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

Question 1: During a PLAB 2 history taking station, a 45-year-old woman presents with chest pain. Which of the following is the most important question to ask first to differentiate cardiac from non-cardiac chest pain?

Do you have any allergies?
Do you smoke?
Have you had any recent surgery?
Can you describe the character of the pain — is it a central, crushing or squeezing sensation, and does it radiate to the jaw, left arm, or back? (Correct answer)

Correct answer: Can you describe the character of the pain — is it a central, crushing or squeezing sensation, and does it radiate to the jaw, left arm, or back?

Characterising the pain using SOCRATES (Site, Onset, Character, Radiation, Associations, Timing, Exacerbating/relieving factors, Severity) is essential. Central crushing pain radiating to the jaw or left arm suggests cardiac origin. This is the most discriminating initial question.

Question 2: 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 recent stress and diet
Ask about hydration and sleep quality only
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 3: A patient presents to A&E with pleuritic chest pain, tachycardia, and haemoptysis 10 days after a long-haul flight. Their Wells score is 7. What is the most appropriate next investigation?

V/Q scan as first-line
CT pulmonary angiography (CTPA) — as the Wells score >4 indicates PE is likely, CTPA is the first-line imaging investigation (Correct answer)
Chest X-ray only
D-dimer test

Correct answer: CT pulmonary angiography (CTPA) — as the Wells score >4 indicates PE is likely, CTPA is the first-line imaging investigation

A Wells score >4 indicates PE is likely, and NICE recommends proceeding directly to CTPA without D-dimer (D-dimer is used when Wells score ≤4). Interim treatment with anticoagulation (LMWH or DOAC) should be started while awaiting imaging if PE is clinically likely.

Question 4: A patient in a PLAB 2 station refuses a blood transfusion on religious grounds (Jehovah's Witness). The transfusion could be life-saving. What is the correct approach?

Respect the patient's autonomous decision after ensuring they have capacity and understand the consequences, document the refusal, and explore alternative treatments (Correct answer)
Discharge the patient for non-compliance
Transfuse the patient anyway as it is in their best interest
Ask the family to override the patient's decision

Correct answer: Respect the patient's autonomous decision after ensuring they have capacity and understand the consequences, document the refusal, and explore alternative treatments

A competent adult has the right to refuse any treatment, even if refusal may result in death. You must assess capacity (Mental Capacity Act 2005), ensure the patient understands the risks, explore alternatives (e.g., cell salvage, erythropoietin), document the discussion, and respect their decision. Family cannot override a competent patient's wishes.

Question 5: A patient in A&E is unconscious after a road traffic collision and requires emergency surgery. There is no time to obtain consent and no family is contactable. What is the legal basis for proceeding with treatment?

A court order must be obtained first
Treatment cannot proceed without consent under any circumstances
Treatment can proceed under the doctrine of necessity and the Mental Capacity Act 2005 Section 5 — emergency treatment in the patient's best interests when they lack capacity and there is no time to consult (Correct answer)
Two doctors must agree before treatment can proceed

Correct answer: Treatment can proceed under the doctrine of necessity and the Mental Capacity Act 2005 Section 5 — emergency treatment in the patient's best interests when they lack capacity and there is no time to consult

In a genuine emergency where the patient lacks capacity and delay would cause serious harm, treatment can proceed without consent under the common law doctrine of necessity and Section 5 of the Mental Capacity Act 2005. Treatment must be limited to what is immediately necessary and in the patient's best interests.

Question 6: During abdominal examination, what is the correct sequence?

Palpation, percussion, inspection, auscultation
Percussion, palpation, auscultation, inspection
Inspection, auscultation, light palpation, deep palpation, percussion, then special tests (Correct answer)
Palpation, auscultation, percussion, inspection

Correct answer: Inspection, auscultation, light palpation, deep palpation, percussion, then special tests

Abdominal examination sequence: Inspect (scars, distension, movement with respiration, visible pulsation, stomas), Auscultate (before palpation to avoid artificially altering bowel sounds), Lightly palpate (tenderness, guarding, rigidity), Deeply palpate (organomegaly), Percuss (liver, spleen, shifting dullness), Special tests (hernial orifices, rectal exam if indicated).

Question 7: During a PLAB 2 station, you are taking a history from a patient who gives only 'yes' and 'no' answers. Which type of question would be most useful to elicit more information?

Open-ended questions (Correct answer)
Closed questions
Leading questions
Multiple-choice questions

Correct answer: Open-ended questions

Open-ended questions ('Tell me more about that', 'How has this affected you?') encourage the patient to expand in their own words and provide richer information. After opening up with open questions, you can use closed questions to clarify specific details. Starting with closed questions limits the patient's responses.

Question 8: 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 never be disclosed without consent under any circumstances
It can be freely shared with all healthcare staff regardless of need
It must be disclosed to the patient's employer immediately
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)

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.

Question 9: A Lasting Power of Attorney (LPA) for Health and Welfare is activated. When does this LPA take effect?

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
Immediately upon registration, even if the person has capacity

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 10: A 78-year-old man with advanced dementia is admitted with pneumonia. He lacks capacity to make treatment decisions. He has no advance directive or lasting power of attorney. According to the Mental Capacity Act 2005, how should treatment decisions be made?

The family must make all decisions on the patient's behalf
Decisions should be made in the patient's best interests, considering their past wishes, beliefs, values, and consulting relevant people (family, carers, IMCA if no one else) (Correct answer)
Treatment cannot be given without the patient's consent under any circumstances
The most senior doctor decides alone based on their clinical judgement

Correct answer: Decisions should be made in the patient's best interests, considering their past wishes, beliefs, values, and consulting relevant people (family, carers, IMCA if no one else)

The Mental Capacity Act 2005 requires best interests decision-making for patients who lack capacity. This involves considering the patient's past and present wishes, beliefs, values, and consulting anyone named by the patient, carers, family, or an Independent Mental Capacity Advocate (IMCA). The least restrictive option must be chosen.

Question 11: A junior doctor makes a prescribing error that causes harm to a patient. According to GMC Duty of Candour, what must happen?

The junior doctor should handle it alone without informing seniors
The patient must be told honestly about the error, given an apology, and offered a remedy. The incident must be reported through the organisation's incident reporting system (Correct answer)
The error should be hidden to avoid litigation
The error should only be disclosed if the patient specifically asks

Correct answer: The patient must be told honestly about the error, given an apology, and offered a remedy. The incident must be reported through the organisation's incident reporting system

The professional duty of candour (GMC) and statutory duty of candour (CQC) require that patients are told when things go wrong, given an honest explanation, an apology, and offered a remedy. The incident must be reported through Datix or equivalent system, investigated, and lessons learned shared.

Question 12: 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
Only use a standardised questionnaire
Refer to psychiatry without asking about suicide — it is too distressing
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 13: During a cerebellar examination, you ask the patient to walk heel-to-toe and they are unable to maintain balance. You also find intention tremor, past-pointing, and dysdiadochokinesia. Which mnemonic summarises cerebellar signs?

CURB-65
DANISH — Dysdiadochokinesia, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia (Correct answer)
ABCDE
SOCRATES

Correct answer: DANISH — Dysdiadochokinesia, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia

DANISH summarises the key cerebellar signs: Dysdiadochokinesia (inability to perform rapid alternating movements), Ataxia (broad-based gait, heel-toe walking difficulty), Nystagmus, Intention tremor (tremor worse on reaching for a target), Slurred/scanning speech, and Hypotonia. Past-pointing is part of the dysmetria spectrum.

Question 14: When taking a social history, which four key areas should always be covered?

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

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 15: 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?

Document the son's request and discharge the patient without discussion
Follow the son's wishes — he has legal authority
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)
Avoid telling the patient to avoid conflict with the family

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 16: You are a foundation year doctor and witness a senior colleague performing a procedure without proper consent. According to GMC guidance, what should you do?

Discuss it only with your peers
Do nothing as they are more senior than you
Wait to see if it happens again before acting
Raise the concern — GMC guidance states that all doctors have a duty to raise concerns about patient safety regardless of the seniority of the person involved, through appropriate channels (Correct answer)

Correct answer: Raise the concern — GMC guidance states that all doctors have a duty to raise concerns about patient safety regardless of the seniority of the person involved, through appropriate channels

GMC guidance (Raising and Acting on Concerns) requires all doctors to raise concerns about patient safety, regardless of the seniority of the person involved. You should raise it with the colleague first if safe to do so, then escalate through clinical governance, patient safety teams, or external whistleblowing channels if necessary.

Question 17: 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 only needs to be discussed with a family member
It must be registered with the GMC
It can be verbal and does not need to be written
It must be in writing, signed, witnessed, and include a specific statement that it applies even if life is at risk (Correct answer)

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 18: 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?

Proceed with ventilation pending court review
Follow the family's wishes as next of kin
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)
Discuss with ethics committee before deciding

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 19: A patient presents with a 3-month history of weight loss. In the OSCE history, which system-specific red flag questions should you prioritise?

Ask about travel history only
Focus exclusively on mental health screening
Screen for malignancy red flags across systems: night sweats, haemoptysis, change in bowel habit, haematuria, lumps, dysphagia, and post-menopausal bleeding (Correct answer)
Ask only about diet and exercise habits

Correct answer: Screen for malignancy red flags across systems: night sweats, haemoptysis, change in bowel habit, haematuria, lumps, dysphagia, and post-menopausal bleeding

Unexplained weight loss is a red flag for malignancy. A systematic review of cancer-related symptoms across all body systems is essential — respiratory, GI, urological, gynaecological, and haematological. Night sweats and fatigue also suggest lymphoma. This approach ensures no serious cause is missed.

Question 20: According to the Mental Capacity Act 2005, what are the five key principles?

Confidentiality, honesty, safety, dignity, and respect
Presumption of capacity; support to make decisions; right to make unwise decisions; best interests; least restrictive option (Correct answer)
Diagnosis, prognosis, treatment, consent, and discharge
Beneficence, non-maleficence, autonomy, justice, and fidelity

Correct answer: Presumption of capacity; support to make decisions; right to make unwise decisions; best interests; least restrictive option

The five principles of the Mental Capacity Act 2005 are: (1) A person is presumed to have capacity unless proven otherwise; (2) All practicable steps to help them decide must be taken first; (3) An unwise decision does not mean lack of capacity; (4) Decisions for those lacking capacity must be in their best interests; (5) The least restrictive option must be chosen.

Question 21: A patient presents with chest pain. Using the SOCRATES framework, which aspect of the pain does 'R' represent?

Recurrence frequency
Radiation — where does the pain spread to? (Correct answer)
Rate (speed of onset)
Response to treatment

Correct answer: Radiation — where does the pain spread to?

SOCRATES: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/relieving factors, Severity. 'R' is Radiation — asking where the pain spreads to (e.g., left arm, jaw in MI; back in aortic dissection; right shoulder tip in biliary colic).

Question 22: A doctor is asked to complete a sick note for a patient they have not examined. The patient states they are too unwell to attend the surgery. What is the most appropriate action?

Issue the sick note on the basis of the patient's account to avoid unnecessary delays
Decline to issue a sick note unless the patient attends in person
Offer a telephone or video consultation to assess the patient before completing any documentation (Correct answer)
Ask a colleague to countersign the sick note to share responsibility

Correct answer: Offer a telephone or video consultation to assess the patient before completing any documentation

GMC Good Medical Practice requires that clinical documentation must be based on an assessment of the patient; a remote consultation satisfies this requirement when an in-person visit is not possible.

Question 23: 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?

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

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 24: 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?
What is the child's favourite food?
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)

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

Recent medications, current medications, allergies, and family medications
Antibiotics, analgesics, vitamins, and vaccines
Prescribed medications, over-the-counter drugs, herbal/complementary remedies, and recreational drugs (including alcohol and smoking) (Correct answer)
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 26: A patient in the Emergency Department is found unresponsive. What is the most appropriate immediate action according to the UK Resuscitation Council guidelines?

Shout for help, check for danger, check for response, open airway (head tilt-chin lift), check for breathing (look, listen, feel for 10 seconds), call the resuscitation team and start CPR (30:2) if not breathing normally (Correct answer)
Check pupils and blood glucose
Perform a 12-lead ECG
Insert an IV cannula and take blood samples

Correct answer: Shout for help, check for danger, check for response, open airway (head tilt-chin lift), check for breathing (look, listen, feel for 10 seconds), call the resuscitation team and start CPR (30:2) if not breathing normally

The UK Resuscitation Council Adult ALS algorithm begins with the basic life support sequence: check safety, check responsiveness, shout for help, open airway, look for normal breathing for no more than 10 seconds, call the resuscitation team (or ask someone to), then start CPR at 30 compressions to 2 breaths at a rate of 100–120/min.

Question 27: A patient in A&E develops anaphylaxis after a penicillin injection. They have widespread urticaria, wheeze, stridor, and a blood pressure of 70/40 mmHg. What is the first-line treatment?

IM adrenaline 500 micrograms (0.5 mL of 1:1000) into the anterolateral thigh, repeated every 5 minutes if needed (Correct answer)
IV chlorphenamine and hydrocortisone
Oral antihistamine and observation
Nebulised salbutamol only

Correct answer: IM adrenaline 500 micrograms (0.5 mL of 1:1000) into the anterolateral thigh, repeated every 5 minutes if needed

UK Resuscitation Council guidelines state that IM adrenaline (1:1000, 500 mcg for adults) is the first-line treatment for anaphylaxis. It is given into the anterolateral thigh and can be repeated every 5 minutes. IV fluids, chlorphenamine, and hydrocortisone are adjuncts but must not delay adrenaline.

Question 28: Which framework is commonly used for breaking bad news in UK clinical practice?

ABCDE (Airway, Breathing, Circulation, Disability, Exposure)
ISBAR: Introduction, Situation, Background, Assessment, Recommendation
SPIKES: Setting, Perception, Invitation, Knowledge, Emotions/Empathy, Strategy/Summary (Correct answer)
SBAR: 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 29: In a PLAB 2 communication station, you need to break bad news to a patient about a cancer diagnosis. Which framework should you use?

Write the diagnosis on a piece of paper and hand it to the patient
The SPIKES framework: Setting, Perception, Invitation, Knowledge, Emotions, Strategy and Summary (Correct answer)
Just tell the patient the diagnosis directly without preparation
Delegate the task to a nurse or counsellor

Correct answer: The SPIKES framework: Setting, Perception, Invitation, Knowledge, Emotions, Strategy and Summary

SPIKES is the validated framework for breaking bad news: Setting (ensure privacy), Perception (assess what the patient knows), Invitation (ask how much they want to know), Knowledge (deliver information clearly using a warning shot), Emotions (acknowledge and respond empathically), Strategy/Summary (discuss next steps).

Question 30: You are asked to perform a nasogastric (NG) tube insertion. After insertion, what is the gold standard method to confirm correct placement before use?

Measure the external length of the tube only
Start feeding immediately and observe for symptoms
Listen for air bubbles by injecting air while auscultating the epigastrium (whoosh test)
Aspirate gastric contents and test with pH indicator paper — a pH of ≤5.5 confirms gastric placement. If unable to aspirate, request a chest X-ray to confirm the tip is below the diaphragm (Correct answer)

Correct answer: Aspirate gastric contents and test with pH indicator paper — a pH of ≤5.5 confirms gastric placement. If unable to aspirate, request a chest X-ray to confirm the tip is below the diaphragm

NPSA (NHS Patient Safety) guidelines require pH testing of aspirate as the first-line method for confirming NG tube placement — pH ≤5.5 confirms gastric position. The 'whoosh test' (auscultation) is unreliable and must NOT be used. If aspirate cannot be obtained or pH is >5.5, a chest X-ray is needed before use.

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.

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40 min

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70%

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