(a) (i) Enlist conditions having an increased risk of malignant disease in bone and cartilage.

(ii) Briefly mention classification of bone tumours. 5+5=10

(b) A 55-year-old male patient underwent subtotal gastrectomy for carcinoma stomach. Briefly

Question

(a) (i) Enlist conditions having an increased risk of malignant disease in bone and cartilage.

(ii) Briefly mention classification of bone tumours. 5+5=10

(b) A 55-year-old male patient underwent subtotal gastrectomy for carcinoma stomach. Briefly describe early and late complications of this procedure. 10

(c) (i) A 25-year-old infertile woman presents with menorrhagia. USG (Ultrasound) pelvis revealed multi-fibroid uterus, largest measuring 3 × 3 cm. Describe the evaluation and management of Fibroid Uterus in the above patient.

(ii) Describe recent classification of Abnormal Uterine Bleeding (AUB). Briefly discuss the endometrial pattern in various types of Abnormal Uterine Bleeding. 5+5=10

(d) (i) A young newly married couple wants advice on contraception. Describe the various methods of contraception which are suitable for them.

(ii) Enlist the various methods of female sterilization and complications of tubectomy. 5+5=10

(e) (i) Describe the 'yellow' category of biomedical waste in terms of — types of waste, types of bags or containers to be used, and treatment and disposal options.

(ii) Comment upon 'incineration' as a method of biomedical waste management. 5+5=10

UPSC Answer Check · Accepted Answer

The directive 'describe' demands systematic, structured exposition across all six sub-parts. Allocate approximately 10 marks worth of content to each sub-part: (a)(i)-(ii) bone tumour risk factors and WHO classification; (b) gastrectomy complications with timeline-based structure; (c)(i)-(ii) fibroid evaluation/management and FIGO PALM-COEIN classification; (d)(i)-(ii) contraceptive counselling and sterilization methods; (e)(i)-(ii) BMW yellow category and incineration critique. Open with brief clinical context where applicable, present core content in organized headings, and conclude with practical takeaways for each part.
- (a)(i) Pre-malignant bone conditions: Paget's disease, osteochondroma (multiple hereditary), enchondroma (Ollier's disease, Maffucci syndrome), fibrous dysplasia, radiation exposure, chronic osteomyelitis
- (a)(ii) WHO 2020 classification of bone tumours: cartilage-forming, osteogenic, fibrogenic, fibrohistiocytic, Ewing/haematopoietic, giant cell, notochordal, vascular, myogenic, lipogenic, epithelial, uncertain differentiation
- (b) Early complications (≤30 days): duodenal stump leak, gastric atony, dumping syndrome, afferent/efferent loop obstruction, nutritional deficiencies; Late complications: gastric remnant carcinoma, bile reflux gastritis, iron/B12/folate deficiency, osteoporosis, malabsorption
- (c)(i) Fibroid evaluation: hysteroscopy, MRI for mapping, endometrial biopsy; Management: myomectomy (fertility-preserving), GnRH agonists, uterine artery embolization, hysteroscopic resection for submucous lesions
- (c)(ii) FIGO PALM-COEIN classification (2011): Polyp, Adenomyosis, Leiomyoma, Malignancy/Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified; Endometrial patterns: proliferative, secretory, hyperplastic, atrophic
- (d)(i) Newly married contraception: Combined oral contraceptives, barrier methods, LNG-IUD, natural family planning; Counselling on efficacy, STI protection, reversibility
- (d)(ii) Female sterilization: laparoscopic tubal ligation (Pomeroy, Filshie clip), hysteroscopic Essure (now withdrawn), postpartum mini-lap; Complications: bleeding, infection, bowel/urinary tract injury, failed sterilization, ectopic pregnancy, post-tubal ligation syndrome
- (e)(i) Yellow category: human anatomical waste, animal waste, soiled waste, expired/discarded medicines, chemical waste; Yellow non-chlorinated bags; Treatment: autoclaving/microwaving then shredding, deep burial, or incineration
- (e)(ii) Incineration: advantages (pathogen destruction, volume reduction, waste-to-energy); disadvantages (dioxin/furan emission, mercury release, high capital/operational cost, ash disposal); WHO/EPA emission standards relevance

Dimension	Weight	Max marks	Excellent	Average	Poor
Concept correctness	20%	12	Accurately names WHO 2020 bone tumour classification, FIGO PALM-COEIN system, BMW 2016 Rules yellow category specifications, and gastrectomy complication timelines without factual errors; cites correct anatomical structures and pathophysiological mechanisms	Identifies major classifications with minor errors (e.g., outdated WHO 2013 instead of 2020, or conflating FIGO 2009 with 2011 PALM-COEIN); some confusion between early and late gastrectomy complications	Significant factual errors: wrong classification systems, incorrect waste category colors, misattributed complications (e.g., calling bile reflux an early complication), or confusion between subtotal and total gastrectomy sequelae
Clinical correlation	20%	12	For (a) links Paget's sarcoma transformation rates; for (b) distinguishes Billroth I vs II complication profiles; for (c) integrates infertility workup with fibroid management decisions; for (d) tailors contraceptive advice to newly married context; for (e) references Indian BMW Management Rules 2016	Provides clinical context superficially without integrating patient-specific factors; generic complication lists without anatomical reasoning; standard contraceptive description without newly married couple considerations	Purely theoretical responses lacking clinical application; no patient-centered reasoning; fails to mention Indian regulatory framework for biomedical waste; ignores fertility preservation in 25-year-old fibroid patient
Diagram / pathway	20%	12	Includes labeled diagram of Billroth II anatomy for (b); flowchart for PALM-COEIN classification in (c)(ii); algorithm for fibroid management in (c)(i); waste segregation color-coding table for (e); clear timeline diagram for early vs late complications	Mentions need for diagrams but execution is incomplete or poorly labeled; describes structures in text without visual representation; flowcharts present but missing decision nodes	No diagrams despite clear visual opportunities; dense text without structural organization; fails to use tables for classification systems or complication comparisons
Differential / staging	20%	12	For (a)(ii) presents WHO 2020 classification by differentiation lineage; for (c)(ii) systematically applies PALM-COEIN with structural vs non-structural categories; for (c)(i) differentiates fibroid types (submucous, intramural, subserous) by FIGO staging; for (b) differentiates afferent vs efferent loop obstruction	Lists categories without hierarchical organization; mentions PALM-COEIN but omits COEIN components; describes fibroids without FIGO 1-8 classification system	No systematic classification attempted; confuses differential diagnoses with classification systems; fails to distinguish structural from non-structural AUB causes; omits FIGO leiomyoma subclassification entirely
Management / public-health angle	20%	12	For (c)(i) justifies myomectomy over hysterectomy for 25-year-old infertile patient; for (d)(i) prioritizes reversible methods for newly married couple; for (e)(ii) critiques incineration citing Stockholm Convention and Indian CPCB emission norms; mentions alternative technologies like plasma pyrolysis	Lists management options without prioritization; describes tubectomy complications without prevention strategies; mentions BMW treatment but omits environmental/occupational health concerns	Inappropriate management suggestions (hysterectomy for young infertile patient); ignores reversibility needs for newly married couple; no environmental or public health perspective on waste management; omits informed consent and counselling aspects

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