The aim of this qualitative case study was to ascertain factors impacting the examination preparation process and causing concerns for London upper secondary students, to learn steps taken to reduce and/or resolve the concerns, and to discuss the implications for teachers and teaching. A subsidiary yet important aim was to give the students a “voice” in the research literature. Using convenient or opportunity sampling, 14 Grade 12 and 13 students, ages 16–18 in a south-west London secondary school, were interviewed face-to-face. The analysis of the data revealed external factors and a personal need factor, that is the need to pass the exam, impacted the examination preparation process and caused concerns for students. Schools and students have use various solutions to reduce and/or resolve concerns. For example, school-based solutions included offering make-up or additional sessions or extra classes. Students—when faced with large amounts of material and information—employed solutions such as “things-to-do lists” and breaking down tasks into manageable sections. Implications for teachers and teaching include the need for teachers’ lesson contents to address factors impacting exam preparation and students’ concerns. Teachers also need to equip students to use a variety of revision strategies, encourage students to use social support and ensure that promised extra lessons materialize.