PLAB 1 Clinical Medicine

Question 1

A 65-year-old man presents with crushing central chest pain radiating to the left arm, sweating, and nausea for 2 hours.
ECG shows ST elevation in leads II, III, and aVF.
What is the most likely diagnosis?

Accepted Answer

Inferior STEMI

Answer

Anterior STEMI

Answer

Unstable angina

Answer

Pericarditis

Question 2

A 70-year-old woman presents with sudden onset severe headache described as 'the worst of her life', nausea and vomiting, and neck stiffness. CT head is normal. What is the most important next investigation?

Accepted Answer

Lumbar puncture

Answer

MRI brain

Answer

EEG

Answer

Carotid Doppler

Question 3

A 45-year-old woman with known rheumatoid arthritis on methotrexate presents with a 2-week history of dry cough and progressive breathlessness. CXR shows bilateral interstitial shadowing. What is the most likely diagnosis?

Accepted Answer

Methotrexate-induced pneumonitis

Answer

Community-acquired pneumonia

Answer

Pulmonary embolism

Answer

Cardiac failure

Question 4

A 25-year-old woman presents with a 3-month history of fatigue, weight loss, mouth ulcers, and a butterfly-shaped facial rash worsened by sunlight. Blood tests show positive ANA and anti-dsDNA antibodies, lymphopenia, and proteinuria. What is the most likely diagnosis?

Accepted Answer

Systemic lupus erythematosus (SLE)

Answer

Systemic sclerosis

Answer

Dermatomyositis

Answer

Sjögren's syndrome

Question 5

A 60-year-old man with a history of alcohol excess presents with haematemesis. On examination he has spider naevi, palmar erythema, and ascites. OGD shows oesophageal varices with active bleeding. What is the most appropriate initial management?

Accepted Answer

Terlipressin IV plus urgent endoscopic band ligation

Answer

Urgent surgical ligation of varices

Answer

IV omeprazole infusion

Answer

Oral propranolol

Question 6

A 72-year-old man presents with sudden-onset unilateral weakness affecting the face, arm, and leg, slurred speech, and left homonymous hemianopia. Symptoms began 3 hours ago. CT head is normal. What is the most appropriate immediate management?

Accepted Answer

IV alteplase (thrombolysis) after confirming no contraindications

Answer

Aspirin 300mg orally and urgent neurology referral

Answer

Anticoagulation with heparin

Answer

CT angiography only, then discharge