SCA practice case · Telephone consultation
“He’s burning up and now there’s a rash”
Telephone consultation
Child patient
Someone else speaking
Hard
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
Leo · 3 years · male
Setting
Telephone — mother of a feverish 3-year-old; a new rash.
Past history
- Nil recorded
Medication
- Paracetamol (OTC, given by mother)
Allergies
None recorded
Recent notes
⚠ Telephone request: fever for 2 days, up to 39.4°C, “not himself”, new spots today. Immunisations up to date per mother. Younger sibling at home.
Reason for contact
“Am I being a neurotic mum? Should I just keep an eye on him?”
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 non-blanching rash (petechiae/purpura) in a febrile, unwell child is a meningococcal sepsis emergency until proven otherwise — the single most important action is to characterise the rash (glass/tumbler test) and, with the systemic picture, arrange immediate emergency assessment (999/ED), never home safety-netting. Assess the child with traffic-light/sepsis thinking (alertness, hydration/wet nappies, colour, work of breathing) rather than fixating on the temperature, and know the paediatric red flags correctly (unexplained petechiae or hepatosplenomegaly → immediate specialist assessment for leukaemia; generalised lymphadenopathy, pallor, persistent fatigue, unexplained fever or bruising, persistent bone pain → very urgent FBC within 48 hours). NICE NG240 covers pre-hospital antibiotics for suspected meningococcal disease, and NICE NG254 covers sepsis in under-16s. The examinable hidden agenda is the mother’s minimising, driven by fear of being judged a "neurotic mum" after a previous dismissive experience — she downplays red-flag features and her own accurate instinct. The skill is to validate parental gut feeling explicitly (an evidence-based warning sign), counter the judgement fear, and convey urgency clearly without paralysing panic, with unambiguous 999 action and safety-netting.
The guidance behind it
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