Jaundice After Returning From Bangladesh, Working in His Father's Takeaway — Free SCA Practice Case
Young man with jaundice after returning from Bangladesh, working in his father's takeaway
Station Timer
Golden Minute
Initial Introduction
•Introduce yourself
•Ask an open question — "How can I help you today?"
•Listen — don't interrupt
•Catch early cues
Data Gathering
History, ICE & Diagnosis
Clinical Management
Diagnosis, Plan & Decisions
Safety Net
Follow-up & Close
Materials for Candidate
Please review before starting the consultation
Full Name
Rahim Uddin
Age
20 years
Consultation Type
VideoAge
20
Situation
Video Consultation.
Reason for Encounter
"I've gone really yellow — my eyes and skin — and my wee's dark. I've been feeling rough since I got back from Bangladesh. I work in my dad's takeaway and I'm meant to be in tonight."
Medical Records
- ●PMH: Nil significant.
- ●Medications: None.
- ●Allergies: NKDA.
- ●Recent contact: No recent consultations. No pre-travel vaccination record on file.
Patient Script
For the friend playing the patient role
Character Overview: You are Rahim, a 20-year-old university student who works part-time in your father's takeaway. You visited family in Bangladesh for a few weeks and came back about three weeks ago. You felt run down there, then developed tummy upset, and now you have gone yellow. You are worried but also concerned about letting your dad down at the takeaway, where you are on the rota tonight. You are cooperative and want to know what is wrong and whether you can work.
Opening Sentence: "Hi Doctor. I've turned really yellow — my eyes especially — and my urine's gone dark, almost like cola. I've been off for a couple of weeks: tired, no appetite, some vomiting and diarrhoea when I was away. I've just noticed I'm itchy all over too. I'm on shift at the takeaway tonight and I don't know if I should go in."
History if Asked (Data Gathering Phase)
- ●The illness: "It started when I was in Bangladesh — really tired, off my food, then vomiting and diarrhoea for a few days. That eased, but then about four or five days ago I noticed my eyes going yellow, and it's got worse."
- ●Jaundice-related symptoms: "My urine's really dark. My stools have gone pale, actually, now you mention it. And I'm itching all over."
- ●Travel: "I was in Bangladesh for about three weeks visiting family, got back three weeks ago. We ate lots of home-cooked and street food, drank the local water sometimes."
- ●Vaccinations: "I didn't get any travel jabs before I went — we booked it last minute."
- ●The takeaway: "I work part-time in my dad's takeaway, handling and serving food. I'm on the rota tonight and it's busy — I don't want to let him down."
ICE — Ideas, Concerns, Expectations
The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.
- ●Ideas: Rahim suspects he "picked something up" in Bangladesh but does not know what, and has not connected it to his job or to anyone else's safety. "I figured I caught a bug out there. I hadn't thought about whether I could pass it to anyone."
- ●Concerns: He is worried about how ill he looks and feels, and — practically — about missing work and letting his father down. When the possibility of infecting others is raised, he becomes concerned about his family and the customers. "I'm worried about how yellow I've gone. And I feel bad about the takeaway — but now you say it, could I have given this to people?"
- ●Expectations: He wants to know what is wrong and whether he can work tonight. "I want to know what this is, and honestly whether I can do my shift."
If Asked — Medical History and Exposures
The patient confirms these details only when directly asked.
- ●Alcohol/drugs: "I don't really drink. No recreational drugs, no injecting."
- ●Paracetamol/medications: "I've taken a bit of paracetamol for feeling rough, nothing else."
- ●Sexual history: "I've got a girlfriend, we're careful. No new partners."
- ●Contacts unwell: "A couple of my cousins in Bangladesh had upset stomachs while I was there."
- ●Household: "I live with my parents and younger sister. Dad and I both work in the takeaway."
- ●Previous liver problems: "No, nothing wrong with my liver before."
Social History and Lifestyle Impact
Rahim is a university student who works part-time in the family takeaway. He lives with his parents and younger sister.
- ●Work: "Part-time at the takeaway — taking orders, handling food, serving. Cash and food, all of it."
- ●Home: "At home with Mum, Dad, and my sister. Dad's in the takeaway with me most shifts."
- ●Diet/alcohol: "Normal diet, barely drink."
- ●Impact: "I feel wiped out. And I'm anxious about work and about looking so yellow."
If Asked — Associated Symptoms and Red-Flag Screen
The patient answers these only when directly asked.
- ●If asked about right-upper-abdominal pain: "A dull ache under my right ribs, yeah, and it feels a bit tender."
- ●If asked about fever: "I felt feverish and achy at the start, in Bangladesh. Not so much now."
- ●If asked about confusion, drowsiness, or personality change (encephalopathy): "No, I'm thinking clearly. Just tired."
- ●If asked about easy bruising or bleeding: "No, no unusual bruising or bleeding."
- ●If asked about weight loss: "I've lost a bit from not eating, over a couple of weeks."
- ●If asked about pale stools / dark urine (cholestasis): "Yes — dark urine and pale stools."
- ●If asked about itch: "Yes, itchy all over, no rash though."
- ●If asked about tattoos, piercings, blood transfusions (hepatitis B/C risk): "No tattoos or piercings recently, no transfusions."
Responses to Management (The Negotiation Phase)
- ●If the Doctor advises he must not work in the takeaway: "I can't work? For how long? My dad's relying on me — he's short-staffed." (The tested point is clearly advising food-handler exclusion and explaining why, while acknowledging the practical difficulty.)
- ●If the Doctor explains this is likely hepatitis A and is infectious: "So I could give it to customers? And my family? How does it spread?" (The tested point is explaining faeco-oral transmission and the risk to contacts.)
- ●If the Doctor explains it needs to be reported to public health: "You have to report it? Are my dad's customers going to be contacted? Will the takeaway get shut down?" (The tested point is explaining notification and its purpose calmly and honestly.)
- ●If the Doctor arranges blood tests: "What are the blood tests for? Will they tell you what it is?"
- ●If the Doctor safety-nets: "What would mean I need to go to hospital?"
Mark Scheme
Domain 1: Data Gathering and Diagnosis
Domain 2: Clinical Management and Medical Complexity
Domain 3: Relating to Others
Clinical Learning Points
Recognising Acute Viral Hepatitis
- ●Acute viral hepatitis typically has a prodrome (fatigue, anorexia, nausea/vomiting, fever, sometimes diarrhoea) followed by jaundice, with dark urine, pale stools, itch (cholestasis), and right-upper-quadrant discomfort.
- ●Hepatitis A is faeco-orally transmitted (contaminated food/water), common in travellers to endemic areas who are unvaccinated, with an incubation of roughly 2–6 weeks. It is usually self-limiting.
Confirming the Diagnosis and Assessing Severity
- ●Check LFTs (markedly raised transaminases, raised bilirubin), hepatitis serology (hepatitis A IgM confirms acute infection; also test B and C, and E where relevant), and — crucially — clotting/INR as a marker of synthetic function and severity.
- ●Encephalopathy or coagulopathy indicates acute liver failure and requires urgent hospital admission.
Food-Handler Exclusion — A Key Public-Health Action
- ●Food handlers with hepatitis A must be excluded from food handling until at least 7 days after the onset of jaundice (and until clinically well), because the virus is shed in stool and transmitted faeco-orally.
- ●This applies regardless of how well the patient otherwise feels.
Notification and Contact Management
- ●Acute infectious hepatitis (including hepatitis A) is a notifiable disease — notify the local UKHSA health protection team.
- ●Public health coordinates contact tracing and control measures; close contacts (and potentially exposed customers/staff) may be offered post-exposure prophylaxis — hepatitis A vaccine (and immunoglobulin for certain groups) — ideally within 14 days of exposure.
Supportive Management
- ●Hepatitis A has no specific antiviral treatment; management is supportive — rest, hydration, avoiding alcohol, and caution with hepatotoxic drugs (including avoiding excess paracetamol).
- ●Advise scrupulous hand hygiene, not preparing food for others, and not sharing towels/utensils.
Prevention
- ●Hepatitis A vaccination is recommended before travel to endemic areas, and for certain occupational and risk groups — a missed opportunity here.
Safety-Netting and Follow-Up
- ●Safety-net for confusion/drowsiness, worsening jaundice, bleeding/bruising, and inability to keep fluids down. Follow up to confirm serology and monitor LFTs to resolution.
Common Candidate Mistakes in This Case
- ●Failing to exclude him from food handling: allowing a food handler with hepatitis A to keep working — the key public-health error.
- ●Not notifying public health: missing the statutory duty and the mechanism for protecting contacts.
- ●Omitting clotting/severity assessment: not checking INR, and so not recognising potential acute liver failure.
- ●Not addressing contacts: overlooking household and workplace contacts who may need prophylaxis.
- ●Poor communication: either being so accommodating that the exclusion is unclear, or alarming him about the family business rather than explaining notification calmly.