworming, intensified year-round behavioural change communication, testing and treatment of anaemia using digital methods, point-of-care treatment, and mandatory provision of fortified foods in ICDS and PM POSHAN; targets children 6-59 months, 5-9 years, 10-19 years, women of reproductive age, pregnant women, and lactating women
  • (c)(i) Infertility definition: failure to conceive after 12 months of unprotected intercourse in women <35 years (6 months if ≥35); tubal factor investigation: HSG (hysterosalpingography), SIS (saline infusion sonography), laparoscopic chromopertubation, and hysterolaparoscopy as gold standard
  • (c)(ii) ART procedures: IUI (intrauterine insemination), IVF (in vitro fertilization), ICSI (intracytoplasmic sperm injection), GIFT (gamete intrafallopian transfer), ZIFT (zygote intrafallopian transfer), TESA/PESA (sperm retrieval), cryopreservation, and preimplantation genetic testing

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10For (a): accurately defines peritonitis types (primary, secondary, tertiary), lists correct diagnostic criteria for spontaneous bacterial peritonitis (SBP) vs secondary peritonitis, and names appropriate antibiotic regimens (piperacillin-tazobactam, carbapenems). For (b): correctly states IFA supplementation dosage (60 mg iron + 500 mcg folic acid for pregnant women, bi-weekly for adolescents). For (c): precise WHO infertility definition with age stratification and correctly identifies HSG as initial screening test for tubal patency.Basic definitions correct but misses SBP diagnostic criteria (ascitic fluid PMN >250/mm³), confuses AMB target groups, or states generic infertility definition without age cutoffs; minor errors in antibiotic naming or ART procedure descriptions.Fundamental errors such as confusing peritonitis with peptic ulcer disease, stating wrong AMB launch year (2018, not 2020), or defining infertility incorrectly as 'inability to bear children' without temporal criteria; significant factual inaccuracies in diagnostic thresholds or drug dosages.
Clinical correlation20%10For (a): correlates clinical signs to pathophysiology (paralytic ileus causing absent bowel sounds, diaphragmatic irritation causing shoulder pain in pelvic peritonitis); distinguishes localized vs generalized peritonitis; mentions Indian context of tuberculous peritonitis as differential. For (c): correlates tubal pathology (hydrosalpinx, fimbrial phimosis) to specific investigation findings and links to pelvic inflammatory disease/endometriosis etiology in Indian women.Lists clinical features without pathophysiological linkage; mentions TB peritonitis but doesn't elaborate on ascitic fluid ADA levels; basic correlation between tubal damage and infertility without discussing Chlamydia prevalence in India.Isolated listing of signs without clinical reasoning; no mention of Indian disease patterns; fails to connect investigations to clinical decision-making or misses tubercular etiology entirely in relevant contexts.
Diagram / pathway20%10Includes labeled diagram for (a): pathophysiology of secondary peritonitis showing bacterial translocation, peritoneal inflammation cascade; OR diagnostic algorithm flowchart. For (c): infertility investigation flowchart showing stepwise approach from history → semen analysis → ovulation confirmation → tubal patency testing → laparoscopy. Diagrams are neat, labeled, and referenced in text.Mentions 'see figure' or draws rough unlabeled sketches; describes diagrams in text without actual visual representation; incomplete flowcharts missing decision nodes.No diagrams despite clear indication for visual representation; or diagrams completely unrelated to question content; messy, uninterpretable sketches without labels.
Differential / staging20%10For (a): comprehensive differential diagnosis of acute abdomen (acute pancreatitis, MI, pneumonia, diabetic ketoacidosis, lead poisoning) with distinguishing features; mentions Mannheim peritonitis index or APACHE II for severity stratification. For (c): differentiates primary vs secondary infertility, and tubal vs other female factors (ovarian, uterine, cervical) with specific distinguishing investigations.Brief mention of 2-3 differentials without discriminating features; basic primary/secondary infertility distinction; no severity scoring mentioned for peritonitis.No differential diagnosis provided; confuses peritonitis with other conditions; fails to distinguish infertility types or omits male factor consideration entirely.
Management / public-health angle20%10For (a): evidence-based stepwise management with sepsis bundle, source control timing (within 6 hours), damage control surgery principles, and mention of open abdomen strategy in severe cases. For (b): detailed AMB implementation through ICDS, Health and Wellness Centres, and Ayushman Bharat; specifies WIFS (Weekly Iron Folic Acid Supplementation) programme for adolescents, fortification standards (FSSAI +F logo), and monitoring through Anaemia Mukt Bharat dashboard. For (c): patient selection criteria for each ART procedure, ethical considerations (PC-PNDT compliance), and cost-effectiveness in Indian context.Generic management principles without specific timelines or protocols; basic AMB description without programme architecture details; lists ART procedures without indications or ethical framework.Outdated or dangerous management advice; omits source control entirely; no public health programme details; describes ART without mentioning regulatory framework (ART Bill 2021) or ethical concerns.

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