SCA practice case · Telephone consultation
“Chest pain, engine running”
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
Barry Quinn · 58 years · male
Setting
Telephone — urgent same-day slot, patient calling from his lorry cab.
Past history
- Type 2 diabetes
- Smoker 20/day
- BMI 33
Medication
- Metformin
Allergies
NKDA
Recent notes
⚠ Reception note: “sounded breathless, said he’s parked up in a layby on the A38”. Occupation: HGV driver. Last contact 11 months ago.
Reason for contact
Urgent telephone slot: “bad indigestion, wants something strong.”
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)
Telephone chest-pain triage is diagnosis by ear: central heavy pain with autonomic features in a high-risk patient is ACS regardless of the word the patient chooses — and a crescendo of exertional episodes is the two-week warning. The clinical actions are scripted (NICE CG95: 999 from the call, location, a single 300 mg aspirin loading dose chewed, nobody drives); the consultation’s real work is the hidden agenda — here the Group 2 licence, answered with honest DVLA specifics (revoked after ACS, relicensing considered from at least 6 weeks if symptom-free with satisfactory functional testing and LVEF at least 40% — pause-and-reinstate, not career death) and the practical chain (dispatcher, load, lorry) solved so the patient can afford to say yes to the ambulance.
The guidance behind it
Similar SCA cases
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