SCA practice case · Telephone consultation
“It’s my fourth water infection this year — just give me antibiotics again”
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
Carla Mendez · 43 years · female
Setting
Telephone — recurrent UTIs requesting more antibiotics.
Past history
- Recurrent UTI — 3 episodes this year
- E. coli on previous cultures
Medication
- No regular medication
Allergies
NKDA
Recent notes
⚠ Three antibiotic courses for UTI this year, all issued remotely. No recurrent-UTI review recorded.
Reason for contact
Telephone call: “another water infection — can you just send the same antibiotics?”
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)
Recurrent UTI in a woman (≥3/year) is the real issue — not a reflex phone-script opportunity — and warrants a proper review (ideally a urine culture to guide therapy and exclude resistance/relapse) rather than endless empirical courses that drive resistance and miss treatable contributors. Explore and address the contributors: the post-coital pattern, peri-menopausal vaginal ATROPHY/dryness, and low fluid intake. A key, often-missed intervention is TOPICAL VAGINAL OESTROGEN: NICE NG112 recommends considering it for recurrent UTI in POSTmenopausal women, and in a perimenopausal woman like Carla it treats the dryness/dyspareunia of urogenital atrophy (NICE NG23), with any reduction in UTIs a possible bonus. Work the prophylaxis LADDER — self-care (hydration, post-coital voiding), a single antibiotic dose after sex, then methenamine hippurate or continuous prophylaxis if needed (standby self-start courses are not an NG112 prevention option), with review and stewardship — and know when to investigate/refer (haematuria, treatment failure, atypical organisms, structural concern, men). The examinable hidden agenda is embarrassment about the sexual link and menopausal dryness driving "just give me antibiotics, don’t make it a thing"; surface and de-shame it gently, frame vaginal oestrogen and the ladder as the route OUT of the cycle (and better for her sex life), and safety-net pyelonephritis.
The guidance behind it
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