Chest tightness that comes and goes
PLAB 2 practice station

The task

You are a doctor in a GP surgery. Mr Gareth Williams, aged 58, has booked a same-day appointment because of chest pain. He is alone. Take a focused history. Then explain to him what you think is happening and what needs to be done next, answering his questions, and tell him what to do if things change. There is no need to examine him. The examiner will not take part in the conversation.

What this station tests

• Suspected acute coronary syndrome with pain in the last 12 hours and an abnormal or unavailable ECG means emergency referral, by ambulance.
• Ask what was happening when the pain started and when the last episode was; the timing changes how urgently you act.
• Do not send a patient with suspected acute coronary syndrome home or on public transport.
• Explore the family history of premature heart disease and smoking as part of risk.
• Acknowledge worries about work and family, and agree who to tell.
• Offer aspirin 300 mg as soon as possible unless the patient is allergic, and send a record of it with them.

Sources for the clinical content

• NICE NG185: Acute coronary syndromes
• NICE CG95: Chest pain of recent onset: assessment and diagnosis

An original practice scenario with invented patients. Not an exam question.

Practise next

• Severe headache since yesterday
• Breathlessness and cough in a long-term smoker
• Lower abdominal pain in a young woman
• Low mood and poor sleep
• Weight loss and a change in bowel habit