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Female genital mutilation: mandatory reporting and protection of a sibling at imminent risk — MRCEM SBA MCQ

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HardProfessional practice and researchFemale genital mutilation: mandatory reporting and protection of a sibling at imminent riskMRCEM SBA

A 17-year-old attends an emergency department in England with palpitations after learning that her father plans to take her 9-year-old sister abroad tomorrow. Her symptoms settle, and she is medically fit for discharge. Speaking to you alone, she says that her father arranged for her to be ‘cut’ during a visit abroad when she was 10 and has told her sister that the same ceremony is planned. She has not previously disclosed this to a healthcare professional. She asks you not to tell her father, who is waiting outside, because she believes he would bring the journey forward. No genital examination is clinically indicated. What is the most appropriate immediate plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Personally report to police, urgently refer both girls to children’s social care, and defer telling the father.

The patient has **directly disclosed** female genital mutilation (FGM) while she is under 18. In England, that triggers the treating doctor’s personal duty to report to police: her age when the cutting occurred, and the absence of a genital examination, do not remove the duty. A safeguarding lead can help coordinate the response but cannot take over this doctor’s reporting responsibility. ([gov.uk](https://www.gov.uk/government/publications/mandatory-reporting-of-female-genital-mutilation-procedural-information/mandatory-reporting-of-female-genital-mutilation-procedural-information-accessible-version)) The sister’s proposed ceremony and imminent travel require **urgent child-safeguarding action**, including referral to children’s social care; suspected future FGM in the sister does not itself constitute a second mandatory report of a known case. The patient’s concern that telling her father could accelerate departure is a reason to defer that discussion pending safety planning. Medical fitness for discharge does not make the safeguarding response routine. ([gov.uk](https://www.gov.uk/government/publications/multi-agency-statutory-guidance-on-female-genital-mutilation/multi-agency-statutory-guidance-on-female-genital-mutilation-accessible-version)) **A** appropriately prioritises safeguarding but incorrectly transfers the personal police-reporting duty. **B** gets reporting and referral right but risks precipitating the feared departure by informing the father. **C** delays a report that a direct disclosure already requires and adds an examination that is not clinically indicated. **D** reports appropriately but fails to match the urgency of the sister’s imminent risk. ([gov.uk](https://www.gov.uk/government/publications/mandatory-reporting-of-female-genital-mutilation-procedural-information/mandatory-reporting-of-female-genital-mutilation-procedural-information-accessible-version))

Reference: Mandatory reporting of female genital mutilation: procedural information, sections 2.1–2.3c (22 January 2020) — https://www.gov.uk/government/publications/mandatory-reporting-of-female-genital-mutilation-procedural-information/mandatory-reporting-of-female-genital-mutilation-procedural-information-accessible-version Multi-agency statutory guidance on female genital mutilation, sections D.2.2 and D.2.4 (30 July 2020) — https://www.gov.uk/government/publications/multi-agency-statutory-guidance-on-female-genital-mutilation/multi-agency-statutory-guidance-on-female-genital-mutilation-accessible-version