PLAB 2 Prescribing Safety & Emergency Management

Question 1

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

Accepted 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

Answer

Check pupils and blood glucose

Answer

Insert an IV cannula and take blood samples

Answer

Perform a 12-lead ECG

Question 2

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

Accepted Answer

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

Answer

IV hydrocortisone 200mg

Answer

IV chlorphenamine 10mg

Answer

Nebulised salbutamol

Question 3

When prescribing in a hospital setting, which five components are essential for a valid drug prescription?

Accepted Answer

Drug name (generic), dose (in approved units), route, frequency/timing, prescriber's signature and date, and the patient's name/date of birth/hospital number on the drug chart

Answer

Drug name, dose, route, frequency, and prescriber's name only

Answer

Drug name, indication, cost, patient name, and ward

Answer

Drug name, manufacturer, batch number, dose, and prescriber grade

Question 4

A patient on a surgical ward develops acute confusion, fever (38.8°C), hypotension (BP 90/60), and tachycardia (HR 115 bpm) on post-operative day 2. What is the most important immediate action?

Accepted Answer

Perform a full sepsis assessment (NEWS score), take blood cultures and other sepsis screen, and start the Sepsis Six bundle within one hour

Answer

Prescribe regular paracetamol and reassess in the morning

Answer

Request an urgent CT scan

Answer

Order a 12-lead ECG and cardiac enzymes

Question 5

A patient's medication chart shows they are prescribed lithium. Which monitoring parameters are essential?

Accepted Answer

Serum lithium level (12 hours post dose), renal function (eGFR, urine output), thyroid function, calcium — all regularly; serum level kept in narrow therapeutic range (0.4–1.0 mmol/L for maintenance)

Answer

Full blood count and liver function tests monthly

Answer

Random serum lithium with no specific timing requirement

Answer

Lithium level and ECG only

Question 6

A patient is prescribed oral morphine for cancer pain. Which medication should always be co-prescribed?

Accepted Answer

A laxative (e.g., co-danthramer or senna + docusate) — opioid-induced constipation is universal and does not develop tolerance unlike nausea

Answer

A proton pump inhibitor

Answer

An antiemetic alone is sufficient

Answer

A benzodiazepine for sedation