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

ST elevation in leads II, III, and aVF indicates inferior STEMI, reflecting occlusion of the right coronary artery (RCA) in most patients. The clinical picture — crushing central chest pain with radiation, diaphoresis and nausea — is classic for acute MI.

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

This presentation is classic for subarachnoid haemorrhage (SAH). When CT head is negative (sensitivity ~98% within 6 hours but lower thereafter), lumbar puncture is essential to look for xanthochromia (yellow discolouration of CSF) due to haemoglobin breakdown, confirming SAH.

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

Methotrexate pneumonitis is a well-recognised and potentially serious complication of methotrexate therapy. It presents with dry cough, progressive dyspnoea, and bilateral interstitial shadowing on CXR. Methotrexate should be stopped immediately and the patient referred urgently.

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

This is a classic presentation of SLE: the malar (butterfly) rash, photosensitivity, oral ulcers, positive ANA and anti-dsDNA (highly specific for SLE), lymphopenia, and renal involvement (proteinuria). Anti-dsDNA antibodies are highly specific for SLE.

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

Acute variceal bleeding is managed with: (1) terlipressin (vasopressin analogue that reduces portal pressure) started immediately; (2) prophylactic IV antibiotics (ciprofloxacin or tazobactam); (3) urgent endoscopic band ligation within 12 hours. Terlipressin reduces mortality when started before endoscopy.

PLAB 1 Practice Test

PLAB 1 Practice Test

PLAB 1 Clinical Medicine