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Sample PLAB 1 Practice Questions

Try these sample questions to review concepts for the PLAB 1 exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 64-year-old man presents with central crushing chest pain radiating to his left arm for the past hour. ECG shows ST elevation in leads II, III and aVF. He has no contraindications to reperfusion and is 30 minutes from a primary PCI centre. What is the most appropriate immediate management?
A.Refer for primary percutaneous coronary intervention
B.Give thrombolysis with alteplase
C.Start a heparin infusion and admit for observation
D.Arrange an urgent outpatient exercise tolerance test
Explanation: This is an inferior STEMI. Primary PCI is the gold-standard reperfusion therapy in the UK when it can be delivered within 120 minutes of when thrombolysis could have been given. At 30 minutes from a PCI centre, immediate transfer for PCI is correct, alongside aspirin and a second antiplatelet.
2A 22-year-old woman is brought to the emergency department with widespread urticaria, lip swelling, wheeze and a blood pressure of 78/40 mmHg minutes after eating peanuts. What is the most appropriate first drug to administer?
A.Intramuscular adrenaline 500 micrograms (0.5 mL of 1:1000)
B.Intravenous hydrocortisone 200 mg
C.Intravenous chlorphenamine 10 mg
D.Nebulised salbutamol 5 mg
Explanation: This is anaphylaxis (airway/breathing/circulation compromise with a likely allergen). The first-line treatment is intramuscular adrenaline 500 micrograms (0.5 mL of 1:1000) into the anterolateral thigh, repeated after 5 minutes if there is no improvement.
3A 19-year-old man is found unresponsive after a paracetamol overdose. He took 30 tablets (500 mg each) approximately 6 hours ago. His paracetamol level is above the treatment line on the nomogram. What is the most appropriate management?
A.Activated charcoal
B.N-acetylcysteine infusion
C.Urgent haemodialysis
D.Observe and recheck level in 4 hours
Explanation: With a paracetamol level above the single treatment line at a known time of ingestion, N-acetylcysteine should be started. It replenishes glutathione and is most effective when given within 8 hours of ingestion, so prompt treatment here is essential.
4A 70-year-old woman presents with sudden severe tearing chest pain radiating to her back. She is hypertensive with a 20 mmHg difference in blood pressure between her arms. A chest X-ray shows a widened mediastinum. What is the most likely diagnosis?
A.Pulmonary embolism
B.Aortic dissection
C.Acute pericarditis
D.Tension pneumothorax
Explanation: Tearing chest pain radiating to the back, an inter-arm blood pressure differential and a widened mediastinum on chest X-ray are classic for aortic dissection. CT angiography of the aorta confirms the diagnosis and urgent vascular/cardiothoracic referral is required.
5A 45-year-old man presents to the emergency department with a temperature of 38.9 C, heart rate 118, respiratory rate 24, blood pressure 88/52 mmHg and a lactate of 4.2 mmol/L following a urinary tract infection. After taking blood cultures, what is the most important immediate intervention?
A.Wait for the lactate to be repeated before acting
B.Arrange an urgent CT abdomen
C.Start oral nitrofurantoin
D.Administer broad-spectrum intravenous antibiotics and a fluid bolus
Explanation: This patient has septic shock. The Sepsis Six bundle should be delivered within the first hour: give oxygen, take blood cultures, give IV antibiotics, give IV fluids, measure lactate and monitor urine output. Broad-spectrum IV antibiotics and a fluid bolus are the priority interventions.
6A 30-year-old man with type 1 diabetes presents with vomiting, abdominal pain and Kussmaul breathing. Capillary glucose is 28 mmol/L, blood ketones 5.1 mmol/L and venous pH 7.18. What is the most appropriate first step in management?
A.Intravenous 0.9% sodium chloride infusion
B.Fixed-rate intravenous insulin infusion before fluids
C.Intravenous sodium bicarbonate
D.Subcutaneous rapid-acting insulin only
Explanation: In diabetic ketoacidosis, fluid resuscitation with 0.9% sodium chloride is the first priority to correct the marked dehydration. A fixed-rate intravenous insulin infusion is then started, with potassium added to fluids once the level is known and the patient is passing urine.
7A 25-year-old woman presents with sudden-onset breathlessness and right-sided pleuritic chest pain. She is tachycardic and her oxygen saturation is 91% on air. She takes the combined oral contraceptive pill. A Wells score is calculated as 6. What is the most appropriate next investigation?
A.D-dimer
B.Lower limb venous Doppler ultrasound
C.CT pulmonary angiogram
D.Echocardiogram
Explanation: A Wells score above 4 makes PE likely, so a CT pulmonary angiogram (CTPA) should be arranged directly. A D-dimer is only useful when PE is unlikely (Wells 4 or less) to rule it out; with a high probability, imaging is required.
8A 55-year-old man collapses on the ward. He is unresponsive, not breathing normally and has no central pulse. The monitor shows ventricular fibrillation. After starting CPR, what is the most appropriate next action?
A.Give 1 mg intravenous adrenaline
B.Deliver a single unsynchronised DC shock
C.Give 300 mg intravenous amiodarone
D.Perform synchronised cardioversion
Explanation: Ventricular fibrillation is a shockable rhythm. The priority is immediate defibrillation with a single unsynchronised DC shock, then resume CPR for 2 minutes before reassessing. Adrenaline and amiodarone are given after the third shock.
9A 60-year-old man presents with severe vomiting of fresh blood. He has known alcohol-related cirrhosis. His blood pressure is 90/55 mmHg and heart rate 120. After resuscitation, which medication should be started to control suspected variceal bleeding before endoscopy?
A.Intravenous omeprazole
B.Oral propranolol
C.Intravenous tranexamic acid
D.Intravenous terlipressin
Explanation: In suspected variceal upper GI bleeding, terlipressin reduces portal pressure and is started as soon as variceal bleeding is suspected, along with prophylactic antibiotics. Endoscopy with band ligation should follow within 24 hours.
10A 35-year-old woman is brought in after a paracetamol and alcohol binge. She is drowsy with a Glasgow Coma Scale of 8. She is maintaining her own airway with snoring respirations. What is the most appropriate immediate action?
A.Insert a nasogastric tube
B.Perform a head-tilt chin-lift and consider an airway adjunct
C.Give intravenous flumazenil
D.Arrange an urgent CT head
Explanation: Snoring respirations indicate partial airway obstruction. The immediate priority following the ABCDE approach is to open the airway with a head-tilt chin-lift (or jaw thrust) and consider an airway adjunct such as a nasopharyngeal airway, while preparing for definitive airway protection given the low GCS.

About the PLAB 1 Exam

PLAB 1 is the first part of the GMC's PLAB test for international medical graduates seeking registration to practise medicine in the UK. It is a three-hour written exam of 180 single best answer questions built on the GMC MLA content map, testing applied clinical knowledge at the level of a doctor starting the second year of the UK Foundation Programme (FY2).

Exam sponsor: General Medical Council (GMC). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

A written applied knowledge test of 180 single best answer (SBA) multiple choice questions, each a short clinical scenario followed by five options from which one best answer is chosen.

Time Limit

3 hours

Passing Score

No fixed pass mark. The GMC sets the pass mark for each paper using the Angoff method plus one standard error of measurement, reflecting the standard of a doctor entering the second year of the Foundation Programme.

Exam / Certification Fees

GBP 283 for bookings from 1 April 2026 (GBP 273 from 1 April 2025), paid to the GMC

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

Not published

Reproductive health

Pregnancy and antenatal care, early pregnancy problems, labour and obstetric emergencies, contraception, menopause, gynaecological conditions and sexual health.

Not published

Renal and urology

Acute kidney injury, chronic kidney disease, electrolyte emergencies, urinary tract infection, renal colic, prostate disease, urological cancers and scrotal emergencies.

Not published

Neurosciences and senses (including skin)

Stroke, headache, seizures, CNS infection, neuromuscular disease, eye and ENT presentations, and dermatology.

Not published

Musculoskeletal

Inflammatory and crystal arthritis, osteoarthritis, back pain, osteoporosis, fractures, orthopaedic emergencies and soft tissue disorders.

Not published

Mental health

Depression, bipolar disorder, psychosis, anxiety, eating and personality disorders, delirium, dementia, substance misuse, self-harm and the Mental Health Act.

Not published

Gastrointestinal

GI bleeding, dyspepsia, inflammatory bowel disease, colorectal cancer referral, the acute abdomen, hepatobiliary disease and pancreatitis.

Not published

Endocrine, metabolic and clinical haematology

Diabetes and its emergencies, thyroid, adrenal and pituitary disease, anaemia, transfusion, haematological malignancy and anticoagulation.

Not published

Child and adolescent health

The febrile child, paediatric emergencies, neonatology, growth and development, safeguarding, immunisation and child mental health.

Not published

Cardiorespiratory

Acute coronary syndromes, heart failure, arrhythmias, hypertension, vascular disease, asthma, COPD, pneumonia, VTE and lung cancer.

Not published

Ethics and other

GMC Good Medical Practice, consent and capacity, confidentiality, safeguarding, end-of-life care, patient safety, prescribing, infection, public health and statistics.

Preparing for the PLAB 1 Exam

What You Need to Know

  • Passing score: No fixed pass mark. The GMC sets the pass mark for each paper using the Angoff method plus one standard error of measurement, reflecting the standard of a doctor entering the second year of the Foundation Programme.
  • Assessment: A written applied knowledge test of 180 single best answer (SBA) multiple choice questions, each a short clinical scenario followed by five options from which one best answer is chosen.
  • Time limit: 3 hours
  • Exam / certification fees: GBP 283 for bookings from 1 April 2026 (GBP 273 from 1 April 2025), paid to the GMC Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

PLAB 1: Suggested Study Strategy

1Use the GMC MLA content map as your checklist and prioritise the most common acute and chronic presentations, since most questions test safe, first-line management rather than rare diagnoses.
2Ground every answer in current UK practice (NICE guidelines, the BNF and GMC Good Medical Practice) because PLAB 1 tests UK-specific thresholds, first-line drugs and ethical and legal duties.
3Practise large numbers of timed single best answer questions to build pace (around one minute per question) and learn to choose the single best option when several answers look plausible.

Frequently Asked Questions

How many questions are in PLAB 1 and how long is the exam?

PLAB 1 is a written exam of 180 single best answer (SBA) multiple choice questions that must be answered within 3 hours. Each question is a short clinical scenario followed by five options.

What is the PLAB 1 pass mark?

There is no fixed pass mark. The GMC sets the pass mark for each paper using the Angoff standard-setting method plus one standard error of measurement. Your results show your score, the pass score and the average score for the paper.

What does PLAB 1 cover?

PLAB 1 is built on the GMC's MLA content map, covering applied clinical knowledge across the areas of clinical practice, professional knowledge and patient presentations expected of a doctor starting the second year of the UK Foundation Programme (FY2).

How much does PLAB 1 cost and where is it held?

From 1 April 2026 the PLAB 1 fee is GBP 283 (it was GBP 273 from 1 April 2025). UK, Dublin and Madrid venues are delivered by VICTVS, and overseas venues by the British Council.