SCA practice case · Video consultation
“I’ve got my scan and blood results to go through — it’s the fibroid, isn’t it?”
Video consultation
Adult patient
Hard
Investigations & resultsLong-term conditions & cancerHealth 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
Tamsin Hale · 43-year-old woman
Setting
Video — results appointment; the patient lives on a narrowboat and is moored near the practice.
Past history
- Nil significant
- Cervical screening: HPV negative, 2 years ago
Medication
- No regular medicines
Allergies
No known drug allergies
Recent notes
Advanced nurse practitioner (7 days ago): “6 weeks bloating, early satiety, tiredness, abdominal swelling. BP 118/70, HR 84, T 36.7 °C, SpO2 97%. Abdomen distended, firm mass arising from pelvis, more to the left, non-tender. Impression: ?fibroid. Plan: bloods, pelvic USS, review with results.” Address on record: “NFA — boater (continuous cruiser); post c/o a friend.” Bloods (6 days ago): CA-125 486 kU/mL (<35); CRP 42 mg/L (<5); Hb 124 g/L; platelets 448 ×10⁹/L (150–400); U&E, LFT and calcium normal. Pelvic ultrasound (3 days ago, transabdominal and transvaginal): left adnexal 74 × 61 × 58 mm complex, predominantly solid-cystic mass with thick irregular septations, papillary projections and marked internal vascularity; uterus, endometrium and right ovary normal; moderate free fluid in the pouch of Douglas. Radiologist: “Urgent gynaecological oncology referral recommended.”
Reason for contact
Video appointment: “Results — bloods and scan.”
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)
Results that strongly suggest cancer must be acted on the same day, whatever the logistics: a suspected cancer pathway referral can be made now and redirected later; waiting for a patient to “settle” is a serious error. For an adnexal mass, NICE recommends calculating the Risk of Malignancy Index (U × M × CA-125); an RMI of 250 or more warrants specialist gynaecological oncology MDT care, and an ultrasound suggestive of ovarian cancer meets the NG12 criteria for a suspected cancer pathway referral. Breaking bad news by video needs the same structure as face to face (SPIKES: setting, perception, invitation, knowledge, emotions, strategy) plus checks on privacy and connection. People without a fixed address — boaters, Gypsies and Travellers, people who are homeless — are entitled to register with any GP practice without proof of address. Protect continuity with multiple contact routes, written copies of results, a named contact and a booked follow-up call.
The guidance behind it
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