SCA practice case · Video consultation
Musculoskeletal: SCA practice case
A builder with back pain asks for stronger painkillers
Video consultation
Adult patient
Typical
Ethnicity, culture & diversityHealth disadvantage & vulnerabilitiesNew & 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
Tomasz Wiśniewski · 45-year-old man
Setting
Video consultation booked by the patient from his van at lunchtime.
Past history
- Nil significant
- Smoker, 15 cigarettes a day
Medication
- No regular medication
- Ibuprofen 200 mg tablets bought over the counter
Allergies
No known drug allergies
Recent notes
Registered four years ago. No previous consultations about back pain. Last BP 132/84 (new patient check). Occupation: builder (zero-hours contract). Preferred language Polish; declined interpreter for this consultation.
Reason for contact
Video consultation: “Back pain three weeks. Need strong painkillers. No sick note please.”
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)
Most acute low back pain is non-specific and improves within weeks; NICE NG59 recommends NSAIDs, keeping active and exercise rather than opioids, and work adjustments rather than time off. The hidden agenda is borrowed tramadol and a dizzy episode at height, which turns a prescribing request into a safety conversation. Good management respects his need to keep earning: a regular NSAID, physiotherapy, and an optional “may be fit” fit note offering lighter duties, while making explicit what cauda equina symptoms would mean.
The guidance behind it
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