SCA practice case · Telephone consultation
“The pain and the envelope”
Telephone consultation
Older adult patient
Someone else speaking
Hard
Long-term conditions & cancerOlder adults
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
Ronald Hayes · 71 years · male
Setting
Telephone — wife calling about her husband (palliative register).
Past history
- Metastatic prostate cancer — bone metastases (spine, pelvis, femurs)
- Palliative care register
Medication
- MST 30 mg BD
- Oramorph 5 mg PRN
- Senna
Allergies
NKDA
Recent notes
⚠ Hospice community team involved. Letter from hospice re: resuscitation sent 4 days ago. Last U&E and calcium: check record.
Reason for contact
Wife Brenda on the phone: “The pain’s got on top of him.”
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 severe weight-bearing pain in a metastatic femur is a pathological fracture until imaged — same-day assessment, handling advice, and the surgical/radiotherapy options named with hope. The opioid arithmetic is examinable: BNF breakthrough dose = usually 1/10 to 1/6 of the 24-hour background (here 6–10 mg; 5 mg is below the range), and regular need for several PRNs a day means the background needs review — with safety checks (sedation, myoclonus, renal function, bowels) before escalation. The hidden agenda is double: the morphine-kills myth (answer it: titrated opioids treat pain, they don’t shorten life) and the unopened DNACPR envelope — reframed from verdict to protection, opened together, never alone.
The guidance behind it
Similar SCA cases
gpreasoning.uk is not affiliated with or endorsed by the RCGP. Our cases are original teaching material written for practice; none is an exam recall. For anything official about the SCA, check the RCGP SCA pages.