Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓
Doctor Instruction:
You are a Junior Doctor in the General Practice. A 16-year-old girl, Leah Crawley, has come in to discuss her contraception options. Please take a brief history and agree on an appropriate form of contraception for her.
Patient History
Leah Crawley, 16 years old. Currently in Sixth Form.
You have come in today because you wanted to discuss options for contraception. You moved to a new school for 6th form last year. There, you met your current boyfriend, Alex. This is the first time you have been in a relationship, and you have never had sexual intercourse before but would really like to try with him soon. You wanted to do it safely and make sure you had some reliable contraception.
However, you are very worried your mother will find out about this consultation. You don’t want her to know about this as she still thinks you are too young and would surely go into a fit. She just doesn’t understand that all your friends have had sex by now!
You want reassurance that your mum will not be told about this consultation. Unless you are reassured, you refuse to continue with the consultation.
You have been reading up on contraception online. The pill looks like a good option, and you think you would remember to take it. After all, you could just place a reminder on your phone. You most certainly do not want anything that needs to be inserted in the womb, it sounds too uncomfortable for you. You are also not keen on injections and implants!
You would like to be told more about the pill as well as how to take it and any side effects of it. You have heard from your friends that it can cause weight gain and you certainly don’t want that. You have to look your best for prom!
Ideas, Concerns, Expectations:
You think you are being smart about coming in today and you feel the pill is a good option for you. You are scared your mum will find out you are planning to have sex. You are hoping for an explanation on how to use contraception and to start taking it today.
Menstrual/Gynecologic History:
Your last menstrual period was 3 days ago.
You had your menarche at age 11. Your cycle was very irregular at the start but has been regular for the past 2 years.
Menses occur every 28 days and last for about 5 days.
There haven’t been any irregularities in your cycle. No menorrhagia, no intermenstrual bleeding/spotting.
Sexual History:
You’ve never had sexual intercourse.
Your boyfriend is 17 years old, and he has been in a relationship before.
Your current relationship is consensual.
Past Medical History:
You have hay fever.
You do get the occasional headache no more than once a week. The pain is around the temples and throbbing in nature. There are never any preceding symptoms. The headaches resolve with some paracetamol. You have never noticed any triggers.
Drug History:
Fexofenadine tablets for hay fever, only during the spring season.
Occasional paracetamol 2 tablets.
NKDA
Family History:
Your mum gets really bad migraines.
Your dad also has hay fever.
Social History:
You’ve tried cigarettes from your boyfriend a couple of times, but you are not an active smoker and neither is he.
You do not consume alcohol as you are underage!
Never tried recreational drugs
You live with your parents and are the only child.
Things at school are fine but your parents have always held you to high expectations and you’re stressed about performing well.
Marking Scheme: