SCA practice case · Telephone consultation
“It’s probably just a water infection again”
Telephone consultation
Adult patient
Typical
Gender, reproductive & sexual healthNew & undifferentiated presentations
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
Demi Carter · 23 years · female
Setting
Telephone — lower abdominal pain + discharge.
Past history
- Previous UTIs (patient-reported)
Medication
- No regular medication
- No contraception
Allergies
NKDA recorded
Recent notes
⚠ Telephone request for antibiotics for a presumed UTI. LMP about 3 weeks ago; no contraception.
Reason for contact
Telephone call. “It’s just another water infection.”
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)
Bilateral lower abdominal pain with abnormal discharge, deep dyspareunia and intermenstrual/post-coital bleeding in a sexually-active young woman is pelvic inflammatory disease, NOT a UTI — and the cardinal rules are: always exclude pregnancy/ectopic (pregnancy test + red-flag screen), and treat PID PROMPTLY and EMPIRICALLY with a low threshold (BASHH 2019 outpatient regimen: ceftriaxone 1 g IM once, plus doxycycline 100 mg twice daily and metronidazole 400 mg twice daily for 14 days), taking swabs/NAAT but NOT waiting for results, because delay risks tubal damage, chronic pelvic pain, ectopic pregnancy and infertility. Offer a full STI screen (incl. HIV), abstinence until treated, and contraception review. The examinable hidden agenda is shame/avoidance — she suspects a sexually transmitted cause, fears judgement and infidelity, dreads partner notification, and carries an unspoken fertility fear. Surface it gently without colluding with the "just a UTI" label, normalise and de-stigmatise, handle partner notification/contact tracing supportively (clinic/provider options), and address fertility honestly — prompt treatment protects it. Safety-net the PID/ectopic red flags.
The guidance behind it
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