SCA practice case · Video consultation
“He woke up and won’t put weight on it”
Video consultation
Child patient
Someone else speaking
Typical
Children & young peopleUrgent & unscheduled careHealth disadvantage & vulnerabilities
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
Finn · 5 years · male
Setting
Video consultation — mother of a 5-year-old refusing to weight-bear.
Past history
- Nil significant
- Coryzal illness last week (parent report)
Medication
- No regular medication
Allergies
NKDA
Recent notes
⚠ Same-day video request: woke limping, now refusing to weight-bear on the right leg. “Feels a bit warm” — temperature not taken. No injury witnessed.
Reason for contact
Mother calling. “Can you just tell me what to do for a sprain?”
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 child REFUSING TO WEIGHT-BEAR is a red flag — "growing pains" never cause a limp or non-weight-bearing and are never the safe label. The can’t-miss diagnosis is septic arthritis (and osteomyelitis): the consultation hinges on establishing whether the child is FEBRILE, because fever plus refusal to weight-bear mandates urgent same-day assessment to exclude joint infection (Kocher-type reasoning; BOAST 2022 for hospital work-up), with the age-appropriate serious differential (transient synovitis as a diagnosis of exclusion, Perthes, SUFE, malignancy/leukaemia, NAI) considered out loud. The examinable hidden agenda is practical: a single parent with no easy transport/childcare and a previous "wasted" A&E trip is steering toward a home label out of real barriers, not neglect — these must be actively problem-solved as part of the plan, not ignored or judged. Use video to observe but not to substitute for examination; arrange urgent assessment (inflammatory markers, blood cultures, imaging per BOAST 2022), screen for malignancy under NICE NG12 and safeguarding (NICE CG89), and safety-net clearly.
The guidance behind it
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