SCA practice case · Telephone consultation
“Just give me the strong anti-inflammatories”
Telephone consultation
Adult patient
Straightforward
Long-term conditions & cancerMental health & addiction
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
Tony Briggs · 49 years · male
Setting
Telephone — acute painful big-toe joint.
Past history
- Nil significant recorded
- Self-reported gout attack earlier this year
Medication
- Ibuprofen (OTC, occasional)
Allergies
NKDA
Recent notes
⚠ BP last check borderline high — no follow-up recorded. BMI 31. Alcohol about 40 units/week. No urate, U&E or lipids on file.
Reason for contact
Telephone appointment. “Gout again — just need the strong anti-inflammatories.”
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)
Acute gout (sudden severe red, hot, swollen first-MTP monoarthritis, allodynia to bedsheets) is treated promptly with an NSAID + gastroprotection, colchicine, or a short steroid course — tailored to comorbidities (BP, renal, GI) rather than handing over generic "strong ones" — while staying alert to septic arthritis if the picture is atypical or systemic. The examinable move is the PREVENTION PIVOT: a second attack within a year is an indication to OFFER urate-lowering therapy (NICE NG219: allopurinol or febuxostat first line, started at least 2–4 weeks after the flare settles, titrated to serum urate below 360 µmol/L, with colchicine cover), and to use gout as a cardiometabolic flag (BP, lipids/QRISK, HbA1c, renal function, alcohol, weight). The hidden agenda is that "just the tablets, no lecture" masks livelihood fear and shame about drinking, and a dread of "becoming his father" who was disabled by gout. Surface that gently, frame urate-lowering therapy and lifestyle change as the route to staying on the tools, address alcohol and weight without moralising (NICE NG219: no specific diet has evidence for preventing flares), and safety-net (including the septic-joint caveat) with follow-up to start prevention and do the metabolic checks.
The guidance behind it
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