Medical Science 2023 Paper I 50 marks Describe

Q6

(a) (i) Enumerate any five risk factors for oral cancer. Describe its morphology. 5+5=10 (ii) Enumerate five causes of membranous glomerulonephritis. Describe its morphology. 5+5=10 (b) State the therapeutic indications, drug interactions and side effects of the following drugs: (i) Aspirin 5 (ii) Cyclosporine 5 (c) (i) Discuss various stages in the asexual life cycle of *Plasmodium falciparum*. Describe the principle, advantages and disadvantages of non-microscopic Rapid Diagnostic Test (RDT) for diagnosis of malaria. 5+5=10 (ii) Enumerate Human Herpes Viruses (HHV) with their primary target cells. How will you approach to diagnose a case of HSV infection in the laboratory? 4+6=10

हिंदी में प्रश्न पढ़ें

(a) (i) मुख कैंसर से सम्बद्ध किन्हीं पाँच जोखिमकारी कारकों के नाम गिनाइए । मुख कैंसर की आकृति का वर्णन कीजिए । 5+5=10 (ii) कलामय स्तवकवृक्कशोथ के पाँच कारण गिनाइए । इस रोग की आकृति का वर्णन कीजिए । 5+5=10 (b) निम्नलिखित औषधियों के चिकित्सार्थ संकेतों, औषधि अन्योन्यक्रियाओं तथा अनुषंगी प्रभावों को उल्लिखित कीजिए : (i) ऐसिपिरिन 5 (ii) साइक्लोस्पोरिन 5 (c) (i) प्लाज्मोडियम फैल्सीपेरम के अलैंगिक जीवन चक्र की विभिन्न अवस्थाओं की व्याख्या कीजिए । मलेरिया के निदान में अ-सूक्ष्मदर्शिकी रैपिड डायनोस्टिक टेस्ट (RDT) का सिद्धांत और उसके लाभ और हानि क्या-क्या हैं, उनका वर्णन कीजिए । 5+5=10 (ii) ह्यूमन हर्पीज विषाणुओं (HHV) तथा उनकी प्राथमिक लक्ष्य कोशिकाओं के नाम गिनाइए । एक HSV संक्रमण के मामले में प्रयोगशाला में निदान करने के लिए क्या पहुँचमार्ग अपनाया जाना चाहिए ? 4+6=10

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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 detailed, structured exposition of morphology, mechanisms and clinical features across all sub-parts. Allocate ~40% time to part (a) [20 marks], ~20% to part (b) [10 marks], and ~40% to part (c) [20 marks]. Structure: brief introduction, then systematic coverage of (a)(i) oral cancer risk factors and morphology, (a)(ii) membranous GN etiology and morphology, (b) pharmacology tables for aspirin and cyclosporine, (c)(i) Plasmodium life cycle with RDT details, and (c)(ii) HHV enumeration with HSV lab diagnosis. Use diagrams for morphology and life cycles.

Key points expected

Oral cancer: 5 risk factors (tobacco, alcohol, betel nut/areca nut, HPV-16, poor oral hygiene) and morphology (exophytic/ulcerative/verrucous, SCC features, field cancerization)
Membranous GN: 5 causes (idiopathic, HBV, drugs like NSAIDs/penicillamine, SLE, malignancy) and morphology (diffuse GBM thickening, spike formation on silver stain, subepithelial deposits)
Aspirin: therapeutic indications (antiplatelet, analgesic, antipyretic, anti-inflammatory), drug interactions (warfarin, methotrexate, ACE inhibitors), side effects (GI bleed, Reye syndrome, asthma)
Cyclosporine: therapeutic indications (transplant rejection prophylaxis, autoimmune diseases), drug interactions (CYP3A4 inhibitors/inducers, nephrotoxic drugs), side effects (nephrotoxicity, hypertension, gingival hyperplasia, hepatotoxicity)
Plasmodium falciparum asexual cycle: liver schizogony (exo-erythrocytic), RBC invasion, ring forms, trophozoites, schizonts, merozoites; RDT principle (HRP-2/pLDH detection), advantages (rapid, field applicable), disadvantages (cost, HRP-2 persistence, inability to quantify)
HHV 1-8 with target cells (HSV-1/2: epithelial/neuronal; VZV: T cells/skin; EBV: B cells; CMV: multiple; HHV-6/7: T cells; HHV-8: endothelial/B cells); HSV lab diagnosis (Tzanck smear, viral culture, PCR, serology, antigen detection)

Evaluation rubric

Dimension	Weight	Max marks	Excellent	Average	Poor
Concept correctness	25%	12.5	Accurately identifies all risk factors for oral cancer including Indian-specific habits (betel nut chewing); correctly classifies membranous GN as immune complex-mediated with precise ultrastructural correlates; states exact molecular targets of aspirin (COX-1/2) and cyclosporine (calcineurin); accurately describes Plasmodium hepatic and erythrocytic stages with correct duration; perfectly matches each HHV to its target cell	Identifies most risk factors but misses Indian context; describes membranous GN morphology without specifying spike formation or subepithelial location; lists indications and side effects but misses key drug interactions; describes Plasmodium stages with minor errors in sequence or duration; correctly names most HHV but confuses target cells	Confuses oral cancer risk factors with other head and neck cancers; misidentifies membranous GN as proliferative or confuses with MPGN; confuses aspirin with other NSAIDs or antiplatelets; major errors in cyclosporine mechanism; fundamental errors in Plasmodium life cycle stages; incomplete or wrong HHV enumeration
Clinical correlation	20%	10	Links oral cancer morphology to TNM staging and prognosis; correlates membranous GN nephrotic presentation with thromboembolic risk; explains aspirin use in Indian context of CAD prevention and acute coronary syndromes; discusses cyclosporine therapeutic drug monitoring in transplant settings; connects RDT utility to India's National Vector Borne Disease Control Programme and elimination goals	Mentions clinical presentations superficially; states nephrotic syndrome features without complications; lists indications without prioritizing by evidence; mentions drug monitoring without rationale; notes RDT use without public health context	No clinical correlation provided; confuses oral cancer with oral ulcers clinically; fails to mention nephrotic syndrome in membranous GN; no mention of aspirin in cardiovascular disease; no clinical context for cyclosporine use; no mention of malaria epidemiology or control programmes
Diagram / pathway	20%	10	Draws labeled diagram of oral cancer showing exophytic/ulcerative/verrucous growth patterns with histological zones; illustrates membranous GN with silver stain showing spikes and subepithelial deposits; sketches aspirin COX inhibition pathway and cyclosporine calcineurin-NFAT pathway; draws complete Plasmodium life cycle diagram with liver and blood stages; illustrates HSV replication cycle or Tzanck smear appearance	Attempts diagrams with partial labeling; describes morphology in text without visual representation; mentions pathways without diagrammatic representation; incomplete Plasmodium cycle diagram; minimal or no diagrams for virology	No diagrams despite explicit 'describe morphology' requirements; text-only descriptions where visual representation is essential; completely misses opportunity to illustrate life cycles or mechanisms
Differential / staging	15%	7.5	Differentiates oral cancer subtypes (well-differentiated SCC vs. verrucous carcinoma) and stages; distinguishes membranous GN from other nephrotic causes (minimal change, FSGS) and secondary vs. primary forms; differentiates aspirin from other antiplatelets (clopidogrel) and NSAIDs; stages Plasmodium asexual cycle precisely (pre-erythrocytic 5-7 days, erythrocytic 48 hours); differentiates HHV-1 from HHV-2 and from VZV clinically and diagnostically	Mentions some differentials without systematic approach; notes some staging parameters; partial differentiation of drug classes; basic cycle timing with minor errors; some HHV differentiation	No differentials provided; confuses oral cancer with potentially malignant disorders without progression; no distinction between primary and secondary membranous GN; no drug differentiation; major errors in Plasmodium staging; no HHV differentiation
Management / public-health angle	20%	10	Discusses oral cancer screening (visual inspection) in India's national programme; mentions ACE inhibitors/ARBs and immunosuppression for membranous GN; emphasizes aspirin low-dose regimen for CVD prevention per Indian guidelines; discusses cyclosporine dose adjustment and monitoring in resource-limited settings; critically evaluates RDT implementation in India's malaria elimination strategy, including HRP-2 deletion concerns in P. falciparum	Mentions treatment modalities without specifics; notes general immunosuppression for GN; states standard aspirin dosing; mentions cyclosporine monitoring without details; describes RDT use without critical evaluation of limitations	No management or public health discussion; misses screening opportunities for oral cancer; no treatment mention for membranous GN; no dosing or monitoring discussion for drugs; no mention of India's malaria control programme or RDT policy

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