SCA practice case · Telephone consultation
“My blood test said my cells are big — is that bad?”
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
Lisa Brennan · 46 years · female
Setting
Telephone — to discuss a recent blood count.
Past history
- Nil relevant recorded
Medication
- None on repeat
Allergies
None recorded
Recent notes
⚠ FBC for tiredness: MCV 105 fL. Hb, WCC and platelets normal. No haematinics, TFT or LFT on this sample.
Reason for contact
Telephone call for results. “Is it leukaemia?”
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)
Isolated macrocytosis (raised MCV without anaemia, normal white cells/platelets) is usually NOT sinister — leukaemia is not the typical cause — and is a finding to work up through its common causes: ALCOHOL (very common), B12/folate deficiency, hypothyroidism, drugs, and liver disease, with a structured panel (B12, folate, TFTs, LFTs/GGT, reticulocytes/film, medication review) and haematology/marrow referral reserved for unexplained, progressive or multi-lineage abnormalities. The examinable hidden agenda is that the likely cause — rising alcohol since a recent bereavement/relationship stress — is something the patient is ashamed of and has framed the call around a leukaemia fear partly to avoid; the result is a DOOR into a sensitive, important issue. Reassure genuinely about leukaemia, take a non-judgemental alcohol/lifestyle history that enables disclosure, and address the underlying distress (screen mood, offer bereavement and alcohol-reduction support) — treating the abnormal result as an opportunity to help, not just a number to recheck. Catching rising alcohol early (the macrocytosis is a useful biological flag) and addressing the bereavement/low mood is genuinely valuable — the abnormal result is an opportunity, not just a number to recheck. Done well, it opens help she might not otherwise have sought.
The guidance behind it
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