Medical Science 2024 Paper I 50 marks Describe

Q6

Describe the microscopic features of breast cancer. Enumerate any five major prognostic factors. Enumerate any five differences between primary tuberculosis and secondary tuberculosis. Explain why primaquine is used for radical cure of malaria. Explain why albendazole is termed as broad-spectrum oral antihelminthic. What is candidiasis? What are its different presentations and etiological causes? Give the laboratory diagnosis of a case of invasive candidiasis. What is shigellosis? What are its causative organisms and their modes of pathogenicity? Give the laboratory diagnosis of a case.

हिंदी में प्रश्न पढ़ें

स्तन कैंसर की सूक्ष्मदर्शीय विशेषताओं का वर्णन कीजिए। किन्हीं पाँच प्रमुख प्राज्ञान घटकों को लिखिए। प्राथमिक ट्यूबरक्यूलोसिस तथा द्वितीयक ट्यूबरक्यूलोसिस के बीच किन्हीं पाँच भिन्नताओं को गिनाइए। समझाइए कि क्यों प्राइमाक्विन मलेरिया से समूल रोगमुक्ति दिलाने में प्रयोग की जाती है। समझाइए कि क्यों एल्बेंडाजोल को विस्तृत-स्पेक्ट्रम मुख्य कृमिरोधी कहा जाता है। कैंडिडा-रणता क्या है? उसकी विभिन्न अभिव्यक्तियों तथा उसकी हेतुकी के कारण क्या हैं? आक्रामक कैंडिडा-रणता के मामले में प्रयोगशाला में कैसे निदान किया जाता है, बताइए। शिगेला-रणता क्या है? उसके कारक जीवाणु कौन-से हैं तथा उनकी रोगजनकता की पद्धति क्या है? प्रयोगशाला में शिगेला-रणता के मामले का कैसे निदान किया जाता है, बताइए।

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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' and 'enumerate' demand comprehensive factual coverage with systematic organization. Structure the answer into six distinct sections corresponding to each sub-question: breast cancer histopathology and prognostic factors; primary vs secondary tuberculosis comparison; primaquine mechanism for radical cure; albendazole spectrum explanation; candidiasis classification, etiology and diagnosis; and shigellosis microbiology, pathogenicity and diagnosis. Use headings, bullet points for enumerations, and labeled diagrams where applicable.

Key points expected

  • Breast cancer: microscopic features (invasive ductal carcinoma NOS—tubule formation, nuclear pleomorphism, mitotic count; Nottingham grading; Paget disease; lobular carcinoma—single file pattern; mucinous, medullary variants) and five prognostic factors (tumor size, nodal status, histological grade, hormone receptor status, HER2 status, LVI, Ki-67)
  • Primary vs secondary TB: five differences covering site (lower lobe vs upper lobe), lesion type (Ghon complex vs fibrocaseous), lymph node involvement, hypersensitivity status, and reversibility
  • Primaquine radical cure: targets hypnozoites (P. vivax/P. ovale) in liver, 8-aminoquinoline mechanism, G6PD deficiency precaution, prevents relapse
  • Albendazole broad-spectrum: inhibits tubulin polymerization, effective against nematodes (roundworms, hookworms, whipworms), cestodes (tapeworms), and some protozoa; high oral bioavailability with albendazole sulfoxide metabolite
  • Candidiasis: mucocutaneous (oropharyngeal, esophageal, vulvovaginal, cutaneous) vs invasive (candidemia, hepatosplenic, CNS); risk factors (immunosuppression, broad-spectrum antibiotics, TPN); blood culture, beta-D-glucan, mannan/anti-mannan antibodies, tissue biopsy with pseudohyphae
  • Shigellosis: S. dysenteriae (type 1, Shiga toxin), S. flexneri, S. boydii, S. sonnei; pathogenicity (invasion of M cells, intercellular spread, Shiga toxin inhibition of protein synthesis, PMN infiltration); stool culture on SS agar, MAC-T, serotyping, PCR for ipaH, antibiotic sensitivity testing

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness25%12.5Accurate histopathological terminology for breast cancer subtypes (Nottingham criteria, E-cadherin loss in lobular carcinoma); precise distinction between primary and post-primary TB; correct mechanism of primaquine action on hypnozoites; accurate albendazole pharmacodynamics; proper classification of candidiasis syndromes and Shigella species with virulence factorsGenerally correct concepts with minor errors in terminology (e.g., confusing carcinoma in situ with invasive); incomplete understanding of primaquine's 8-aminoquinoline class; superficial knowledge of Shigella toxinsMajor factual errors (e.g., stating primaquine treats blood schizonts, confusing primary/secondary TB, misidentifying Candida as dimorphic fungus incorrectly)
Clinical correlation20%10Links microscopic features to clinical presentation (e.g., peau d'orange with invasive carcinoma, intestinal TB with obstruction, hemolytic anemia with primaquine in G6PD deficiency, NEC with S. dysenteriae type 1 in Indian outbreaks); mentions Indian epidemiology (high TB burden, chloroquine-resistant malaria, fluconazole-resistant Candida)Some clinical connections made but lacking depth on Indian context or specific complications; generic statements without disease-specific examplesNo clinical correlation provided; purely theoretical answer without mention of patient presentation, complications, or epidemiological relevance
Diagram / pathway15%7.5Labeled diagrams of: (1) invasive ductal carcinoma histology showing tubules, nuclear features; (2) Ghon complex vs fibrocaseous lesion; (3) Plasmodium life cycle with primaquine target site; (4) Candida pseudohyphae and budding yeast; (5) Shigella invasion mechanism through M cells. Clear, accurate, and referenced in textAt least 2-3 relevant diagrams attempted but with incomplete labeling or minor anatomical errors; diagrams mentioned but not well-integratedNo diagrams despite clear opportunities (histology, life cycles); or diagrams completely unlabeled and irrelevant to the question asked
Differential / staging20%10Breast cancer: TNM staging correlation with prognostic factors; candidiasis: differential diagnosis with other opportunistic infections (PCP, CMV, HSV esophagitis); shigellosis: differentiation from EIEC, Campylobacter, amoebic dysentery; TB: radiological differential between primary and post-primary patternsLimited differential discussion; staging mentioned superficially without correlation to the prognostic factors enumerated; some confusion between entitiesNo differential diagnosis or staging provided; fails to distinguish between clinically similar conditions (e.g., Candida vs Aspergillus in invasive disease)
Management / public-health angle20%10Breast cancer: adjuvant therapy based on receptor status (tamoxifen, trastuzumab), RNTCP guidelines for TB treatment categories, ACT with primaquine for P. vivax per NVBDCP India, mass drug administration with albendazole for lymphatic filariasis and STH control, fluconazole/amphotericin B for invasive candidiasis per ICMR guidelines, oral rehydration and antibiotic stewardship for shigellosis with mention of Indian vaccine development (Shigella flexneri 2a candidates)Generic treatment mentioned without national program integration; incomplete antibiotic regimens; missing public health relevanceNo management discussed; or dangerously incorrect regimens (e.g., primaquine as monotherapy for acute malaria, no mention of G6PD testing)

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