SCA practice case · Telephone consultation
Cardiovascular: SCA practice case
A call about medicines after an out-of-hours visit
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
Leonard Ashby · 77-year-old man
Setting
Telephone consultation arranged by the GP after reviewing an out-of-hours discharge summary.
Past history
- Atrial fibrillation (new, diagnosed at the weekend)
- Hypertension
- Osteoarthritis of both knees
- Chronic kidney disease stage 3a
Medication
- Apixaban 5 mg twice daily (new, out-of-hours)
- Bisoprolol 2.5 mg once daily (new, out-of-hours)
- Aspirin 75 mg once daily (repeat since 2012, primary prevention)
- Naproxen 500 mg twice daily (repeat)
- Amlodipine 5 mg once daily
- Atorvastatin 20 mg at night
Allergies
No known drug allergies
Recent notes
Out-of-hours discharge summary (Saturday): palpitations, ECG atrial fibrillation rate 128, started apixaban and bisoprolol, “GP to review”. Repeat medicines not listed on the summary. Bloods: Hb 138 g/L, platelets 245, creatinine 118 µmol/L, eGFR 52, ALT normal. Weight 82 kg. BP 138/82. Medicines dispensed weekly in a blister pack. No history of stroke, heart failure, diabetes, vascular disease or GI bleeding recorded.
Reason for contact
GP-initiated call: medicines reconciliation after out-of-hours discharge.
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)
Transitions of care are where prescribing errors happen: an out-of-hours clinician starts an anticoagulant without seeing the repeat list, and the patient ends up on apixaban, aspirin and naproxen together. Medicines reconciliation means finding out what the patient actually takes, checking dose and interactions against the SPC, stopping what adds risk without benefit, replacing what is needed, and fixing the system (repeat template, blister pack). The human side is a carer whose fear of stroke made him start the new tablets immediately, and whose dog walks depend on the knee painkiller.
The guidance behind it
Similar SCA cases
gpreasoning.uk is not affiliated with or endorsed by the RCGP. Our cases are original teaching material written for practice; none is an exam recall. For anything official about the SCA, check the RCGP SCA pages.