SCA practice case · Telephone consultation
“Back pain that isn’t mechanical”
Telephone consultation
Older adult patient
Hard
Older adultsLong-term conditions & cancerInvestigations & results
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
Gordon Pryce · 72 years · male
Setting
Telephone call-back — locum bloods flagged for review.
Past history
- Lumbago (historical)
- Retired postman, widower
Medication
- No repeat prescriptions
- OTC ibuprofen and paracetamol (patient-reported)
Allergies
NKDA
Recent notes
⚠ Locum bloods: Hb 108, ESR 88, adjusted Ca 2.68, creatinine 128, eGFR 48 (72 last year). No electrophoresis or light chains sent. Note: wife died of metastatic cancer 3 years ago.
Reason for contact
Telephone call-back with results. “I’d rather have it straight.”
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)
NICE NG12: age 60+ with persistent unexplained back pain plus anaemia, raised ESR/plasma viscosity, hypercalcaemia or renal impairment = suspected myeloma — NG12 asks for FBC, calcium, ESR/plasma viscosity, serum protein electrophoresis and serum free light chains together (urine Bence-Jones only if free light chains are unavailable), then a suspected cancer pathway referral if the results suggest myeloma. Screen cord compression and hypercalcaemia the same call, and stop nephrotoxic NSAIDs immediately. The hidden agenda — a man who watched late diagnosis kill his wife and has been "getting things in order" instead of attending — is answered with honest asymmetry, not reassurance.
The guidance behind it
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