SCA practice case · Video consultation
“The X-ray says I’m ‘bone on bone’ — am I crippled?”
Video consultation
Adult patient
Straightforward
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 Nash · 58 years · male
Setting
Video consultation — explaining a knee X-ray report.
Past history
- Chronic knee pain
Medication
- No regular medication recorded
Allergies
NKDA
Recent notes
⚠ Knee X-ray report: “moderate degenerative changes, reduced joint space, consistent with osteoarthritis.” Report viewed by patient before the appointment.
Reason for contact
Video consultation: “X-ray result — wants to discuss.”
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)
X-ray reports use alarming language — "degenerative changes", "reduced joint space", "bone on bone" — that patients read catastrophically, so the core task is to UN-FRIGHTEN the words: radiographic OA changes are common, correlate POORLY with pain and prognosis, do NOT mean the joint is "crumbling away", and are NOT a sentence to disability or imminent replacement. The crucial, examinable reframe is the EXERCISE misconception: activity does NOT "wear the joint out faster" — strengthening (quadriceps), aerobic exercise and weight management are core, evidence-based TREATMENTS that reduce pain and improve function, while rest/deconditioning makes it worse ("motion is lotion"). Offer an active plan (education, physio/exercise, weight, analgesia, work modification), give realistic replacement information (a person-and-symptom decision for severe refractory disease, not an X-ray-dictated inevitability at 58 with moderate symptoms), and address the hidden agenda — terror for his livelihood and a developing low mood, with the activity-avoidance deconditioning him into the very disability he fears. Restore agency and hope: he is the main treatment.
The guidance behind it
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