SCA practice case · Telephone consultation
“Bad indigestion after my takeaway — just need strong antacids”
Telephone consultation
Adult patient
Straightforward
Urgent & unscheduled careNew & undifferentiated presentations
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
Aisha Khan · 41 years · female
Setting
Telephone — recurrent RUQ pain after fatty food.
Past history
- Overweight
- Recurrent upper abdominal pain — no investigations on file
Medication
- Nil recorded
Allergies
NKDA
Recent notes
⚠ Receptionist note: “wants strong antacids — says she feels a bit feverish today.”
Reason for contact
Telephone consultation: “Bad indigestion after my takeaway — just need strong antacids.”
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)
Severe RUQ/epigastric pain coming on after fatty/large meals, lasting 1–3 hours then settling, radiating to the right scapula, recurrent, in a woman with risk factors (overweight, possible family history) — though the pain pattern, not a stereotyped profile, makes the diagnosis — is BILIARY COLIC from gallstones — not "indigestion" for phone antacids — and warrants LFTs, ultrasound and outpatient surgical referral. The examinable pivot is recognising when it is NO LONGER simple colic: today’s episode persisting >6 hours WITH FEVER and systemic upset suggests acute CHOLECYSTITIS (screen also for cholangitis — jaundice, rigors, confusion), needing urgent same-day assessment/admission, not reassurance. Keep the differential open (cardiac/atypical, peptic ulcer, pancreatitis). The hidden agenda is avoidance driven by a childcare barrier and minimisation of the fever; surface and problem-solve the barrier as part of the plan rather than colluding with "just antacids", convey clearly why today is different, arrange urgent assessment with a sepsis/cholangitis safety-net (999/A&E for rigors, jaundice, confusion, severe worsening), and plan the ongoing gallstone work-up once the acute issue is managed.
The guidance behind it
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