SCA practice case · Telephone consultation
“The watch that wouldn’t settle”
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Sylvia Beech · 72 years · female
Setting
Telephone — results discussion after a recent ECG.
Past history
- Hypertension
- AF (new, ECG last week)
Medication
- Amlodipine
Allergies
NKDA
Recent notes
⚠ 12-lead ECG: atrial fibrillation, rate 88. BP 138/82. No stroke or TIA, no diabetes. Record: husband died 2021, intracranial bleed on warfarin after a fall.
Reason for contact
Results call. Smartwatch flagged an irregular rhythm.
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
Incidental, asymptomatic AF is a stroke-prevention consultation in disguise: explain the quivering-pouch mechanism (well-feeling and high-risk coexist), personalise CHA₂DS₂-VASc into honest annual odds (score 3: about 3% a year, Friberg 2012; offer anticoagulation at 2 or more, NICE NG196), retire aspirin explicitly (NICE NG196: not for stroke prevention alone; little protection, real bleed risk), and distinguish DOACs from warfarin — no INR monitoring, lower intracranial-bleed rates (about half, Ruff, Lancet 2014). The hidden agenda is the warfarin ghost: a spouse’s fatal bleed makes the anticoagulant the villain of the family story. Hear the grief in full BEFORE the pharmacology, honour the ledger while correcting its categories (valve = forced warfarin; she = neither), and hand the decision back with structure — a thinking week, written information, a booked second call. Refusal is today’s decision, never the final one.
The guidance behind it
Similar SCA cases
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