SCA practice case · Telephone consultation
“She’s just not herself today — the dip was positive, so can you send some antibiotics over?”
Telephone consultation
Older adult patient
Someone else speaking
Typical
Older adultsUrgent & unscheduled careProfessional & ethical dilemmas
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
Dorothy Pearce · 91 years · female
Setting
Telephone — senior carer at a residential care home calling about a resident.
Past history
- Vascular dementia (moderate) — lives in Elm Court residential home
- Hypertension
- Osteoarthritis — mobile with a frame
- Incontinence of urine (uses pads)
- ReSPECT form on file (completed with patient and son, 2025)
Medication
- Amlodipine 5 mg once daily
- Donepezil 10 mg at night
- Paracetamol 1 g up to four times daily when required
- Macrogol one sachet daily
Allergies
Penicillin — rash (1990s)
Recent notes
Care-home ward round 6 weeks ago: settled, eating well, walks with frame, “chatty, knows staff by name”. Weight stable. Next of kin: son, Peter Pearce.
Reason for contact
Telephone call from senior carer at the care home: “not herself today, positive urine dip, requests antibiotics”.
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)
An unwell care-home resident who is “not herself” needs observations, not a dipstick. Acute confusion with NEWS2 of 7 or more is an emergency whatever the presumed source — here likely a chest infection with sepsis. In people over 65, urine dipsticks are not used to diagnose UTI because asymptomatic bacteriuria is common; treating the dipstick both misses the real diagnosis and drives antibiotic resistance. The ReSPECT form guides the level of treatment: not for CPR does not mean not for hospital. On the telephone, a clear, ordered plan with practical steps and support for the carer is what keeps the resident safe.
The guidance behind it
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