SCA practice case · Telephone consultation
“I just tripped, that’s all — these old carpets”
Telephone consultation
Older adult patient
Typical
Older adultsHealth disadvantage & vulnerabilities
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
Eunice Barley · 79 years · female
Setting
Telephone — third fall in three months; daughter prompted the call.
Past history
- Hypertension
- Cataracts (awaiting surgery)
- Lives alone
Medication
- Amlodipine
- Indapamide
- Amitriptyline (for sleep)
- Zopiclone PRN
Allergies
NKDA
Recent notes
⚠ Third fall in three months; bruised hip; on the floor about 40 minutes. BMI 21. No falls or bone-health assessment on file.
Reason for contact
“My daughter made me ring. I just tripped on the carpet.”
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)
Three falls in three months is recurrent falls requiring a structured MULTIFACTORIAL assessment (NICE NG249: 2 or more falls, injury or being unable to get up each qualifies — she has all three), not acceptance of "just the carpet". The highest-yield intervention is almost always the MEDICATION review/deprescribing — here a polypharmacy cluster (two antihypertensives including a diuretic, amitriptyline, zopiclone) driving postural drop and sedation. The full assessment spans postural BP (NICE NG136: a systolic fall of 20 mmHg or more after standing for at least 1 minute is significant), vision (expedite the cataracts), gait/balance/strength (physio/falls service), continence, cognition, footwear, alcohol, home hazards (OT), and — importantly — bone health (a bruised hip + recurrent falls warrants fracture-risk assessment per NICE NG259 and NOGG 2024, with DXA where it would change management) and the long lie (40 minutes on the floor is a red flag prompting a personal alarm). The examinable hidden agenda is the fear that admitting falls means losing her home; the minimisation is a shield and the daughter’s worry is the reliable signal. Reframe every intervention around PRESERVING independence — the assessment is how she STAYS home, not the road to a care home — and safety-net the long lie. Dignity protected, risk reduced.
The guidance behind it
Similar SCA cases
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