Case 81: Vikki Nicolaides

INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please conduct this consultation as you would in clinical practice.

The following information is on her summary sheet:

• Past medical history

• Glandular fever

• Mild anxiety—postgraduate exams 2005

• Medication

• Ethinyloestradiol 30 mcg/levonorgestrel 150 mcg (Microgynon 30)

• Allergies

• Nil

• Immunisations

• Nil recorded

• Cervical screening

• 2018 normal

• Social history

• Parents migrated from Cyprus in 1960s

• Non-smoker

• Binge drinking at university.

INSTRUCTIONS FOR THE PATIENT, VIKKI NICOLAIDES

You are 34 years old and work long hours as an accountant. Over the past year you have been discussing with your boyfriend the possibility of starting a family. You want to find out from the GP when to stop taking the pill and would be happy to have any other advice that you are offered.

You have regular periods on the pill and your BMI is 24 kg/m².

Your Mum and sister have diabetes. They were both diagnosed in their 30s. Your maternal grandmother is now on dialysis due to her kidney trouble and also was diagnosed young with diabetes. But they’re all heavyset and you think you got your Dad’s genes. You’re hoping this won’t be an issue for you.

The following information is on your medical record:

• Past medical history

• Glandular fever

• Mild anxiety—postgraduate exams 2005

• Medication

• Ethinyloestradiol 30 mcg/levonorgestrel 150 mcg (Microgynon 30)

• Allergies

• Nil

• Immunisations

• Up-to-date

• Cervical screening

• 2018 normal

• Social history

• Parents migrated from Cyprus in 1960s

• Non-smoker

• Binge drinking at university.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Open questions to explore Vikki’s ideas, concerns and expectations regarding this consultation

General health

• — Diet, check BMI, BP

• — Smoking

• — Caffeine and alcohol intake—note past history

• — Exercise

Briefly review past medical history—include drug use (prescribed, over the counter and illicit), exclude diabetes, epilepsy, depression

Cervical screening test.

Specific advice

Tailor advice to the answers given to the questions above, plus:

Diet and toxin avoidance

• — Folic acid (500 mcg od) and iodine supplements (150 mcg od)

• — Avoid eating liver

• — Eat fish twice a week

• — Hygiene—fresh food, care with cat litter

• — Avoid environmental toxins

Physical activity

• — Aim for 30 minutes/day of physical activity to optimise fitness

Smoking and alcohol

• — Enquire about substance use and advise regarding dangers of smoking, ...