SCA practice case · Telephone consultation
“The drip her brother wants”
Telephone consultation
Older adult patient
Someone else speaking
Hard
Older adultsLong-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
Iris Caldwell · 88 years · female
Setting
Telephone — daughter calling; brother in the background.
Past history
- End-stage heart failure (EF 15%)
- Palliative care register
Medication
- Oxycodone (low dose) for breathlessness
- Furosemide and ramipril stopped 1 month ago
Allergies
NKDA
Recent notes
⚠ ReSPECT form 3 months ago: comfort focus, preferred place of death home, DNACPR. Completed with Iris (full capacity), GP and heart failure nurse. Lives with daughter Wendy.
Reason for contact
Daughter on the phone: “Mum’s gone muddled and sleepy, hardly drinking.”
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)
New confusion near end of life still earns a reversibility screen (infection, retention, constipation, drugs, opioid toxicity) — but days of progressive withdrawal, minimal intake, terminal restlessness and lucid intervals in end-stage heart failure is the dying phase, and naming it kindly is the treatment. NICE NG31: clinically assisted hydration is not routine in the dying — mouth care relieves thirst better; in heart failure fluids can add harm — though a trial is offered if dryness itself causes distress. The hidden agenda is the promise: answer "am I doing something terrible?" first, anchor every decision to the patient’s own ReSPECT words, and convert the angry absent sibling with inclusion and tasks, not victory.
The guidance behind it
Similar SCA cases
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