Medical Science 2023 Paper I 50 marks Compulsory Describe

Q1

A 35-year-old male smoker with complaints of difficulty in swallowing and ulcer on tip of his tongue for last one month, visits an ENT surgeon. Based on his clinical examination and histopathological investigation of tongue lesion, he is diagnosed as a case of carcinoma of tongue with cervical lymphadenopathy. (i) Using a flowchart, show the principal lymph node involved and its further distribution. (5 marks) (ii) Explain the role of tongue in swallowing. (5 marks) (b) Describe the following in the context of 'Auditory pathway' : (i) Its course from internal ear to auditory cortex (5 marks) (ii) Blood supply of the auditory cortex (5 marks) (c) Discuss the sources and Recommended Daily Allowance (RDA) of Folic Acid and the clinical manifestations of its deficiency in the body. Add a note on 'Folate Trap'. (10 marks) (d) Describe the role of cerebellum in control of voluntary movement. Add a note on cerebellar dysfunction. (6+4=10 marks) (e) Describe the genesis of Rapid Eye Movement (REM) sleep. Why is REM sleep called paradoxical sleep ? (5+5=10 marks)

हिंदी में प्रश्न पढ़ें

एक 35-वर्षीय पुरुष जो धूम्रपान करता है, उसे विगत एक माह से निगलने में कठिनाई है और उसकी जिभा के अग्रभाग पर व्रण है । वह एक ई.एन.टी. सर्जन के पास जाता है । उसकी जिभा व्रण की रोगलाक्षणिक जाँच तथा उतकविकृति जाँच करने पर निदान होता है कि उसे जिभा का कार्सिनोमा है जिसके साथ ग्रीवा लसिकापर्वविकृति है । (i) फ्लोचार्ट (डायग्राम) के माध्यम से मुख्य प्रभावित लसिका पर्व तथा उसके और आगे के विस्तार को दर्शाइए । (5 अंक) (ii) निगलने की क्रिया में जिभा की भूमिका की व्याख्या कीजिए । (5 अंक) (b) 'श्रवण मार्ग' के संदर्भ में निम्नलिखित का वर्णन कीजिए : (i) आभ्यंतर कर्ण से श्रवण प्रान्तस्था तक उसका पथ (5 अंक) (ii) श्रवण प्रान्तस्था की रक्त आपूर्ति (5 अंक) (c) फोलिक एसिड के स्रोत और दैनिक अनुशंसित अलाउंस (RDA) तथा शरीर में उसकी अल्पता से उत्पन्न रोगलाक्षणिक अभिव्यक्तियों की व्याख्या कीजिए । साथ ही 'फोलेट ट्रैप' पर एक टिप्पणी लिखिए । (10 अंक) (d) ऐच्छिक गति के नियंत्रण में अनुमस्तिष्क की भूमिका का वर्णन कीजिए । साथ ही अनुमस्तिष्क दुर्दशा पर एक टिप्पणी लिखिए । (6+4=10 अंक) (e) रैपिड आई मूवमेंट (आर.ई.एम.) निद्रा की उत्पत्ति का वर्णन कीजिए । आर.ई.एम. निद्रा को क्यों विरोधाभासी निद्रा कहा जाता है ? (5+5=10 अंक)

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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 comprehensive, structured exposition of anatomical pathways, physiological mechanisms, and biochemical processes. Allocate time proportionally: ~20% for (a)(i)-(ii) lymphatic drainage and swallowing; ~20% for (b)(i)-(ii) auditory pathway and cortical blood supply; ~20% for (c) folic acid biochemistry; ~20% for (d) cerebellar physiology; and ~20% for (e) sleep physiology. Begin each sub-part with a brief contextual statement, present core content with appropriate headings, and conclude with clinical significance where applicable.

Key points expected

  • For (a)(i): Flowchart showing submandibular → deep cervical (jugulodigastric/jugulo-omohyoid) → supraclavicular nodes; mention of lymphatic levels I-V for oral cancer staging
  • For (a)(ii): Sequential phases of swallowing (oral preparatory, oral, pharyngeal, esophageal) with tongue's propulsive, sensory, and airway protective roles
  • For (b)(i)-(ii): Complete auditory pathway (cochlear nerve → cochlear nuclei → superior olivary complex → lateral lemniscus → inferior colliculus → medial geniculate body → Heschl's gyrus); middle cerebral artery (temporal branches) and posterior cerebral artery supply to auditory cortex
  • For (c): Dietary sources (green leafy vegetables, lentils, liver); RDA (400 μg adults, 600 μg pregnancy); megaloblastic anemia, neural tube defects, hyperhomocysteinemia; folate trap mechanism (B12 deficiency blocking THF regeneration)
  • For (d): Cerebellar coordination via feedforward/feedback mechanisms (comparator function, error correction, motor learning); dysfunction signs (intention tremor, dysmetria, dysdiadochokinesia, nystagmus, ataxia)
  • For (e): REM genesis (pons-geniculate-occipital waves, cholinergic activation, monoaminergic inhibition); paradoxical features (EEG desynchronization resembling wakefulness with muscle atonia, vivid dreams, penile erection)

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness25%12.5Precise anatomical terminology throughout: correctly identifies jugulodigastric as principal node for tongue; accurate relay stations in auditory pathway; correct RDA values with units; distinguishes folate from B12 deficiency; accurate cerebellar peduncle functions; correct neurotransmitter mechanisms in REM genesisGenerally correct concepts with minor errors: confuses jugulodigastric with jugulo-omohyoid; misses some auditory relay nuclei; approximate RDA values without pregnancy distinction; incomplete folate trap explanation; oversimplified cerebellar circuitryMajor conceptual errors: incorrect lymphatic drainage direction; fundamental errors in auditory pathway sequence; wrong RDA by factor >2; conflates folate and B12 deficiency completely; incorrect neurotransmitter roles in sleep
Clinical correlation20%10Strong clinical integration: links cervical lymphadenopathy to TNM staging; explains dysphagia mechanisms in tongue cancer; relates auditory cortex lesions to Wernicke's aphasia; connects folate deficiency to Indian context (vegetarian diets, neural tube defects); cerebellar signs linked to specific lesion localization; REM deprivation effects on cognitionSome clinical connections made but superficial: mentions cancer spread without staging; notes hearing loss without cortical localization; lists deficiency signs without Indian epidemiology; generic cerebellar ataxia description; basic REM function statementMinimal or absent clinical correlation: purely anatomical description without disease context; no mention of Indian public health relevance; fails to connect physiological mechanisms to clinical signs
Diagram / pathway20%10Clear, labeled flowchart for lymphatic drainage with levels I-V; accurate schematic of auditory pathway with decussation shown; well-structured representation of folate cycle; cerebellar circuit diagram with comparator function illustrated; REM sleep cycle graph with sleep stagesBasic diagrams present but incomplete: lymphatic flowchart without levels; auditory pathway as list rather than diagram; folate cycle described textually; cerebellar connections mentioned without illustration; sleep stages described without hypnogramAbsent or seriously flawed diagrams: no flowchart for 5-mark lymphatic question; purely textual description where visual representation essential; incorrect anatomical relationships in any diagram
Differential / staging15%7.5Appropriate differentials: for tongue lesion—squamous vs. basaloid SCC, TB, syphilitic chancre, traumatic ulcer; cervical lymphadenopathy differential (reactive, metastatic, lymphoma); distinguishes conductive vs. sensorineural hearing loss; differentiates megaloblastic anemias by methylmalonic acid; cerebellar vs. sensory/proprioceptive ataxia; NREM vs. REM parasomniasLimited differential consideration: mentions one or two alternatives for tongue lesion; basic conductive/sensorineural distinction; conflates folate and B12 deficiency without laboratory differentiation; generic ataxia description; minimal sleep disorder differentiationNo differential or staging: misses opportunity for clinical reasoning; accepts given diagnosis without critical evaluation; fails to distinguish related conditions in any sub-part
Management / public-health angle20%10Relevant management implications: neck dissection levels for tongue cancer; rehabilitation for dysphagia; cochlear implant candidacy; folic acid fortification in Indian context (mandatory wheat flour fortification 2016); cerebellar rehabilitation strategies; sleep hygiene and REM behavior disorder managementGeneric management statements: mentions surgery/chemotherapy without specificity; standard supplementation advice; basic physical therapy mention; general sleep recommendations without specific disordersAbsent or irrelevant management: no treatment implications; fails to mention national health programs (anemia mukt Bharat, iodine fortification parallels); ignores preventive aspects entirely

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