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June 2022 Exam
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A 15-year-old girl presents with her mother to A&E with abdominal pain. This began yesterday around the belly button, but has now moved to the right iliac fossa. She has previously been well, and was a FTND. She is on no regular medications and is fully immunised. There is no family history of note. On examination her vital signs are stable. She has guarding and rebound maximal over McBurney's point. Your surgical colleagues agree to perform appendicectomy. Prior to anaesthesia the anaesthetist wants you to confirm that she is not pregnant. The patient fully understands the implications of everything that is happening.
What is the best next step?
Obtain a urine sample for pregnancy testing
Ask about periods with mother present
Ask whether she is sexually active
Ask about periods with mother absent
Ask if she wants mother present
Key Learning Point
Understand the principles of child advocacy i.e. that all decisions are to be made in the best interest of the child and issues relating to consent and confidentiality.
The clinical presentation suggests acute appendicitis, which requires surgery. Anaesthesia and surgery increase the risk to the fetus. It is therefore important to establish whether a child at this age is pregnant. We are told that she is Gillick competent (https://www.cqc.org.uk/guidance-providers/gps/nigels-surgery-8-gillick-competency-fraser-guidelines). She can therefore decide whether she wants her mother present when you ask confidential questions. Next establish whether she has started her periods, as this can start anywhere between 7-17 years. Consider the possibility of haematocolpos in a young woman who looks sexually mature. Next establish whether she is sexually active. If she is, then consent should be taken from her (if Gillick competent) or from a person with parental responsibility before pregnancy testing of the urine.
[FEthL1] Understand the principles of child advocacy i.e. that all decisions are to be made in the best interest of the child and issues relating to consent and confidentiality.