SCA practice case · Telephone consultation
“I can’t leave the house on my heavy days”
Telephone consultation
Adult patient
Straightforward
Gender, reproductive & sexual healthInvestigations & results
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
Folake Adeyemi · 43 years · female
Setting
Telephone — heavy periods; recent scan result to discuss.
Past history
- Heavy menstrual bleeding
- Para 2
Medication
- No regular medication
Allergies
NKDA
Recent notes
Pelvic USS: several intramural fibroids, largest 4 cm; endometrium normal. ⚠ Hb 104 g/L, ferritin 8. Smear up to date.
Reason for contact
Telephone: results of scan and bloods.
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)
Heavy menstrual bleeding with small fibroids, a normal endometrium, a regular cycle and no intermenstrual/postcoital bleeding is a benign picture — fibroids are common and not cancer, and the normal lining is reassuring. Two clinical tasks are easily missed: actively treating the iron-deficiency anaemia (Hb 104, ferritin 8) that the patient has normalised into "just tired", and laying out the HMB options (NICE NG88 for fibroids of 3 cm or more: tranexamic/mefenamic acid, LNG-IUS, hormonal options, and consideration of specialist referral to discuss uterine artery embolisation, myomectomy or hysterectomy — LNG-IUS-first applies to no identified pathology or fibroids under 3 cm, and hormonal options are contraceptive, so they do not fit a wanted pregnancy; hysterectomy only as a last-resort choice) rather than jumping to surgery. Treat the anaemia per BSG 2021 (oral iron once daily, Hb recheck at about 4 weeks, coeliac serology). The examinable hidden agenda is a fertility fear: she has "coped" for years because she believed treatment meant a hysterectomy and the end of a possible baby with her new partner. Surfacing and dismantling that — fertility-sparing options exist, hysterectomy is a choice not an inevitability — restores agency and is the heart of the consultation. Confirm the benign/red-flag picture, safety-net for what would change management, and agree a shared, stepped plan.
The guidance behind it
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