SCA practice case · Video consultation
Women’s health: SCA practice case
A video call about a long-standing intimate itch
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
Eileen Prothero · 74-year-old woman
Setting
Video consultation booked by the patient about an itch she has had for about a year.
Past history
- Hypothyroidism (since 2009)
- Osteoarthritis of the knees
- Hysterectomy for fibroids (1994), ovaries conserved
Medication
- Levothyroxine 75 micrograms once daily
- Paracetamol 1 g up to four times daily as needed
Allergies
No known drug allergies
Recent notes
TSH 2.1 mU/L six months ago. HbA1c 39 mmol/mol two years ago. Pharmacy records: clotrimazole 1% cream purchased twice in the last six months. No previous consultation about vulval symptoms. Last cervical screening not applicable after hysterectomy.
Reason for contact
Video consultation booked by the patient: “a private matter”.
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 year of vulval itch with white, shiny, crinkly skin in an older woman is lichen sclerosus until proven otherwise, and the treatment is an ultrapotent topical steroid, not more antifungal cream. The exam skill is twofold: obtaining a careful history including red flags for vulval cancer when the patient is embarrassed, and converting a video call into a face-to-face examination she will actually attend by understanding why she has avoided it. The hidden agendas are a friend’s vulval cancer and painful sex that is straining her marriage.
The guidance behind it
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