SCA practice case · Telephone consultation
“Stiff every morning — and now this headache”
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
Eleanor Vance · 72 years · female
Setting
Telephone — shoulder/hip girdle stiffness, new headache.
Past history
- Hypertension
- Carer for husband (dementia)
Medication
- Amlodipine
Allergies
NKDA
Recent notes
⚠ No bloods in the last 12 months. No steroid history. Reception note: “wants something for the stiffness — friend had polymyalgia”.
Reason for contact
Telephone appointment. “Stiff every morning — could I have a course of steroids?”
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)
Polymyalgia rheumatica (bilateral girdle pain, prolonged morning stiffness, age >50, steroid-responsive) carries a sight-threatening companion: giant cell arteritis. The examinable skill is to actively ask about and act on the GCA red flags — new unilateral headache, scalp tenderness, jaw claudication (and visual symptoms) — even when the patient dismisses them, because GCA can cause sudden, irreversible blindness. The absence of visual loss now is the window to PREVENT it. Suspected GCA is treated with HIGH-dose corticosteroid IMMEDIATELY (BSR 2020: prednisolone 40–60 mg once daily; IV methylprednisolone via same-day ophthalmology if any visual symptoms) WITHOUT waiting for ESR/CRP or temporal artery biopsy, plus urgent GCA fast-track referral (BSR 2020: ideally the same working day, in all cases within 3 working days); any visual symptom is a same-day ophthalmology emergency. This contrasts with isolated PMR (prednisolone 15 mg daily, BSR/BHPR 2010). The hidden agenda is steroid fear (hoping for a short course) and carer pressure driving her to minimise the headache/jaw clues; counsel steroids honestly (necessity for sight, prolonged taper, bone protection per NOGG 2024, a PPI considered rather than routine per BSR 2020, Steroid Emergency Card, sick-day rules per NICE NG243), support her as a carer, and safety-net visual symptoms emphatically.
The guidance behind it
Similar SCA cases
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