SCA practice case · Video consultation
“My daughter says I rattle when I walk — and I keep ending up on the floor”
Video consultation
Older adult patient
Someone else speaking
Hard
Older adultsLong-term conditions & cancerInvestigations & results
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
Winifred (Winnie) Clarke · 84 years · female
Setting
Video — booked structured medication review after three falls; her daughter joins on the same call at the patient’s request.
Past history
- Hypertension (2001)
- Type 2 diabetes (2009)
- Osteoarthritis both knees
- Overactive bladder (2019)
- Osteoporosis — wrist fracture 2018
- Widowed 2017; lives alone, ground-floor flat
- Electronic frailty index: moderate frailty
Medication
- Amlodipine 10 mg once daily
- Ramipril 10 mg once daily
- Bendroflumethiazide 2.5 mg once daily
- Atorvastatin 40 mg at night
- Aspirin 75 mg once daily (no cardiovascular history recorded)
- Omeprazole 20 mg once daily (started 2016, indication not recorded)
- Oxybutynin 5 mg twice daily
- Amitriptyline 25 mg at night
- Zopiclone 7.5 mg at night
- Co-codamol 30/500 two tablets up to four times daily
- Metformin 1 g twice daily
- Alendronic acid 70 mg weekly (since 2018)
- Colecalciferol with calcium carbonate one tablet twice daily
Allergies
No known drug allergies
Recent notes
Practice nurse home visit 2 days ago (falls review): three falls since late August, no head injury. Lying BP 138/72; standing 1 min 112/64 and 3 min 108/60 with dizziness. Pulse 68 regular. Weight 54 kg (57 kg a year ago). Clinical Frailty Scale 6. Bloods same day: Na 131 (133–146), K 4.6, eGFR 41 (48 last year), HbA1c 43 mmol/mol, Hb 121. ACB score calculated by nurse: 7. Daughter Marcia (next of kin) to join the video at patient’s request.
Reason for contact
Structured medication review by video after recurrent falls.
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 structured medication review in frailty starts with the person, not the list: what matters to them, how they actually take their medicines, and what the falls look like. Here the falls are explained by symptomatic postural hypotension on three antihypertensives, a thiazide-associated low sodium, an anticholinergic burden of 7, a hypnotic (sometimes doubled) and metformin overtreatment in a frail woman with an eGFR of 41. The skill is to prioritise and stage the changes, agree them with the patient who has capacity, involve the relative without letting her decide, and combine deprescribing with falls prevention, blood tests and early review.
The guidance behind it
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