PLAB 2 (Professional and Linguistic Assessments Board Part 2) — Questions and Answers

Question 1: What does the ICE framework stand for in patient-centred consulting?

Initial Complaint Evaluation
Information, Confidence, Evidence
Ideas, Concerns, and Expectations (Correct answer)
Investigation, Care, and Explanation

Correct answer: Ideas, Concerns, and Expectations

ICE — Ideas (what the patient thinks is wrong), Concerns (what they are worried about), Expectations (what they hope will happen) — is a cornerstone of patient-centred consulting. Eliciting ICE helps understand the patient's perspective, address hidden agendas, and provide appropriate reassurance or management.

Question 2: When breaking bad news, what does 'warning shot' mean?

Giving a preparatory phrase before delivering bad news to allow the patient to mentally prepare ('I'm afraid the results are more serious than we hoped...') (Correct answer)
Informing security staff before a difficult consultation
Checking that emergency equipment is available
Asking a colleague to be present in case of adverse reactions

Correct answer: Giving a preparatory phrase before delivering bad news to allow the patient to mentally prepare ('I'm afraid the results are more serious than we hoped...')

A 'warning shot' is a brief phrase that signals difficult news is coming, giving the patient a moment to prepare emotionally before hearing the details. Examples: 'I'm afraid the news is not as good as we hoped' or 'The results have shown something we need to discuss seriously.' It prevents the patient from being completely blindsided.

Question 3: A colleague confides in you that they have been drinking alcohol before coming to work. What is your professional obligation according to GMC guidance?

Keep it confidential as they are your friend
Ignore it as it is not your responsibility
You have a duty to raise concerns about patient safety — discuss it with your colleague first, then escalate to a senior clinician or through the appropriate reporting channels if the issue is not addressed (Correct answer)
Post about it on social media to warn others

Correct answer: You have a duty to raise concerns about patient safety — discuss it with your colleague first, then escalate to a senior clinician or through the appropriate reporting channels if the issue is not addressed

GMC guidance requires all doctors to raise concerns about patient safety. You should speak to your colleague first, encourage them to seek help, and if the concern is not addressed, escalate to a senior colleague, clinical director, or through formal channels. Patient safety takes priority over personal loyalty.

Question 4: A doctor is involved in a significant adverse event. The trust's risk management team asks the doctor to write a reflective account for the Serious Incident review. What does GMC guidance state about this?

Doctors should decline to write personal reflective accounts as these could be used against them in legal proceedings
Reflective accounts written for governance purposes are protected under duty of candour and should be honest and learning-focused (Correct answer)
The reflective account should focus on system failures only and avoid any personal acknowledgement of error
Reflective accounts are voluntary and have no bearing on the doctor's GMC fitness to practise assessment

Correct answer: Reflective accounts written for governance purposes are protected under duty of candour and should be honest and learning-focused

GMC guidance supports open and honest reflection as part of the learning culture following adverse events, and emphasises that reflective practice is a professional requirement that should not be discouraged by fears of legal or regulatory consequences.

Question 5: You are explaining a surgical procedure to a patient and obtaining informed consent. According to the Montgomery ruling (2015), what is required?

You only need to mention risks with >10% probability
Simply getting the patient to sign a consent form is sufficient
You must discuss all material risks that a reasonable person in the patient's position would want to know about, including alternatives to the procedure (Correct answer)
Consent can be obtained by the most junior team member without detailed explanation

Correct answer: You must discuss all material risks that a reasonable person in the patient's position would want to know about, including alternatives to the procedure

The Montgomery v Lanarkshire ruling (2015) established that doctors must inform patients of all material risks — those to which a reasonable person in the patient's position would attach significance. This includes risks specific to that patient. Alternatives must also be discussed. This replaced the previous Bolam test for consent.

Question 6: A patient in your clinic discloses she is experiencing domestic violence from her partner. She does not want anyone to know. What is the most appropriate response?

Report to police immediately without her consent
Provide immediate safety information, document sensitively, offer referral to domestic violence support services, consider safeguarding risk (especially if children are involved or severe risk to life), and respect her autonomy while maintaining regular review (Correct answer)
Ask her partner to come in for a joint consultation
Dismiss the disclosure as it is not a medical matter

Correct answer: Provide immediate safety information, document sensitively, offer referral to domestic violence support services, consider safeguarding risk (especially if children are involved or severe risk to life), and respect her autonomy while maintaining regular review

Domestic violence requires a sensitive, non-judgmental, empowering response. Give immediate safety information (National DV helpline), document carefully (may be needed later), offer specialist referral (IDVA, shelter), but respect her autonomy in deciding what to do. However, if there is a serious and imminent risk to her life or a child's safety, confidentiality may need to be breached.

Question 7: Under the MCA 2005, what are the two diagnostic tests required to establish that a person lacks capacity?

GP assessment and consultant review
Age over 65 and confirmed diagnosis of dementia
Psychiatric assessment and neuroimaging
A diagnostic threshold (the person has an impairment or disturbance in mind or brain) AND a functional test (as a result, they cannot understand, retain, weigh, or communicate information relevant to the decision) (Correct answer)

Correct answer: A diagnostic threshold (the person has an impairment or disturbance in mind or brain) AND a functional test (as a result, they cannot understand, retain, weigh, or communicate information relevant to the decision)

The MCA two-stage test: (1) Diagnostic — is there an impairment or disturbance in the functioning of the mind or brain? (2) Functional — as a result, can the person understand information, retain it long enough to make a decision, weigh it, and communicate their decision? Both tests must be satisfied, and capacity is decision-specific and time-specific.

Question 8: A patient presents with headache. Which 'red flag' features require urgent investigation to exclude dangerous causes?

Frontal location, nasal congestion, and facial pain
Gradual onset, bilateral tension-type, and fatigue
Bilateral location, onset with stress, and long duration
Thunderclap onset ('worst headache of life'), associated neurological deficit, fever + photophobia + neck stiffness, waking from sleep, new onset in >50 years, or following head trauma (Correct answer)

Correct answer: Thunderclap onset ('worst headache of life'), associated neurological deficit, fever + photophobia + neck stiffness, waking from sleep, new onset in >50 years, or following head trauma

Red flags for headache (SNOOP4): Systemic symptoms/signs (fever, weight loss); Neurological symptoms; Onset sudden (thunderclap); Onset after 50; Positional (worse lying down); Papilloedema; Progressive worsening; Prior headache history change. These require urgent investigation (CT, LP) to exclude SAH, meningitis, or intracranial mass.

Question 9: In a PLAB 2 station, you are taking a sexual health history. According to best practice, which of the following is the most appropriate opening approach?

Ask directly about sexually transmitted infections without context
Normalise the questions by explaining that you ask all patients these questions as part of a routine assessment, then ask open questions about partners, practices, and protection (Correct answer)
Skip the sexual history as it may embarrass the patient
Only take a sexual history if the patient volunteers the information

Correct answer: Normalise the questions by explaining that you ask all patients these questions as part of a routine assessment, then ask open questions about partners, practices, and protection

Best practice involves normalising the conversation ('I ask these questions to all patients'), ensuring privacy, and using the framework of partners, practices, and protection (contraception, condom use). Open, non-judgemental questioning and using the patient's own language is essential.

Question 10: You are performing a lumbar puncture. At which vertebral level should you insert the needle, and how do you identify this landmark?

Between T12 and L1, using the lowest rib as a landmark
Between L1 and L2, identified by counting down from C7
At L5/S1, identified by palpating the sacrum
At or below the L3/L4 interspace, identified using the intercristal line (a line between the iliac crests crosses the spine at approximately L4) (Correct answer)

Correct answer: At or below the L3/L4 interspace, identified using the intercristal line (a line between the iliac crests crosses the spine at approximately L4)

Lumbar puncture should be performed at L3/L4 or L4/L5 to avoid the conus medullaris (which ends at L1/L2 in adults). The intercristal line (Tuffier's line) — an imaginary line between the iliac crests — crosses the spine at approximately L4, providing the landmark for needle insertion.

Question 11: During a psychiatric history, what does 'MSE' stand for and what does it assess?

Mental State Examination — a systematic assessment of appearance, behaviour, speech, mood, affect, thought, perception, cognition, insight, and judgement (Correct answer)
Medication Safety Evaluation — checking for psychiatric drug side effects
Mental Safety Enquiry — a risk assessment tool
Medical and Surgical Evaluation — assessment of physical health in psychiatric patients

Correct answer: Mental State Examination — a systematic assessment of appearance, behaviour, speech, mood, affect, thought, perception, cognition, insight, and judgement

The MSE is the psychiatric equivalent of a physical examination. It assesses: Appearance and behaviour; Speech (rate, volume, form); Mood (subjective) and Affect (objective); Thought (form, content — including suicidal ideation); Perception (hallucinations, illusions); Cognition (orientation, memory); Insight; Judgement.

Question 12: During a consultation about a patient's terminal illness, what is the purpose of checking understanding (the 'chunk and check' technique)?

To document that information was given for medico-legal purposes
To test the patient's intelligence
To deliver information in small pieces and regularly check comprehension, so the patient can absorb what they have been told and ask questions (Correct answer)
To speed up the consultation by skipping already-known information

Correct answer: To deliver information in small pieces and regularly check comprehension, so the patient can absorb what they have been told and ask questions

'Chunk and check' involves giving a small amount of information, then pausing to check understanding and invite questions before continuing. In emotionally charged consultations (breaking bad news), patients retain little after the initial shock — chunking ensures information is absorbed and allows the patient to guide the pace of the consultation.

Question 13: During a PLAB 2 history station, a 55-year-old man presents with a change in bowel habit. Which features would prompt an urgent 2-week wait cancer referral?

Occasional constipation relieved by dietary changes
Unexplained change in bowel habit lasting >4 weeks in a patient over 40, especially with rectal bleeding, weight loss, or iron deficiency anaemia (Correct answer)
Loose stools for 2 days after a curry
Alternating constipation and diarrhoea for 10 years with normal investigations

Correct answer: Unexplained change in bowel habit lasting >4 weeks in a patient over 40, especially with rectal bleeding, weight loss, or iron deficiency anaemia

NICE NG12 recommends 2-week wait referral for suspected colorectal cancer when patients over 40 have unexplained change in bowel habit, especially with rectal bleeding or iron deficiency anaemia. Over 50 with unexplained rectal bleeding alone also qualifies.

Question 14: A patient is admitted to hospital under Section 2 of the Mental Health Act for assessment. Can this section be used to treat their physical health conditions (e.g., diabetes)?

Yes — detained patients lose all rights to refuse treatment
No — physical health conditions cannot be treated at all while a patient is sectioned
No — the Mental Health Act only authorises treatment for mental disorder. Physical health conditions require separate consent or, if the patient lacks capacity for that decision, the Mental Capacity Act 2005 applies (Correct answer)
Yes — Section 2 allows treatment for any medical condition

Correct answer: No — the Mental Health Act only authorises treatment for mental disorder. Physical health conditions require separate consent or, if the patient lacks capacity for that decision, the Mental Capacity Act 2005 applies

The Mental Health Act only authorises treatment for the mental disorder for which the patient is detained (with some exceptions for conditions directly causing or contributing to the mental disorder). Physical health treatment requires the usual consent process, or if the patient lacks capacity, the Mental Capacity Act 2005 applies.

Question 15: In a PLAB 2 station, you are asked to take a history from a patient with joint pain. What is the single most important initial question to differentiate inflammatory from mechanical joint disease?

Have you injured the joint recently?
Do you take any painkillers?
Is the stiffness worse in the morning, and if so, how long does it last — more or less than 30 minutes? (Correct answer)
Which joint is affected?

Correct answer: Is the stiffness worse in the morning, and if so, how long does it last — more or less than 30 minutes?

Morning stiffness lasting >30 minutes is the hallmark of inflammatory joint disease (e.g., rheumatoid arthritis, ankylosing spondylitis). Mechanical joint disease (e.g., osteoarthritis) causes brief stiffness (<30 minutes) that worsens with use. This is the most discriminating single question.

Question 16: A patient writes an Advance Decision to Refuse Treatment (ADRT) stating they do not want CPR. For this ADRT to be legally valid and applicable to life-sustaining treatment, which conditions must be met?

It must be in writing, signed, witnessed, and include a specific statement that it applies even if life is at risk (Correct answer)
It can be verbal and does not need to be written
It must be registered with the GMC
It only needs to be discussed with a family member

Correct answer: It must be in writing, signed, witnessed, and include a specific statement that it applies even if life is at risk

Under the Mental Capacity Act 2005, an ADRT refusing life-sustaining treatment must be: (1) in writing, (2) signed by the person (or someone on their behalf in their presence), (3) witnessed, and (4) must include a clear statement that the decision applies 'even if life is at risk.' Without these requirements, it is not legally binding for life-sustaining treatment.

Question 17: When taking a drug history, which four categories of medication should always be specifically asked about?

Antibiotics, analgesics, vitamins, and vaccines
Prescribed medications, over-the-counter drugs, herbal/complementary remedies, and recreational drugs (including alcohol and smoking) (Correct answer)
Recent medications, current medications, allergies, and family medications
IV drugs, oral drugs, inhaled drugs, and topical drugs

Correct answer: Prescribed medications, over-the-counter drugs, herbal/complementary remedies, and recreational drugs (including alcohol and smoking)

A complete drug history includes all four categories: prescribed medications (including dose, frequency, and compliance), OTC medications (many patients don't consider these 'real' drugs), herbal/complementary remedies (significant interactions, e.g., St John's Wort), and social/recreational substances (alcohol, tobacco, illicit drugs) — all clinically relevant.

Question 18: In a paediatric history station, a mother brings her 18-month-old child who has had a fever and is not feeding well. Which question is most important for assessing severity in a febrile child?

When was the child's last dental check-up?
Does the child attend nursery?
Has the child had a non-blanching rash, reduced consciousness, or is unusually drowsy or unresponsive — features of meningococcal disease? (Correct answer)
What is the child's favourite food?

Correct answer: Has the child had a non-blanching rash, reduced consciousness, or is unusually drowsy or unresponsive — features of meningococcal disease?

In a febrile child, the NICE traffic light system prioritises red flag features: non-blanching rash, reduced consciousness, neck stiffness, bulging fontanelle, seizures, and signs of meningococcal disease. These features indicate a life-threatening condition requiring immediate action.

Question 19: A frail 85-year-old patient is brought to hospital by her son who mentions he has Power of Attorney. He asks that his mother not be told about her cancer diagnosis 'as it would upset her'. What should you do?

Follow the son's wishes — he has legal authority
Avoid telling the patient to avoid conflict with the family
Assess the patient's capacity; if she has capacity, she has the right to receive information about her own health. An LPA for health and welfare does not allow the attorney to prevent disclosure of a diagnosis to a patient with capacity. If she lacks capacity, best interests still usually supports honesty (Correct answer)
Document the son's request and discharge the patient without discussion

Correct answer: Assess the patient's capacity; if she has capacity, she has the right to receive information about her own health. An LPA for health and welfare does not allow the attorney to prevent disclosure of a diagnosis to a patient with capacity. If she lacks capacity, best interests still usually supports honesty

Having a Power of Attorney does not allow an attorney to withhold information from a patient who has capacity — doing so would be a breach of the patient's rights. A person with capacity has the right to information about their own health. If the patient lacks capacity, you must still consider whether knowing would be in their best interests (often it is). Collusion with family to withhold a diagnosis from a capacitous patient is not acceptable.

Question 20: Which of the following best describes a 'systematic inquiry' (systems review) in clinical history-taking?

A review of previous medical records
A review of all medications the patient is taking
Screening questions about symptoms in body systems not already covered, to avoid missing important diagnoses (Correct answer)
An assessment of the patient's social background

Correct answer: Screening questions about symptoms in body systems not already covered, to avoid missing important diagnoses

The systems review (or systematic inquiry) asks brief screening questions about common symptoms in major body systems (cardiovascular, respiratory, GI, neurological, etc.) that haven't already been covered. It serves as a safety net to catch symptoms the patient has forgotten to mention or doesn't connect with their main complaint.

Question 21: What is a 'Lasting Power of Attorney' (LPA) for health and welfare, and what can the attorney decide?

A document giving a GP the power to override a patient's treatment preferences
A document allowing a family member to access medical records
A legal document allowing a solicitor to manage medical decisions
A legal document (registered with the Office of the Public Guardian) appointing a trusted person to make health and welfare decisions on behalf of someone who has lost capacity, including consent to and refusal of medical treatment (Correct answer)

Correct answer: A legal document (registered with the Office of the Public Guardian) appointing a trusted person to make health and welfare decisions on behalf of someone who has lost capacity, including consent to and refusal of medical treatment

A Health and Welfare LPA is a legal document that appoints an attorney to make decisions about personal welfare and medical treatment when the donor loses capacity. The attorney can consent to or refuse treatment on the donor's behalf, but only within the scope granted in the LPA and only when the donor lacks capacity.

Question 22: Which framework is commonly used for breaking bad news in UK clinical practice?

ABCDE (Airway, Breathing, Circulation, Disability, Exposure)
SPIKES: Setting, Perception, Invitation, Knowledge, Emotions/Empathy, Strategy/Summary (Correct answer)
SBAR: Situation, Background, Assessment, Recommendation
ISBAR: Introduction, Situation, Background, Assessment, Recommendation

Correct answer: SPIKES: Setting, Perception, Invitation, Knowledge, Emotions/Empathy, Strategy/Summary

SPIKES (Buckman, 1992) is the widely used framework for breaking bad news: S — set up the meeting (private, seated, support person); P — assess the patient's Perception; I — obtain the patient's Invitation to discuss findings; K — give Knowledge/information gradually; E — address Emotions with Empathy; S — Strategy and Summary with a plan.

Question 23: During a PLAB 2 OSCE station, you are asked to take a history from a patient through an interpreter. What communication principles should you follow?

Speak loudly and slowly to the patient without a professional interpreter
Speak directly to the patient (not the interpreter), use short sentences, pause frequently, avoid medical jargon, use professional interpreters rather than family members, and check understanding regularly (Correct answer)
Use written communication only
Speak to the interpreter and let them manage the conversation

Correct answer: Speak directly to the patient (not the interpreter), use short sentences, pause frequently, avoid medical jargon, use professional interpreters rather than family members, and check understanding regularly

When using an interpreter: speak directly to the patient, maintaining eye contact with them not the interpreter; use short sentences; pause frequently for accurate interpretation; avoid jargon; use a professional interpreter (not family members who may filter, add, or omit information); check understanding with the patient directly; document that an interpreter was used.

Question 24: A 55-year-old man presents with 3 weeks of low mood. Which specific questions should you ask to assess suicide risk?

Ask about sleep and appetite only
Refer to psychiatry without asking about suicide — it is too distressing
Only use a standardised questionnaire
Directly ask about suicidal ideation ('Have you had thoughts of harming yourself or ending your life?'), and if present: frequency, intent, plans, means, and protective factors (Correct answer)

Correct answer: Directly ask about suicidal ideation ('Have you had thoughts of harming yourself or ending your life?'), and if present: frequency, intent, plans, means, and protective factors

Directly asking about suicidal ideation does not increase risk — it may provide relief. A complete suicide risk assessment includes: passive ideation ('life not worth living') → active ideation → plan → means → intent → previous attempts → protective factors (family, religion, hope). Risk stratification guides management.

Question 25: When taking a social history, which four key areas should always be covered?

Employment, housing, relationships, and hobbies
Occupation, smoking, alcohol, recreational drugs, living situation, social support, functional status, and relevant travel (Correct answer)
Exercise, diet, sleep, and stress levels
Income, education, religion, and marital status

Correct answer: Occupation, smoking, alcohol, recreational drugs, living situation, social support, functional status, and relevant travel

A thorough social history covers: Occupation (current and past — exposure risks, sick leave), Smoking (pack years), Alcohol (units per week — use CAGE or AUDIT if concerned), Illicit drugs, Home situation (who they live with, housing conditions), Social support, Functional status (ADLs), and recent travel (for infectious disease screening).

Question 26: A 70-year-old man presents with progressive memory loss. His wife is concerned he may have dementia. Which cognitive screening tool is most commonly used in a PLAB 2 OSCE setting?

AUDIT questionnaire
PHQ-9
Glasgow Coma Scale
Abbreviated Mental Test Score (AMTS) or Montreal Cognitive Assessment (MoCA) (Correct answer)

Correct answer: Abbreviated Mental Test Score (AMTS) or Montreal Cognitive Assessment (MoCA)

The AMTS (10 questions, score <7 suggests cognitive impairment) and the MoCA (more detailed, score <26 suggests impairment) are validated cognitive screening tools. In a PLAB 2 station, you would typically perform the AMTS or relevant components. NICE recommends formal cognitive testing as part of dementia assessment.

Question 27: An 82-year-old woman has a valid Advance Decision to Refuse Treatment (ADRT) refusing artificial ventilation. She is now incapacitated with respiratory failure. The family is insisting on ventilation. What should you do?

Discuss with ethics committee before deciding
Proceed with ventilation pending court review
Respect the valid ADRT — it is legally binding under the MCA 2005, and the patient's prior autonomous refusal overrides the family's request (Correct answer)
Follow the family's wishes as next of kin

Correct answer: Respect the valid ADRT — it is legally binding under the MCA 2005, and the patient's prior autonomous refusal overrides the family's request

A valid and applicable ADRT is legally binding under the MCA 2005 and has the same force as a contemporaneous refusal by a capacitous patient. For an ADRT refusing life-sustaining treatment to be valid, it must be written, signed, witnessed, and state that it applies 'even if life is at risk'. Family wishes cannot override a valid ADRT.

Question 28: In a PLAB 2 station, a 28-year-old man presents with headache. You need to assess for red flags. Which combination of features would be most concerning for a serious underlying cause?

Mild bilateral frontal headache present for 2 years with normal neurological examination
Headache after a long day at work, relieved by paracetamol
Sudden-onset thunderclap headache, neck stiffness, photophobia, and fever (Correct answer)
Headache triggered by bright lights and associated with nausea

Correct answer: Sudden-onset thunderclap headache, neck stiffness, photophobia, and fever

Sudden-onset thunderclap headache with meningism (neck stiffness, photophobia) and fever suggests subarachnoid haemorrhage or meningitis — both are life-threatening emergencies. These red flags mandate immediate investigation and should never be dismissed.

Question 29: A 78-year-old woman with advanced dementia requires a hip replacement following a fractured neck of femur. She lacks capacity to consent. Under the Mental Capacity Act 2005, what is the most appropriate way to proceed?

Apply to the Court of Protection before any treatment
Wait until she regains capacity
Seek consent from her next of kin
Proceed under best interests following a best interests assessment, consulting the patient's family, carers, and any advance decisions, and consider appointing an IMCA if there is no one to consult (Correct answer)

Correct answer: Proceed under best interests following a best interests assessment, consulting the patient's family, carers, and any advance decisions, and consider appointing an IMCA if there is no one to consult

When a patient lacks capacity, treatment proceeds under the MCA 2005 best interests principle. For medical decisions: consult family/carers (they advise on patient's wishes/values but do not consent); check for Lasting Power of Attorney (healthcare); check for Advance Decision to Refuse Treatment; appoint an IMCA if no appropriate consultee is available. Surgery can proceed in best interests.

Question 30: When examining cranial nerve V (trigeminal nerve), what do you assess?

Facial sensation (three divisions: ophthalmic, maxillary, mandibular), muscles of mastication (masseter, temporalis — jaw clench), and the corneal reflex (afferent limb) (Correct answer)
Eye movements and pupillary reactions
Facial expression and taste on anterior 2/3 of tongue
Hearing, balance, and the gag reflex

Correct answer: Facial sensation (three divisions: ophthalmic, maxillary, mandibular), muscles of mastication (masseter, temporalis — jaw clench), and the corneal reflex (afferent limb)

CN V (trigeminal nerve): sensory — facial sensation in three divisions (forehead/ophthalmic V1, cheek/maxillary V2, jaw/mandibular V3); motor — muscles of mastication (masseter, temporalis, pterygoids); special — afferent limb of corneal reflex. Testing: light touch and pin-prick in all three divisions; jaw clench and opening against resistance.

Question 31: During a history station, the patient mentions they drink alcohol. According to UK screening guidelines, which validated tool should you use to assess alcohol use?

Ask them to estimate their weekly units only
Ask if they think they drink too much
Use the PHQ-9 questionnaire
Use the AUDIT-C (Alcohol Use Disorders Identification Test) or full AUDIT questionnaire (Correct answer)

Correct answer: Use the AUDIT-C (Alcohol Use Disorders Identification Test) or full AUDIT questionnaire

The AUDIT-C (first 3 questions of AUDIT) or full AUDIT (10 questions) is the validated screening tool for alcohol misuse recommended by NICE. It assesses consumption, dependence symptoms, and harmful consequences. A score of 8+ on full AUDIT suggests harmful or hazardous drinking.

Question 32: A 30-year-old woman presents with palpitations. In your history, which question best assesses whether these could represent a serious arrhythmia?

How many cups of coffee do you drink per day?
Have you changed your diet recently?
Have you experienced associated syncope, presyncope, chest pain, or breathlessness, and are the palpitations regular or irregular, sudden onset or gradual? (Correct answer)
Do you feel stressed at work?

Correct answer: Have you experienced associated syncope, presyncope, chest pain, or breathlessness, and are the palpitations regular or irregular, sudden onset or gradual?

Associated syncope, presyncope, chest pain, or breathlessness suggest a haemodynamically significant arrhythmia. The nature of the palpitations (regular vs irregular, sudden vs gradual onset and offset) helps identify the type — sudden onset/offset suggests SVT, while irregularly irregular suggests AF.

Question 33: A patient with type 1 diabetes presents with vomiting, abdominal pain, Kussmaul breathing, and a blood glucose of 28 mmol/L. Blood gases show pH 7.1, bicarbonate 10 mmol/L, and ketones 5.5 mmol/L. What is the diagnosis and first priority of management?

Hypoglycaemia — give IV dextrose
Lactic acidosis — give IV sodium bicarbonate
Hyperglycaemic hyperosmolar state — give oral fluids
Diabetic ketoacidosis — IV 0.9% sodium chloride fluid resuscitation is the first priority, followed by fixed-rate IV insulin infusion (0.1 units/kg/hour) (Correct answer)

Correct answer: Diabetic ketoacidosis — IV 0.9% sodium chloride fluid resuscitation is the first priority, followed by fixed-rate IV insulin infusion (0.1 units/kg/hour)

DKA is defined by hyperglycaemia (>11 mmol/L), ketosis (ketones >3 mmol/L), and acidosis (pH <7.3 or bicarbonate <15 mmol/L). UK Joint British Diabetes Societies guidelines prioritise IV fluid resuscitation (0.9% NaCl 1L in first hour), then fixed-rate insulin infusion. Potassium replacement is critical and must be monitored.

Question 34: A 45-year-old man with paranoid schizophrenia refuses oral antipsychotic medication. His community psychiatric nurse reports he is responding to command hallucinations and there is risk to others. Under which legislation can he be treated without consent?

Mental Health Act 1983 (as amended 2007) — compulsory detention and treatment for mental disorder is governed by the MHA, not the MCA (Correct answer)
Common law doctrine of necessity
Consumer Rights Act
Mental Capacity Act 2005

Correct answer: Mental Health Act 1983 (as amended 2007) — compulsory detention and treatment for mental disorder is governed by the MHA, not the MCA

The Mental Health Act 1983 (amended 2007) provides the framework for compulsory detention and treatment of mental disorder in England and Wales, independently of capacity. It can apply even if the patient has capacity. The MCA covers those who lack capacity for non-psychiatric decisions. A patient with schizophrenia can be detained under MHA Section 2 (assessment) or Section 3 (treatment).

Question 35: A Lasting Power of Attorney (LPA) for Health and Welfare is activated. When does this LPA take effect?

Immediately upon registration, even if the person has capacity
Only when the person (donor) loses capacity to make the specific decision in question (Correct answer)
When the person is admitted to hospital
When the attorney decides it should take effect

Correct answer: Only when the person (donor) loses capacity to make the specific decision in question

An LPA for Health and Welfare only takes effect when the donor lacks capacity to make the specific decision. While the person retains capacity, they make their own decisions. An LPA for Property and Finance can take effect while the person has capacity if they choose. All LPAs must be registered with the Office of the Public Guardian.

Question 36: In a PLAB 2 station, a patient asks 'Am I going to die, doctor?' after being diagnosed with advanced cancer. What is the most appropriate response?

Say 'I don't know' and end the conversation
Give a precise life expectancy in weeks
Change the subject to avoid distressing the patient
Acknowledge the question with empathy, explore what prompted it, give honest information at the patient's pace about prognosis, and ensure support is in place (Correct answer)

Correct answer: Acknowledge the question with empathy, explore what prompted it, give honest information at the patient's pace about prognosis, and ensure support is in place

This requires a compassionate, honest response. Acknowledge the question ('That's a really important question'), explore the patient's concerns and understanding, provide honest but sensitive prognostic information, avoid false reassurance, and ensure emotional and practical support. Never give exact timeframes as they are unreliable.

Question 37: A doctor is concerned that a patient may have been the victim of domestic abuse but the patient denies it and does not wish to discuss it. What is the most appropriate course of action?

Do nothing further as the patient has denied abuse and their autonomy must be fully respected
Immediately notify the police as a safeguarding concern overrides patient confidentiality in all domestic abuse cases
Respect the patient's wishes, document concerns sensitively in the notes, offer appropriate resources, and ensure the patient knows they can return (Correct answer)
Refuse to end the consultation until the patient acknowledges the concern

Correct answer: Respect the patient's wishes, document concerns sensitively in the notes, offer appropriate resources, and ensure the patient knows they can return

When a patient denies abuse but the doctor has concerns, best practice is to sensitively document findings, provide information about support services, and leave an open door for future disclosure while respecting patient autonomy.

Question 38: During a neurological examination of the lower limbs, what does 'clonus' indicate?

Flaccid muscle tone
Rhythmic, involuntary muscle contractions elicited by sudden passive stretch, indicating upper motor neurone lesion with hyperreflexia (Correct answer)
Reduced reflexes due to lower motor neurone lesion
A cerebellar sign indicating ataxia

Correct answer: Rhythmic, involuntary muscle contractions elicited by sudden passive stretch, indicating upper motor neurone lesion with hyperreflexia

Clonus is a series of rhythmic involuntary muscle contractions triggered by sudden passive dorsiflexion of the ankle (or other joint). Sustained clonus (>5 beats) is pathological and indicates an upper motor neurone lesion (e.g., stroke, cord compression), reflecting loss of descending inhibitory control on stretch reflexes.

Question 39: In a PLAB 2 examination station, you assess a patient's visual fields by confrontation. You find a left homonymous hemianopia. Where is the most likely site of the lesion?

Left retina
Optic chiasm
Right optic tract or right occipital cortex (Correct answer)
Left optic nerve

Correct answer: Right optic tract or right occipital cortex

A left homonymous hemianopia (loss of the left visual field in both eyes) indicates a lesion posterior to the optic chiasm on the right side — either the right optic tract, right lateral geniculate nucleus, right optic radiation, or right occipital cortex. The most common cause is a right-sided stroke.

Question 40: Under GMC guidance, what is a doctor's responsibility when delegating tasks to other healthcare professionals?

Delegation is only permitted to doctors of the same or higher grade
The delegating doctor must ensure the person they delegate to has the skills, knowledge and experience to carry out the task safely (Correct answer)
Delegation requires written consent from the patient specifying who will perform the task
Once a task is delegated, all responsibility transfers entirely to the person carrying out the task

Correct answer: The delegating doctor must ensure the person they delegate to has the skills, knowledge and experience to carry out the task safely

GMC Good Medical Practice states that when delegating, doctors retain a responsibility to ensure the person they delegate to is competent to perform the task, and overall accountability is not extinguished by delegation.

Question 41: A 16-year-old patient wants to refuse a life-saving blood transfusion. Their parents consent to the treatment. According to UK law, can the young person's refusal be overridden?

Yes — anyone under 18 has no say in their medical treatment
No — if the patient is Gillick competent, their decision is final regardless of age
Yes — while a 16-17 year old can consent to treatment, their refusal of life-saving treatment can be overridden by someone with parental responsibility or by a court order (Correct answer)
No — a 16-year-old has the same rights as an adult and their refusal is absolute

Correct answer: Yes — while a 16-17 year old can consent to treatment, their refusal of life-saving treatment can be overridden by someone with parental responsibility or by a court order

Under UK law, while 16-17 year olds can consent to treatment (Family Law Reform Act 1969), their refusal of treatment can be overridden by a parent or court order, particularly for life-saving treatment. This is different from adult patients whose competent refusal is absolute. A court order provides the safest legal route.

Question 42: A 10-year-old boy attends A&E with a bruise on his back. His mother explains he fell down stairs. On examination you notice multiple old bruises in various stages of healing and a pattern inconsistent with accidental injury. What is the most appropriate action?

Call the police immediately and accuse the mother
Accept the explanation and discharge
Maintain a high index of suspicion for non-accidental injury; admit the child for safeguarding assessment; consult the paediatric safeguarding team; do not discharge without specialist review; document all findings accurately (Correct answer)
Discuss with the mother only and seek her consent before involving safeguarding teams

Correct answer: Maintain a high index of suspicion for non-accidental injury; admit the child for safeguarding assessment; consult the paediatric safeguarding team; do not discharge without specialist review; document all findings accurately

Multiple bruises in various stages of healing, a pattern inconsistent with the stated mechanism, and the specific location (back — not a typical accidental injury site) are all indicators of possible non-accidental injury (NAI). The child should not be discharged. Safeguarding referral is mandatory. Section 47 enquiries may be triggered. You do not need parental consent to make a safeguarding referral.

Question 43: During an OSCE station, you discover that a colleague has been consistently arriving drunk to work. What is your professional obligation?

You have a duty to report your concerns to a senior colleague, clinical supervisor, or responsible officer — patient safety takes precedence. The GMC guidance 'Raising and Acting on Concerns' requires action when patients may be at risk (Correct answer)
Directly confront the colleague in public
Write an anonymous letter to the GMC immediately without speaking to the colleague first
It is not your responsibility — ignore it

Correct answer: You have a duty to report your concerns to a senior colleague, clinical supervisor, or responsible officer — patient safety takes precedence. The GMC guidance 'Raising and Acting on Concerns' requires action when patients may be at risk

GMC guidance 'Raising and Acting on Concerns about Patient Safety' requires that doctors take action if they believe patients are at risk from a colleague's health, performance, or conduct. This should be raised with an appropriate person (clinical supervisor, medical director, or responsible officer). The colleague may also need occupational health support.

Question 44: A patient presents with a 6-week history of weight loss, fatigue, night sweats, and a lump in their neck. Which additional history questions are most important?

Ask about hydration and sleep quality only
Ask about recent stress and diet
Ask about fever, pruritis, alcohol-induced pain in the lump, family history of malignancy, travel to TB-endemic areas, and full systematic review for malignancy symptoms (Correct answer)
Ask about recent viral illnesses only

Correct answer: Ask about fever, pruritis, alcohol-induced pain in the lump, family history of malignancy, travel to TB-endemic areas, and full systematic review for malignancy symptoms

Constitutional B symptoms (weight loss, night sweats, fever) with a neck lump raise concern for lymphoma. Important questions: fever pattern (Pel-Ebstein in Hodgkin's), pruritus, alcohol-induced pain (Hodgkin's), occupational exposures, travel (TB), family history of malignancy, and full systems review for primary malignancy with nodal spread.

Question 45: According to GMC guidance on social media, which of the following is a doctor's professional responsibility?

Doctors are free to post about patients on personal social media accounts as long as they do not name the patient
Doctors may share clinical photos on professional networking sites without patient consent if educational value is high
GMC social media guidance only applies to posts made during working hours
Doctors must maintain patient confidentiality and not post information that could identify a patient, even if posted in their personal capacity (Correct answer)

Correct answer: Doctors must maintain patient confidentiality and not post information that could identify a patient, even if posted in their personal capacity

GMC guidance makes clear that professional standards, including confidentiality, apply to a doctor's online activity regardless of whether they are posting in a personal or professional capacity.

Question 46: Where is the normal apex beat located and what does a displaced apex beat suggest?

6th intercostal space, midclavicular line; displacement suggests right heart failure
5th intercostal space, midclavicular line; displacement laterally suggests cardiomegaly (e.g., dilated cardiomyopathy, left ventricular failure, mitral regurgitation) (Correct answer)
5th intercostal space, midsternal line; displaced laterally suggests aortic stenosis
4th intercostal space, anterior axillary line; displacement indicates normal variant

Correct answer: 5th intercostal space, midclavicular line; displacement laterally suggests cardiomegaly (e.g., dilated cardiomyopathy, left ventricular failure, mitral regurgitation)

The apex beat is normally in the 5th intercostal space, midclavicular line. Lateral displacement (to the anterior axillary line or beyond) indicates cardiomegaly, caused by left ventricular dilation (dilated cardiomyopathy, severe MR, volume overload). A thrusting apex is volume overloaded; a heaving apex is pressure overloaded (hypertension, AS).

Question 47: A competent adult patient with terminal cancer has decided to stop all active treatment. They understand the consequences. Their family disagrees and asks you to continue treatment. What should you do?

Respect the patient's autonomous decision — a competent adult has the right to refuse treatment even if it leads to death. Support the family with information and emotional care, but do not override the patient's wishes (Correct answer)
Follow the family's wishes as they know the patient best
Seek a court order to continue treatment
Secretly continue treatment without the patient's knowledge

Correct answer: Respect the patient's autonomous decision — a competent adult has the right to refuse treatment even if it leads to death. Support the family with information and emotional care, but do not override the patient's wishes

A competent adult's right to refuse treatment is absolute in UK law, even if the refusal leads to death. The family has no legal authority to override this decision. You should support the family emotionally, explain the patient's right to autonomy, and ensure the patient receives appropriate palliative care.

Question 48: A doctor discovers that a patient is HIV positive while treating them for an unrelated condition. Under what circumstances can this information be disclosed without the patient's consent?

It can be freely shared with all healthcare staff regardless of need
Disclosure without consent may be justified if there is a serious and identifiable risk to a specific individual (e.g., a sexual partner), and the patient has refused to disclose despite counselling — as per GMC guidance on confidentiality (Correct answer)
It must be disclosed to the patient's employer immediately
It can never be disclosed without consent under any circumstances

Correct answer: Disclosure without consent may be justified if there is a serious and identifiable risk to a specific individual (e.g., a sexual partner), and the patient has refused to disclose despite counselling — as per GMC guidance on confidentiality

GMC guidance allows disclosure without consent in exceptional circumstances where failure to disclose poses a serious risk of death or serious harm to an identifiable individual. The doctor should first encourage voluntary disclosure, offer support, and seek advice from a senior colleague or Caldicott Guardian before disclosing.

PLAB 2 (Professional and Linguistic Assessments Board Part 2)

The PLAB 2 is the GMC's Objective Structured Clinical Examination (OSCE) assessing clinical and communication competence across 16 simulated patient stations. It tests whether international medical graduates can practise safely and effectively in the NHS.

Questions

90 min

Time Limit

70%

To Pass

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