PLAB 2 Procedural Skills

Question 1

You are performing venepuncture on a patient. According to best practice, what is the correct order of the procedure?

Accepted Answer

Apply the tourniquet, identify a suitable vein, clean the site with a 2% chlorhexidine swab, allow to dry for 30 seconds, insert the needle bevel up at 15-30 degrees, collect samples in the correct order of draw, remove tourniquet, withdraw needle, apply pressure

Answer

The correct venepuncture technique follows ANTT (Aseptic Non-Touch Technique): apply tourniquet, identify vein, clean with 2% chlorhexidine (allow 30 seconds to dry), insert needle bevel up at 15-30 degrees. The order of draw prevents cross-contamination between additives in tubes.

Question 2

You need to perform an arterial blood gas (ABG) sample. Which artery is the first-choice site, and what should you do before attempting the procedure?

Accepted Answer

Radial artery — perform a modified Allen's test to confirm adequate collateral circulation via the ulnar artery before puncturing

Answer

The radial artery is the first-choice site for ABG sampling because of its superficial location and dual blood supply to the hand. A modified Allen's test must be performed before puncture to confirm adequate ulnar artery collateral circulation. If Allen's test is negative, use the other wrist or an alternative site.

Question 3

You are inserting a urinary catheter in a male patient. After inflating the balloon, the patient experiences severe pain. What is the most likely cause and what should you do?

Accepted Answer

The balloon may have been inflated in the urethra rather than the bladder — immediately deflate the balloon, advance the catheter further until urine drains, then re-inflate

Answer

Pain on balloon inflation usually indicates the balloon is in the urethra, not the bladder. You must immediately deflate the balloon to prevent urethral trauma, advance the catheter until urine drains freely (confirming it is in the bladder), and then re-inflate. A key tip: always advance the catheter 'to the hilt' in male patients before inflating.

Question 4

You are performing a lumbar puncture. At which vertebral level should you insert the needle, and how do you identify this landmark?

Accepted Answer

At or below the L3/L4 interspace, identified using the intercristal line (a line between the iliac crests crosses the spine at approximately L4)

Answer

Lumbar puncture should be performed at L3/L4 or L4/L5 to avoid the conus medullaris (which ends at L1/L2 in adults). The intercristal line (Tuffier's line) — an imaginary line between the iliac crests — crosses the spine at approximately L4, providing the landmark for needle insertion.

Question 5

You are suturing a laceration on a patient's forearm. Which suture technique is most appropriate for a simple, clean, linear wound in the emergency department?

Accepted Answer

Simple interrupted sutures — they are versatile, allow drainage, and individual sutures can be removed if infection develops without compromising the entire closure

Answer

Simple interrupted sutures are the most versatile technique for ED wound closure. Each suture is independent, allowing removal of individual sutures if infection develops. They provide good wound edge eversion, are easy to learn, and can be adjusted for tension. The wound should be cleaned and irrigated before closure.

PLAB 2 Practice Test

PLAB 2 Practice Test

PLAB 2 Procedural Skills