SCA practice case · Telephone consultation
“But the X-ray was clear”
Telephone consultation
Adult patient
Typical
Long-term conditions & cancerNew & undifferentiated presentationsInvestigations & results
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
Derek Halloran · 64 years · male
Setting
Telephone — results call: chest X-ray normal, cough ongoing.
Past history
- Ex-smoker, 40 pack-years (stopped 8 years ago)
- Cough 11 weeks
Medication
- Nil regular
Allergies
NKDA
Recent notes
⚠ CXR for 11-week cough: reported NORMAL. Weight on record steady. No haemoptysis documented. Occupation: retired (previous job not recorded).
Reason for contact
Telephone call for X-ray result. “I just want to hear it from a doctor.”
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)
The whole case is a single refusal: do not convert a normal chest X-ray into a false all-clear. A plain film misses lung cancer and mesothelioma, and an 11-week unremitting cough in a 40-pack-year ex-smoker with a fleck of blood in the sputum and a hoarse voice is NICE NG12 territory regardless of that film. Two acts of clinical curiosity carry the marks: taking the occupational history no template prompts (30 years of asbestos behind one question), and actively re-screening the symptoms the patient minimises (progressive breathlessness, hoarseness, weight loss, a possible fleck of blood). State the NG12 routes explicitly — unexplained haemoptysis at 40+ means a suspected cancer pathway lung referral despite the normal CXR; persistent hoarseness at 45+ means considering a laryngeal suspected cancer pathway referral; persisting symptoms after a normal film are discussed with the lung team, who usually go to CT — and do it while managing a man who is actively asking to be discharged because a dead workmate has made the truth unbearable. Override his wish kindly; meet the dread; close with reliability, not "ring if worried".
The guidance behind it
Similar SCA cases
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