PLAB 2 History Taking Stations 2 — Questions and Answers
Question 1: 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 2: 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 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?
- Have you changed your diet recently?
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 3: 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?
- Skip the sexual history as it may embarrass the patient
- 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)
- Ask directly about sexually transmitted infections without context
- 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 4: 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?
- PHQ-9
- Abbreviated Mental Test Score (AMTS) or Montreal Cognitive Assessment (MoCA) (Correct answer)
- AUDIT questionnaire
- Glasgow Coma Scale
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 5: During a history station, a patient describes epigastric pain. Which feature in the history most strongly suggests peptic ulcer disease rather than functional dyspepsia?
- Pain that occurs randomly throughout the day
- Burning epigastric pain related to meals, relieved by antacids, associated with NSAID use or H. pylori risk factors, and presence of alarm features such as weight loss or vomiting (Correct answer)
- Pain that improves with eating spicy food
- Pain present only when lying flat at night
Correct answer: Burning epigastric pain related to meals, relieved by antacids, associated with NSAID use or H. pylori risk factors, and presence of alarm features such as weight loss or vomiting
Peptic ulcer pain is typically burning, epigastric, related to meals (gastric ulcer worsened by eating, duodenal ulcer relieved by eating), and may be relieved by antacids. Risk factors include NSAID use, H. pylori infection, smoking, and alcohol. Alarm features require urgent investigation.
Question 6: 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?
- Which joint is affected?
- Is the stiffness worse in the morning, and if so, how long does it last — more or less than 30 minutes? (Correct answer)
- Do you take any painkillers?
- Have you injured the joint recently?
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.
PLAB 2 History Taking Stations 2
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?