SCA practice case · Video consultation
“A "water infection" at 87”
Video consultation
Older adult patient
Someone else speaking
Typical
Older adultsUrgent & unscheduled care
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
Harold Finch · 87-year-old man
Setting
Video consultation — daughter connects the call from her father’s sitting room.
Past history
- Hypertension
- Osteoarthritis of the shoulder
Medication
- Amlodipine 5 mg once daily
- Co-codamol 30/500 four times daily (started 3 weeks ago by a locum for shoulder pain)
Allergies
No known drug allergies
Recent notes
Care agency dipsticked his urine yesterday — reported “positive”. Daughter Carol reports a week of strong-smelling urine, dribbling and increased confusion in the evenings. Two weeks ago independent: crossword, walking to the paper shop. Lives at home with a care agency; Carol visits daily.
Reason for contact
Urgent video consultation requested by his daughter, who wants antibiotics started today.
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)
In the very old, "UTI" is the label that stops people thinking. UKHSA advises against dipsticks over 65 (up to half of older adults have asymptomatic bacteriuria); smelly, concentrated urine usually means dehydration, and new confusion needs a cause hunted, not a reflex antibiotic. New dribbling plus new confusion are two UKHSA over-65 criteria, so infection is not dismissed — the urine goes for culture while the other causes are examined for. Here the cause is iatrogenic: opioid-induced constipation causing retention with overflow. The hidden agenda — the daughter’s terror of hospital after her husband died there — drives the antibiotic demand, and only naming it lets the right plan land.
The guidance behind it
Similar SCA cases
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