Paper details
- Paper: "Case on IMED, SURG and GYN and PEDS", 160 marks. The scan has no printed date or unit code, so it is filed as undated.
- Questions: 6 case questions (hypothyroidism and thyroid surgery, infertility, IVF, term rupture of membranes, neonatal sepsis, separation anxiety disorder).
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Topics tested: hypothyroidism, thyroid surgery and anatomy, infertility work-up and treatment, IVF, premature rupture of membranes, neonatal sepsis, childhood anxiety disorders.
Case 1 (50 marks). A 50-year-old housewife with 20 lb weight gain in a year, fatigue, dizziness, memory loss, slow speech, a deepening voice, dry skin, constipation and cold intolerance. Temperature 96.8 °F, pulse 58 regular, BP 110/60, moderately obese, slow speech, puffy face, pale cool dry thick skin, thyroid not palpable, delayed reflex relaxation
(a) Likely diagnosis (1 mark)
(b) Symptoms that point to it (5 marks)
(c) Supporting physical findings (5 marks)
(d) Additional history and examination to help diagnosis (10 marks)
(e) Tests to confirm (5 marks)
(f) Treatment and drug mechanism (10 marks)
(g) Types of thyroid surgery (5 marks)
(h) Complications of surgery (5 marks)
(i) Structures in the same fascial plane as the thyroid (4 marks)
Case 2 (25 marks). A patient with infertility: outline your management before diagnosis
Case 3. If she is considered for IVF
Preconception care (5 marks)
Risks of IVF
Case 4 (5 marks each). After IVF, at 37 weeks she has a constant trickle of clear fluid for 8 hours, scanty first-trimester bleeding, reassuring fetal wellbeing, no contractions, soft abdomen, afebrile
At 37 completed weeks this is premature rupture of membranes at term (PROM). (Rupture before 37 weeks is PPROM.)