SCA practice case · Video consultation
“Everyone keeps saying how well I look”
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
Priya Sundaram · 27 years · female
Setting
Video consultation — palpitations and tremor; TFTs abnormal.
Past history
- Nil significant
Medication
- Nil regular
Allergies
NKDA
Recent notes
⚠ TSH <0.01, FT4 38 pmol/L (high), FT3 high, TRAb positive. Resting pulse 104 regular. ~9 kg weight loss over 4 months “without trying”.
Reason for contact
Results follow-up. “Can we just sort the heart bit?”
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)
Florid hyperthyroidism (suppressed TSH, high T4/T3, TRAb positive, eye signs) is serious, not cosmetic — the "welcome" weight loss is catabolism, including of cardiac muscle. Manage the heart promptly (ECG for AF, beta-blocker for symptom control), check for asthma before a non-selective beta-blocker, refer urgently for definitive treatment (carbimazole with the mandatory agranulocytosis safety-net, and — MHRA Drug Safety Update, February 2019 — effective contraception for a woman who could become pregnant, because of the risk of congenital malformations), and screen for thyroid eye disease and storm. The examinable core is the hidden agenda: a patient with a body-image history who is reluctant to be fully treated because the illness is finally winning her compliments. Validate that loss honestly, refuse to collude or bargain treatment away, reframe treatment as protecting her heart, address the regain fear realistically, and follow up the body-image cost as a real part of care.
The guidance behind it
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