PLAB 1 UK Clinical Guidelines & Prescribing Safety

Question 1

According to NICE guidelines, what is the first-line antihypertensive for a 65-year-old Caucasian man with no other comorbidities?

Accepted Answer

Calcium channel blocker (e.g., amlodipine)

Answer

NICE hypertension guidelines (NG136): for patients aged 55 or over, or people of any age who are Black British/African/Caribbean, the first-line treatment is a calcium channel blocker (CCB). For under-55 non-Black patients, an ACE inhibitor or ARB is first line. At 65, a CCB is recommended.

Question 2

According to NICE guidelines (NG28), which of the following patients with type 2 diabetes should be started on metformin as first-line therapy?

Accepted Answer

A patient with no contraindications to metformin and HbA1c above the agreed target

Answer

NICE recommends metformin as first-line pharmacological therapy for type 2 diabetes in patients who have no contraindications (renal impairment eGFR<30, hepatic failure, alcohol excess) and whose HbA1c is above their agreed target after lifestyle modification. It does not cause hypoglycaemia and aids weight neutrality.

Question 3

According to the BNF and NICE, what is the recommended first-line treatment for uncomplicated lower urinary tract infection (UTI) in a non-pregnant woman?

Accepted Answer

Nitrofurantoin for 3 days (if eGFR >45) or trimethoprim for 3 days

Answer

PHE/NICE guidelines recommend nitrofurantoin (3 days, if eGFR >45) or trimethoprim (3 days, if low local resistance) as first-line for uncomplicated lower UTI in women. Ciprofloxacin should be reserved for complicated UTIs or resistant organisms to preserve its effectiveness.

Question 4

A 72-year-old man has an acute exacerbation of COPD. Arterial blood gas shows: pH 7.29, PaCO2 8.5 kPa, PaO2 7.0 kPa, HCO3 26 mmol/L. His oxygen saturations are 82% on air. What is the target oxygen saturation for this patient according to BTS guidelines?

Accepted Answer

88–92%

Answer

BTS guidelines for COPD exacerbation recommend a target SpO2 of 88–92% for patients at risk of hypercapnic respiratory failure (type 2 respiratory failure, as shown here by elevated PaCO2). High-flow oxygen can suppress the hypoxic ventilatory drive in these patients, worsening CO2 retention.

Question 5

According to NICE stroke guidelines, which antiplatelet regimen should be started within 24 hours of a confirmed ischaemic stroke (not thrombolysed)?

Accepted Answer

Dual antiplatelet therapy: aspirin 300mg for 2 weeks, then clopidogrel 75mg monotherapy

Answer

NICE NG128: After ischaemic stroke, start aspirin 300mg immediately (if haemorrhage excluded), continue for 2 weeks, then switch to clopidogrel 75mg monotherapy for long-term secondary prevention. NICE (2023) updated guidance recommends clopidogrel as first-line long-term antiplatelet over aspirin.

PLAB 1 Practice Test

PLAB 1 Practice Test

PLAB 1 UK Clinical Guidelines & Prescribing Safety