SCA practice case · Video consultation
“My cholesterol’s really high — but I’m fit and slim, it must be a mistake”
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
Daniel Okonkwo · 38 years · male
Setting
Video consultation — to discuss a cholesterol result.
Past history
- Nil significant
- Non-smoker · BMI 23
Medication
- No regular medication
Allergies
NKDA
Recent notes
⚠ Lipids: TC 9.2 mmol/L, LDL-C 6.8 mmol/L. Repeat fasting sample: similar. No family history recorded in the notes.
Reason for contact
Video consultation to discuss cholesterol result. “I think there’s been a mistake.”
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 markedly elevated, confirmed LDL/total cholesterol in a young, fit, slim, healthy-eating non-smoker is familial hypercholesterolaemia (FH) — a GENETIC condition, not a lifestyle problem or a lab error — so "I’m fit so it must be wrong / I’ll fix it with diet" is the misconception: diet and exercise help only modestly and FH needs a STATIN (usually high-intensity) plus lipid-clinic/genetic referral. The clinching clues are a premature-cardiovascular family history (father’s MI at 44, young sudden death) and FH signs (tendon xanthomata, corneal arcus <45), per Simon Broome/Dutch criteria — and standard QRISK UNDERESTIMATES risk in FH and shouldn’t be used to decide treatment. FH is autosomal dominant, so family CASCADE testing of first-degree relatives is a core part of the consultation. The examinable hidden agenda is identity-threat (fitness is core to him; a heart-risk label at 38 feels impossible) plus a buried fear from his father’s early heart attack; validate his healthy lifestyle, reframe as genetic (not failure), surface and use the family history, and motivate treatment as protecting him from his father’s fate — not "diet and recheck".
The guidance behind it
Similar SCA cases
gpreasoning.uk is not affiliated with or endorsed by the RCGP. Our cases are original teaching material written for practice; none is an exam recall. For anything official about the SCA, check the RCGP SCA pages.