SCA practice case · Video consultation
“The headache at 34 weeks”
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Nadia Hassan · 29 years · female
Setting
Video consultation — 34 weeks pregnant, new headache.
Past history
- Pregnant, 34 weeks
- Previous emergency caesarean section; HDU admission
Medication
- Paracetamol OTC (patient-reported)
Allergies
None recorded
Recent notes
⚠ No BP or urinalysis recorded recently. Booked a video slot herself.
Reason for contact
Video consultation. “Could you just tell me which painkillers are safe in pregnancy?”
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
A new, persistent headache in the second half of pregnancy is pre-eclampsia until proven otherwise — and here the full cluster is present: headache unrelieved by paracetamol, visual disturbance, epigastric/RUQ pain (mislabelled "indigestion") and new oedema at 34 weeks. The trap is treating it as a tension/hormonal headache and answering the literal "which painkillers are safe?" question; the right action is urgent SAME-DAY assessment — BP, urine protein, bloods (FBC/liver transaminases/renal function; NICE NG133), PlGF-based testing where available (NICE HTG630, formerly DG49) and fetal assessment via the maternity unit — because pre-eclampsia can progress to eclampsia, HELLP and fetal compromise. NICE NG201 tells pregnant women to seek immediate advice for exactly these symptoms. The examinable hidden agenda is hospital-avoidance born of a previous traumatic birth: "I don’t want to be a nuisance" is fear, not stoicism. Elicit it with warmth, validate it, and actively problem-solve to get her assessed (named contact, support, what to expect), check fetal movements, and safety-net the 999 danger signs — ensuring she actually goes.
The guidance behind it
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