SCA practice case · Telephone consultation
“I did a pregnancy test and it’s still positive — is something wrong?”
Telephone consultation
Adult patient
Typical
Gender, reproductive & sexual healthMental health & addictionInvestigations & 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
Nkechi Adeyemi · 33 years · female
Setting
Telephone — patient-initiated call 16 days after medical management of a miscarriage.
Past history
- G2 P0 — miscarriage at 7 weeks (March 2025)
- Missed miscarriage at 9 weeks (scan: no fetal heartbeat, CRL consistent with 7 weeks) — medical management with misoprostol at home 16 days ago
- Blood group O RhD negative
Medication
- Folic acid 400 micrograms daily (stopped after miscarriage)
- Paracetamol when needed
Allergies
No known drug allergies
Recent notes
EPAU discharge letter: medical management completed at home; heavy bleeding and passage of tissue on day 1. RhD negative — anti-D not indicated (NICE NG126, June 2026). Advised urine pregnancy test 3 weeks after treatment; contact EPAU if positive. Patient message today: “Pregnancy test still positive — please call.”
Reason for contact
Telephone call-back requested by patient: “pregnancy test still positive after miscarriage”.
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 telephone follow-up after early miscarriage has a safety part and a human part. Safety: screen for heavy bleeding, pain, fever and offensive discharge; after medical or expectant management NICE NG126 advises a urine pregnancy test at 3 weeks, with review if positive — a faint positive at 2 weeks is often normal. Anti-D is no longer recommended for miscarriage up to 11+6 weeks (NG126, 2026 update). The human part: treat it as a bereavement, address self-blame directly (most losses are chromosomal and not caused by anything she did), advise on the next pregnancy, discuss assessment after two losses, check mood and partner support, and offer practical help and follow-up.
The guidance behind it
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