SCA practice case · Video consultation
“Ten weeks and still barking”
Video consultation
Adult patient
Straightforward
New & undifferentiated presentationsLong-term conditions & cancer
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
Amara Okafor · 29 years · female
Setting
Video consultation — "cough that won’t shift, wants antibiotics".
Past history
- Childhood eczema
- Hay fever
Medication
- Cetirizine PRN
Allergies
NKDA
Recent notes
⚠ Locum telephone contact 4 weeks ago: delayed antibiotic for cough, taken, no better. Recorded non-smoker. Primary-school teacher.
Reason for contact
“Cough 10 weeks, kept awake at night, wants antibiotics — it’s affecting my teaching.”
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 10-week dry cough, nocturnal, triggered by cold air / laughter / exertion, on an atopic background with childhood asthma and family history, is cough-variant asthma — not an infection, and a second antibiotic is the wrong reflex. The skill is twofold: hold the differential cleanly (reflux, post-infective/pertussis, and the red flags that aren’t there) and treat correctly per NICE NG245: objective testing first (eosinophils or FeNO — FeNO 50 ppb or more confirms; then spirometry with reversibility), then as-needed low-dose ICS/formoterol, never a SABA alone. But the marks live in the hidden agenda: the antibiotic request masks a newly-discovered pregnancy and a terror that treatment will harm the baby. Make disclosure safe (vaping shame, then the pregnancy), then deliver the counter-intuitive truth — uncontrolled asthma harms the fetus, the inhaler does not — and weave proportionate pregnancy housekeeping (folic acid per NICE NG247, stop smoking service support to come off the vape without relapsing to cigarettes per NICE NG209, booking) without hijacking the consultation.
The guidance behind it
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