SCA practice case · Video consultation
Cardiovascular: SCA practice case
New heart medicines, with an interpreter on the line
Video consultation
Adult patient
Someone else speaking
Hard
Ethnicity, culture & diversityLong-term conditions & cancer
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
Abdul Karim Miah · 61-year-old man
Setting
Video consultation with a telephone interpreter joined on the line; the patient’s wife is beside him on screen.
Past history
- Heart failure with reduced ejection fraction, diagnosed on admission three weeks ago (echo: LVEF 32%)
- Type 2 diabetes (HbA1c 58 mmol/mol)
- Hypertension
- Non-smoker, no alcohol
Medication
- Ramipril 2.5 mg once daily (new)
- Bisoprolol 2.5 mg once daily (new)
- Furosemide 40 mg each morning (new)
- Dapagliflozin 10 mg once daily (new)
- Metformin 1 g twice daily
- Atorvastatin 20 mg at night
Allergies
No known drug allergies
Recent notes
Discharged three weeks ago after a 6-day admission with breathlessness and leg swelling. Discharge weight 81 kg. Bloods 5 days ago: potassium 4.8 mmol/L, creatinine 98 micromol/L, eGFR 71. Community heart failure nurse referral made on discharge, first contact not yet recorded. Record: ’Sylheti (Bengali) speaker, interpreter required’. Works as a chef. Telephone interpreter booked and joined to this call.
Reason for contact
Video consultation booked by his wife: ’new heart tablets, still breathless’. Mrs Miah is beside him on screen.
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)
Decompensation three weeks after a heart failure admission is far more often about the medicines not being taken than about the medicines not being strong enough. Here the interpreter and the wife both sit between you and the truth: the skill is to run a clean three-way consultation, speak to the patient, and ask about each tablet in a way that makes it safe to answer. Then the plan has to fit a chef’s shift, correct a frightening mistranslation of ’heart failure’, and get him examined promptly.
The guidance behind it
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