SCA practice case · Video consultation
“The nurse did the blowing test — I just need a stronger inhaler, don’t I?”
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
Linda Barker · 58-year-old woman
Setting
Video — results of spirometry done for breathlessness.
Past history
- Hypertension
- Anxiety
- Two lower respiratory tract infections last winter (amoxicillin; one course of prednisolone from out-of-hours)
Medication
- Amlodipine 5 mg once daily
- Salbutamol 100 micrograms inhaler — 2 puffs when required (issued by out-of-hours in January; using 2–3 times a week)
Allergies
No known drug allergies
Recent notes
Spirometry (practice nurse, ARTP-certified; good quality, 3 acceptable and repeatable blows) 1 week ago — see report. MRC dyspnoea grade 3. BMI 23. SpO2 96%. FBC: Hb 146 g/L, eosinophils 0.2 × 10⁹/L. Chest X-ray 3 weeks ago: hyperinflated lungs, no focal lesion or mass. Smoking status at booking: “cutting down”. Pack-years documented: about 32.
Reason for contact
Video appointment to discuss her breathing test results.
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)
COPD is diagnosed by symptoms and risk factors plus post-bronchodilator spirometry showing FEV1/FVC below 0.7; severity is graded by FEV1 % predicted (mild 80% or more with symptoms, moderate 50–79%, severe 30–49%, very severe under 30%). Large reversibility (over 400 mL) suggests asthma. Explain spirometry in plain language. NICE management: smoking cessation is the most effective intervention (offer behavioural support plus pharmacotherapy — combination NRT or varenicline — and e-cigarettes as an option); offer pneumococcal and annual flu vaccination (and COVID-19 as eligible); pulmonary rehabilitation for those functionally limited (MRC 3 or more, or 2 if limited); a personalised self-management plan; optimise treatable traits and comorbidities. Inhalers: SABA or SAMA first; if still limited and no asthmatic or steroid-responsive features, LABA+LAMA; consider LABA+ICS only with asthmatic features or raised eosinophils. Check technique before escalating. Address emotional responses (fear from a family history, shame about smoking) to support engagement.
The guidance behind it
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