SCA practice case · Video consultation
“The calcium and the wedding”
Video consultation
Adult patient
Hard
Long-term conditions & cancerGender, reproductive & sexual health
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
Annette Boateng · 58 years · female
Setting
Video consultation — urgent recall after blood results.
Past history
- Breast cancer 4 years ago (WLE and radiotherapy)
- Oncology review 14 months ago: clear
Medication
- Anastrozole 1 mg once daily
- Calcium and vitamin D supplement
Allergies
NKDA
Recent notes
⚠ Adjusted calcium 2.82 mmol/L (FBC, U&E, LFTs unremarkable). Presented with tiredness, constipation and thirst. No PTH on file.
Reason for contact
Urgent recall to discuss blood results.
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)
Symptomatic hypercalcaemia (here 2.82 adjusted) in a patient with a breast cancer history needs same-day assessment (Society for Endocrinology 2016) — repeat adjusted calcium + paired PTH (NICE NG132; the fork between recurrence and primary hyperparathyroidism), same-day GP contact with the oncology team, fluids, stopping contributory drugs — with a hard emergency-admission line for confusion, drowsiness, persistent vomiting, dehydration, AKI or calcium ≥3.5, and same-day hospital assessment at 3.0–3.5. The hidden agenda is the wedding: the candidate who fights the date loses the patient; the one who fits the diagnostics inside it keeps both. Never deliver false certainty in either direction — PTH decides.
The guidance behind it
Similar SCA cases
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