SCA practice case · Video consultation
Endocrine: SCA practice case
Vomiting on a weight-loss injection
Video consultation
Adult patient
Typical
Gender, reproductive & sexual healthProfessional & ethical dilemmas
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
Leanne Brooks · 47-year-old woman
Setting
Video consultation booked by a woman who has been vomiting since starting a weight-loss injection.
Past history
- Primary hypothyroidism (12 years)
- Obesity: BMI 37 four months ago (weight 98 kg, height 1.63 m)
- Two vaginal deliveries; no other gynaecological history
Medication
- Levothyroxine 100 micrograms once daily
- Ethinylestradiol 30 micrograms / levonorgestrel 150 micrograms combined oral contraceptive, taken continuously with a 7-day break every 3 months
- Tirzepatide 5 mg weekly subcutaneous injection (private supply from an online pharmacy; not on practice record until yesterday)
Allergies
No known drug allergies
Recent notes
Pill review four months ago (by online questionnaire): BMI 37, BP 132/84, non-smoker; combined pill reissued for 12 months. TSH 2.1 eight months ago. Letter from a UK online pharmacy received yesterday: tirzepatide started 2.5 mg weekly six weeks ago, increased to 5 mg weekly nine days ago.
Reason for contact
Booked herself a video appointment: “Being sick for four days. Think it’s my injection.”
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)
GLP-1 and GIP/GLP-1 receptor agonists bought privately are now a common GP problem. The safety issues are predictable: gastrointestinal side effects that peak after dose increases, dehydration and acute kidney injury, pancreatitis and gallbladder disease, and reduced absorption of oral medicines. The SPC for tirzepatide advises a non-oral or added barrier method for four weeks after starting and after each dose increase in women taking oral contraceptives, and the MHRA has highlighted unplanned pregnancies. The station tests whether the candidate links the vomiting to the pill and the levothyroxine, finds the pregnancy worry, notices that the combined pill is UKMEC 3 at a BMI of 37, and handles private prescribing without judgement or taking over the prescribing.
The guidance behind it
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