PLAB 1 Medical Assessment — Questions and Answers

Question 1: Which feature most clearly distinguishes a manic episode from a hypomanic episode in bipolar disorder?

Grandiosity
Decreased need for sleep
Marked functional impairment or need for hospitalization (Correct answer)
Elevated or irritable mood

Correct answer: Marked functional impairment or need for hospitalization

Mania, unlike hypomania, causes marked functional impairment, may require hospitalization, and can include psychotic features.

Question 2: When can patient confidentiality be legally breached in the United States?

When the physician feels the family should know
Patient confidentiality can never be breached under any circumstance
When required by law, such as reporting certain communicable diseases or suspected child abuse (Correct answer)
Whenever a family member requests medical information

Correct answer: When required by law, such as reporting certain communicable diseases or suspected child abuse

Patient confidentiality may be legally breached when required by law (mandatory disease reporting, suspected child/elder abuse), when there is a serious risk to others, or with valid court orders.

Question 3: How should core concepts and principles knowledge be maintained and updated?

Learning stops after certification
Initial training provides lifelong competence
Through continuous professional development, current literature review, and professional networking (Correct answer)
Knowledge updates are only needed every five years

Correct answer: Through continuous professional development, current literature review, and professional networking

Professional competence requires ongoing development through education, literature review, and engagement with the professional community.

Question 4: What is the foundational principle of professional standards and ethics in the Professional and Linguistic Assessments Board field?

Maximizing personal advancement
Following the easiest path available
Avoiding all challenging situations
Maintaining competence, integrity, and service to stakeholders (Correct answer)

Correct answer: Maintaining competence, integrity, and service to stakeholders

The foundational principles of professional standards and ethics in Professional and Linguistic Assessments Board center on maintaining competence, integrity, and quality service.

Question 5: What ethical standard governs core concepts and principles practice?

Ethics only apply in academic settings
Ethics are personal opinions, not professional requirements
Adherence to the profession's code of ethics and applicable laws and regulations (Correct answer)
Ethical standards are optional for certified professionals

Correct answer: Adherence to the profession's code of ethics and applicable laws and regulations

Professional ethics codes and applicable laws provide the framework for ethical practice in every professional field.

Question 6: Which investigation is most useful to confirm ovarian torsion in a woman presenting with acute unilateral pelvic pain?

Transvaginal ultrasound with Doppler (Correct answer)
CT abdomen and pelvis
Diagnostic laparoscopy
Serum CA-125

Correct answer: Transvaginal ultrasound with Doppler

Transvaginal ultrasound with Doppler flow studies is the first-line investigation for suspected ovarian torsion, assessing ovarian morphology and blood flow, though absence of flow is not always present.

Question 7: Which drug is used to prevent neural tube defects when taken periconceptionally?

Vitamin D
Iron
Folic acid (Correct answer)
Vitamin B12

Correct answer: Folic acid

Folic acid (400 mcg daily for women at standard risk, 5 mg for high-risk women) taken at least one month before conception and through the first trimester significantly reduces the risk of neural tube defects such as spina bifida.

Question 8: How should professional standards and ethics knowledge be maintained and updated?

Initial training provides lifelong competence
Knowledge updates are only needed every five years
Learning stops after certification
Through continuous professional development, current literature review, and professional networking (Correct answer)

Correct answer: Through continuous professional development, current literature review, and professional networking

Professional competence requires ongoing development through education, literature review, and engagement with the professional community.

Question 9: What is the focus of PLAB Part 2?

Discussing medical ethics verbally.
Answering theoretical multiple-choice questions.
Writing essays on medical topics.
Performing practical assessments in simulated settings. (Correct answer)

Correct answer: Performing practical assessments in simulated settings.

PLAB Part 2 focuses on assessing practical skills and clinical competence through an Objective Structured Clinical Examination (OSCE). Candidates move through a series of simulated clinical scenarios, interacting with actors playing patients or healthcare professionals. This format evaluates their ability to diagnose, manage, communicate, and perform procedures in a realistic medical environment.

Question 10: Which test is used to screen newborns for congenital hypothyroidism in the UK?

Serum T4 measurement at birth
Urine iodine at 2 weeks
Thyroid ultrasound at 6 weeks
Heel-prick TSH measurement at day 5 (Correct answer)

Correct answer: Heel-prick TSH measurement at day 5

The UK newborn bloodspot (heel-prick) screening program tests TSH on day 5 of life; elevated TSH suggests primary congenital hypothyroidism, which requires prompt treatment to prevent intellectual disability.

Question 11: A 6-week-old male infant presents with projectile non-bilious vomiting after every feed, is hungry immediately after vomiting, and has a palpable olive-shaped mass in the right upper quadrant. What is the diagnosis?

Intussusception
Pyloric stenosis (Correct answer)
Duodenal atresia
Gastroesophageal reflux

Correct answer: Pyloric stenosis

Pyloric stenosis classically presents at 3–6 weeks of age with forceful projectile non-bilious vomiting, persistent hunger, and a palpable pyloric 'olive' mass; it is more common in firstborn males.

Question 12: Which extrapyramidal side effect of antipsychotics typically appears within hours to days of starting treatment and presents with involuntary muscle spasms?

Akathisia
Tardive dyskinesia
Acute dystonia (Correct answer)
Metabolic syndrome

Correct answer: Acute dystonia

Acute dystonia involves sudden involuntary muscle contractions and is the earliest appearing extrapyramidal side effect, occurring hours to days after antipsychotic initiation.

Question 13: What is the format of PLAB Part 2?

Group presentations.
Objective Structured Clinical Examination (OSCE). (Correct answer)
Written long-answer essays.
Standardized patient interviews.

Correct answer: Objective Structured Clinical Examination (OSCE).

The format of PLAB Part 2 is an Objective Structured Clinical Examination (OSCE). This involves a series of 'stations' where candidates interact with simulated patients or perform practical tasks. The OSCE format allows for a standardized and objective assessment of clinical skills, communication, and professionalism in a controlled environment.

Question 14: A 55-year-old woman presents with low mood, early morning waking, anorexia, weight loss, and feelings of worthlessness. Which antidepressant class is the recommended first-line treatment?

Selective serotonin reuptake inhibitors (SSRIs) (Correct answer)
Tricyclic antidepressants (TCAs)
Benzodiazepines
Monoamine oxidase inhibitors (MAOIs)

Correct answer: Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are first-line antidepressants because of their efficacy and superior safety and tolerability profile compared to TCAs and MAOIs.

Question 15: What ethical standard governs applied methods and techniques practice?

Ethical standards are optional for certified professionals
Ethics only apply in academic settings
Adherence to the profession's code of ethics and applicable laws and regulations (Correct answer)
Ethics are personal opinions, not professional requirements

Correct answer: Adherence to the profession's code of ethics and applicable laws and regulations

Professional ethics codes and applicable laws provide the framework for ethical practice in every professional field.

Question 16: What advantage does PLAB certification offer to international medical graduates?

Automatic qualification for a UK visa.
Direct placement in UK hospitals.
Eligibility to apply for GMC registration. (Correct answer)
Exemption from licensing requirements worldwide.

Correct answer: Eligibility to apply for GMC registration.

PLAB certification offers international medical graduates the significant advantage of eligibility to apply for General Medical Council (GMC) registration. This registration is a mandatory legal requirement for any doctor wishing to practice medicine in the United Kingdom, opening doors to professional opportunities.

Question 17: What is the mechanism of action of metformin?

Decreases hepatic glucose production and increases insulin sensitivity (Correct answer)
Increases urine glucose excretion
Stimulates insulin release from pancreatic beta cells
Blocks glucose absorption in the intestines completely

Correct answer: Decreases hepatic glucose production and increases insulin sensitivity

Metformin works primarily by reducing hepatic glucose production and improving peripheral insulin sensitivity, making it the first-line treatment for type 2 diabetes.

Question 18: What is the most appropriate initial investigation for suspected deep vein thrombosis?

Chest X-ray
Liver function tests
D-dimer test combined with Wells score assessment (Correct answer)
Full blood count only

Correct answer: D-dimer test combined with Wells score assessment

Initial investigation of suspected DVT involves calculating the Wells score to determine pre-test probability, combined with a D-dimer test. A positive D-dimer in a moderate/high probability patient warrants ultrasound.

Question 19: What is the purpose of the application fee for the PLAB test?

To cover visa processing fees.
To provide study materials.
To fund the administration and evaluation of the test. (Correct answer)
To secure accommodations for candidates.

Correct answer: To fund the administration and evaluation of the test.

The application fee for the PLAB test is primarily used to cover the operational costs involved in developing, administering, and scoring the examination. These funds ensure the integrity and continued availability of the test, which is crucial for assessing the competency of international medical graduates seeking to practice in the UK.

Question 20: A 2-year-old child presents with a barking cough, stridor, and low-grade fever. Symptoms are worse at night. What is the most likely diagnosis?

Foreign body aspiration
Epiglottitis
Croup (laryngotracheobronchitis) (Correct answer)
Bacterial tracheitis

Correct answer: Croup (laryngotracheobronchitis)

Croup (laryngotracheobronchitis) is caused most commonly by parainfluenza virus, presenting with the characteristic barking 'seal-like' cough, inspiratory stridor, and nocturnal worsening in children aged 6 months to 3 years.

Question 21: How should a physician deliver bad news to a patient?

As quickly as possible to minimize the patient's time in the office
Only in writing to avoid emotional confrontation
By having a nurse deliver the information instead
Using a structured approach like SPIKES: Setting, Perception, Invitation, Knowledge, Emotions, Strategy (Correct answer)

Correct answer: Using a structured approach like SPIKES: Setting, Perception, Invitation, Knowledge, Emotions, Strategy

The SPIKES protocol provides a structured approach: prepare the Setting, assess patient's Perception, get an Invitation to share, give Knowledge/information, address Emotions, and discuss Strategy/next steps.

Question 22: A 4-year-old child presents with a widespread purpuric rash, arthritis, colicky abdominal pain, and haematuria. What is the most likely diagnosis?

Henoch-Schönlein Purpura (IgA vasculitis) (Correct answer)
Idiopathic thrombocytopenic purpura
Meningococcal septicemia
Systemic lupus erythematosus

Correct answer: Henoch-Schönlein Purpura (IgA vasculitis)

Henoch-Schönlein Purpura (IgA vasculitis) is the most common childhood vasculitis, characterized by the tetrad of palpable purpura (predominantly lower limbs/buttocks), arthritis, colicky abdominal pain, and renal involvement (haematuria).

Question 23: According to DSM-5, which symptom is essential (i.e., must be present) for a diagnosis of major depressive disorder?

Significant weight change
Suicidal ideation
Insomnia or hypersomnia
Depressed mood or anhedonia (Correct answer)

Correct answer: Depressed mood or anhedonia

DSM-5 requires that at least one of the five or more symptoms must be either depressed mood or anhedonia to meet the MDD diagnostic criteria.

Question 24: A 3-year-old presents with high fever, drooling, muffled 'hot potato' voice, and reluctance to move the neck. He sits in a tripod position and appears toxic. What is the most dangerous diagnosis to exclude?

Ludwig's angina
Croup
Peritonsillar abscess
Epiglottitis (Correct answer)

Correct answer: Epiglottitis

Epiglottitis (most commonly due to Haemophilus influenzae type b pre-vaccination era, now Streptococcus/Staphylococcus) is a life-threatening emergency presenting with high fever, drooling, muffled voice, and the tripod position; airway management takes priority.

Question 25: Which vaccine is administered at birth as part of the standard UK immunization schedule for infants born to hepatitis B-positive mothers?

Rotavirus vaccine
BCG vaccine
Hepatitis A vaccine
Hepatitis B vaccine (Correct answer)

Correct answer: Hepatitis B vaccine

Infants born to hepatitis B surface antigen-positive mothers receive hepatitis B vaccine at birth (along with HBIG if high-risk) to prevent perinatal transmission, which carries high risk of chronic infection.

Question 26: What is informed consent?

A signed form that protects the hospital from lawsuits
A verbal agreement between the doctor and patient's family
Automatic consent given when a patient enters a hospital
A process where patients receive adequate information to make voluntary decisions about their treatment (Correct answer)

Correct answer: A process where patients receive adequate information to make voluntary decisions about their treatment

Informed consent is a process (not just a form) where patients receive information about diagnosis, treatment options, risks, benefits, and alternatives, enabling voluntary, informed decision-making.

Question 27: How can candidates apply for the PLAB test?

Through the General Medical Council's (GMC) online portal. (Correct answer)
Via postal mail to the UK government.
In person at a testing center.
By submitting a handwritten application.

Correct answer: Through the General Medical Council's (GMC) online portal.

Candidates can apply for the PLAB test exclusively through the General Medical Council's (GMC) online portal. The GMC manages the entire registration and application process for the PLAB exams. This centralized online system ensures efficiency and provides candidates with all necessary information and updates regarding their application.

Question 28: Which antibiotic class should be avoided in children due to effects on developing cartilage?

Cephalosporins
Macrolides
Fluoroquinolones (Correct answer)
Penicillins

Correct answer: Fluoroquinolones

Fluoroquinolones (e.g., ciprofloxacin) are generally avoided in children because they can cause damage to developing cartilage and tendons, with exceptions only for serious infections.

Question 29: What quality assurance measure supports professional standards and ethics?

Quality checks are unnecessary for experienced professionals
Annual review is sufficient
Quality only matters for new practitioners
Regular self-assessment, peer review, and adherence to established standards (Correct answer)

Correct answer: Regular self-assessment, peer review, and adherence to established standards

Ongoing quality assurance through self-assessment, peer review, and standards adherence ensures continuous improvement.

Question 30: A patient presents with right upper quadrant pain, fever, and jaundice. What is this triad known as?

Beck's triad, suggesting cardiac tamponade
Charcot's triad, suggesting ascending cholangitis (Correct answer)
Cushing's triad, suggesting raised intracranial pressure
Virchow's triad, suggesting deep vein thrombosis

Correct answer: Charcot's triad, suggesting ascending cholangitis

Charcot's triad (right upper quadrant pain, fever, and jaundice) classically indicates ascending cholangitis — infection of the bile duct system requiring urgent drainage.

Question 31: Why is the PLAB test required for international medical graduates?

To bypass medical licensing exams.
To demonstrate comparable skills and knowledge to UK medical graduates. (Correct answer)
To gain automatic residency.
To certify English language proficiency only.

Correct answer: To demonstrate comparable skills and knowledge to UK medical graduates.

The PLAB test is required for international medical graduates to demonstrate that they possess the same level of skills and knowledge as a doctor graduating from a UK medical school. This ensures that all doctors practicing in the UK, regardless of their origin, meet the General Medical Council's (GMC) standards for safe and effective patient care. It acts as a benchmark for competence.

Question 32: A 10-year-old child presents with a 3-week history of painless, unilateral cervical lymphadenopathy, night sweats, weight loss, and fatigue. What investigation is most important?

Monospot test
Excisional lymph node biopsy
Chest X-ray followed by lymph node biopsy (Correct answer)
Throat swab culture

Correct answer: Chest X-ray followed by lymph node biopsy

Painless cervical lymphadenopathy with B symptoms (night sweats, weight loss, fever) in a child raises concern for Hodgkin lymphoma; CXR to assess mediastinal involvement followed by excisional biopsy for histological diagnosis is the appropriate approach.

Question 33: A 40-year-old alcohol-dependent man presents 48 hours after his last drink with agitation, tremor, diaphoresis, and tachycardia. What is the most serious complication to anticipate?

Hepatic encephalopathy
Wernicke's encephalopathy
Korsakoff psychosis
Delirium tremens with seizures (Correct answer)

Correct answer: Delirium tremens with seizures

Delirium tremens typically emerges 48–72 hours after alcohol cessation and carries significant mortality without prompt treatment with benzodiazepines.

Question 34: How should challenges in assessment and evaluation be addressed?

Delegate all challenges to supervisors
Ignore challenges until they resolve themselves
Apply systematic problem-solving, seek expert guidance when needed, and document decisions (Correct answer)
Avoid challenges and stick to familiar tasks

Correct answer: Apply systematic problem-solving, seek expert guidance when needed, and document decisions

Systematic problem-solving combined with appropriate consultation and documentation ensures challenges are addressed effectively.

Question 35: What is Gillick competence?

A standardized exam for medical licensing
A test measuring a doctor's clinical competence
A legal concept where a minor under 16 can consent to treatment if they demonstrate sufficient understanding (Correct answer)
A rating system for hospital quality

Correct answer: A legal concept where a minor under 16 can consent to treatment if they demonstrate sufficient understanding

Gillick competence (established in Gillick v West Norfolk, 1985) allows minors under 16 to consent to medical treatment if they demonstrate sufficient intelligence and understanding of the proposed treatment.

Question 36: What is the primary management of a child with suspected anaphylaxis presenting with urticaria, bronchospasm, and hypotension after a bee sting?

IM adrenaline (epinephrine) 0.01 mg/kg (1:1000) into the anterolateral thigh (Correct answer)
Inhaled salbutamol only
IV antihistamines
Oral prednisolone

Correct answer: IM adrenaline (epinephrine) 0.01 mg/kg (1:1000) into the anterolateral thigh

IM adrenaline (epinephrine) 0.01 mg/kg of 1:1000 solution into the anterolateral thigh is the immediate first-line treatment for anaphylaxis in children, rapidly reversing bronchospasm, vasodilation, and mast cell mediator release.

Question 37: Who recognizes the PLAB certification?

The World Health Organization (WHO).
The European Union Medical Board.
The UK Ministry of Education.
The General Medical Council (GMC). (Correct answer)

Correct answer: The General Medical Council (GMC).

The PLAB certification is officially recognized by the General Medical Council (GMC), which is the regulatory body for doctors in the United Kingdom. Successful completion of the PLAB test is a mandatory requirement for international medical graduates to apply for GMC registration and practice medicine in the UK.

Question 38: Which condition is characterized by endometrial glands and stroma found within the myometrium, causing dysmenorrhea and a uniformly enlarged uterus?

Adenomyosis (Correct answer)
Endometriosis
Endometrial hyperplasia
Uterine fibroids

Correct answer: Adenomyosis

Adenomyosis is defined by ectopic endometrial glands and stroma embedded within the myometrium, resulting in a symmetrically enlarged, globular uterus and severe dysmenorrhea with heavy menstrual bleeding.

Question 39: How does PLAB certification impact career opportunities?

Enhances eligibility for UK-based medical roles. (Correct answer)
Guarantees permanent employment.
Allows skipping specialty training.
Excludes the need for experience.

Correct answer: Enhances eligibility for UK-based medical roles.

PLAB certification significantly impacts career opportunities by enhancing an international medical graduate's eligibility for UK-based medical roles. By enabling GMC registration, it allows doctors to legally work in the National Health Service (NHS) and other healthcare providers across the UK, opening up professional pathways.

Question 40: A 35-year-old woman presents with sudden severe lower abdominal pain, shoulder tip pain, and a positive urine pregnancy test. Ultrasound shows no intrauterine pregnancy. What is the most likely diagnosis?

Appendicitis
Ruptured ectopic pregnancy (Correct answer)
Placenta previa
Ovarian torsion

Correct answer: Ruptured ectopic pregnancy

Ruptured ectopic pregnancy classically presents with acute abdominal pain, peritoneal irritation causing referred shoulder tip pain (diaphragmatic irritation from hemoperitoneum), and a positive pregnancy test without intrauterine pregnancy on ultrasound.

Question 41: Which resource is officially recommended for PLAB preparation?

General Medical Council (GMC) sample questions and guidance. (Correct answer)
Internet blogs from test-takers.
General medical textbooks.
Non-medical self-help books.

Correct answer: General Medical Council (GMC) sample questions and guidance.

The General Medical Council (GMC) is the official body responsible for the PLAB test, making their sample questions and guidance the most authoritative and reliable resource for preparation. These materials accurately reflect the exam's format, content, and the standards expected, ensuring candidates prepare with the most relevant information.

Question 42: Which anticoagulant requires regular INR monitoring?

Rivaroxaban
Warfarin (Correct answer)
Apixaban
Dabigatran

Correct answer: Warfarin

Warfarin requires regular INR (International Normalized Ratio) monitoring because it has a narrow therapeutic index and its effect is influenced by diet, medications, and individual metabolism.

Question 43: What is the primary purpose of the Professional and Linguistic Assessments Board (PLAB) test?

To verify language proficiency exclusively.
To test theoretical medical knowledge only.
To assess practical skills and medical knowledge. (Correct answer)
To replace residency requirements.

Correct answer: To assess practical skills and medical knowledge.

The primary purpose of the PLAB test is to ensure that international medical graduates (IMGs) possess the necessary practical skills and medical knowledge to practice safely and effectively in the UK. It assesses whether their abilities are comparable to those of a UK medical graduate starting their second year of foundation training. This comprehensive evaluation covers both theoretical understanding and clinical application.

Question 44: What is the most common cause of acute appendicitis?

Viral infection spreading from the respiratory tract
Allergic reaction to certain foods
Bacterial infection from contaminated food
Obstruction of the appendiceal lumen, often by a fecalith (Correct answer)

Correct answer: Obstruction of the appendiceal lumen, often by a fecalith

Acute appendicitis most commonly results from obstruction of the appendiceal lumen by a fecalith (hardened stool), lymphoid hyperplasia, or rarely a foreign body, leading to inflammation and infection.

Question 45: How should challenges in professional standards and ethics be addressed?

Ignore challenges until they resolve themselves
Delegate all challenges to supervisors
Apply systematic problem-solving, seek expert guidance when needed, and document decisions (Correct answer)
Avoid challenges and stick to familiar tasks

Correct answer: Apply systematic problem-solving, seek expert guidance when needed, and document decisions

Systematic problem-solving combined with appropriate consultation and documentation ensures challenges are addressed effectively.

Question 46: A patient presents with polyuria, polydipsia, and unexplained weight loss. Which condition should be investigated first?

Diabetes mellitus (Correct answer)
Chronic kidney disease
Hyperthyroidism
Urinary tract infection

Correct answer: Diabetes mellitus

The classic triad of polyuria (frequent urination), polydipsia (excessive thirst), and unexplained weight loss strongly suggests diabetes mellitus, requiring blood glucose testing.

Question 47: What is the foundational principle of applied methods and techniques in the Professional and Linguistic Assessments Board field?

Avoiding all challenging situations
Following the easiest path available
Maintaining competence, integrity, and service to stakeholders (Correct answer)
Maximizing personal advancement

Correct answer: Maintaining competence, integrity, and service to stakeholders

The foundational principles of applied methods and techniques in Professional and Linguistic Assessments Board center on maintaining competence, integrity, and quality service.

Question 48: Under the Mental Health Act in England, which section specifically allows compulsory admission for treatment of a patient with schizophrenia who poses a risk to themselves or others?

Section 2
Section 4
Section 5(2)
Section 3 (Correct answer)

Correct answer: Section 3

Section 3 allows compulsory admission for treatment for up to 6 months when the patient has a mental disorder and poses a risk to themselves or others.

Question 49: What is a recommended first step in preparing for the PLAB test?

Scheduling the test without preparation.
Reviewing the PLAB blueprint and guidelines. (Correct answer)
Taking mock exams immediately.
Enrolling in an advanced English course.

Correct answer: Reviewing the PLAB blueprint and guidelines.

A recommended first step in preparing for the PLAB test is to thoroughly review the PLAB blueprint and guidelines. This provides candidates with a clear understanding of the exam's structure, content, and the specific competencies assessed, enabling them to plan their study effectively and focus on relevant topics.

Question 50: What are the signs of peritonitis on abdominal examination?

Normal abdominal examination with groin pain
Board-like rigidity, rebound tenderness, and guarding (Correct answer)
Localized swelling without tenderness
Soft, non-tender abdomen with active bowel sounds

Correct answer: Board-like rigidity, rebound tenderness, and guarding

Peritonitis presents with a rigid, board-like abdomen, rebound tenderness (pain on release of pressure), involuntary guarding, and absent bowel sounds, indicating peritoneal inflammation.

Question 51: A woman at 39 weeks presents with regular contractions. CTG shows prolonged deceleration to 80 bpm lasting 4 minutes that does not recover. What is the most appropriate action?

Continue monitoring and reassess in 30 minutes
Emergency cesarean section (Correct answer)
Increase oxytocin infusion rate
Administer tocolytics and await spontaneous recovery

Correct answer: Emergency cesarean section

A prolonged deceleration lasting more than 3 minutes is a CTG emergency requiring immediate delivery, typically by emergency cesarean section (Category 1), as it indicates severe fetal compromise.

Question 52: Which component is part of PLAB Part 1?

Practical procedure demonstrations.
Language proficiency test.
Multiple-choice questions (MCQs). (Correct answer)
Objective Structured Clinical Examination (OSCE).

Correct answer: Multiple-choice questions (MCQs).

PLAB Part 1 is a written examination consisting entirely of multiple-choice questions (MCQs). This part of the test assesses a candidate's ability to apply their knowledge to the care of patients, rather than just recalling facts. It covers common, important, or serious conditions seen in the UK, focusing on the management of patients in various settings.

Question 53: A 50-year-old postmenopausal woman presents with vaginal bleeding. What is the most important first investigation?

Pelvic MRI
Pap smear
Endometrial biopsy (Correct answer)
Serum CA-125

Correct answer: Endometrial biopsy

Postmenopausal bleeding must be evaluated with endometrial biopsy (or transvaginal ultrasound measuring endometrial thickness) to exclude endometrial carcinoma, which is the most concerning cause.

Question 54: What does PLAB certification signify about a medical professional?

Competence in core medical knowledge and skills. (Correct answer)
Proficiency in advanced surgical procedures.
Expertise in medical research only.
Specialization in a medical field.

Correct answer: Competence in core medical knowledge and skills.

PLAB certification signifies that a medical professional has demonstrated competence in the core medical knowledge and clinical skills expected of a doctor entering the UK healthcare system. It confirms their ability to apply medical principles effectively and safely, aligning with the standards of a Foundation Year 2 (FY2) doctor.

Question 55: Why is time management important during PLAB preparation?

To complete preparation in a single session.
To focus only on easy topics.
To allocate sufficient time to all subjects and practical skills. (Correct answer)
To avoid taking breaks.

Correct answer: To allocate sufficient time to all subjects and practical skills.

Time management is crucial during PLAB preparation to ensure sufficient time is allocated to all subjects and practical skills. Given the extensive curriculum, effective scheduling prevents last-minute cramming and promotes a balanced, comprehensive understanding necessary for success in both parts of the exam.

Question 56: What role do study groups play in PLAB preparation?

They offer peer support and varied perspectives on challenging topics. (Correct answer)
They eliminate the need for additional resources.
They are a substitute for individual study.
They focus solely on theoretical knowledge.

Correct answer: They offer peer support and varied perspectives on challenging topics.

Study groups play a valuable role in PLAB preparation by offering peer support and varied perspectives on challenging topics. Collaborating with others allows candidates to discuss complex concepts, share insights, and clarify doubts, which can deepen understanding and make learning more effective than individual study alone.

Question 57: What is the purpose of the PLAB certification?

To allow automatic residency.
To replace specialty training requirements.
To validate medical knowledge and skills for UK practice. (Correct answer)
To provide free medical education.

Correct answer: To validate medical knowledge and skills for UK practice.

The purpose of PLAB certification is to validate that an international medical graduate's medical knowledge and clinical skills meet the standards required for safe and effective practice within the UK healthcare system. It serves as a crucial assessment to ensure competence before a doctor can register with the GMC.

Question 58: A 28-year-old has recurrent 4-day episodes of elevated mood, increased energy, decreased sleep, and heightened productivity that do not cause severe impairment or require hospitalization. He also has a history of major depressive episodes. What is the most likely diagnosis?

Major depressive disorder with mixed features
Bipolar I disorder
Cyclothymia
Bipolar II disorder (Correct answer)

Correct answer: Bipolar II disorder

Bipolar II disorder is characterized by at least one hypomanic episode lasting ≥4 days without severe impairment plus at least one major depressive episode.

Question 59: Which investigation is the gold standard for diagnosing pulmonary embolism?

Chest X-ray
CT pulmonary angiography (CTPA) (Correct answer)
Electrocardiogram
D-dimer blood test

Correct answer: CT pulmonary angiography (CTPA)

CT pulmonary angiography is the gold standard investigation for diagnosing pulmonary embolism, providing direct visualization of clots in the pulmonary arterial system.

Question 60: A 45-year-old with depression is found hoarding large quantities of medication at home and expresses hopelessness, stating his family would be better off without him. What is the most appropriate immediate action?

Increase the antidepressant dose
Urgent crisis assessment and consider inpatient admission (Correct answer)
Schedule outpatient CBT next week
Advise the patient to call a helpline if needed

Correct answer: Urgent crisis assessment and consider inpatient admission

Active suicidal ideation with a specific plan and available means (hoarded medications) constitutes a psychiatric emergency requiring urgent risk assessment and likely inpatient admission.

Question 61: How should assessment and evaluation knowledge be maintained and updated?

Learning stops after certification
Knowledge updates are only needed every five years
Through continuous professional development, current literature review, and professional networking (Correct answer)
Initial training provides lifelong competence

Correct answer: Through continuous professional development, current literature review, and professional networking

Professional competence requires ongoing development through education, literature review, and engagement with the professional community.

Question 62: A patient on a statin reports new-onset muscle pain. What blood test should be ordered?

Serum calcium
Blood glucose
Thyroid function tests
Creatine kinase (CK) levels (Correct answer)

Correct answer: Creatine kinase (CK) levels

Statin-related myopathy is assessed by measuring creatine kinase levels. Significantly elevated CK suggests muscle damage (rhabdomyolysis) requiring immediate statin discontinuation.

Question 63: What is the Glasgow Coma Scale (GCS) used to assess?

The degree of bone fracture displacement
Blood glucose levels in diabetic patients
The severity of chronic pain
Level of consciousness based on eye opening, verbal response, and motor response (Correct answer)

Correct answer: Level of consciousness based on eye opening, verbal response, and motor response

The GCS scores three components — eye opening (1-4), verbal response (1-5), and motor response (1-6) — with a total range of 3-15, where lower scores indicate deeper impairment of consciousness.

Question 64: How should professionals apply professional standards and ethics in daily practice?

Consistently integrate best practices into every aspect of professional work (Correct answer)
Follow standards only for complex tasks
Only when being evaluated
Apply principles selectively based on convenience

Correct answer: Consistently integrate best practices into every aspect of professional work

Consistent application of professional standards ensures quality outcomes and builds professional credibility.

Question 65: How should professionals apply core concepts and principles in daily practice?

Apply principles selectively based on convenience
Follow standards only for complex tasks
Only when being evaluated
Consistently integrate best practices into every aspect of professional work (Correct answer)

Correct answer: Consistently integrate best practices into every aspect of professional work

Consistent application of professional standards ensures quality outcomes and builds professional credibility.

Question 66: How can candidates improve their clinical skills for PLAB Part 2?

Watching online tutorials only.
Reading case studies without practice.
Memorizing clinical definitions.
Attending hands-on simulation training sessions. (Correct answer)

Correct answer: Attending hands-on simulation training sessions.

PLAB Part 2 is an Objective Structured Clinical Examination (OSCE) that assesses practical clinical skills. Attending hands-on simulation training sessions is crucial for improving these skills, as it provides a realistic environment to practice patient interactions, examinations, and procedures, which are vital for success in this part of the exam.

Question 67: A 6-year-old boy is brought in with episodic facial flushing, abdominal pain, and dark spots appearing on his lips and buccal mucosa. His father had similar symptoms. What syndrome does this suggest?

Gardner syndrome
Familial adenomatous polyposis
Juvenile polyposis syndrome
Peutz-Jeghers syndrome (Correct answer)

Correct answer: Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is an autosomal dominant condition characterized by hamartomatous gastrointestinal polyps and mucocutaneous melanin pigmentation (dark spots on lips, buccal mucosa, and fingers), with increased GI and other cancer risk.

Question 68: What quality assurance measure supports assessment and evaluation?

Quality only matters for new practitioners
Annual review is sufficient
Regular self-assessment, peer review, and adherence to established standards (Correct answer)
Quality checks are unnecessary for experienced professionals

Correct answer: Regular self-assessment, peer review, and adherence to established standards

Ongoing quality assurance through self-assessment, peer review, and standards adherence ensures continuous improvement.

Question 69: How should challenges in core concepts and principles be addressed?

Avoid challenges and stick to familiar tasks
Apply systematic problem-solving, seek expert guidance when needed, and document decisions (Correct answer)
Ignore challenges until they resolve themselves
Delegate all challenges to supervisors

Correct answer: Apply systematic problem-solving, seek expert guidance when needed, and document decisions

Systematic problem-solving combined with appropriate consultation and documentation ensures challenges are addressed effectively.

Question 70: What quality assurance measure supports core concepts and principles?

Annual review is sufficient
Quality checks are unnecessary for experienced professionals
Regular self-assessment, peer review, and adherence to established standards (Correct answer)
Quality only matters for new practitioners

Correct answer: Regular self-assessment, peer review, and adherence to established standards

Ongoing quality assurance through self-assessment, peer review, and standards adherence ensures continuous improvement.

Question 71: A 28-year-old woman at 32 weeks gestation presents with sudden-onset severe headache, visual disturbances, and BP of 160/110 mmHg. What is the most likely diagnosis?

Pre-eclampsia (Correct answer)
Migraine
Intracranial hemorrhage
Tension headache

Correct answer: Pre-eclampsia

Pre-eclampsia is defined by hypertension (≥140/90 mmHg) with proteinuria or end-organ dysfunction after 20 weeks gestation, and severe features include BP ≥160/110 mmHg with neurological symptoms.

Question 72: What quality assurance measure supports applied methods and techniques?

Quality checks are unnecessary for experienced professionals
Quality only matters for new practitioners
Regular self-assessment, peer review, and adherence to established standards (Correct answer)
Annual review is sufficient

Correct answer: Regular self-assessment, peer review, and adherence to established standards

Ongoing quality assurance through self-assessment, peer review, and standards adherence ensures continuous improvement.

Question 73: What ethical standard governs professional standards and ethics practice?

Ethics are personal opinions, not professional requirements
Ethical standards are optional for certified professionals
Adherence to the profession's code of ethics and applicable laws and regulations (Correct answer)
Ethics only apply in academic settings

Correct answer: Adherence to the profession's code of ethics and applicable laws and regulations

Professional ethics codes and applicable laws provide the framework for ethical practice in every professional field.

Question 74: A 19-year-old male presents with auditory hallucinations, delusions of persecution, and social withdrawal for 6 months. What is the most appropriate first-line pharmacological treatment?

Risperidone (Correct answer)
Fluoxetine
Diazepam
Lithium carbonate

Correct answer: Risperidone

Atypical antipsychotics such as risperidone are recommended as first-line pharmacological treatment for schizophrenia.

Question 75: A 25-year-old describes intrusive thoughts about contamination, spends hours washing hands, and recognizes these thoughts as irrational. What is the diagnosis?

Obsessive-compulsive disorder (Correct answer)
Generalized anxiety disorder
Specific phobia
Illness anxiety disorder

Correct answer: Obsessive-compulsive disorder

OCD is defined by ego-dystonic obsessions and compulsions; the patient's insight into irrationality is a classic feature.

Question 76: How many questions are included in PLAB Part 1?

120 questions.
150 questions.
200 questions. (Correct answer)
250 questions.

Correct answer: 200 questions.

PLAB Part 1 consists of 200 multiple-choice questions. Candidates are given three hours to complete the exam. This extensive number of questions ensures a broad assessment of medical knowledge across various specialties and clinical scenarios relevant to practicing medicine in the UK.

Question 77: What is the initial management for a tension pneumothorax?

Needle decompression followed by chest tube insertion (Correct answer)
Emergency thoracotomy in the operating room
Oral antibiotics and rest
Observation and serial chest X-rays

Correct answer: Needle decompression followed by chest tube insertion

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression (2nd intercostal space, midclavicular line) to relieve the life-threatening pressure, followed by definitive chest tube placement.

Question 78: What documents are required during the application process for PLAB?

Proof of medical qualification, valid ID, and English proficiency certificate. (Correct answer)
Evidence of residency in the UK.
A recommendation letter from a UK doctor.
Only a copy of the passport.

Correct answer: Proof of medical qualification, valid ID, and English proficiency certificate.

To ensure eligibility for the PLAB test, the General Medical Council (GMC) requires specific documentation from candidates. These essential documents include proof of a recognized medical qualification, a valid form of identification, and an English language proficiency certificate, all of which are fundamental prerequisites for medical practice in the UK.

Question 79: A 9-month-old infant is brought in with a 2-day history of diarrhea, vomiting, and mild dehydration. Stool examination shows no blood. What is the most likely causative organism?

Campylobacter
Salmonella
Escherichia coli O157:H7
Rotavirus (Correct answer)

Correct answer: Rotavirus

Rotavirus is the most common cause of acute gastroenteritis in infants and young children aged 6–24 months, causing watery (non-bloody) diarrhea and vomiting, particularly in the winter months.

Question 80: Which class of medication is first-line for treating hypertension in patients under 55 years old according to current guidelines?

Thiazide diuretics
Calcium channel blockers
ACE inhibitors or ARBs (Correct answer)
Beta-blockers

Correct answer: ACE inhibitors or ARBs

ACE inhibitors (e.g., ramipril) or ARBs (e.g., losartan) are first-line antihypertensives for patients under 55, as they target the renin-angiotensin system that is typically more active in younger patients.

Question 81: A 55-year-old male presents with crushing central chest pain radiating to the left arm and jaw. What is the most likely diagnosis?

Musculoskeletal chest pain
Gastroesophageal reflux disease
Acute myocardial infarction (Correct answer)
Pulmonary embolism

Correct answer: Acute myocardial infarction

Crushing central chest pain radiating to the left arm and jaw in a middle-aged male is a classic presentation of acute myocardial infarction requiring immediate assessment and treatment.

Question 82: What is the mechanism of action of combined oral contraceptive pills (COCPs) in preventing pregnancy?

Inhibiting sperm motility
Thickening cervical mucus only
Preventing implantation only
Inhibiting ovulation via suppression of LH and FSH (Correct answer)

Correct answer: Inhibiting ovulation via suppression of LH and FSH

COCPs primarily work by suppressing the LH surge and FSH release through negative feedback on the hypothalamic-pituitary axis, thereby inhibiting ovulation; secondary mechanisms include cervical mucus thickening and endometrial changes.

Question 83: A patient on lithium presents with coarse tremor, vomiting, confusion, and ataxia. What is the most important immediate step?

Increase fluid intake and continue lithium
Add propranolol to manage the tremor
Measure serum lithium level urgently (Correct answer)
Switch to valproate immediately

Correct answer: Measure serum lithium level urgently

The constellation of neurological and gastrointestinal symptoms suggests lithium toxicity; an urgent serum lithium level is essential to confirm and guide management.

Question 84: How should applied methods and techniques knowledge be maintained and updated?

Learning stops after certification
Through continuous professional development, current literature review, and professional networking (Correct answer)
Knowledge updates are only needed every five years
Initial training provides lifelong competence

Correct answer: Through continuous professional development, current literature review, and professional networking

Professional competence requires ongoing development through education, literature review, and engagement with the professional community.

Question 85: How should challenges in applied methods and techniques be addressed?

Avoid challenges and stick to familiar tasks
Apply systematic problem-solving, seek expert guidance when needed, and document decisions (Correct answer)
Delegate all challenges to supervisors
Ignore challenges until they resolve themselves

Correct answer: Apply systematic problem-solving, seek expert guidance when needed, and document decisions

Systematic problem-solving combined with appropriate consultation and documentation ensures challenges are addressed effectively.

Question 86: Which developmental milestone should a child typically achieve by 18 months of age?

Riding a tricycle
Speaking in 4–6 word sentences
Walking independently (Correct answer)
Reading simple words

Correct answer: Walking independently

Independent walking is typically achieved between 9–15 months, and failure to walk by 18 months is a developmental red flag requiring assessment; most children walk confidently by 12–15 months.

Question 87: Which finding on newborn examination is a normal variant and requires no treatment?

Mongolian blue spot on the lower back (Correct answer)
Subconjunctival hemorrhage with proptosis
Unilateral undescended testis at 12 months
Erb's palsy with no recovery at 3 months

Correct answer: Mongolian blue spot on the lower back

Mongolian spots (congenital dermal melanocytosis) are blue-grey pigmented areas on the lower back/buttocks seen commonly in Asian, Black, and Hispanic neonates; they are benign and typically fade by early childhood.

Question 88: How should professionals apply applied methods and techniques in daily practice?

Only when being evaluated
Consistently integrate best practices into every aspect of professional work (Correct answer)
Apply principles selectively based on convenience
Follow standards only for complex tasks

Correct answer: Consistently integrate best practices into every aspect of professional work

Consistent application of professional standards ensures quality outcomes and builds professional credibility.

Question 89: What is the benefit of using mock exams in PLAB preparation?

To avoid studying other materials.
To memorize questions for the real exam.
To eliminate the need for clinical training.
To practice under timed conditions and improve test readiness. (Correct answer)

Correct answer: To practice under timed conditions and improve test readiness.

Mock exams are an essential tool for PLAB preparation as they allow candidates to practice under timed conditions, simulating the actual test environment. This helps improve time management, identify areas needing further study, and build confidence, ultimately enhancing overall test readiness and performance.

Question 90: Which mood stabilizer requires regular monitoring of serum levels, renal function, and thyroid function due to its narrow therapeutic index?

Lamotrigine
Carbamazepine
Sodium valproate
Lithium (Correct answer)

Correct answer: Lithium

Lithium has a narrow therapeutic index and long-term use can cause hypothyroidism and nephrogenic diabetes insipidus, necessitating regular monitoring.

Question 91: A 45-year-old woman presents with heavy menstrual bleeding, pelvic pressure, and urinary frequency. Pelvic examination reveals an enlarged, irregular uterus. What is the most likely diagnosis?

Endometrial carcinoma
Endometriosis
Adenomyosis
Uterine fibroids (leiomyomas) (Correct answer)

Correct answer: Uterine fibroids (leiomyomas)

Uterine fibroids (leiomyomas) are benign smooth muscle tumors causing uterine enlargement with irregular contour, heavy menstrual bleeding, and bulk symptoms such as pelvic pressure and urinary frequency.

Question 92: A 30-year-old experiences recurrent unexpected episodes of intense fear with palpitations, shortness of breath, sweating, and a feeling of impending doom, each lasting about 10 minutes. What is the most likely diagnosis?

Panic disorder (Correct answer)
Agoraphobia
Social anxiety disorder
Generalized anxiety disorder

Correct answer: Panic disorder

Panic disorder is characterized by recurrent unexpected panic attacks with persistent concern about future attacks or their consequences.

Question 93: A pregnant woman at 26 weeks has a routine glucose challenge test (GCT) result of 165 mg/dL. What is the next step?

Repeat the GCT in 4 weeks
Diagnose gestational diabetes and start insulin
Perform a 3-hour 100g oral glucose tolerance test (OGTT) (Correct answer)
No further testing needed

Correct answer: Perform a 3-hour 100g oral glucose tolerance test (OGTT)

A GCT result ≥140 mg/dL (some centers use ≥130 mg/dL) is a positive screen that requires confirmation with a diagnostic 3-hour 100g OGTT to diagnose or exclude gestational diabetes mellitus.

Question 94: Which medication is first-line for cervical ripening and labor induction in a patient with an unfavorable cervix at term?

Dinoprostone (prostaglandin E2) (Correct answer)
Mifepristone
Oxytocin IV infusion
Misoprostol

Correct answer: Dinoprostone (prostaglandin E2)

Dinoprostone (prostaglandin E2) gel or insert is the standard first-line agent for cervical ripening in patients with an unfavorable Bishop score at term.

Question 95: Which hormone is measured in a serum pregnancy test, and at what level does a transvaginal ultrasound typically visualize an intrauterine gestational sac?

hCG; >1500–2000 mIU/mL (Correct answer)
Estradiol; >200 pg/mL
LH; >25 IU/L
Progesterone; >500 mIU/mL

Correct answer: hCG; >1500–2000 mIU/mL

Human chorionic gonadotropin (hCG) is produced by the syncytiotrophoblast after implantation, and a transvaginal ultrasound can typically identify an intrauterine gestational sac when hCG exceeds 1500–2000 mIU/mL (the discriminatory zone).

Question 96: What ethical standard governs assessment and evaluation practice?

Ethics only apply in academic settings
Ethical standards are optional for certified professionals
Ethics are personal opinions, not professional requirements
Adherence to the profession's code of ethics and applicable laws and regulations (Correct answer)

Correct answer: Adherence to the profession's code of ethics and applicable laws and regulations

Professional ethics codes and applicable laws provide the framework for ethical practice in every professional field.

Question 97: Which psychological intervention has the strongest evidence base for the treatment of PTSD according to NICE guidelines?

Mindfulness-based stress reduction
Psychodynamic therapy
Supportive counseling
Trauma-focused CBT or EMDR (Correct answer)

Correct answer: Trauma-focused CBT or EMDR

NICE guidelines recommend trauma-focused CBT and Eye Movement Desensitization and Reprocessing (EMDR) as first-line psychological treatments for PTSD.

Question 98: Which organism is the most common cause of bacterial meningitis in children aged 1 month to 5 years?

Listeria monocytogenes
Neisseria meningitidis
Streptococcus pneumoniae (Correct answer)
Haemophilus influenzae type b

Correct answer: Streptococcus pneumoniae

Streptococcus pneumoniae is the most common cause of bacterial meningitis in children over 1 month of age (along with Neisseria meningitidis), with pneumococcal meningitis carrying a higher mortality and complication rate.

Question 99: What is a 'Do Not Resuscitate' (DNR) order?

A medical order indicating that CPR should not be performed if the patient's heart stops (Correct answer)
An instruction to discharge the patient immediately
A request to not be given pain medication
A hospital policy that limits visiting hours

Correct answer: A medical order indicating that CPR should not be performed if the patient's heart stops

A DNR order is a medical directive stating that cardiopulmonary resuscitation should not be attempted if the patient experiences cardiac or respiratory arrest, respecting the patient's wishes about end-of-life care.

Question 100: A 22-year-old is brought in 2 hours after taking 30 paracetamol tablets. She is calm and denies current suicidal intent. What is the most important immediate action?

Refer to psychiatry only and observe
Discharge with urgent outpatient psychiatry referral
Administer N-acetylcysteine (Correct answer)
Perform gastric lavage

Correct answer: Administer N-acetylcysteine

N-acetylcysteine is the antidote for paracetamol overdose and must be administered urgently to prevent potentially fatal hepatotoxicity.

Question 101: What is the antidote for paracetamol (acetaminophen) overdose?

Naloxone
Activated charcoal only
Flumazenil
N-acetylcysteine (NAC) (Correct answer)

Correct answer: N-acetylcysteine (NAC)

N-acetylcysteine is the specific antidote for paracetamol overdose, replenishing glutathione stores and protecting the liver from the toxic metabolite NAPQI.

Question 102: A 30-year-old woman is found to have a cervical smear showing high-grade dyskaryosis (CIN II–III). What is the recommended management?

HPV vaccination only
Immediate hysterectomy
Colposcopy and biopsy (Correct answer)
Repeat smear in 12 months

Correct answer: Colposcopy and biopsy

High-grade dyskaryosis (CIN II–III) on cervical smear requires urgent colposcopy with directed biopsy to confirm histology and guide treatment (e.g., LLETZ/LEEP excision).

Question 103: A 45-year-old with schizophrenia on haloperidol for 3 years develops involuntary repetitive movements of the mouth and tongue. What is the most likely diagnosis?

Acute dystonia
Drug-induced parkinsonism
Akathisia
Tardive dyskinesia (Correct answer)

Correct answer: Tardive dyskinesia

Tardive dyskinesia is a late-onset movement disorder caused by prolonged antipsychotic use, characteristically involving orofacial repetitive movements.

Question 104: A 32-year-old woman presents with recurrent binge eating followed by self-induced vomiting. Her BMI is 22. What is the most likely diagnosis?

Bulimia nervosa (Correct answer)
Anorexia nervosa binge-purge subtype
Avoidant/restrictive food intake disorder
Binge eating disorder

Correct answer: Bulimia nervosa

Bulimia nervosa is characterized by recurrent binge-purge cycles with a normal or near-normal BMI, distinguishing it from anorexia nervosa.

Question 105: When can candidates retake the PLAB test if they fail?

After completing an additional training program.
Immediately after failing.
After six months of the first attempt.
As per the test center's availability. (Correct answer)

Correct answer: As per the test center's availability.

Candidates who fail the PLAB test can retake it, but the timing is dependent on the availability of test slots at various centers. There isn't a fixed waiting period; instead, candidates must reapply and secure a booking based on the capacity and scheduling of the test centers, allowing for flexibility in retake attempts.

Question 106: A 12-year-old girl presents with polyuria, polydipsia, weight loss, and a blood glucose of 28 mmol/L. She is alert with Kussmaul breathing and blood gas shows pH 7.1. What is the diagnosis?

Diabetic ketoacidosis (DKA) (Correct answer)
Type 2 diabetes mellitus
Hyperosmolar hyperglycemic state
Diabetes insipidus

Correct answer: Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) in a child is defined by hyperglycemia, acidosis (pH <7.3), ketonemia/ketonuria, and dehydration, with Kussmaul (deep, rapid) breathing as a compensatory response to metabolic acidosis.

Question 107: A 70-year-old develops sudden-onset confusion and visual hallucinations fluctuating throughout the day, 2 days after hip replacement surgery. What is the most likely diagnosis?

Delirium (Correct answer)
Acute psychosis
Alzheimer's dementia
Lewy body dementia

Correct answer: Delirium

Delirium is characterized by acute onset, fluctuating consciousness, and is a common postoperative complication, particularly in elderly patients.

Question 108: Who is eligible to take the Professional and Linguistic Assessments Board (PLAB) test?

UK medical graduates.
International medical graduates with a recognized primary medical qualification. (Correct answer)
Individuals with nursing qualifications.
Graduates of non-medical fields.

Correct answer: International medical graduates with a recognized primary medical qualification.

Eligibility for the PLAB test is specifically for international medical graduates (IMGs) who hold a primary medical qualification recognized by the General Medical Council (GMC). This ensures that candidates have completed a medical degree that meets international standards. UK medical graduates do not need to take PLAB as their qualifications are already recognized.

Question 109: What is a mandatory requirement before applying for the PLAB test?

Demonstrating English language proficiency through an approved test. (Correct answer)
Registration with the General Medical Council (GMC).
A minimum of five years of medical practice.
Completion of an internship in the UK.

Correct answer: Demonstrating English language proficiency through an approved test.

A mandatory requirement before applying for the PLAB test is to demonstrate English language proficiency. This is typically done by achieving the required scores in an approved English language test, such as IELTS or OET. This ensures that international medical graduates can communicate effectively with patients and colleagues in the UK healthcare system.

Question 110: A 7-year-old boy with known asthma presents with a wheeze, respiratory rate of 40/min, SpO2 88% on air, and is unable to complete sentences. What severity of asthma attack is this?

Mild acute asthma
Moderate acute asthma
Life-threatening asthma (Correct answer)
Severe acute asthma

Correct answer: Life-threatening asthma

Life-threatening asthma in children includes SpO2 <92%, silent chest, cyanosis, poor respiratory effort, exhaustion, or altered consciousness; SpO2 of 88% meets this threshold and requires immediate aggressive management.

Question 111: What are the four pillars of medical ethics?

Autonomy, beneficence, non-maleficence, and justice (Correct answer)
Honesty, charity, loyalty, and efficiency
Privacy, dignity, safety, and transparency
Consent, confidentiality, competence, and care

Correct answer: Autonomy, beneficence, non-maleficence, and justice

The four pillars of medical ethics — autonomy (patient choice), beneficence (doing good), non-maleficence (do no harm), and justice (fairness) — guide all medical decision-making.

Question 112: How should professionals apply assessment and evaluation in daily practice?

Only when being evaluated
Consistently integrate best practices into every aspect of professional work (Correct answer)
Apply principles selectively based on convenience
Follow standards only for complex tasks

Correct answer: Consistently integrate best practices into every aspect of professional work

Consistent application of professional standards ensures quality outcomes and builds professional credibility.

Question 113: What is the hallmark ECG finding in complete atrioventricular (AV) block in a neonate?

Prolonged QT interval
Short PR interval with delta wave
ST elevation in V1–V3
Complete dissociation between P waves and QRS complexes (Correct answer)

Correct answer: Complete dissociation between P waves and QRS complexes

Complete (third-degree) AV block is characterized on ECG by complete dissociation between atrial P waves and ventricular QRS complexes, with the ventricles beating independently at a slow escape rate.

Question 114: What is the foundational principle of core concepts and principles in the Professional and Linguistic Assessments Board field?

Avoiding all challenging situations
Following the easiest path available
Maximizing personal advancement
Maintaining competence, integrity, and service to stakeholders (Correct answer)

Correct answer: Maintaining competence, integrity, and service to stakeholders

The foundational principles of core concepts and principles in Professional and Linguistic Assessments Board center on maintaining competence, integrity, and quality service.

Question 115: What is the most common cause of postpartum hemorrhage (PPH)?

Coagulopathy
Retained placenta
Uterine atony (Correct answer)
Genital tract trauma

Correct answer: Uterine atony

Uterine atony (failure of the uterus to contract adequately after delivery) accounts for approximately 70–80% of postpartum hemorrhage cases, making it the most common cause.

Question 116: What is the recommended maintenance fluid for children in most UK pediatric settings?

0.9% NaCl with 5% dextrose (Correct answer)
5% dextrose alone
0.9% normal saline alone
0.45% NaCl with 5% dextrose

Correct answer: 0.9% NaCl with 5% dextrose

Current NICE guidelines recommend isotonic fluids (0.9% NaCl with 5% dextrose) for pediatric maintenance to reduce the risk of hyponatremia that occurred with hypotonic solutions.

Question 117: What is the first-line treatment for community-acquired pneumonia in an otherwise healthy adult in the United States?

Amoxicillin or azithromycin (Correct answer)
Oral metronidazole
Topical gentamicin
Intravenous vancomycin

Correct answer: Amoxicillin or azithromycin

For community-acquired pneumonia in healthy adults without comorbidities, amoxicillin or azithromycin (for penicillin-allergic patients) is recommended as first-line outpatient therapy.

Question 118: What is the first-line treatment for a febrile seizure in a child who is currently seizing for more than 5 minutes?

Rectal diazepam or buccal/intranasal midazolam (Correct answer)
IV lorazepam only
Oral paracetamol
IV phenytoin

Correct answer: Rectal diazepam or buccal/intranasal midazolam

Prolonged febrile seizures (>5 minutes) are treated as status epilepticus; rectal diazepam or buccal/intranasal midazolam are the first-line benzodiazepines recommended when IV access is unavailable in the community or prehospital setting.

Question 119: Which antibiotic is recommended for Group B Streptococcus (GBS) prophylaxis during labor in penicillin-allergic patients with low anaphylaxis risk?

Vancomycin
Erythromycin
Clindamycin
Cefazolin (Correct answer)

Correct answer: Cefazolin

Cefazolin is the recommended alternative for GBS intrapartum prophylaxis in penicillin-allergic patients with low risk of anaphylaxis (no history of urticaria, angioedema, or anaphylaxis to penicillin).

Question 120: A 62-year-old presents with a 2-year history of progressive memory loss, getting lost in familiar areas, and personality changes. MMSE score is 18/30. What is the most likely diagnosis?

Alzheimer's disease (Correct answer)
Frontotemporal dementia
Delirium
Vascular dementia

Correct answer: Alzheimer's disease

Alzheimer's disease is the most common cause of dementia, presenting with insidious progressive memory loss, disorientation, and behavioral changes.

Question 121: A primigravida at 38 weeks presents with mild contractions and her cervix is 4 cm dilated, fully effaced, with the fetal head at 0 station. What stage of labor is she in?

Active phase of first stage (Correct answer)
Second stage
Latent phase of first stage
Third stage

Correct answer: Active phase of first stage

The active phase of the first stage of labor begins at 6 cm dilation in most modern guidelines, but reaching 4 cm effaced with regular contractions is transitioning into active labor; cervical dilation ≥6 cm with contractions defines active phase per ACOG 2014 guidelines.

Question 122: A 32-year-old woman at 34 weeks gestation presents with painless bright red vaginal bleeding. Ultrasound confirms placenta previa. What is the most appropriate immediate management?

Emergency cesarean section
Immediate digital cervical examination
IV access, blood type and crossmatch, IV fluids, and obstetric team review (Correct answer)
Amniotomy to expedite delivery

Correct answer: IV access, blood type and crossmatch, IV fluids, and obstetric team review

Initial management of placenta previa with bleeding involves stabilizing the patient with IV access, blood typing and crossmatch, IV fluid resuscitation, and urgent obstetric team involvement; digital vaginal examination is contraindicated.

Question 123: A 16-year-old girl with a BMI of 15.5 presents with severe caloric restriction, intense fear of weight gain, and distorted body image. What is the most appropriate initial management priority?

Family-based therapy alone
Outpatient CBT alone
Medical stabilization and inpatient nutritional rehabilitation (Correct answer)
Initiate fluoxetine

Correct answer: Medical stabilization and inpatient nutritional rehabilitation

Severe anorexia nervosa with a very low BMI requires urgent medical stabilization and nutritional rehabilitation, often necessitating inpatient admission before psychological treatment.

Question 124: A 28-year-old presents with persistent low mood, anhedonia, disturbed sleep, and poor concentration lasting 3 months. Which diagnosis is most likely?

Bipolar disorder
Adjustment disorder
Dysthymia
Major depressive disorder (Correct answer)

Correct answer: Major depressive disorder

Major depressive disorder requires depressed mood or anhedonia plus at least four additional symptoms persisting for a minimum of two weeks.

Question 125: Which finding on fetal cardiotocography (CTG) is most reassuring of fetal well-being?

Sinusoidal pattern
Baseline fetal heart rate of 155 bpm with good variability and accelerations (Correct answer)
Late decelerations with reduced variability
Variable decelerations with good baseline variability

Correct answer: Baseline fetal heart rate of 155 bpm with good variability and accelerations

A baseline fetal heart rate of 110–160 bpm with normal variability (6–25 bpm) and accelerations indicates a reactive, well-oxygenated fetus on CTG monitoring.

Question 126: What is the foundational principle of assessment and evaluation in the Professional and Linguistic Assessments Board field?

Maintaining competence, integrity, and service to stakeholders (Correct answer)
Following the easiest path available
Maximizing personal advancement
Avoiding all challenging situations

Correct answer: Maintaining competence, integrity, and service to stakeholders

The foundational principles of assessment and evaluation in Professional and Linguistic Assessments Board center on maintaining competence, integrity, and quality service.

Question 127: In trauma assessment, what does the primary survey (ABCDE) stand for?

Anatomy, Biology, Chemistry, Drugs, Emergency
Airway, Breathing, Circulation, Disability, Exposure (Correct answer)
Assessment, Blood pressure, Chest, Diagnosis, Evaluation
Abdomen, Back, Chest, Digits, Eyes

Correct answer: Airway, Breathing, Circulation, Disability, Exposure

The ABCDE primary survey systematically assesses life-threatening conditions: Airway (with cervical spine protection), Breathing, Circulation (hemorrhage control), Disability (neurological status), and Exposure (undress and examine).

Question 128: A patient presents with sudden onset severe headache described as 'the worst headache of my life.' What is the most important diagnosis to exclude?

Migraine with aura
Tension headache
Subarachnoid hemorrhage (Correct answer)
Cluster headache

Correct answer: Subarachnoid hemorrhage

A sudden-onset severe 'thunderclap' headache described as the worst ever experienced requires urgent exclusion of subarachnoid hemorrhage, a potentially life-threatening condition.

Question 129: What is the next step after obtaining PLAB certification?

Begin specialty training immediately.
Seek permanent residency in the UK.
Apply for GMC registration. (Correct answer)
Enroll in advanced English courses.

Correct answer: Apply for GMC registration.

After successfully obtaining PLAB certification, the crucial next step for international medical graduates is to apply for full registration with the General Medical Council (GMC). This registration is a legal prerequisite for practicing medicine in the UK and is essential before commencing any medical employment.

PLAB 1 Medical Assessment

The PLAB 1 exam is set by the General Medical Council (GMC) and tests clinical knowledge across medicine, surgery, obstetrics, paediatrics, pharmacology, and ethics for international medical graduates seeking registration in the UK.

180

Questions

180 min

Time Limit

65%

To Pass

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