SCA practice case · Video consultation
“Persistent cough in a smoker”
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
Raymond Powell · 56 years · male
Setting
Booked video appointment. Patient self-referred.
Past history
- Hypertension — well controlled
- Smoker: 20/day × 35 years (recorded 14 months ago)
Medication
- Ramipril 5 mg OD
Allergies
NKDA
Recent notes
Last seen 14 months ago (BP review — stable). No chest imaging anywhere on record. Self-booked today: "chesty cough, needs antibiotics for work".
Reason for contact
Video consultation — cough, wants to get back on site.
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 marking trapdoor here is the patient asking for antibiotics — accepting the framing makes you miss the suspected cancer pathway referral. The single highest-yield behaviour is slowing down on the throwaway phrase ("a streak of blood") and naming the worry explicitly. NICE NG12: ≥40 y/o smoker with unexplained cough → urgent CXR.
The guidance behind it
Similar SCA cases
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