SCA practice case · Telephone consultation
“Something to make her sleep”
Telephone consultation
Older adult patient
Someone else speaking
Typical
Older adultsHealth disadvantage & vulnerabilities
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
Joan Tully · 81 years · female
Setting
Telephone — husband (carer) calling at the end of his rope.
Past history
- Alzheimer’s disease (3 years)
- Knee osteoarthritis
Medication
- Donepezil 10 mg daily
- Paracetamol PRN
Allergies
NKDA
Recent notes
Last review: “grimaces on standing”. Carer: husband Frank, 83 (also our patient — BP raised at last check, rarely attends). Carers declined 3 years ago; no carer’s assessment recorded.
Reason for contact
⚠ Telephone: Frank asking for “something to make her sleep”.
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)
Night-time disturbance in dementia is a cause-hunt, not a prescription: untreated pain (assess with an observational tool and treat on a schedule — topical NSAIDs first for knee OA per NICE NG226; she cannot request PRN), daytime napping, caffeine, light, inactivity, and cholinesterase-inhibitor timing (bedtime per the SPC; a morning move is off-label) all drive 2am waking — while Z-drugs worsen falls and confusion, and antipsychotics carry stroke/death warnings reserved for severe risk after specialist input. The carer is the second patient: new exertional chest pain at 83 is its own urgent presentation. The hidden agenda is the confession — a grabbed arm and a mark — received without panic as carer breakdown, documented honestly, answered with same-week respite and review rather than accusation. Secrecy, not Frank, was the danger.
The guidance behind it
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