SCA practice case · Telephone consultation
“My baby looks a bit yellow and she’s really sleepy — is that normal?”
Telephone consultation
Child patient
Someone else speaking
Typical
Children & young peopleUrgent & unscheduled care
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
Freya Evans (call from her mother, Chloe Evans) · 5 days · female
Setting
Telephone call from the mother of a 5-day-old baby.
Past history
- Born 38+5 weeks, spontaneous vaginal delivery; birth weight 3.38 kg
- Newborn infant physical examination (NIPE) day 1: normal
- Exclusively breastfed
Medication
- Vitamin K given IM at birth
Allergies
NKDA
Recent notes
Community midwife, day 3 (Tuesday): “Mild jaundice face and chest. Weight 3.12 kg (−7.7%). Feeding 6–7 times a day, short feeds; latch reviewed. 3 wet nappies, meconium changing. Next visit day 6. Maternal blood group O RhD positive, antibody screen negative.”
Reason for contact
Telephone call — mother rang reception: “baby looks yellow and sleepy”. Consent: mother has parental responsibility.
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)
Most newborn jaundice is physiological, but every baby with visible jaundice needs a bilirubin level: within 2 hours if jaundice appears in the first 24 hours, and within 6 hours if it is noticed after 24 hours. Do not rely on visual inspection to estimate the level, particularly in darker skin. Sleepiness and poor feeding are both a cause and a consequence of rising bilirubin. Always ask about stool and urine colour: pale chalky stools or dark urine suggest conjugated jaundice (for example biliary atresia) and need urgent specialist referral. Prolonged jaundice is beyond 14 days in term babies (21 in preterm). Encourage frequent breastfeeding and arrange skilled support rather than advising formula or water; check the mother’s mood and support.
The guidance behind it
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