PUID 49:: Unplanned Teenage Pregnancy Presenting with Nausea:: A PLAB 2 Mock:: 1st Attempt

Practice a case with the AI patient 🤖

Summary:

This scenario involves a 15-year-old female presenting with vomiting, ultimately diagnosed with pregnancy. It tests the candidate’s ability to address adolescent health issues, safeguarding, and sensitive communication, including breaking significant news and discussing management options in a patient-centred manner.

Key Points:

Adolescent Health & Reproductive System

• Ask about LMP, menstrual regularity, and associated symptoms.

• Explore sexual history: age at first sexual contact, number of partners, contraception use, consent, and coercion concerns.

• Consider underlying causes for amenorrhea if not pregnancy-related.

Gastrointestinal & General Health

• Assess vomiting in detail: onset, frequency, content, triggers.

• Enquire about associated symptoms: headache, dizziness, fever, diarrhoea, abdominal pain.

• Assess hydration status and consider differential diagnoses like GI infections.

Confidentiality & Safeguarding

• Politely ask parent/guardian to step out to ensure confidential history taking.

• Clearly explain limits of confidentiality: "everything will be kept confidential unless someone is at risk."

• Assess for safeguarding concerns even if partner is of similar age: was consent obtained? Was there coercion?

• Document clearly all steps taken.

Psychological & Social Aspects

• Ask about school performance, support systems, lifestyle, and mental wellbeing.

• Explore dietary habits, smoking, alcohol, or drug use.

• Signpost to counselling and youth support services.

Important Considerations:

• Recognize and handle sensitive news (pregnancy) with empathy and structured communication.

• Safeguarding is essential regardless of whether the relationship seems consensual.

• Establish Gillick competence if offering contraception, though not mandatory post-pregnancy.

• Avoid interrupting the patient—allow her to share her narrative.

• Tailor language and content to patient’s age and comprehension.

Diagnostic Approach:

1. History Taking

   • Menstrual and sexual history

   • Symptoms review

   • Psychosocial context

2. Physical Examination

   • Assess dehydration

   • Abdominal exam

3. Investigations

   • Urine pregnancy test (UPT)

   • Urinalysis

   • Consider infection markers if symptomatic (e.g., temperature)

Management:

• Breaking the News: Use a stepwise approach:

  • Mention pregnancy gently after rapport is built.

  • Allow patient to process the information before elaborating.

• Discuss Options:

  • Continuing pregnancy

  • Adoption

  • Termination (with appropriate referral and counselling)

• Safeguarding Actions:

  • Assess for coercion or abuse

  • Encourage parental involvement but do not force

• Support Services:

  • Provide leaflets on contraception and pregnancy options

  • Refer to GP or local youth services for further management

• Follow-up & Safety Netting:

  • Explain when to return (e.g., worsening symptoms, emotional distress)

  • Offer emotional support pathways

Communication Skills:

• Avoid abrupt language when breaking sensitive news.

• Use age-appropriate, non-medical jargon.

• Validate feelings, show empathy, and listen actively.

• Maintain a calm, non-judgmental tone.

• Encourage open dialogue, offer reassurance and support.

Ethical Considerations:

• Autonomy: Respect patient's right to make informed decisions.

• Confidentiality: Explain its scope and limits appropriately.

• Safeguarding: Identify signs of exploitation or coercion, even in seemingly consensual relationships.

• Gillick Competence: Generally applied when offering contraception, less relevant post-conception but still important for future preventive care.

Additional Resources:

• GMC Good Medical Practice: Confidentiality & safeguarding guidelines.

• NHS sexual health and contraceptive services (e.g., Brook, FPA).

• Local safeguarding policies and referral pathways.