SCA practice case · Video consultation
“The sleeping tablet repeat”
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
Jean Hardcastle · 76-year-old woman
Setting
Booked after reception flagged an early repeat request.
Past history
- Hypertension
- Osteoarthritis of the hands
- Fall at home last week — bruised hip and shoulder, X-ray normal (urgent treatment centre)
Medication
- Amlodipine 5 mg once daily
- Zopiclone 7.5 mg at night (on repeat for 12 years, started after bereavement)
Allergies
No known drug allergies
Recent notes
Seen in the urgent treatment centre last week after a fall at 3am on the way to the toilet — no fracture. Zopiclone repeat requested two weeks early; flagged by reception. No medication review recorded for the zopiclone. Widowed 12 years; lives alone, daughter nearby.
Reason for contact
Video consultation (set up by her daughter) to request her zopiclone repeat.
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)
Z-drugs and benzodiazepines raise the risk of falls and fractures in older people, and tolerance makes long-term use ineffective for sleep. The exam skill is deprescribing as a negotiation: validate the fear, harness the patient’s own motivation, taper slowly (never stop abruptly), and replace the tablet with something — CBT-I principles and attention to the loneliness driving the 3am waking. Escalating to temazepam is the station’s trapdoor.
The guidance behind it
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