OSCE

Question 1

Steps for EC assessment (OSCE)

Answer 1

Time of UPSI
Prev SI within the cycle
Regular or recent contraception
LMP + regularity 
Calculate expected ovulation date
Explain options - IUD / Levonelle / Ella one 
- MOA
- Efficacy / implications of failure
- pros and cons
- SE / impact on next period
When to do UPT
Ongoing contraception 
Safe sex / condoms / PIL

Question 2

Considerations for providing contraception to <16yo (OSCE)

Answer 2

Confirm if already sexually active / planning to be
LSI + Current contraception
consider EC
Advise to discuss with parent / guardian
sexual partners age / where met
Where they have sex
coercion / pressure / gifts
who do they live with 
do they attend school
any symptoms / pain 
safe sex / condoms / LARCS / EC

Question 3

Confidentiality statement for YP consultation (OSCE)

Answer 3

This is a confidential consultation.
If we have concerns that you or someone else is at risk of serious harm then we may need to share information with other services, but this is rare.

Question 4

YP assessment to assess for risk of CSE

OSCE

Answer 4

Are Parent/ guardian aware they are here?
Are they aware of the sexual activity?
Do they know the partner?
Home address + who lives there
Are you safe at home? Can you talk to someone about sex / relationships
registered with a GP?
Attend school / pupil referral unit / do they like it.
Contact with other services? (mental health, social work etc)
Age at first sex? Number of lifetime partners? Multiple partners at present?
Duration of current relationship + age of partner
alcohol / drugs - Does use affect sexual choices?
Partner position of trust/ Power imbalance / feel pressure
any non-consensual sex / can they say no
ever been paid, or given gifts for sex?
Young carer
Looked after child
Homeless
Runaway
Family bereavement
Learning or physical disability

Question 5

YP patient risk factors - consider referral to safeguarding

Answer 5

1. Under 13yrs (very high risk)
2. Lacks maturity
3. Unusual level of secrecy for age
4. Withdrawn / anxious
5. Dismisses concerns
6. Presents alone or isolated
7. Previous STI
8. Previous pregnancy
9. History of self harm
10. Regular alcohol / drugs
11. Alcohol / drugs at time of sex 12. Violent / forced / pressurised
    relationship
12. Evidence of grooming
13. Poor school attendance
14. Lives away from parents
15. Problems at home
16. Social worker / Youth worker 18. Mental health problems
17. Looked after child
18. On a child protection plan
19. Learning disability

Question 6

YP partner risk factors - to consider referral to safeguarding

Answer 6

1. Controlling/intimidating partner
2. Partner > 5 years older than patient
3. Partner not in school year
   – less risk if patient is older
4. Partner drives or works
   – less risk if patient is older
5. Imbalance of power or
   mental capacity
6. Partner is a family member
7. Partner is in a position of responsibility
8. Violent / forced / pressurised relationship
9. Partner supplies alcohol or drugs to patient
10. Partner known to police
11. Social worker / Youth worker
12. Mental health problems
13. Learning disability

Question 7

HIV and contraception (OSCE)

Answer 7

Treatment type, duration, compliance
Recent VL and 
CD4 count - <200 - IUCD = UKMEC 3
Liverpool interaction checker
if enzyme inducer advise - IUS /IUD / DMPA
Annual smears 25-65yo
STI screen annually min
Pregnancy planning in future
Avoid spermicide - increase HIV transmission 
Discuss menopause symptoms if 45yo+

Question 8

BBN - giving a HIV diagnosis (OSCE)

Answer 8

Setting / privacy
Perception of patient / expectations / knowledge
Inform result, explain disease, ask if support wanted, confirmatory test needed
Knowledge - virus, treatment, transmission, partners, disclosure, PEPSE, U=U, pregnancy and existing children, Ref to HIV team
Emotions - identify and discuss pt emotions / concerns / emotional state and plan
Summary / plan - confirmatory bloods, PN + PEPSE, HIV team, counselling, HA, safe sex, PIL, support groups / websites