Medical Science 2025 Paper I 50 marks Compulsory Enumerate

Q5

(a) (i) Enumerate the topical antifungal drugs along with their indication and side effects. 5 marks (ii) Name antihelminitic drugs used in treatment of neurocysticercosis and also mention their side effects. 5 marks (b) (i) Enumerate the cells of lymphoreticular system. Schematically represent the process of B-cell maturation. 5 marks (ii) Make a schematic flowchart of pathogenesis of Salmonella causing enteric fever. Mention two important categories of drug resistance in Salmonella typhi. 5 marks (c) What are the risk factors for lung carcinoma ? Describe the morphological features of three major histological types of lung carcinoma. 4+6=10 marks (d) Describe the classification of cervical intraepithelial neoplasia/squamous intraepithelial lesion. Write a note on the role of Human papilloma virus in the pathogenesis of cervical carcinoma. 5+5=10 marks (e) Classify poisons based on the chief symptoms. Describe the legal duties of a medical practitioner in a case of suspected poisoning. 10 marks

हिंदी में प्रश्न पढ़ें

(a) (i) स्थल-कवकरोधी औषधियों के नाम उनके चिकित्सार्थ संकेतों तथा अनुषंगी प्रभावों के साथ गिनाइए। 5 (ii) न्यूरोसिस्टिसर्कोसिस के उपचार में प्रयुक्त होने वाली कृमिरोधी औषधियों के नाम बताइए तथा उनके अनुषंगी प्रभावों को भी उल्लिखित कीजिए। 5 (b) (i) लसीका-जालीय प्रणाली की कोशिकाओं के नाम गिनाइए। B-कोशिका परिपक्वता की प्रक्रिया का आरेखीय चित्रण कीजिए। 5 (ii) आरेखीय फ्लो-चार्ट के माध्यम से साल्मोनेला के रोगजनन, जिससे आंत्र ज्वर उत्पन्न होता है, को दर्शाइए। साल्मोनेला टाइफी में औषध प्रतिरोध की दो महत्वपूर्ण श्रेणियों को उल्लिखित कीजिए। 5 (c) फुप्फुस कार्सिनोमा के जोखिम कारक तत्व कौन-कौन से हैं ? फुप्फुस कार्सिनोमा के तीन प्रमुख उतकविज्ञान प्रकारों की आकृतिक विशिष्टताओं का वर्णन कीजिए। 4+6=10 (d) गर्भाशयप्रिवा अंतरपकला अबृंद रचना/पड़की अंतरपकला विधति के वर्गीकरण का वर्णन कीजिए। गर्भाशयप्रिवा कार्सिनोमा के रोगजनन में मानव पैपिलोमा वायरस की भूमिका पर टिप्पणी लिखिए। 5+5=10 (e) प्रमुख लक्षणों के आधार पर विषों को वर्गीकृत कीजिए। विषाक्तता के संदिग्ध मामले में मैडिकल प्रैक्टिशनर के वैधिक दायित्वों का वर्णन कीजिए। 10

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Directive word: Enumerate

This question asks you to enumerate. The directive word signals the depth of analysis expected, the structure of your answer, and the weight of evidence you must bring.

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How this answer will be evaluated

Approach

This multi-part question demands systematic enumeration across pharmacology, pathology, microbiology, and forensic medicine. Allocate approximately 10 minutes each to parts (a), (b), (c), (d), and (e) proportionally. Begin with precise drug lists for (a), followed by schematic diagrams for B-cell maturation and Salmonella pathogenesis in (b). For (c) and (d), integrate risk factors with morphological descriptions and HPV-mediated oncogenesis. Conclude (e) with the classification framework and legal duties under Indian law (CrPC Section 39, IPC 304B). Use tables for drug side effects and flowcharts for pathways.

Key points expected

  • Topical antifungals: imidazoles (clotrimazole, miconazole), allylamines (terbinafine), polyenes (nystatin, amphotericin B), ciclopirox olamine—with specific indications (dermatophytosis, candidiasis, tinea versicolor) and side effects (irritation, burning, rare systemic absorption)
  • Neurocysticercosis: albendazole (15 mg/kg/day × 28 days) and praziquantel (50 mg/kg/day × 15 days) as first-line; side effects include headache, seizures, alopecia, hepatotoxicity; mention corticosteroid co-administration to manage inflammatory response
  • Lymphoreticular cells: lymphocytes (T, B, NK), plasma cells, macrophages, dendritic cells, reticular cells; B-cell maturation schematic showing bone marrow (pro-B → pre-B → immature B) to peripheral lymphoid organs (follicular mantle → germinal center → plasma cell/memory B)
  • Salmonella typhi pathogenesis: ingestion → M-cell invasion → Peyer's patch multiplication → mesenteric lymph nodes → primary bacteremia → gallbladder colonization → secondary bacteremia → systemic illness; drug resistance: chromosomal (gyrA/parC mutations, decreased permeability) and plasmid-mediated (NDM-1, ESBL, AmpC)
  • Lung carcinoma risk factors: smoking (90% cases), radon exposure, asbestos, air pollution (India-specific: biomass fuel, chulha smoke), genetic susceptibility; histological types—squamous cell (central, keratin pearls, intercellular bridges), adenocarcinoma (peripheral, lepidic/glandular patterns, EGFR mutations in Asian populations), small cell (central, neuroendocrine features, paraneoplastic syndromes)
  • CIN/SIL classification: CIN 1/LSIL (lower 1/3 dysplasia), CIN 2/HSIL (lower 2/3), CIN 3/HSIL (full thickness); Bethesda system correlation; HPV pathogenesis: E6 (p53 degradation) and E7 (pRb inactivation) oncoproteins, high-risk types 16/18 (70% cervical cancers), integration into host genome
  • Poison classification by symptoms: corrosives (burning pain), irritants (GI symptoms), neurotics (CNS depression/stimulation), asphyxiants (cyanosis), cardiac poisons (arrhythmias), miscellaneous; legal duties under CrPC: inform police (Section 39), preserve evidence, maintain detailed records, issue dying declaration if applicable, attend court when summoned

Evaluation rubric

DimensionWeightMax marksExcellentAveragePoor
Concept correctness25%12.5Demonstrates precise pharmacological knowledge: correct drug classes, accurate dosing for neurocysticercosis, exact molecular targets of antifungals; pathology concepts accurately distinguish CIN grades and HPV oncogenesis; microbiology correctly identifies Salmonella invasion mechanism and resistance genes; forensic duties cite specific CrPC sectionsLists most drugs and cells correctly but confuses indications (e.g., nystatin for systemic use) or CIN grading; Salmonella pathogenesis described without specific cellular targets; legal duties mentioned without statutory referencesMajor conceptual errors: systemic antifungals listed as topical, neurocysticercosis drugs incorrect, CIN/SIL confusion, fundamental misunderstanding of HPV oncogenesis, omission of legal reporting duties
Clinical correlation20%10Links antifungal choice to specific clinical scenarios (terbinafine for onychomycosis due to nail penetration); explains why albendazole preferred over praziquantel in neurocysticercosis (better CSF penetration, single cyst efficacy); connects lung cancer histology to smoking status and EGFR testing for targeted therapy; relates HPV vaccination (Gardasil/Cervarix) to cancer preventionMentions clinical uses without explaining rationale; notes neurocysticercosis treatment without corticosteroid context; lists lung cancer types without treatment implications; describes CIN without screening relevanceNo clinical context provided; drugs listed without indications; histological types described without prognostic or therapeutic relevance; HPV discussion lacks vaccination or screening connection
Diagram / pathway20%10Clear, labeled schematic of B-cell maturation showing Ig gene rearrangement checkpoints (VDJ recombination, surrogate light chain, negative selection); detailed Salmonella pathogenesis flowchart with anatomical landmarks (Peyer's patches, mesenteric nodes, gallbladder) and immune evasion mechanisms; optional but helpful: HPV genome integration diagramBasic B-cell maturation outline without molecular details; Salmonella pathogenesis as linear text rather than flowchart; diagrams present but poorly labeled or anatomically impreciseNo diagrams despite explicit requirement; text description substitutes for required schematics; incorrect pathway representation (e.g., T-cell maturation instead of B-cell)
Differential / staging15%7.5Precise CIN/SIL classification with Bethesda correlation and management implications (observation for LSIL, LEEP/cone for HSIL); lung cancer TNM staging awareness implicit in morphological description; distinguishes neurocysticercosis from other CNS cystic lesions (hydatid, tuberculoma); poison classification systematically organized by symptom complexesCIN grades listed without Bethesda system; lung cancer types described without staging awareness; poison classification incomplete or disorganizedConfuses CIN with invasive cancer staging; no differential consideration for cystic brain lesions; poison classification missing major categories
Management / public-health angle20%10Integrates public health: HPV vaccination program (India's indigenous vaccine development), cervical cancer screening (VIA, HPV DNA testing); lung cancer prevention (tobacco control, clean fuel initiatives); multidrug-resistant typhoid (XDR S. Typhi in Pakistan/India) and antibiotic stewardship; forensic duties emphasizing poisoning as medico-legal case requiring police intimationMentions vaccination or screening without programmatic details; notes MDR typhoid without resistance mechanism explanation; legal duties listed without emphasizing mandatory reportingNo public health context; forensic answer ignores legal obligations; antimicrobial resistance mentioned without clinical significance

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