PLAB 1 UK Clinical Guidelines & Prescribing Safety 2

Question 1

According to NICE guidance (NG12), which patients should be referred on a 2-week wait (suspected cancer) pathway for colorectal cancer?

Accepted Answer

Patients aged 40 or over with unexplained rectal bleeding; OR aged 60 or over with change in bowel habit; OR aged 40 or over with iron deficiency anaemia without an obvious cause

Answer

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.

Question 2

A 30-year-old woman with newly diagnosed mild-to-moderate ulcerative colitis (proctosigmoiditis) should be offered which first-line treatment according to NICE guidelines?

Accepted Answer

Topical aminosalicylate (mesalazine suppository or enema) ± oral aminosalicylate

Answer

NICE (NG130) recommends first-line treatment for mild-to-moderate UC as topical mesalazine (suppository for proctitis, enema for proctosigmoiditis) with or without oral mesalazine. Oral steroids are used for moderate-to-severe disease or insufficient response. Immunosuppressants are for maintenance of remission or steroid-dependent disease.

Question 3

According to NICE guidance on sepsis (NG51), what is the 'Sepsis Six' hour-1 bundle for a patient with suspected sepsis?

Accepted Answer

High-flow oxygen, blood cultures, IV broad-spectrum antibiotics, IV fluid bolus, lactate measurement, and urine output monitoring

Answer

The Sepsis Six (to be completed within 1 hour): (1) High-flow O2; (2) Blood cultures; (3) IV broad-spectrum antibiotics; (4) IV fluid bolus (500ml crystalloid if hypotensive); (5) Serum lactate; (6) Urine output monitoring (catheterise if needed). Early completion reduces sepsis mortality significantly.

Question 4

A patient presents with an acute severe asthma attack (SpO2 91%, PEFR 35% predicted, RR 30, pulse 125). According to BTS guidelines, what is the most appropriate immediate management?

Accepted Answer

High-flow oxygen, back-to-back nebulised salbutamol + ipratropium, oral/IV prednisolone, and hospital admission

Answer

BTS/SIGN asthma guidelines for acute severe attack: high-flow O2 (target SpO2 94–98%), back-to-back (or continuous) nebulised salbutamol + ipratropium bromide every 20–30 minutes, systemic steroids (prednisolone 40–50mg oral or IV hydrocortisone 100mg), and admission. IV magnesium sulphate is added for life-threatening features.

Question 5

According to NICE guidance, which patients with community-acquired pneumonia should be considered for hospital admission using the CRB-65 score?

Accepted Answer

Patients with CRB-65 score ≥2 should be considered for hospital admission; score of 1 requires clinical judgement

Answer

CRB-65 (Confusion, Respiratory rate ≥30, BP systolic <90 or diastolic ≤60, age 65+): 0 = low risk, consider home treatment; 1–2 = moderate risk, hospital assessment considered; 3–4 = high severity, urgent hospital admission. CURB-65 adds urea >7 mmol/L and is used in hospital settings.

PLAB 1 Practice Test

PLAB 1 Practice Test

PLAB 1 UK Clinical Guidelines & Prescribing Safety 2