PLAB 2 Procedural Skills 2

Question 1

You need to insert a chest drain for a large pneumothorax. According to BTS guidelines, where is the safe triangle for insertion?

Accepted Answer

The triangle bordered by the anterior border of latissimus dorsi, the lateral border of pectoralis major, and a line superior to the horizontal level of the nipple (5th intercostal space), in the mid-axillary line

Answer

BTS guidelines recommend chest drain insertion within the 'safe triangle': bordered by the anterior border of latissimus dorsi posteriorly, the lateral border of pectoralis major anteriorly, and a horizontal line at the level of the nipple inferiorly (approximately 5th intercostal space). This minimises risk to internal structures.

Question 2

During a PLAB 2 station, you are performing a peak expiratory flow rate (PEFR) measurement. The patient produces three readings: 320, 340, and 310 L/min. Which value should be recorded?

Accepted Answer

The highest of the three readings (340 L/min), as per BTS guidelines

Answer

BTS guidelines state that the highest of three technically satisfactory attempts should be recorded as the PEFR. This is because the best effort represents the patient's true maximum expiratory flow. The result is then compared to the patient's predicted value based on age, height, and sex.

Question 3

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?

Accepted Answer

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

Answer

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).

Question 4

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

Accepted 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

Answer

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.

Question 5

During a PLAB 2 station on IV cannulation, you attempt to insert a cannula but fail on the first attempt. What is the recommended maximum number of attempts by a single practitioner?

Accepted Answer

A maximum of two attempts — if both fail, seek assistance from a more experienced colleague or consider alternative access (ultrasound-guided, central venous)

Answer

Best practice guidelines recommend a maximum of two attempts at IV cannulation per practitioner. Multiple failed attempts cause patient distress, tissue damage, and venous access compromise. After two failures, seek help from a more experienced colleague, consider ultrasound-guided insertion, or escalate to central venous access if appropriate.

PLAB 2 Practice Test

PLAB 2 Practice Test

PLAB 2 Procedural Skills 2