PLAB 1 Study Guide 2026
Everything you need to pass the PLAB 1 exam in one place: the exam format, every topic to study, real practice questions with explanations, flashcards, and full-length practice tests. Free, no sign-up needed.
📋 PLAB 1 Exam Format at a Glance
📚 PLAB 1 Topics to Study (26)
✍️ Sample PLAB 1 Questions & Answers
1. A 45-year-old woman has a urinalysis showing: blood 3+, protein 2+, red cell casts on microscopy. What does the presence of red cell casts indicate?
Red cell casts form in the renal tubules when red cells leak through a damaged glomerular basement membrane into the tubular lumen. Their presence is pathognomonic of glomerulonephritis (glomerular inflammation). Haematuria with red cell casts always requires urgent nephrology investigation.
2. A newborn infant is found to have bilateral undescended testes and ambiguous genitalia. What is the most important initial investigation?
Bilateral undescended testes with ambiguous genitalia requires urgent investigation for congenital adrenal hyperplasia (CAH), which can cause a life-threatening salt-wasting crisis. Serum 17-hydroxyprogesterone is the key initial test. Electrolytes should also be checked urgently as hyponatraemia and hyperkalaemia can be fatal.
3. According to NICE guidance (NG12), which patients should be referred on a 2-week wait (suspected cancer) pathway for colorectal cancer?
NICE NG12 criteria for 2WW colorectal referral include: ≥40 with unexplained rectal bleeding; ≥50 with unexplained abdominal pain or weight loss; ≥60 with change in bowel habit; ≥60 with iron deficiency anaemia; any age with rectal mass/unexplained iron deficiency anaemia. Haemorrhoids are not an automatic exclusion for referral if other criteria are met.
4. What is the principle of 'Gillick competence' and how does it apply to children under 16?
Gillick competence holds that a child under 16 may consent to medical treatment if they demonstrate sufficient intelligence and maturity to understand the nature and implications of the proposed treatment. The more complex or serious the decision, the higher the threshold of understanding required. Parents cannot overrule a Gillick-competent child's consent.
5. A patient on metformin 1g BD develops an eGFR of 28 mL/min. According to BNF guidelines, what should be done with the metformin?
Metformin should be stopped when eGFR falls below 30 mL/min/1.73m2 due to the risk of lactic acidosis from impaired renal clearance. The dose should be reviewed when eGFR falls below 45, and reduced when below 30. An alternative glucose-lowering agent should be substituted.
6. A 68-year-old man presents with sudden onset severe pain, erythema, and swelling of the first metatarsophalangeal joint. Serum uric acid is elevated at 560 µmol/L. What is the most likely diagnosis?
Gout classically presents with acute monoarthritis of the first MTP joint (podagra) with hyperuricaemia, often triggered by alcohol, dehydration, or diuretics.