SCA practice case · Video consultation
“His ear’s been running all night — he needs antibiotics, doesn’t he?”
Video consultation
Child patient
Someone else speaking
Straightforward
Children & young peopleUrgent & unscheduled care
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
Theo Marsh · 4 years · male
Setting
Video consultation — a child with a discharging ear (mother present).
Past history
- Nil significant recorded
Medication
- No regular medication
Allergies
None recorded
Recent notes
⚠ Urgent video slot booked by mother: earache and cold for a few days; ear discharge overnight. No previous ear problems recorded.
Reason for contact
“His ear’s been running all night — he needs antibiotics, doesn’t he?”
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)
A discharging ear in a child is usually acute otitis media with a perforated eardrum: the otorrhoea releases pus and characteristically relieves the pain (hence the child being "brighter"), it looks alarming but is common and usually self-limiting, and the perforation typically heals — so assess the child as well versus unwell first (temperature, systemic state, feeding/fluids, NICE NG143 traffic-light, with a face-to-face ear/throat/chest examination because otoscopy cannot be done by video) rather than assuming severity from the discharge. Apply NICE NG91 antibiotic stewardship: most acute otitis media resolves without antibiotics and many children need only analgesia or a back-up (delayed) prescription; an immediate antibiotic is for the systemically very unwell, features of a serious illness/complication, or high risk of complications, while for children under 2 with bilateral AOM and AOM with otorrhoea (discharge) NG91 advises considering no antibiotic, a back-up or an immediate antibiotic — so this child, with a discharging ear, falls into a group where all three are reasonable, with the decision shared with the parent, made on assessment and with stewardship, not reflexively (if used, amoxicillin for 5–7 days, dose per BNFC). Emphasise analgesia as the mainstay (regular weight-based paracetamol/ibuprofen, frequently under-used), explain the natural course (keep the ear dry, the drum heals), and avoid decongestants/antihistamines and anaesthetic ear drops (phenazone with lidocaine) when the drum is perforated or the ear is discharging. Safety-net explicitly for the rare serious complications — mastoiditis (swelling/redness behind the ear, the pinna pushed forward), meningitis (very unwell, neck stiffness, photophobia, non-blanching rash, drowsiness), worsening or high fever, facial weakness, and persistent discharge/hearing loss — with plain-language red flags. The hidden agenda is parental worry and a belief that discharge means a serious spreading infection needing antibiotics; manage that expectation with explanation and partnership, using this as a teachable shared decision rather than a flat refusal or a reflexive prescription.
The guidance behind it
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