SCA practice case · Video consultation
“I’ve got these intensely itchy purple bumps on my wrists, and now sore white streaks inside my mouth”
Video consultation
Adult patient
Straightforward
New & undifferentiated presentationsLong-term conditions & cancer
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
Diane Forsyth · 49 years · female
Setting
Video consultation, with the skin and mouth examination arranged face to face — an itchy violaceous rash with oral changes.
Past history
- Nil recorded
Medication
- Nil recorded
Allergies
NKDA
Recent notes
No previous skin or mouth consultations.
Reason for contact
“Itchy purple bumps on my wrists and shins, and sore white streaks in my mouth — is it serious?”
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)
LICHEN PLANUS is recognised by the classic "6 Ps" — PRURITIC, PLANAR (flat-topped), POLYGONAL, PURPLE/violaceous PAPULES/plaques — with fine white surface lines (WICKHAM STRIAE), favouring the flexor wrists, ankles and shins, and often with ORAL involvement (white lacy/reticular, sometimes erosive streaks) and sometimes nail (ridging/pterygium), SCALP (scarring alopecia/lichen planopilaris) and GENITAL disease, with Koebner phenomenon at trauma sites. Consider a drug-induced LICHENOID eruption (thiazides, antimalarials, beta-blockers, ACE inhibitors, NSAIDs — review medications) and the recognised association of oral lichen planus with HEPATITIS C. Manage cutaneous LP with POTENT (or very potent) TOPICAL CORTICOSTEROIDS first-line (BAD 2024; PCDS) plus antihistamines/emollients for itch, and oral LP with topical steroids and oral hygiene; refer to dermatology for extensive, erosive, nail/scalp-scarring or refractory disease. Counsel that cutaneous lichen planus is usually SELF-LIMITING over months to ~1–2 years (may leave post-inflammatory pigmentation) but can recur, and note that ORAL lichen planus carries a SMALL risk of malignant transformation (SCC) — about 1% over 10 years (BAD) — and erosive genital disease also needs follow-up, warranting monitoring and dental/specialist review; NICE NG12: unexplained oral ulceration for more than 3 weeks, or a lump or red/red-and-white patch, needs referral. Reassure (not serious/not contagious), treat the itch, review drugs/associations, and arrange appropriate monitoring.
The guidance behind it
Similar SCA cases
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