History Taking · Intermediate · O&G

Persistent Abdominal Bloating and Pelvic Discomfort

Practise this PLAB 2 history taking station on Suspected Ovarian Cancer. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a GP surgery. Mrs Moira McGee, a 62-year-old woman, has come to see you with persistent abdominal bloating and pelvic pain over the past three months. Please take a focused history and discuss initial investigation options and referral pathways.

Background notes: PMH: Menopause age 54, Appendectomy age 28, Hypertension, Mild hypercholesterolaemia

What this station tests

  • NICE NG12 ovarian cancer red flags: persistent bloating, early satiety, pelvic pain, urinary frequency
  • CA-125 as first investigation: raised level triggers urgent USS
  • Vague symptoms easily dismissed as IBS: the reason ovarian cancer is diagnosed late
  • 2-week-wait referral pathway if CA-125 raised plus complex mass on USS
  • Family history of ovarian/breast cancer: BRCA association increases risk

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, confirm identity, open question. 'What's brought you in today?'
  • 1-4 min — Systematic History: Presenting complaint detail (SOCRATES for pain, timeline, severity). Systems review. PMH, medications, allergies.
  • 4-6 min — Context and ICE: Social history (smoking, alcohol, occupation, living situation). Family history. Ideas, Concerns, Expectations.
  • 6-7 min — Summary and Plan: Summarise findings back to patient. Share differential/working diagnosis. Outline investigation and management plan.
  • 7-8 min — Closing: Safety netting with specific red flags. Arrange follow-up. Check for questions.

Consultation approach

The opening

Persistent bloating, early satiety, and pelvic discomfort in a postmenopausal woman are ovarian cancer red flags per NICE NG12. The candidate must recognise these vague symptoms as potentially sinister. Mrs McGee is 62, with 3 months of bloating and pelvic pain. Open with: 'Mrs McGee, persistent bloating like this is something we take seriously. Tell me about all the symptoms you have been having.'

Core approach

NICE NG12 ovarian cancer red flags. Persistent bloating (not intermittent, present most days for >3 weeks). Early satiety (feeling full after small amounts). Pelvic or abdominal pain. Urinary frequency or urgency. Mrs McGee has all four. These are vague symptoms that are easily dismissed as IBS or menopause, which is why ovarian cancer is often diagnosed late.

She is 62 (postmenopausal, higher risk). Ask about family history of ovarian or breast cancer (BRCA association). Weight loss? Change in bowel habit? Ascites (increasing abdominal girth)?

She initially attributed symptoms to diet and IBS. Her daughter persuaded her to come. She is now worried about cancer but has been dismissing the symptoms for months.

Closing and safety netting

Urgent investigation: serum CA-125 (tumour marker, elevated in ovarian cancer but not specific). If CA-125 is raised (>35 IU/mL): urgent pelvic and abdominal USS. If USS shows a complex mass: 2-week-wait referral to gynaecological oncology. If CA-125 normal but symptoms persist: USS anyway and reassess.

Communicate honestly. 'The combination of persistent bloating, feeling full quickly, and pelvic discomfort are symptoms we take seriously because, although they have many causes, they can sometimes indicate a problem with the ovaries. I want to arrange a blood test and scan to investigate properly.' Safety net: 'If you develop sudden severe abdominal pain or rapid abdominal swelling, come in urgently.' Follow-up with results within 2 weeks.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for suspected ovarian cancer. Domain 1 (Data Gathering) carries the most weight: expect marks for systematic coverage of presenting complaint, red flags, PMH, medications, social and family history. Domain 2 (Clinical Management) requires a clear differential, appropriate investigations, and a safe management plan with safety netting. Domain 3 (Interpersonal Skills) is assessed throughout: genuine exploration of ICE, active listening, empathic responses, and clear communication without jargon.

Domain 1 (Primary focus)

Scores well: NICE red flags identified. Family history checked. Duration and persistence confirmed. Other symptoms screened (weight loss, bowel change, ascites).

Costs marks: Not recognising red flags. Diagnosing IBS. Not asking about family history.

Domain 2 (Primary focus)

Scores well: CA-125 arranged. USS pathway if raised. 2-week-wait referral if mass found. Safety netting for acute complications.

Costs marks: No CA-125. Routine referral. No investigation plan.

Domain 3 (Throughout)

Scores well: Taking her symptoms seriously. Proportionate communication. Validating her daughter's concern. Acknowledging the delay without blame.

Costs marks: Dismissing as IBS. Being alarmist. Not taking symptoms seriously.

Common examiner feedback (and how to fix it)

Did not gather sufficient information to make an adequate assessment of the patient's condition

Fix: Use a consistent framework for every history. After covering the presenting complaint, systematically move through PMH, drug history, social history, family history, and ICE. Keep a mental checklist.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Reserve the final 2 minutes to summarise your findings, share your working diagnosis with the patient, and outline your investigation and management plan including safety netting.

Common mistakes in this station

  1. Attributing symptoms to IBS without investigating: persistent bloating in a 62-year-old is not IBS until cancer is excluded
  2. Not requesting CA-125: this is the first-line investigation per NICE for suspected ovarian cancer
  3. Being either too alarming or too casual: proportionate communication about a potentially serious diagnosis

Resitting PLAB 2?

If you have previously struggled with history taking stations, focus on building a consistent systematic framework that you apply to every case. Practise structuring your history into clear phases (presenting complaint, systems review, PMH, social, ICE) so that even under pressure, you cover all domains. Many resitters lose marks not on knowledge but on organisation and time management.

Example opening

Good morning/afternoon, my name is Dr [Name], I'm one of the doctors here today. Could I confirm your name and date of birth please? Thank you. So, what's brought you in to see me today?

Frequently asked questions

How do I approach the consultation in this suspected ovarian cancer station?

Persistent bloating, early satiety, and pelvic discomfort in a postmenopausal woman are ovarian cancer red flags per NICE NG12. The candidate must recognise these vague symptoms as potentially sinister. Mrs McGee is 62, with 3 months of bloating and pelvic pain.

What does a strong performance look like to the examiner in this station?

Strong performances show: NICE red flags identified. Family history checked. Duration and persistence confirmed. Other symptoms screened (weight loss, bowel change, ascites). Weak performances: Not recognising red flags. Diagnosing IBS. Not asking about family history.

What is the biggest pitfall in this suspected ovarian cancer station?

Attributing symptoms to IBS without investigating: persistent bloating in a 62-year-old is not IBS until cancer is excluded.

How should I prepare for suspected ovarian cancer if I have never seen it in practice?

Structure beats experience here. Focus on cA-125 as first investigation: raised level triggers urgent USS. The written guidance on this page covers the full approach, and practising the consultation aloud builds the fluency the examiner is listening for.

Related cases