SCA practice case · Video consultation
Cardiovascular: SCA practice case
A blood pressure review after missed appointments
Video consultation
Adult patient
Typical
Ethnicity, culture & diversityLong-term conditions & cancerMental health & addiction
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
Abdirahman Warsame · 58-year-old man
Setting
Video consultation for a hypertension review after several missed appointments.
Past history
- Essential hypertension (diagnosed 4 years ago)
- QRISK3 22% nine months ago; statin declined
- Did not attend hypertension review three times in the last year
Medication
- Amlodipine 10 mg once daily (last collected 10 weeks ago)
- Ramipril 10 mg once daily (last collected 10 weeks ago)
Allergies
No known drug allergies
Recent notes
Clinic BP six months ago 172/104. Bloods nine months ago: eGFR 68, potassium 4.4, urine ACR 4 mg/mmol, HbA1c 44 mmol/mol, total cholesterol 6.2, HDL 1.0. No ECG on record. Prescription collection shows gaps of several weeks. Occupation: private hire driver.
Reason for contact
Video hypertension review, booked by the patient after a text reminder.
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)
Poor blood pressure control is rarely about the drug choice. This consultation finds the real reasons: night shifts and daytime appointments, letters he does not read, beliefs that blood pressure is ’stress’ and that tablets harm kidneys, missed doses on fasting days, khat use, and erectile dysfunction blamed on the tablets. The skill is to work with his faith, work and culture rather than against them: a once-daily evening regimen, a frank and confidential conversation about khat, honest advice about Group 2 driving standards, and an offer of treatment for erectile dysfunction.
The guidance behind it
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