PLAB 2 History Taking Stations

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?

Accepted 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?

Answer

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 3-month history of weight loss. In the OSCE history, which system-specific red flag questions should you prioritise?

Accepted Answer

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

Answer

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 3

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?

Accepted Answer

Sudden-onset thunderclap headache, neck stiffness, photophobia, and fever

Answer

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 4

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?

Accepted Answer

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

Answer

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 5

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

Accepted Answer

PHQ-9 (Patient Health Questionnaire-9)

Answer

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.

PLAB 2 Practice Test

PLAB 2 Practice Test

PLAB 2 History Taking Stations