SCA practice case · Video consultation
“I keep waking up drenched — it’s probably just stress, right?”
Video 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
Tomas Vidal · 26 years · male
Setting
Video consultation — night sweats for several weeks.
Past history
- Nil significant recorded
Medication
- None recorded
Allergies
NKDA
Recent notes
No consultations or blood tests in the last two years.
Reason for contact
Video consultation. “Night sweats, can’t sleep.”
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)
Drenching night sweats (soaking nightclothes/sheets) persisting for weeks must be taken seriously and worked up structurally — NOT reassured away as stress/overheating or met with a sleep aid. In a young adult especially, drenching night sweats are a classic LYMPHOMA "B symptom": screen the constellation — unexplained weight loss, fevers, drenching night sweats, pruritus/itch, fatigue, and lymphadenopathy (painless rubbery nodes) — and elicit the red flags the patient may be downplaying. Examine (lymph nodes, hepatosplenomegaly), arrange urgent bloods (FBC/film, ESR, LDH), and consider the broader differential (thyroid/hyperthyroidism; infection — TB, HIV; drugs), treating anxiety as a diagnosis of EXCLUSION, not the opening assumption. Given an unexplained lump with drenching sweats, weight loss and itch, arrange a suspected cancer pathway referral under NICE NG12 (Suspected cancer: recognition and referral, last updated April 2026), which is triggered by unexplained lymphadenopathy (or splenomegaly for non-Hodgkin lymphoma) with these symptoms taken into account. The examinable hidden agenda is "just stress / something to help me sleep" as AVOIDANCE masking a noticed lump and real fear; surface it gently without colluding, balance honesty with calm reassurance (lymphoma is highly treatable; many causes are benign), and act — structured work-up of the can’t-miss causes, not a sleep aid.
The guidance behind it
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