SCA practice case · Video consultation
“It was only a tiny bit, probably nothing”
Video consultation
Adult patient
Straightforward
Long-term conditions & cancerGender, reproductive & sexual health
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
Carol Easton · 61 years · female
Setting
Video consultation — one episode of vaginal bleeding, postmenopausal.
Past history
- Type 2 diabetes
- Hypertension
- BMI 33
Medication
- Metformin
- Ramipril
- Atorvastatin
Allergies
NKDA
Recent notes
Retired teacher. Menopause age 51. No HRT on record. ⚠ Cervical screening history not yet reviewed.
Reason for contact
Video appointment: “a tiny bit of bleeding, probably nothing”.
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)
Postmenopausal bleeding is a cardinal red flag and a defined NICE NG12 suspected cancer pathway: a woman aged 55 and over with unexplained postmenopausal bleeding that cannot be attributed to HRT warrants a suspected cancer pathway referral for endometrial cancer (under 55: consider it); the service usually starts with transvaginal ultrasound of the endometrial thickness. A single episode, years after the LMP and off HRT, counts — it must never be reassured away as "dryness". This patient stacks endometrial-cancer risk factors (obesity, type 2 diabetes, nulliparity, hypertension, family history). The examinable hidden agenda is that her minimising is fear-driven — she suspects cancer (mother’s "womb trouble") and booked a VIDEO appointment partly to dodge an examination she dreads after a bad smear. The skill is to refuse the dismissal without frightening her into disengagement (state the pathway, balance it honestly with the fact most PMB is benign), name and accommodate the examination dread (choice, chaperone, control), and complete the suspected cancer pathway referral with a clear safety-net and follow-up.
The guidance behind it
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