PLAB 1 Sample Bank | Dr Sachin Swargiary

Free public preview: These 10 complete questions and explanations are open to everyone. Registered members receive access to the full 500 clinical SBAs.

001A 58-year-old man has 45 minutes of crushing central chest pain with diaphoresis. ECG shows ST elevation in V2-V5. He has no allergy and no active bleeding. Which is the single best diagnosis?Emergency

A. Delirium

B. Valid treatment refusal by an adult with capacity

C. Severe community-acquired pneumonia

D. Moderate dehydration from gastroenteritis

E. Anterior STEMI

Correct answer: E. Anterior STEMI
Explanation: Anterior STEMI best integrates the presentation. Do not delay reperfusion for routine blood results.

051A 74-year-old woman has palpitations and irregular pulse 132/min. She is haemodynamically stable and symptoms began 3 days ago. Which is the single best diagnosis?Cardiology

A. Hyperemesis gravidarum

B. Obstructive sleep apnoea

C. Infective endocarditis

D. Possible serious bacterial infection/sepsis

E. Atrial fibrillation

Correct answer: E. Atrial fibrillation
Explanation: Atrial fibrillation best integrates the presentation. Cardioversion strategy depends on duration, stability and anticoagulation.

101A 69-year-old smoker with COPD has worsening dyspnoea and purulent sputum. SpO2 is 82% on air. Which is the single best diagnosis?Respiratory

A. Endometrial malignancy until excluded

B. Hypertrophic pyloric stenosis

C. Nephrotic syndrome

D. Bell palsy

E. Acute COPD exacerbation

Correct answer: E. Acute COPD exacerbation
Explanation: Acute COPD exacerbation best integrates the presentation. Excess oxygen can worsen hypercapnia in susceptible patients.

151A 20-year-old develops central abdominal pain migrating to the right iliac fossa with anorexia and local tenderness. Which is the single best diagnosis?Gastroenterology

A. Severe community-acquired pneumonia

B. Pleural effusion

C. Transient ischaemic attack

D. Possible colorectal cancer

E. Acute appendicitis

Correct answer: E. Acute appendicitis
Explanation: Acute appendicitis best integrates the presentation. Pregnancy and atypical anatomy can alter presentation and imaging choice.

201A 70-year-old develops aphasia and right hemiparesis 90 minutes ago. CT shows no haemorrhage. Which is the single best diagnosis?Neurology

A. Possible serious bacterial infection/sepsis

B. Life-threatening hyperkalaemia

C. Spontaneous pneumothorax

D. Viral croup

E. Acute ischaemic stroke

Correct answer: E. Acute ischaemic stroke
Explanation: Acute ischaemic stroke best integrates the presentation. Time last known well and contraindications must be established immediately.

251A diabetic patient on insulin is sweaty, confused and capillary glucose is 2.1 mmol/L. Which is the single best diagnosis?Endocrine-Renal

A. Ovarian torsion

B. Hypertensive emergency

C. Acute pancreatitis

D. Acute kidney injury

E. Hypoglycaemia

Correct answer: E. Hypoglycaemia
Explanation: Hypoglycaemia best integrates the presentation. Recheck glucose and identify the cause after recovery.

301A 2-year-old has fever, lethargy, mottled skin and prolonged capillary refill. Which is the single best diagnosis?Paediatrics

A. Acute severe/life-threatening asthma

B. Possible lung cancer

C. Coeliac disease

D. Multiple sclerosis

E. Possible serious bacterial infection/sepsis

Correct answer: E. Possible serious bacterial infection/sepsis
Explanation: Possible serious bacterial infection/sepsis best integrates the presentation. Appearance and perfusion are more important than fever height alone.

351A 29-year-old with 7 weeks amenorrhoea has unilateral pelvic pain, spotting and positive pregnancy test. Which is the single best diagnosis?Obstetrics-Gynaecology

A. Sepsis with shock physiology

B. Acute pancreatitis

C. Bronchiectasis

D. Intussusception

E. Ectopic pregnancy

Correct answer: E. Ectopic pregnancy
Explanation: Ectopic pregnancy best integrates the presentation. Haemodynamic instability or suspected rupture requires emergency surgery.

401A 34-year-old with severe depression says he has bought tablets and plans to take them tonight. He asks you not to tell anyone. Which is the single best diagnosis?Psychiatry-Ethics

A. Aortic stenosis

B. Ectopic pregnancy

C. Bacterial meningitis/meningococcal disease

D. Acute ascending cholangitis

E. Major depression with immediate suicide risk

Correct answer: E. Major depression with immediate suicide risk
Explanation: Major depression with immediate suicide risk best integrates the presentation. Patient safety can justify necessary disclosure when there is imminent serious risk.

002A 58-year-old man has 45 minutes of crushing central chest pain with diaphoresis. ECG shows ST elevation in V2-V5. He has no allergy and no active bleeding. Which is the most appropriate next investigation or assessment?Emergency

A. Morning cortisol/ACTH and stimulation testing when stable

B. Immediate 12-lead ECG and urgent reperfusion pathway assessment

C. Immediate capillary glucose

D. Transvaginal ultrasound and serial quantitative hCG

E. Clinical diagnosis with specialist assessment

Correct answer: B. Immediate 12-lead ECG and urgent reperfusion pathway assessment
Explanation: Immediate 12-lead ECG and urgent reperfusion pathway assessment is the most appropriate next diagnostic/assessment step. Do not delay reperfusion for routine blood results.

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