SCA practice case · Video consultation
“I’m stopping on Monday, on my own”
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
Sean Doherty · 47 years · male
Setting
Video consultation — heavy drinker, "wants to cut down".
Past history
- Alcohol excess
- Deranged LFTs, macrocytosis, thrombocytopenia (months ago, not followed up)
Medication
- No regular medication
Allergies
NKDA
Recent notes
⚠ Last bloods: MCV high, ALT/AST raised, platelets low. DNA follow-up. Off work 3 months (scaffolder).
Reason for contact
E-booking: “Need help cutting down the drink.”
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)
"I want to cut down" can conceal two emergencies. First, the hidden red flag: coffee-ground/fresh haematemesis and melaena in a likely-cirrhotic drinker is a possible variceal bleed — an immediate admission, not a routine plan; it hides here because the patient is terrified it means cancer. Second, the danger in his stated plan: physical alcohol dependence (relief drinking, morning tremor, a prior withdrawal seizure) makes abrupt unplanned cessation hazardous — seizures and delirium tremens — so "stopping dead on Monday on my own" must be redirected to medically-supported detox with benzodiazepines and thiamine (Wernicke’s prevention; NICE CG100 and CG115 — inpatient here), not praised. The bleed itself is managed per NICE CG141 (acute upper GI bleeding), not as a cancer-referral question. Add assessment for decompensation (jaundice, ascites, encephalopathy) and a sensitive risk/mood screen (shame, relationship crisis, hopelessness). The skill is to catch the bleed, refuse to endorse unsafe self-detox without crushing motivation, act on the emergency today, and wrap the patient in coordinated, compassionate care.
The guidance behind it
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