Mixed Deck — All PLAB 2 Topics Flashcards

A doctor becomes aware that they are experiencing significant stress and burnout that is affecting their ability to concentrate during clinical duties. What should they do first?

Answer: Seek support from their own GP or occupational health and consider whether their fitness to practise is affected

GMC guidance requires doctors to look after their own health and wellbeing and to seek help when needed, and to consider whether their health is affecting their ability to practise safely.

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?

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.

A doctor working in A&E is approached by a journalist asking for details about a celebrity patient admitted after a road traffic accident. What should the doctor do?

Answer: Decline to provide any information and direct the journalist to the hospital communications team

Patient confidentiality must be maintained regardless of the patient's public profile; any media enquiries should be directed to the official hospital communications department.

During a medical emergency, a patient has anaphylaxis following an antibiotic injection. What is the first-line treatment and route of administration?

Answer: IM adrenaline 0.5mg (1:1000) into the anterolateral thigh

Adrenaline (epinephrine) 0.5mg IM (1:1000 solution = 0.5ml) into the anterolateral thigh is the life-saving first-line treatment for anaphylaxis. IM injection into the thigh provides faster and more reliable absorption than subcutaneous administration. IV adrenaline is only for use by specialists in specific circumstances. Antihistamines and steroids are adjunctive, not first-line.

A patient presents to a PLAB 2 station with symptoms of depression. Which validated screening tool should you use to assess severity?

Answer: PHQ-9 (Patient Health Questionnaire-9)

The PHQ-9 is the validated screening and severity assessment tool for depression recommended by NICE. Scores range from 0-27: 5-9 (mild), 10-14 (moderate), 15-19 (moderately severe), 20-27 (severe). It also includes a question about suicidal ideation which must always be explored further.

A doctor is asked to provide a reference for a former colleague who was subject to a conduct investigation that was ultimately not proven. What should the reference include?

Answer: The reference should be factually accurate, honest and not misleading, including relevant information about the investigation if directly relevant to the role

GMC guidance requires references to be honest, accurate and not misleading; omitting relevant factual information that could affect patient safety is a breach of professional standards.

According to GMC guidance, what is a doctor's responsibility regarding maintaining their medical knowledge and skills?

Answer: Doctors must keep their knowledge and skills up to date throughout their careers and participate in continuing professional development

GMC Good Medical Practice places a clear professional obligation on all doctors to keep their knowledge and skills up to date and to participate in continuing medical education throughout their careers.

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?

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.

A researcher approaches you about recruiting your patients for a clinical trial. What ethical principles must be followed according to the Declaration of Helsinki and UK research governance?

Answer: Voluntary informed consent is essential, participants must understand the risks and benefits, they can withdraw at any time, the research must have ethical approval (REC), and patient welfare must always take precedence over the interests of science

The Declaration of Helsinki and UK Research Governance Framework require: voluntary informed consent, ethical approval from a Research Ethics Committee (REC), the right to withdraw at any time, that patient welfare takes precedence over research interests, and that vulnerable groups receive additional protection.

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?

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.

A patient in the Emergency Department is found unresponsive. What is the most appropriate immediate action according to the UK Resuscitation Council guidelines?

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.

Under GMC guidance, when is a doctor permitted to breach patient confidentiality without consent?

Answer: When disclosure is required by law, necessary to prevent serious harm to the patient or others, or in the public interest as defined by law

GMC guidance permits breach of confidentiality without consent in specific circumstances: legal obligation, serious risk of harm to the patient or third parties, or a clear public interest justification.

A GP is treating a patient who is also a close friend. The patient requests a prescription for a controlled drug for pain relief after a minor procedure. What is the most appropriate action?

Answer: Decline to prescribe and arrange for the patient to be seen by another doctor

GMC guidance advises that wherever possible you should avoid treating those with whom you have a close personal relationship, especially when prescribing controlled drugs, to maintain objectivity and professional boundaries.

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?

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.

You examine a patient's hands and find Heberden's nodes at the distal interphalangeal joints and Bouchard's nodes at the proximal interphalangeal joints. What is the most likely diagnosis?

Answer: Osteoarthritis

Heberden's nodes (DIP joints) and Bouchard's nodes (PIP joints) are bony enlargements characteristic of osteoarthritis. Rheumatoid arthritis typically affects the MCP and PIP joints (sparing the DIP joints) and causes soft tissue swelling, ulnar deviation, and swan neck or boutonniere deformities.

You are performing a digital rectal examination (DRE) as part of an abdominal examination station. Which of the following findings would be most concerning for rectal malignancy?

Answer: A hard, irregular, fixed mass with a loss of the normal mucosal pattern, which may be blood-stained on the examining finger

Features suspicious for rectal malignancy on DRE include: a hard, irregular mass, fixation to surrounding structures, loss of normal mucosal pattern, and blood on the examining finger. Any suspicious mass requires urgent 2-week wait referral for further investigation (flexible sigmoidoscopy or colonoscopy).

During a PLAB 2 station on discharge planning, a patient with newly diagnosed diabetes asks about their condition. Which communication technique is most effective for ensuring the patient understands?

Answer: Use plain language, chunk information into manageable portions, check understanding at each stage using teach-back technique, and provide written information to take home

Effective patient education uses plain language, breaks information into small chunks, uses the teach-back technique ('Can you tell me in your own words...'), and supplements verbal explanation with written materials. This approach improves understanding, adherence, and health outcomes.

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?

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.

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?

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.

When examining a patient for jaundice, which additional examination findings would suggest a hepatic cause rather than post-hepatic (obstructive) jaundice?

Answer: Spider naevi, palmar erythema, leukonychia, caput medusae, hepatic encephalopathy, ascites, and splenomegaly — stigmata of chronic liver disease

Hepatic (hepatocellular) jaundice is associated with stigmata of chronic liver disease: spider naevi (>5 is significant), palmar erythema, leukonychia, Dupuytren's contracture, caput medusae, gynaecomastia, testicular atrophy, asterixis, ascites, splenomegaly. Obstructive jaundice features pale stools, dark urine, and often a palpable gallbladder (Courvoisier's sign if non-tender).