Breathlessness and cough in a long-term smoker
PLAB 2 practice station

The task

You are a doctor in a GP surgery. Mr Rajesh Patel, aged 61, has come because he is becoming short of breath. He is alone. Take a focused history. Then explain what you think needs to happen next and why, 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

• Unexplained haemoptysis at age 40 or over means a suspected cancer pathway referral, with an urgent chest X-ray as well.
• Ask about blood in the sputum directly; patients often leave it out.
• Do not treat a changing pattern as simple COPD without excluding other causes.
• Be honest that the diagnosis is unknown and avoid false reassurance.
• Use safety-netting with specific triggers and the right emergency number.

Sources for the clinical content

• NICE NG12: Suspected cancer: recognition and referral
• NICE NG115: Chronic obstructive pulmonary disease in over 16s

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

Practise next

• Severe headache since yesterday
• Chest tightness that comes and goes
• Lower abdominal pain in a young woman
• Low mood and poor sleep
• Weight loss and a change in bowel habit