Medical Science 2022 Paper II 50 marks Discuss

Q8

8.(a) The 'End TB Strategy' is an evolution over the previous strategies to win over tuberculosis. (i) What are the key principles of the 'End TB Strategy' ? (4 marks) (ii) What are the 'pillars and components' of this strategy ? (10 marks) (iii) What are the major barriers that have thwarted the progress in the battle against the disease ? (6 marks) 8.(b) (i) What has been the impact of HPV vaccination in India ? (7½ marks) (ii) Discuss the currently available Human Papilloma Virus (HPV) Vaccines and their schedules. (7½ marks) 8.(c) A 60 year old lady comes to surgery OPD with 6×4 cm lump in her right breast with nipple discharge. (i) What will be the possible findings on clinical examination if this lump were to be malignant ? (6 marks) (ii) How will you investigate this patient ? (6 marks) (iii) What are the important structures which are to be preserved during modified radical mastectomy ? (3 marks)

हिंदी में प्रश्न पढ़ें

८.(क) ट्यूबरकुलोसिस पर विजय प्राप्त करने हेतु 'एंड टी.बी. रणनीति' पूर्व में अपनाई गई रणनीतियों की तुलना में अधिक उन्नत है । (i) 'एंड टी.बी. रणनीति' के मुख्य सिद्धांत क्या हैं ? (4 अंक) (ii) इस रणनीति के 'स्तंभ तथा घटक' क्या हैं ? (10 अंक) (iii) ऐसे मुख्य अवरोधक कौन से हैं जो रोग पर विजय प्राप्त करने में बाधक बने हुए हैं ? (6 अंक) ८.(ख) (i) एच.पी.वी. (HPV) टीकाकरण का भारत पर क्या प्रभाव पड़ा है ? (7½ अंक) (ii) आजकल उपलब्ध ह्यूमन पैपिलोमा वायरस (HPV) टीकों और उनमें से प्रत्येक को लगाए जाने की सारणी की व्याख्या कीजिए । (7½ अंक) ८.(ग) एक 60-वर्षीय महिला जिसके दाहिने स्तन में 6×4 cm का पिंड है और जिसे स्तनाग्र से स्राव आ रहा है, शल्यचिकित्सा बाह्य रोग विभाग में आती है । (i) यदि यह पिंड दुर्दम है तो रोगलाक्षणिक जांच करने पर क्या-क्या संभावित लक्षण मिलेंगे ? (6 अंक) (ii) इस रोगी की जांच कैसे की जानी चाहिए ? (6 अंक) (iii) संशोधित समूल स्तनोच्छेदन करते समय किन-किन रचनाओं को सुरक्षित रखना होता है ? (3 अंक)

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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 comprehensive, analytical treatment across all sub-parts. Allocate approximately 40% of time/words to 8(a) End TB Strategy (20 marks), 30% to 8(b) HPV vaccination (15 marks), and 30% to 8(c) breast cancer case (15 marks). Structure: begin with WHO End TB Strategy principles and pillars, transition to HPV vaccines with Indian context (SIIP, Tamil Nadu pilot), conclude with systematic breast cancer workup and MRM anatomy.

Key points expected

  • 8(a)(i-iii): End TB Strategy principles (SDG alignment, patient-centered care), three pillars with 13 components, barriers (MDR-TB, stigma, COVID-19 disruption, funding gaps)
  • 8(b)(i): India-specific HPV impact data—Tamil Nadu demonstration project, SIIP inclusion, coverage challenges, potential for cervical cancer reduction
  • 8(b)(ii): Bivalent (Cervarix: 0, 1-2, 6 months), Quadrivalent (Gardasil: 0, 2, 6 months), Nonavalent (Gardasil 9: same schedule); age groups 9-14 vs 15-26; 2-dose vs 3-dose schedules
  • 8(c)(i): Malignant breast lump features—hard, irregular, fixed, skin dimpling/peau d'orange, nipple retraction, bloody discharge, axillary lymphadenopathy
  • 8(c)(ii): Triple assessment—clinical examination, imaging (mammography/USG/MRI), cytology/histology (FNAC/core biopsy); receptor status (ER/PR/HER2)
  • 8(c)(iii): MRM preservation—pectoralis major, pectoralis minor (or only major in Patey modification), long thoracic nerve (serratus anterior), thoracodorsal nerve (latissimus dorsi), intercostobrachial nerve

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness20%10Accurately states WHO End TB Strategy 2016-2035 targets (90% reduction in TB deaths, 80% reduction in incidence), correctly identifies all three pillars and their components; precise HPV serotypes covered by each vaccine (16/18 for bivalent, adds 6/11 for quadrivalent, adds 31/33/45/52/58 for nonavalent); correct TNM staging awareness for breast cancerMixes up Stop TB Strategy with End TB Strategy; confuses vaccine serotypes or schedules; vague on breast cancer examination findings without specific descriptorsFundamental errors like stating TB is eradicated, confusing HPV with HSV, describing radical mastectomy instead of modified radical mastectomy
Clinical correlation20%10Links nipple discharge characteristics to pathology (bloody/serous vs milky), correlates lump fixity to Cooper's ligament involvement, connects axillary nodes to lymphatic drainage pathways; contextualizes HPV vaccination within India's cervical cancer burden (highest globally) and screening gapsLists examination findings without pathophysiological linkage; mentions HPV vaccines without India's disease burden context; describes investigations without prioritizationNo clinical reasoning—random list of findings; ignores Indian epidemiology; fails to distinguish physiological from pathological nipple discharge
Diagram / pathway15%7.5Draws End TB Strategy pillars-components flowchart; sketches breast lymphatic drainage levels (I, II, III axillary nodes, Rotter's nodes, internal mammary chain); illustrates MRM surgical planes showing pectoral muscles and nerve preservationMentions diagrams without drawing; describes lymphatic levels textually only; no visual representation of surgical anatomyNo diagrammatic attempt; confuses anatomical levels; incorrect nerve-muscle relationships
Differential / staging20%10Provides structured differential for breast lump (fibroadenoma, cyst, phyllodes, malignancy) with distinguishing features; outlines TNM staging (T1-T4, N0-N3, M0-M1) relevant to 6×4 cm lump; discusses drug-resistant TB classification (RR-TB, MDR-TB, XDR-TB, TDR-TB) as barrierLists differentials without discriminators; mentions staging without specifics; vague on DR-TB categoriesNo differential diagnosis; confuses clinical with pathological staging; omits drug resistance patterns entirely
Management / public-health angle25%12.5Critically evaluates India's TB elimination challenges (Nikshay portal, DBT, private sector engagement); analyzes HPV vaccine policy evolution (delayed national program vs state initiatives, cost-effectiveness); outlines neoadjuvant vs adjuvant therapy decision for locally advanced breast cancer, sentinel node biopsy as alternative to axillary clearanceDescriptive coverage of strategies without critical analysis; lists vaccine schedules without policy critique; describes MRM without mentioning breast conservation alternativesNo public health perspective; ignores India's programmatic challenges; surgical description only without oncological staging or adjuvant therapy planning

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