Cases/Mental Health

Student Assaulted At A Party Two Nights Ago — Free SCA Practice Case

Student assaulted at a party two nights ago

Station Timer

12:00

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

12:00

Golden Minute

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Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Keira Nwosu

Age

20 years

Consultation Type

Telephone

Age

Situation

Telephone Consultation. Urgent appointment.

Reason for Encounter

"I need the morning after pill. It's been a couple of days."

Medical Records

●PMH: Nil significant.
●Medications: None. Combined pill stopped about a year and a half ago, no contraception since.
●Allergies: NKDA.
●Observations on record: Weight 58 kg, BMI 21 (2 years ago).
●Immunisations: HPV (2 doses), MenACWY and MMR complete. Hepatitis B not recorded.
●Sexual health: Chlamydia screen negative 14 months ago.
●Social: Second year student, shared house. Non smoker.

Recent Notes

●Reception, today: Urgent telephone appointment for emergency contraception. Asked for no voicemail.

Patient Script

For the friend playing the patient role

Character Overview: You are Keira Nwosu, a 20 year old second year geography student. You share a student house with Maddie and Rosie, who are both away until tomorrow, so you have been alone since it happened. You have told your mum nothing and you will not. Two nights ago, at about midnight, at a house party, a man you know from your course had sex with you when you did not want it. You said no and he did not stop. You went quiet and still and waited for it to be over. You have told nobody and are not sure it counts, because you know him and you did not fight. You went to a pharmacy yesterday, were asked questions across the counter with a queue behind you, and walked out. You have spent a day and a half in your room, showering, crying and checking your phone. Your voice is quiet, flat and tired, and wobbles when you get close to what happened. Your opening is only the request for the tablet. You do not hint that anything was done to you until the doctor asks what led to you needing it, or whether the sex was something you wanted, and you never use the words rape or assault yourself. You say what happened when the doctor asks gently, without going through it blow by blow. You do not want the police involved. You are frightened of everyone finding out.

Opening Sentence: "Hi. Um, sorry. I need the morning after pill, please. I think it's been a couple of days, so I don't know if it's too late."

History if Asked (Data Gathering Phase)

●Whether she can talk (if asked): "Yes, I'm in my room with the door shut. If we get cut off, ring my mobile. Please don't leave a voicemail or ring the landline."
●Why she needs the pill (only if the doctor asks gently what happened or what led to needing it, or whether the sex was something she wanted): "I didn't want it to happen. It was someone I know. I said no and he didn't stop." If asked for details or his name: "I'd rather not say it out loud, or give his name." If told she only needs to share what matters for her care: "Okay. I can do that."
●Who, when and where: He is from her course, a friend of a friend she has known since first year. "The night before last, about midnight." At a house party, in an upstairs bedroom.
●What happened (if asked sensitively): "He had sex with me. All the way, I mean. Nothing else, just that. No condom. I think he finished inside me but I don't know for sure."
●Symptoms since (if asked): "I'm a bit sore down there. There was a little blood on the toilet paper the next morning but nothing since. No pain when I wee, no discharge. I've got bruises on my upper arm as well."
●Sex before and since (if asked): "Nothing since. My last boyfriend was four months ago and we used condoms. Nobody else this month."
●Periods, contraception and health (if asked): "I came off the pill about a year and a half ago because it made me feel flat. My periods are regular, every 28 days. My last one started exactly two weeks ago." Healthy, no asthma, no regular tablets, no allergies, not breastfeeding, about nine stone.
●Vaccines and tests (if asked): "I had the HPV jabs at school. I've never had a hepatitis B one. I did a postal chlamydia test over a year ago and it was fine." She knows nothing of his sexual history.
●Alcohol, drugs and memory (if asked): "About four vodka and lemonades over five hours. That's not a lot for me, but I felt really drunk. There's a gap where I can't remember going upstairs. I do remember saying no, and I remember afterwards." If the doctor raises that her drink may have been interfered with: "Oh. I hadn't thought of that. Could that be what happened?"
●What she has done since (if asked about washing, clothes or telling anyone): "I had a long shower as soon as I got home, and another yesterday, and brushed my teeth. Everything I was wearing is in a carrier bag under my bed, unwashed."
●Contact and safety (if asked whether she has heard from him or feels safe): "He messaged yesterday: 'hope you're ok, last night was fun x'. I haven't replied or deleted it. He knows where I live. I've locked the front door and my bedroom door. I've got a seminar with him later this week." Nobody else is known to be at risk.
●Mood and coping (if asked): "I keep crying and I've hardly eaten. I'm not sleeping, because when I close my eyes I'm back in that room. I've showered about five times and I still don't feel clean." Asked directly about self harm: "No, I wouldn't. I don't want to die. I just wish I could switch my head off for a few days."
●Support (if asked who knows or who she could be with): "Nobody knows. Funmi, my best friend from home, is who I'd tell, but I don't know how to say it."

Ideas, Concerns, Expectations

Gating note: Keira volunteers none of this. Each part comes out only when the doctor asks what she thinks about what happened, what is worrying her, or what she was hoping for from this call.

●Ideas: She keeps blaming herself. She had been drinking, she went upstairs with him and she did not fight. "I don't know if it even counts as anything, because I know him."
●Concerns: Being pregnant, and everyone finding out. His friends are her friends and she is sure he would say she wanted it. She fears the police would ask how much she had drunk, and dreads her mum coming up to make it huge. If the doctor explores further: "And I don't know about other things. Like if you can catch something. I haven't let myself think about it."
●Expectations: Only the tablet, quick and private. "I just want the pill, please, and for it to be over. I don't want the police. I don't want anyone told."

Social History and Lifestyle Impact

●Study, friends and past history (if asked): Coursework due in four days: "I can't read a sentence at the moment." Most of her social life is the same friend group as the man involved. No mental health history, no drugs, a few drinks once or twice a week.

Responses to Management (The Negotiation Phase)

●
If the doctor responds to the disclosure:
- ●Reaction: If met with belief and told it was not her fault: quiet, then a shaky breath. "Thank you. I'd already decided it was down to me." If the doctor calls it assault or rape: tearful. "I didn't know if I could call it that. He's someone I know and I didn't fight." She is relieved if told that freezing is common and knowing him changes nothing. If asked why she went upstairs, whether she said no clearly, or how much she drank without explanation: defensive. "I said no. I knew you'd think it was my fault." Her answers get shorter. If pressed for his name: "Please, can we just do the tablet?"
●
If the doctor explains confidentiality and the police:
- ●Reaction: If told nothing goes to the police without her agreement: her voice steadies. "Would you tell my mum or the uni?" Reassured by no. If told the practice must report: panicked. "You can't. I'll say I made it up." If pushed to report more than once: "I said I don't want to. I think I should go." She stays on the line if the doctor stops and apologises.
●
If the doctor explains a sexual assault referral centre, examination or evidence:
- ●Reaction: Doubtful. "Do I have to talk to the police to go?" On examination: "I don't want anyone touching me. Can I just have the tablets and the tests?" She softens if told she chooses which parts she has, can ask for a woman, bring a friend and stop at any point. If the doctor offers to ring the centre or pass on her story: "Yes, please. I can't say it all again." On company: "I'd rather not go on my own. I don't drive." She is satisfied if travel is arranged. On evidence: "I've already showered twice. Is it too late?" She is relieved if told it is still worth coming.
●
If the doctor discusses emergency contraception:
- ●Reaction: Wary of the coil. "I couldn't do that today. Is the pill really not enough?" If told the coil is the most effective: "Okay. I'll take the tablet now. Could I think about the coil?" "What if I'm sick after?" If told it will definitely work: "Are you sure? Because that's what I'm scared of." She is steadier if told it works best early, is not certain, and there is a follow up plan.
●
If the doctor raises HIV, tests or the hepatitis B vaccine:
- ●Reaction: Stunned. "HIV? How likely is it?" If told the chance is low but needs checking today: "So I need to be seen today for that too? How long are the tablets for?" On tests and the vaccine: "That's so much. Do I have to do it all today?" She is calmer if told what is for today and what can wait.
●
If the doctor covers support, her drink, her mum and the university, and the plan:
- ●Reaction: If her drink may have been interfered with: shaken. "Could someone have put something in it? Should I tell the centre?" "Not my mum, please, and not the uni," but she is open to a letter about her coursework that does not say why. On vague safety netting: "Worse how? Who do I ring out of hours?" Any call back must go to her mobile, with no message and no text saying what it is about. After a clear summary: "So the tablet today, the centre today, and you'll ring me later. Thank you."

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 14 indicators checked+0−0

Positive (0/7)

Negative (0/7)

Domain 2: Clinical Management and Medical Complexity

0 / 22 indicators checked+0−0

Positive (0/11)

Negative (0/11)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

The Presentation, the Time Clocks and the Model Plan

●A request for the morning after pill is one of the commonest ways a recent sexual assault reaches a GP. The BASHH 2022 guideline on sexual violence says to ask routinely about assault when someone asks for emergency contraception, STI testing or HIV post exposure prophylaxis (PEP).
●Keira rings about 36 hours after the assault, and several treatments run on clocks. The copper IUD can be fitted up to 5 days after the first unprotected sex, or up to 5 days after the earliest expected ovulation, whichever is later. Ulipristal is licensed to 120 hours and levonorgestrel to 72 hours. PEP should start as soon as possible, preferably within 24 hours, and not beyond 72 hours (BHIVA and BASHH 2021, amended 2023), so about 36 hours remain. Hepatitis B vaccine is best within 24 hours, with little benefit beyond 7 days.
●Model plan: make it safe to disclose, explain confidentiality, arrange same day care at a sexual assault referral centre (SARC) by making the call with her, give or arrange ulipristal today, ensure a same day HIV risk assessment, start hepatitis B vaccine, give evidence advice, agree a plan for tonight and a same day check back.
●Also acceptable: a same day sexual health clinic or emergency department if the SARC cannot see her today, or seeing her at the surgery, provided no genital examination or swabs are taken before she decides about forensic examination. Completing the HIV risk assessment on the call and deciding with her that PEP is not indicated also passes, if the 72 hour limit is stated and she can still ask the SARC about it today.

Responding to a Disclosure

●Ask a gentle, open question about what led to needing the pill, then wait. Take only the history needed for treatment: when, what contact, condom or not, any injury. A name is not needed. Accept "I'd rather not say".
●Believe her and say plainly it was not her fault. Not fighting, drinking, knowing him or going upstairs does not change that. Freezing is common, and being intoxicated is not consent.
●Avoid questions that sound like blame, such as why she went upstairs. Ask about alcohol and memory only to learn whether drugs may be involved, and say so.
●Explain why each personal question is needed. On the telephone, check she is private and what number to ring if the line drops.

Consent, Confidentiality and the Police

●An adult with capacity decides whether to involve the police. BASHH 2022, drawing on General Medical Council guidance, says that once adult or child protection concerns are excluded her decision should be respected, even if it seems unwise.
●Explain the limits early. Information may be shared without consent only if required by law or a court, to protect a child or vulnerable adult from serious harm, or in the public interest where others may be at risk of serious harm. Ask whether anyone else may be at risk. Keira knows of nobody, so no exception applies.
●Options: no sharing, anonymised intelligence reporting with her explicit consent, third party reporting by an agency, or reporting herself. There is no time limit on reporting. Accepting no for now and leaving the door open brings her back more often than repeated persuasion.

SARC, Forensic Evidence and a Possible Drug Facilitated Assault

●SARCs serve anyone raped or sexually assaulted, however long ago, and adults can self refer 24 hours a day without the police. They offer crisis care, forensic examination, emergency contraception, an independent sexual violence adviser (ISVA) and mental health support. Samples can be stored while she decides about the police, and she chooses which parts she has.
●If she may want forensic capture, avoid genital examination or swabs at the surgery or a clinic first unless clinically urgent. Phoning the SARC with her on the line spares her retelling.
●Advise avoiding further washing where possible, keeping clothing even if laundered, and keeping his message. Having showered does not rule out useful evidence.
●Four drinks with marked intoxication and a memory gap raise the possibility of drink interference. Forensic windows (Faculty of Forensic and Legal Medicine): blood for drugs and alcohol 3 days, urine 5 days (14 if drug facilitation is suspected), genital swabs 7 days. The blood window has about 36 hours left, so the memory gap must reach the SARC today.
●Rape Crisis support line: 0808 500 2222, free, 24 hours, whether or not she reports.

Emergency Contraception

●NICE Clinical Knowledge Summaries (CKS, October 2025) say that after sexual assault all methods should be offered. The copper IUD is the most effective.
●For the oral choice, find the earliest likely ovulation: first day of the last period plus the shortest cycle minus 14. Keira's period began 14 days ago on a 28 day cycle, so ovulation is about today and the assault was about a day and a half before it. When sex falls in the 5 days before earliest ovulation, CKS advises ulipristal 30 mg as a single dose, because levonorgestrel stops working in the late follicular phase. Levonorgestrel 1.5 mg is second choice if ulipristal is unsuitable or she prefers it after hearing this.
●Ulipristal is unsuitable in severe asthma on oral steroids and is less effective if a progestogen was taken close to the dose. Keira takes no medicines. Start regular contraception 5 days after ulipristal. If she is referred for an IUD, give the tablet as well and do not wait for forensic examination.
●Counsel: repeat the dose if she vomits within 3 hours, the next period may be early or late, seek prompt advice for lower abdominal pain (possible ectopic pregnancy), test if the period is more than 7 days late, lighter or painful, and use condoms meanwhile.

HIV Post Exposure Prophylaxis

●First line PEP is tenofovir disoproxil with emtricitabine and raltegravir for 28 days. The guideline recommends PEP more readily after aggravated sex, genital injury or bleeding, or a high prevalence assailant, and generally not for a low prevalence assailant.
●Keira has one episode of vaginal sex, unknown assailant status, soreness and a little bleeding, so a specialist decision is needed. The GP's job is to see that someone who can prescribe PEP assesses her today, not to decide alone. Telling her honestly that the risk is low and PEP may not be recommended is fair if assessment still happens.
●If PEP is taken, repeat HIV testing at least 45 days after finishing the course, usually done at 12 weeks.

Follow Up Tests and Hepatitis B Vaccination

●Tests now show her baseline, not infection from the assault. Plan chlamydia, gonorrhoea and trichomonas at about 2 weeks, a fourth generation HIV test at least 45 days after the assault, syphilis, hepatitis B and hepatitis C bloods at 3 to 6 months, and a pregnancy test from 3 weeks, sooner if her period is late, light or painful. Do not give antibiotics routinely, unless she is unlikely to return or the assailant has a known infection.
●Offer hepatitis B vaccine now, in an accelerated or ultra rapid schedule for better completion. The infant programme began for babies born from 1 August 2017, so she missed it.

Mental Health, Privacy and Follow Up

●Acute distress is expected and most people recover without post traumatic stress disorder. Ask gently about self harm, alcohol as coping and support, and agree a plan for tonight, as she is alone until tomorrow.
●NICE NG116: active monitoring for subthreshold symptoms in the first month with follow up within a month, individual trauma focused therapy for clinically important symptoms, no psychologically focused debriefing, and no drugs including benzodiazepines to prevent PTSD.
●Safety net specifically: 999 if she is in danger or he comes to the house, and same day contact with the practice or NHS 111 out of hours if she has thoughts of harming herself.
●Contact her by mobile only, with no voicemail or text mentioning the reason. Tell her who can see the record, including online access, and share only with her agreement. Arrange a same day call back and GP review within days and again within a month.

Common Candidate Mistakes in This Station

●Issuing the tablet without asking what happened.
●Asking how much she drank without saying why, or pressing for detail or his name.
●Telling her the GP must report, or pressing her to go to the police.
●Offering only levonorgestrel, saying it is too late, or leaving the tablet to a later appointment.
●Forgetting the 72 hour PEP window or dismissing HIV without assessment.
●One set of tests then telling her she is clear, routine antibiotics, or no hepatitis B vaccine.
●Examining or swabbing at the surgery before she has decided about forensic examination.
●Missing the memory gap and possible drink interference.
●Leaving a voicemail or message revealing the reason, or sharing without telling her.
●Prescribing a benzodiazepine, arranging debriefing, or ending with no plan for tonight, a safe contact route and a same day check back.

Mapped to the RCGP curriculum topic: Mental Health.

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