SCA practice case · Telephone consultation
“My hand goes numb at night — I’m scared it’s the start of MS”
Telephone consultation
Adult patient
Straightforward
New & undifferentiated presentationsMental 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
Donna Whitfield · 48 years · female
Setting
Telephone — nocturnal hand numbness and tingling.
Past history
- Nil significant recorded
Medication
- No regular medication
Allergies
NKDA
Recent notes
No previous consultations about her hand. Occupation: supermarket worker.
Reason for contact
Telephone call requested: “hand going numb at night — worried it’s MS.”
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)
Tingling/numbness in the MEDIAN nerve distribution (thumb, index, middle, half ring finger), worst AT NIGHT, waking the patient and relieved by shaking the hand, with clumsiness, is classic CARPAL TUNNEL SYNDROME — a benign median-nerve compression at the wrist — and warrants a confident POSITIVE diagnosis. The examinable communication task is REASONED reassurance that distinguishes it from the patient’s googled fears: the nocturnal, hand-specific, median pattern is NOT the diffuse/relapsing CNS pattern of MS nor the sudden focal deficit of a stroke — explained, not dismissed ("it’s just carpal tunnel" without the why will fail). Screen for treatable ASSOCIATIONS (hypothyroidism — her weight gain/tiredness/cold — diabetes, pregnancy, obesity, RA, occupational use), since the hand symptom can flag an underlying condition. Offer the management ladder (nocturnal wrist splints first, ergonomic modification and treating associations; steroid injection; nerve conduction studies/decompression for severe/persistent/motor signs), and safety-net the genuine red flags (diffuse/bilateral symptoms, CNS signs, sudden focal deficit, progressive wasting) so reassurance is safe.
The guidance behind it
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