Q6
(a) (i) Write in brief the reasons for rising Caesarean Section rates globally and in India. (5 marks) (ii) Discuss briefly the advantages and disadvantages of Vaginal birth and Caesarean Section. (5 marks) (iii) What measures can be adopted to reduce Caesarean Section rates? (5 marks) (iv) How will you counsel a patient who had previous Caesarean Section for vaginal delivery? (5 marks) (5+5+5+5=20 marks) (b) A 55-year-old male, tobacco chewer, presents to OPD with difficulty in opening mouth for one month. On examination, he is found to be having poor oral hygiene and a white patch on right buccal mucosa. (i) Briefly describe leukoplakia and its significance. (5 marks) (ii) What are the premalignant conditions for oral cavity cancer? (5 marks) (iii) What are the different cervical lymph nodes which can get involved in a patient with oral cavity cancer? (5 marks) (5+5+5=15 marks) (c) (i) When is a protein said to be "biologically complete"? (5 marks) (ii) How do vegetable proteins compare and compete with animal proteins? (5 marks) (iii) What are proteins needed for in the body? (5 marks) (5+5+5=15 marks)
हिंदी में प्रश्न पढ़ें
(a) (i) उन कारणों के बारे में संक्षेप में लिखिए जिनके कारण भारत और विश्व में सीजेरियन सेक्शन होने की दर में वृद्धि आई है। (5) (ii) योनि द्वारा (सामान्य) प्रसव तथा सीजेरियन सेक्शन के लाभ और हानियों की संक्षेप में विवेचना कीजिए। (5) (iii) सीजेरियन सेक्शन की दर घटाने के लिए क्या-क्या उपाय व्यवहार में लाए जा सकते हैं? (5) (iv) एक महिला जिसका पूर्व में सीजेरियन सेक्शन हुआ है, उसे योनि द्वारा प्रसव के लिए आप कैसे काउंसलिंग (परामर्श) देंगे? (5) (5+5+5+5=20) (b) एक 55-वर्षीय पुरुष जिसे तंबाकू चबाने की लत है, विगत एक माह से मुँह खुलने में कठिनाई अनुभव होने के कारण ओ.पी.डी. में आता है। जाँच करने पर उसके मुख का स्वच्छताविहीन (हाइजीन) अवस्था है तथा उसके दाहिने मुखीय स्लेष्मकला पर एक श्वेत क्षेत्र दृष्टिगत है। (i) श्वेतशल्कता (ल्यूकोप्लेकिया) और उसके महत्व का संक्षेप में वर्णन कीजिए। (5) (ii) मुख गुहा के कैंसर की पूर्व-दुर्दश्म रुपताएँ कौन-कौन सी हैं? (5) (iii) मुख गुहा के कैंसर के रोगी में कौन-कौन से विभिन्न ग्रीवा लसिका-पर्व रोगग्रस्त हो सकते हैं? (5) (5+5+5=15) (c) (i) प्रोटीन को "जैविक रूप से पूर्ण" कब कहा जाता है? (5) (ii) शाकाहारी प्रोटीन और पशु प्रोटीन की आपस में तुलना कीजिए तथा यह स्पष्ट कीजिए कि शाकाहारी प्रोटीन किस प्रकार पशु प्रोटीन से स्पर्धा कर पाती है। (5) (iii) शरीर में प्रोटीन किस-किस कार्य के लिए आवश्यक है? (5) (5+5+5=15)
Directive word: Discuss
This question asks you to discuss. 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 'discuss' demands a balanced, analytical treatment across all sub-parts. Allocate approximately 40% of effort to part (a) given its 20 marks, 30% each to (b) and (c). Structure: brief introduction on rising C-section rates and oral cancer burden in India; body addressing each sub-part sequentially with clinical depth; conclusion emphasizing integrated public health strategies for maternal and oral health.
Key points expected
- Part (a)(i): Reasons for rising C-section rates—medical (breech, placenta previa), non-medical (patient request, defensive medicine, commercial incentives), Robson classification; India-specific (institutional deliveries under JSY, private sector dominance, urban-rural disparity)
- Part (a)(ii): Vaginal birth advantages (microbiome colonization, maternal recovery, lower hemorrhage) vs C-section (reduced birth trauma, planned delivery); disadvantages of each mode with evidence from WHO and ICMR studies
- Part (a)(iii): Robson 10-group classification for audit, WHO partograph use, midwife-led care, financial disincentives for unnecessary C-sections, institutional protocols
- Part (a)(iv): VBAC counseling—TOLAC criteria (previous low transverse incision, no contraindications), success rates (60-80%), risks (uterine rupture ~0.5%), shared decision-making, NICE guidelines adaptation
- Part (b)(i)-(iii): Leukoplakia definition (WHO 2005), histopathological grades, malignant transformation rates; premalignant conditions (erythroplakia, oral submucous fibrosis, lichen planus, syphilitic glossitis); cervical lymph node levels I-V with oral cavity drainage patterns (submental, submandibular, jugulodigastric)
- Part (c)(i)-(iii): Biological value/PER/NPU criteria for complete proteins; limiting amino acids in cereals (lysine) and pulses (methionine), mutual supplementation; protein functions—structural, enzymatic, hormonal, immune, transport, energy
Evaluation rubric
| Dimension | Weight | Max marks | Excellent | Average | Poor |
|---|---|---|---|---|---|
| Concept correctness | 22% | 11 | Precise definitions: leukoplakia as 'white patch of questionable risk' excluding other diseases; biological protein completeness by essential amino acid profile matching human needs; accurate Robson classification groups; correct lymph node levels per AJCC/UICC; no confusion between premalignant conditions and lesions | Generally correct definitions but minor errors—e.g., conflating leukoplakia with lichen planus, vague protein completeness criteria, approximate lymph node descriptions without level specificity | Major conceptual errors—calling leukoplakia always premalignant, defining protein completeness only by source (animal vs vegetable), incorrect lymph node drainage patterns, fundamental misunderstanding of VBAC contraindications |
| Clinical correlation | 20% | 10 | Strong clinical integration: for (a) links rising C-sections to India's MMR goals and institutional delivery push; for (b) connects OSMF with areca nut chewing, trismus significance, and early oral cancer detection under NPCDCS; for (c) applies protein quality to Indian dietary patterns (cereal-pulse combination) | Some clinical links made but superficial—mentions JSY without connecting to C-section rise, notes tobacco without specifying smokeless forms common in India, generic protein examples without Indian dietary context | Purely theoretical answers with no Indian public health context, no mention of NPCDCS/NRHM relevance, ignores social determinants like poverty affecting protein intake or oral cancer risk |
| Diagram / pathway | 16% | 8 | Clear labeled diagram of cervical lymph node levels I-VI with oral cavity drainage; Robson 10-group classification flowchart; protein complementarity diagram showing cereal-pulse amino acid profiles; VBAC decision algorithm | Attempted diagrams but incomplete labeling, or describes diagrams in text without visual clarity; mentions pathways verbally without structured representation | No diagrams where expected (lymphatic drainage essential), or completely incorrect schematic representations; ignores visual components entirely |
| Differential / staging | 18% | 9 | Systematic differentials: for buccal white patch—lichen planus, candidiasis, frictional keratosis, squamous cell carcinoma; leukoplakia grading (homogeneous vs non-homogeneous, Prognostic index); cervical nodal staging N0-N3; clear distinction between premalignant conditions vs lesions | Lists some differentials but incomplete; mentions leukoplakia grades without clinical significance; basic nodal involvement without staging correlation | No differential approach, confuses leukoplakia with established malignancy, ignores nodal staging entirely, fails to distinguish premalignant conditions from lesions |
| Management / public-health angle | 24% | 12 | Comprehensive public health strategies: for C-section reduction—Robson audit implementation, WHO Mother-Baby Friendly Hospital Initiative, insurance regulation, Partograph mandatory use; for oral cancer—tobacco control under COTPA, early detection camps, VIA/VILI adaptation; for nutrition—ICDS supplementation, midday meal protein quality, biofortification; counseling frameworks with shared decision-making | Generic management suggestions without specific programs; mentions 'awareness' and 'screening' without naming NPCDCS, NSSK, or national nutrition missions; basic counseling points without structured approach | No public health perspective, purely individual-level management, ignores government programs entirely, no mention of counseling protocols or community-based interventions |
Practice this exact question
Write your answer, then get a detailed evaluation from our AI trained on UPSC's answer-writing standards. Free first evaluation — no signup needed to start.
Evaluate my answer →More from Medical Science 2021 Paper II
- Q1 (a) Discuss in brief the role of ultrasound in the investigation of pain in right hypochondrium. (10 marks) (b) Outline the pharmacological…
- Q2 (a) A sixty-year-old diabetic male presented to the emergency department with acute onset, central squeezing type of chest pain, which is s…
- Q3 (a) A 40-year-old male who was bedridden for the last two months following a fracture in the lower limb developed sudden breathlessness. (i…
- Q4 (a) Discuss in short the etiology, diagnosis, treatment and complications of cirrhosis of liver. (5+5+5+5=20 marks) (b) A 15-month-old chil…
- Q5 (a) Briefly describe the clinical features, diagnostic workup and management of a patient of choledochal cyst. (3+4+3=10 marks) (b) A 60-ye…
- Q6 (a) (i) Write in brief the reasons for rising Caesarean Section rates globally and in India. (5 marks) (ii) Discuss briefly the advantages…
- Q7 (a) A 60-year-old male presents with progressively increasing jaundice for 2 months. He is having clay coloured stools and pruritus. On exa…
- Q8 (a) (i) Summarise the spectrum of Iodine Deficiency Disorders. (10 marks) (ii) State the goal, objectives and salient features of Iodine De…