SCA practice case · Video consultation
“The man who cancelled the caravan”
Video consultation
Older adult patient
Typical
Long-term conditions & cancerInvestigations & results
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
Trevor Mott · 66 years · male
Setting
Video consultation — review after a recent echocardiogram.
Past history
- HFrEF, new: LVEF 33%
Medication
- Ramipril 2.5 mg OD
- Furosemide 40 mg OD
Allergies
NKDA
Recent notes
⚠ Echo last week: LVEF 33%. Cardiology letter: GP to initiate and titrate standard HFrEF therapy; community HF nurse referral requested. Usually attends with wife Lynne.
Reason for contact
Review to discuss the diagnosis and plan. Logged on 15 minutes early, alone.
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 new HFrEF diagnosis is a prognosis consultation wearing a medication review’s clothes. Dismantle the word first (underperforming, not finished; reverse remodelling is real), explain the four pillars as a build project (NICE NG106: ACE inhibitor — or sacubitril valsartan on specialist advice — beta-blocker, MRA, SGLT2 inhibitor — each with mortality benefit, titrated with the HF nurse and monitored with bloods at each step), and answer "how long" honestly without a fake number: measured, not guessed. The hidden agenda is the quiet shutdown — cancelled plans, reassigned allotments, password folders — driven by a colleague’s timeline and the word itself; reinstate a concrete future goal (the caravan, with an August checkpoint) as clinical treatment. And find the protected spouse: a secret diagnosis is a second illness — offer to do the telling.
The guidance behind it
Similar SCA cases
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