SCA practice case · Telephone consultation
Respiratory: SCA practice case
A pharmacist’s query about an antibiotic prescription
Telephone consultation
Older adult patient
Someone else speaking
Typical
Older adultsProfessional & ethical dilemmasUrgent & 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
Dennis Whitlock · 79-year-old man
Setting
Telephone consultation with a community pharmacist querying a prescription you issued this morning.
Past history
- Atrial fibrillation (CHA2DS2-VASc 4)
- Hypertension
- Chronic kidney disease stage 3b
- Previous TIA (2021)
- Penicillin allergy recorded 1978: ’rash’
Medication
- Rivaroxaban 15 mg once daily with food
- Simvastatin 40 mg at night
- Amlodipine 10 mg once daily
- Bisoprolol 5 mg once daily
- Clarithromycin 500 mg twice daily for 5 days (issued today 09:52, not yet collected)
Allergies
Penicillin: rash (1978)
Recent notes
Your telephone consultation today 09:40: 4 days of cough with green sputum, fever 38.2 at home, mild breathlessness on walking, self-measured oxygen saturation 95%, alert and orientated, no chest pain. Impression: lower respiratory tract infection, possible community-acquired pneumonia, CRB-65 score 1 (age). Clarithromycin issued; prescribing system interaction alert overridden. Weight 72 kg; creatinine 148 micromol/L (estimated creatinine clearance about 41 mL/min) in January. Lives with wife, Joan.
Reason for contact
Telephone call from the community pharmacist, Tomasz Nowak, about this morning’s prescription. It is 3.15pm.
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 pharmacist’s interaction query looks like a prescribing question, and the interaction is real: clarithromycin with simvastatin is contraindicated and raises rivaroxaban levels in a man with impaired kidneys. But the real data-gathering prize is the throwaway comment that the patient is now confused with a saturation of 91%. That moves him from a home-treated chest infection to someone who needs assessment today. Own the error, thank the colleague, and act on the new information.
The guidance behind it
Similar SCA cases
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