SCA practice case · Telephone consultation
Infection: SCA practice case
A practice nurse asks you to sign for a travel vaccine
Telephone consultation
Adult patient
Someone else speaking
Typical
Professional & ethical dilemmasLong-term conditions & cancer
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
Graham Oduya · 58-year-old man
Setting
Telephone consultation: the practice nurse rings you between patients about travel vaccines for a man you have not seen.
Past history
- Rheumatoid arthritis (diagnosed 2019), under rheumatology; stable
- Hypertension
Medication
- Methotrexate 15 mg once weekly (Mondays)
- Folic acid 5 mg once weekly (Thursdays)
- Ramipril 5 mg once daily
Allergies
Penicillin (rash)
Recent notes
Shared-care blood monitoring last month: FBC, LFT and U&E normal. Rheumatology letter four months ago: disease in remission, no steroid for over a year. Travel risk assessment form completed with the nurse today: Kenya (Nairobi, safari in Maasai Mara, family visit near Kisumu), departing in three weeks for four weeks. Previous travel vaccines: none recorded.
Reason for contact
Nurse request by telephone: “Could you e-sign a PSD for hep A and typhoid? He’s in my room.”
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 Patient Specific Direction is a prescriber’s written instruction to supply or administer a medicine to a named patient after the prescriber has assessed that patient individually; it is not a signature that covers someone else’s decision, and it cannot be signed in bulk or after the event. A Patient Group Direction lets a registered professional supply or administer to patients who meet its criteria, and lapses when it expires. This case tests whether a GP can hold that line while helping a stressed colleague, spot the immunosuppression that makes oral typhoid and yellow fever unsafe, and fix the system rather than just today’s patient.
The guidance behind it
Similar SCA cases
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