SCA practice case · Video consultation
Older adults: SCA practice case
An annual health check that raised questions
Video consultation
Adult patient
Someone else speaking
Typical
Health disadvantage & vulnerabilitiesNew & undifferentiated presentations
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
Thomas (Tom) Keane · 34-year-old man
Setting
Video consultation with a man with Down’s syndrome and his sister, following up his annual learning disability health check.
Past history
- Down’s syndrome; moderate learning disability
- Atrioventricular septal defect, repaired in infancy; cardiology discharged 2015
- Thyroid function last checked 3 years ago: normal
- Glasses for short sight; last hearing test 4 years ago
Medication
- No regular medication
Allergies
No known drug allergies
Recent notes
Annual learning disability health check with the practice nurse last week: weight 61 kg (68 kg a year ago), BMI 22, BP 108/70, pulse 58. Sister reported he is more withdrawn and has stopped joining activities. Blood tests not taken: became distressed at sight of the needle. Father died 5 months ago; moved into supported living 3 months ago. Health action plan and reasonable adjustments flag: ’needs extra time, prefers his sister present, likes pictures’.
Reason for contact
Video consultation (double appointment) to follow up the health check. Tom and his sister Claire are on screen together from his flat.
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)
Change in an adult with Down’s syndrome invites diagnostic overshadowing: putting everything down to the learning disability, to grief or, especially, to early dementia. Weight loss with abdominal pain and loose pale stools points first to physical causes that are commoner in Down’s syndrome, such as coeliac disease and thyroid disease, alongside hearing loss and depression after a bereavement and a move. Speak to Tom directly, make the blood test possible with reasonable adjustments, take the sister’s dementia fear seriously, and do not let ’Kev shouts’ pass.
The guidance behind it
Similar SCA cases
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