No past PLAB 1 papers are published. What the GMC does publish is the scope of the exam and the ten content areas it reports your results in — and those tell you what practice should look like: UK best practice, applied to the common, important and acute conditions an F2 doctor sees. The twelve questions below are drawn from the Myndaq practice bank and are not reproductions of any official item. There is at least one for each of the GMC's ten areas, each with the answer and the UK guidance or principle behind it, alongside the Myndaq PLAB and UKMLA course.
Management guidance changes. The answers reflect UK practice as generally taught when this page was written; check current NICE and national guidance for anything you plan to rely on.
The pattern you are practising for
- 180 single-best-answer questions in three hours — a short scenario, a question, and five options.
- One mark per correct answer; the GMC describes no deduction for wrong answers.
- Pass mark set per test by the Angoff method plus one standard error of measurement.
- Scope: common, important and acute conditions seen by an F2 doctor, and long-term conditions in primary care, managed as in the UK.
- Results reported by the ten areas below, with your percentage and the cohort average for each.
Cardiorespiratory
Question 1. A 62-year-old man collapses on a medical ward. He is unresponsive, not breathing normally and has no central pulse. CPR is started and the monitor shows pulseless electrical activity. According to the adult Advanced Life Support algorithm, when should the first dose of intravenous adrenaline 1 mg be given?
- A. After 10 minutes of CPR
- B. Only if the rhythm converts to ventricular fibrillation
- C. After the third shock
- D. After the second cycle of CPR regardless of access
- E. As soon as possible once IV access is obtained
Answer: E. In non-shockable rhythms (PEA and asystole), adrenaline 1 mg is given as soon as vascular access is achieved, then every 3–5 minutes. "After the third shock" belongs to the shockable arm of the algorithm — the most common confusion.
Question 2. A 68-year-old man is found to have atrial fibrillation. He has hypertension and type 2 diabetes and had an ischaemic stroke four years ago. He is stable and asymptomatic; eGFR is 68. What is the most appropriate agent for stroke prevention?
- A. Clopidogrel 75 mg daily
- B. Low-dose subcutaneous heparin
- C. Aspirin 75 mg daily
- D. No anticoagulation needed
- E. Apixaban
Answer: E. Prior stroke, hypertension, diabetes and age give a high CHA₂DS₂-VASc score, so he needs anticoagulation, and UK guidance favours a direct oral anticoagulant. Antiplatelets are not used for stroke prevention in AF.
Question 3. A 30-year-old woman develops facial swelling, widespread urticaria, wheeze and stridor minutes after eating in a restaurant. BP is 80/46, saturations 90% on air. She has no IV access. What is the most appropriate immediate drug, dose and route?
- A. Adrenaline 500 micrograms (0.5 mL of 1:1000) intramuscularly
- B. Hydrocortisone 200 mg intramuscularly
- C. Adrenaline 100 micrograms (1 mL of 1:10 000) intravenously
- D. Chlorphenamine 10 mg intramuscularly
- E. Adrenaline 1 mg (10 mL of 1:10 000) intravenously
Answer: A. Intramuscular adrenaline 500 micrograms is first-line in adult anaphylaxis and needs no access. IV adrenaline is for specialist settings; antihistamines and steroids do not treat the airway and circulatory compromise.
Renal and urology
Question 4. A 48-year-old man has severe left loin-to-groin pain, rigors and a temperature of 39.2 °C; pulse 120, BP 88/50. CT KUB shows a 9 mm obstructing stone at the left vesicoureteric junction with hydronephrosis; white cell count and CRP are raised. What is the most appropriate immediate management?
- A. Immediate extracorporeal shock wave lithotripsy
- B. Rectal NSAID and outpatient CT in 4 weeks
- C. Oral antibiotics and discharge with urology follow-up
- D. Immediate ureteroscopy and stone removal
- E. IV fluids and antibiotics with urgent decompression by nephrostomy or ureteric stent
Answer: E. An obstructed, infected kidney with sepsis is a urological emergency: resuscitate, give antibiotics, and decompress. Definitive stone treatment waits until the sepsis is controlled. The trap is D, which treats the stone before the sepsis.
Neurosciences and senses
Question 5. A 65-year-old woman with metastatic lung cancer has 36 hours of worsening back pain, bilateral leg weakness and difficulty passing urine. There is a sensory level at T8 and brisk lower-limb reflexes. While an urgent whole-spine MRI is arranged, what is the most appropriate immediate drug treatment?
- A. Intramuscular hydrocortisone 100 mg
- B. Intravenous zoledronic acid
- C. Oral prednisolone 40 mg daily
- D. Oral dexamethasone 16 mg daily with gastric protection
- E. Subcutaneous enoxaparin
Answer: D. Suspected metastatic spinal cord compression: dexamethasone 16 mg daily with a proton-pump inhibitor, pending MRI and definitive treatment. Zoledronic acid is for hypercalcaemia, a different oncological emergency.
Musculoskeletal
Question 6. A 55-year-old man has two months of lateral elbow pain, worse gripping and lifting, after decorating his house. He is tender over the lateral epicondyle and resisted wrist extension reproduces the pain. What is the most appropriate first-line management?
- A. Plain radiograph of the elbow
- B. Corticosteroid injection into the lateral epicondyle
- C. Surgical release of the common extensor origin
- D. Referral for extracorporeal shockwave therapy
- E. Activity modification, analgesia and reassurance about the self-limiting course
Answer: E. Lateral epicondylitis is usually self-limiting, and first-line care is conservative. Steroid injection gives short-term relief with worse long-term outcomes. PLAB favours the least invasive correct step — a recurring pattern in musculoskeletal questions.
Mental health
Question 7. A 75-year-old woman admitted with a urinary tract infection develops acute delirium and refuses intravenous antibiotics. She cannot understand, retain or weigh the information. She has no advance decision and no attorney. The team judges antibiotics essential and in her best interests. Under which legal framework should treatment be given?
- A. Section 5(2) of the Mental Health Act 1983
- B. A Deprivation of Liberty Safeguards authorisation
- C. Section 136 of the Mental Health Act 1983
- D. The Mental Capacity Act 2005
- E. Section 2 of the Mental Health Act 1983
Answer: D. Treating a physical illness in someone who lacks capacity is done in their best interests under the Mental Capacity Act. The Mental Health Act concerns detention and treatment for mental disorder.
Gastrointestinal
Question 8. A 76-year-old woman in a care home, with chronic constipation and several sedating medicines, has three days of colicky lower abdominal pain, marked distension and absolute constipation. The abdominal radiograph shows a hugely dilated loop of large bowel with a "coffee bean" appearance. She is stable with no peritonism. What is the most appropriate initial management?
- A. Oral laxatives and a phosphate enema
- B. Nasogastric tube and intravenous fluids alone
- C. Flexible sigmoidoscopy and insertion of a flatus tube
- D. CT colonography for staging
- E. Emergency laparotomy and Hartmann's procedure
Answer: C. Sigmoid volvulus in a stable patient without peritonism is first decompressed endoscopically. Laparotomy is for peritonism, perforation or failed decompression. The case gives you the risk factors (elderly, institutionalised, constipated, sedated) before the X-ray sign.
Endocrine, metabolic and clinical haematology
Question 9. A 45-year-old woman with type 1 diabetes is found alert but shaky, sweaty and irritable at work. Capillary glucose is 2.7 mmol/L and she can swallow safely. What is the most appropriate immediate treatment?
- A. Withhold treatment and recheck in 30 minutes
- B. Intravenous 20% glucose 100 mL
- C. A slice of wholemeal bread
- D. Intramuscular glucagon 1 mg
- E. 15–20 g of fast-acting oral carbohydrate
Answer: E. A conscious patient who can swallow gets fast-acting oral carbohydrate, repeated until glucose recovers, then longer-acting carbohydrate. Glucagon and IV glucose are for those who cannot take oral treatment.
Child and adolescent health
Question 10. A 4-year-old boy has a barking cough, hoarse voice and inspiratory stridor at rest, without cyanosis or significant recession. He has had coryza for two days, temperature 38.0 °C; he is alert and drinking. What is the first-line treatment?
- A. A single dose of oral dexamethasone
- B. Nebulised salbutamol
- C. Intravenous ceftriaxone
- D. Oral amoxicillin
- E. Nebulised adrenaline as sole treatment and discharge
Answer: A. This is croup, and a single dose of oral dexamethasone is first-line whatever the severity. Nebulised adrenaline is for severe croup and requires observation afterwards, which is why "and discharge" makes E wrong.
Reproductive health
Question 11. A 63-year-old woman has a single episode of postmenopausal bleeding. Her last period was 12 years ago; she is not on HRT; abdominal and speculum examinations are normal. What is the most appropriate next step?
- A. Reassure her that a single episode needs no investigation
- B. Refer on a suspected gynaecological cancer pathway
- C. Prescribe topical oestrogen and review in three months
- D. Arrange a routine gynaecology referral
- E. Arrange a cervical smear and review the result
Answer: B. NICE's suspected-cancer guidance recommends a suspected cancer pathway referral for women aged 55 and over with postmenopausal bleeding, to exclude endometrial cancer. A smear screens the cervix, not the endometrium.
Ethics and other
Question 12. A 14-year-old girl attends a sexual health clinic alone asking for emergency contraception. She discloses that she is having sex with a 25-year-old man she met online, who gives her gifts and asks her to keep the relationship secret. She does not want her parents told. What is the most appropriate immediate action?
- A. Make a safeguarding referral for suspected child sexual exploitation
- B. Provide emergency contraception and take no further action
- C. Advise her to return with a parent before any care is given
- D. Contact her parents against her wishes as a first step
- E. Respect her wish for confidentiality without involving anyone else
Answer: A. A secret relationship with a much older adult who gives gifts is a textbook sign of child sexual exploitation; safeguarding overrides confidentiality here, and she should still be given the emergency contraception she came for — B fails because of "no further action", not because of the treatment. Contacting the parents first (D) is not the safeguarding route and may increase the risk. In ethics questions, find the principle the GMC ranks highest in the situation — here, protecting a child at risk.
How to use practice like this
Mirror the GMC's feedback from the start: log every miss under one of the ten areas and note whether you lacked the fact, misapplied it, or misread the scenario. Practise in blocks of 60 questions in 60 minutes to build the pace, and when you get a question wrong, read the current UK guidance behind it rather than only the explanation. For the scope and areas in full, see the PLAB 1 syllabus and content areas; for the preparation route, see the PLAB and UKMLA guide.
Quick answers
Are there PLAB 1 past papers?
No past papers are published. Practise with single-best-answer questions written to the PLAB 1 scope and UK guidance.
How many questions are in PLAB 1 and how long is it?
180 single-best-answer questions in three hours, each with five options.
Is there negative marking in PLAB 1?
The GMC scores one mark per correct answer and describes no deduction, so answer every question.
Which guidelines should I follow for PLAB 1?
Current UK best practice — the GMC says questions relate to current best practice in the UK and to equipment routinely available in UK hospitals.
What are the PLAB 1 content areas?
Reproductive health; renal and urology; neurosciences and senses; musculoskeletal; mental health; gastrointestinal; endocrine, metabolic and clinical haematology; child and adolescent health; cardiorespiratory; and ethics and other.
