PLAB 1 / UKMLA COMPLETE HIGH-YIELD QUESTIONS AND EXPLAINED
ANSWERS LATEST VERSION 2026/2027 (PASS GUARANTEE)
Q1. [Cardiology] A 55-year-old man presents with crushing central chest pain
radiating to the left arm for 2 hours. His ECG shows ST elevation in leads II, III,
and aVF. What is the most likely diagnosis?
Answer: Inferior STEMI (ST-Elevation Myocardial Infarction). The inferior leads
(II, III, aVF) correspond to the right coronary artery territory. Immediate
management: dual antiplatelet therapy (aspirin + ticagrelor/clopidogrel),
anticoagulation, and primary PCI within 90 minutes.
Q2. [Cardiology] A patient has a pulse of 160 bpm, narrow complex tachycardia
on ECG, blood pressure 110/70 mmHg. They are haemodynamically stable. What
is the first-line treatment?
Answer: Vagal manoeuvres (e.g. Valsalva manoeuvre or carotid sinus massage).
If ineffective, IV adenosine 6 mg rapid bolus, followed by 12 mg if no response.
This is consistent with SVT (supraventricular tachycardia).
Q3. [Cardiology] A 70-year-old woman has an irregularly irregular pulse,
fatigue, and palpitations. ECG shows absent P waves and irregularly irregular
QRS complexes. What is the diagnosis and first consideration?
Answer: Atrial fibrillation (AF). First assess haemodynamic stability. CHA2DS2-
VASc score should be calculated for stroke risk assessment and anticoagulation
decision. Rate control with beta-blockers or digoxin is first-line for rate
management.
Q4. [Cardiology] A 45-year-old man presents with sudden onset severe tearing
chest pain radiating to the back. His BP is 180/100 in the right arm and 140/80 in
the left arm. Chest X-ray shows widened mediastinum. What is the diagnosis?
Answer: Aortic dissection (Type A until proven otherwise). The blood pressure
differential between arms and widened mediastinum are key clues. CT
aortography is the investigation of choice. Type A (involving ascending aorta)
requires emergency surgery.
Q5. [Cardiology] A 65-year-old patient is found to have a BP of 165/100 on two
separate occasions. They have no end-organ damage. What is the first-line
antihypertensive for a 65-year-old?
PLAB 1 / UKMLA Question Bank — 300 Questions & Answers | Page 1 of 63
,Answer: Calcium channel blocker (e.g. amlodipine) is first-line for patients aged
55+ or those of African/Caribbean origin, according to NICE guidelines (step 1).
ACE inhibitors are first-line for patients under 55.
Q6. [Cardiology] A 60-year-old man with known ischaemic heart disease
develops a broad complex regular tachycardia at 180 bpm with haemodynamic
compromise. What is the immediate management?
Answer: Synchronised DC cardioversion (200J biphasic) immediately, as the
patient is haemodynamically unstable. This is ventricular tachycardia (VT) until
proven otherwise. If stable VT, amiodarone 300 mg IV over 20-60 minutes is
used.
Q7. [Cardiology] A patient with known heart failure has worsening dyspnoea
and bilateral ankle oedema. Their current medications are bisoprolol and ramipril.
What medication should be added for symptomatic relief?
Answer: A loop diuretic such as furosemide. Diuretics are the cornerstone of
symptomatic relief in heart failure with fluid overload. Spironolactone can also be
considered for additional mortality benefit in HFrEF (NYHA II-IV).
Q8. [Cardiology] An ECG shows a shortened PR interval and a delta wave. What
is the diagnosis and associated risk?
Answer: Wolff-Parkinson-White (WPW) syndrome. There is an accessory
pathway (Bundle of Kent) causing pre-excitation. The risk is that AF in WPW can
conduct rapidly via the accessory pathway, causing ventricular fibrillation. Avoid
AV nodal blockers (adenosine, verapamil, digoxin) in WPW with AF.
Q9. [Cardiology] A 50-year-old smoker has exertional chest tightness relieved by
rest. Exercise stress test shows ST depression. What is the diagnosis and first-line
management?
Answer: Stable angina. First-line symptomatic treatment: sublingual GTN
(glyceryl trinitrate) for acute episodes. Regular preventive therapy: beta-blocker
(e.g. atenolol) or calcium channel blocker. All patients should receive aspirin 75
mg and a statin.
Q10. [Cardiology] A 75-year-old woman is found unresponsive with no pulse.
Cardiac monitor shows ventricular fibrillation. What is the immediate action?
Answer: Immediate defibrillation with 200J biphasic shock (unsynchronised).
This is a shockable rhythm. Begin CPR if defibrillator not immediately available.
Follow ALS algorithm: CPR 30:2, shock every 2 minutes, adrenaline 1 mg IV
every 3-5 minutes after 3rd shock.
Q11. [Respiratory] A 30-year-old asthmatic presents with wheeze, RR 28,
unable to complete sentences, SpO2 93%, PEFR 40% predicted. How would you
classify this and what is the immediate management?
PLAB 1 / UKMLA Question Bank — 300 Questions & Answers | Page 2 of 63
,Answer: Severe acute asthma. Immediate management: high-flow oxygen (target
SpO2 94-98%), back-to-back salbutamol nebulisers (2.5-5 mg), ipratropium
bromide 0.5 mg nebuliser, oral prednisolone 40-50 mg or IV hydrocortisone 100
mg. Reassess frequently.
Q12. [Respiratory] A 65-year-old smoker has FEV1/FVC ratio of 0.65 and
FEV1 55% predicted. He has chronic productive cough. What is the diagnosis and
GOLD stage?
Answer: COPD (Chronic Obstructive Pulmonary Disease), GOLD Stage 2
(Moderate) — FEV1 50-79% predicted. Management: SAMA (ipratropium) or
SABA (salbutamol), with LAMA (tiotropium) or LABA for regular use. Smoking
cessation is the most important intervention.
Q13. [Respiratory] A 25-year-old man develops sudden onset pleuritic chest
pain and dyspnoea. He is tall and thin. Chest X-ray shows absence of lung
markings on the left. What is the diagnosis and management?
Answer: Left-sided spontaneous pneumothorax. If >2 cm from chest wall (large)
or symptomatic: aspiration with a 14-16G cannula at 2nd intercostal space, mid-
clavicular line. If aspiration fails, insert chest drain. Small (<2 cm, no dyspnoea):
observe and discharge with advice.
Q14. [Respiratory] A 70-year-old woman presents with progressive dyspnoea,
dry cough, and bilateral basal crackles. CT shows honeycombing and traction
bronchiectasis. What is the diagnosis?
Answer: Idiopathic Pulmonary Fibrosis (IPF). It is a progressive condition with
poor prognosis. Anti-fibrotic agents (pirfenidone or nintedanib) slow progression.
Lung transplantation is the only curative option. Steroids are not beneficial in IPF.
Q15. [Respiratory] A 45-year-old presents with haemoptysis, weight loss, and a
2 cm spiculated lesion on CT chest. He has a 40-pack-year smoking history. What
is the most important next step?
Answer: CT-guided biopsy or bronchoscopy with biopsy to obtain histological
diagnosis. This is suspicious for lung cancer (likely non-small cell). Staging CT of
chest, abdomen, and pelvis is also needed. Refer to lung cancer MDT.
Q16. [Respiratory] A patient with known COPD develops increased purulent
sputum, worsening dyspnoea, and fever. CRP is elevated. What antibiotic is first-
line?
Answer: Amoxicillin 500 mg TDS for 5 days (or doxycycline/clarithromycin if
penicillin allergic). This is an acute exacerbation of COPD (AECOPD). Add
prednisolone 30 mg for 5 days and increase bronchodilator use. Consider hospital
admission if severe.
PLAB 1 / UKMLA Question Bank — 300 Questions & Answers | Page 3 of 63
, Q17. [Respiratory] A 35-year-old woman is found to have a pleural effusion.
Pleural fluid analysis shows: LDH >200 IU/L, protein >30 g/L, and pleural:serum
LDH ratio >0.6. What type of effusion is this?
Answer: Exudate, based on Light's criteria. Causes include malignancy,
pneumonia (parapneumonic), TB, and pulmonary embolism. A transudate (protein
<25 g/L, LDH <200) would suggest heart failure, hypoalbuminaemia, or cirrhosis.
Q18. [Respiratory] A 50-year-old patient is on long-term home oxygen therapy
for COPD. What is the target SpO2 for patients with COPD during acute illness?
Answer: 88-92% SpO2. This is because patients with COPD who are chronic
CO2 retainers rely on hypoxic drive. Excessive oxygen can suppress this drive and
worsen hypercapnia. High-flow O2 is used in non-COPD patients (target 94-98%).
Q19. [Respiratory] A patient presents with signs of consolidation in the right
lower lobe: dullness to percussion, bronchial breathing, and increased vocal
resonance. CXR confirms right lower lobe opacity. What is the likely organism in
a community-acquired case?
Answer: Streptococcus pneumoniae is the most common cause of community-
acquired pneumonia (CAP). CURB-65 score guides severity and admission. Score
0-1: home treatment with amoxicillin. Score 2: consider admission. Score 3+:
hospital admission, dual antibiotics.
Q20. [Respiratory] A 60-year-old woman is found to have a PE on CTPA. She is
haemodynamically stable. What is the treatment?
Answer: Anticoagulation. First-line: direct oral anticoagulants (DOACs) such as
rivaroxaban or apixaban. Duration depends on provoked vs unprovoked PE. For a
first provoked PE: 3 months. Thrombolysis is reserved for massive PE with
haemodynamic instability.
Q21. [Gastroenterology] A 45-year-old man presents with epigastric pain
relieved by eating and worsened at night. Helicobacter pylori testing is positive.
What is the treatment?
Answer: Helicobacter pylori eradication therapy. First-line: triple therapy — PPI
(e.g. omeprazole 20 mg BD) + clarithromycin 500 mg BD + amoxicillin 1 g BD
for 7 days. Retest 4-6 weeks after completion to confirm eradication.
Q22. [Gastroenterology] A 70-year-old man presents with painless jaundice,
pale stools, dark urine, and weight loss. He has a palpable gallbladder. What is
Courvoisier's law and likely diagnosis?
Answer: Courvoisier's law: a palpable gallbladder with jaundice is unlikely to be
caused by gallstones (as chronic inflammation causes fibrosis). This picture
suggests carcinoma of the head of pancreas. Investigations: CA 19-9, CT pancreas
protocol, ERCP.
PLAB 1 / UKMLA Question Bank — 300 Questions & Answers | Page 4 of 63
ANSWERS LATEST VERSION 2026/2027 (PASS GUARANTEE)
Q1. [Cardiology] A 55-year-old man presents with crushing central chest pain
radiating to the left arm for 2 hours. His ECG shows ST elevation in leads II, III,
and aVF. What is the most likely diagnosis?
Answer: Inferior STEMI (ST-Elevation Myocardial Infarction). The inferior leads
(II, III, aVF) correspond to the right coronary artery territory. Immediate
management: dual antiplatelet therapy (aspirin + ticagrelor/clopidogrel),
anticoagulation, and primary PCI within 90 minutes.
Q2. [Cardiology] A patient has a pulse of 160 bpm, narrow complex tachycardia
on ECG, blood pressure 110/70 mmHg. They are haemodynamically stable. What
is the first-line treatment?
Answer: Vagal manoeuvres (e.g. Valsalva manoeuvre or carotid sinus massage).
If ineffective, IV adenosine 6 mg rapid bolus, followed by 12 mg if no response.
This is consistent with SVT (supraventricular tachycardia).
Q3. [Cardiology] A 70-year-old woman has an irregularly irregular pulse,
fatigue, and palpitations. ECG shows absent P waves and irregularly irregular
QRS complexes. What is the diagnosis and first consideration?
Answer: Atrial fibrillation (AF). First assess haemodynamic stability. CHA2DS2-
VASc score should be calculated for stroke risk assessment and anticoagulation
decision. Rate control with beta-blockers or digoxin is first-line for rate
management.
Q4. [Cardiology] A 45-year-old man presents with sudden onset severe tearing
chest pain radiating to the back. His BP is 180/100 in the right arm and 140/80 in
the left arm. Chest X-ray shows widened mediastinum. What is the diagnosis?
Answer: Aortic dissection (Type A until proven otherwise). The blood pressure
differential between arms and widened mediastinum are key clues. CT
aortography is the investigation of choice. Type A (involving ascending aorta)
requires emergency surgery.
Q5. [Cardiology] A 65-year-old patient is found to have a BP of 165/100 on two
separate occasions. They have no end-organ damage. What is the first-line
antihypertensive for a 65-year-old?
PLAB 1 / UKMLA Question Bank — 300 Questions & Answers | Page 1 of 63
,Answer: Calcium channel blocker (e.g. amlodipine) is first-line for patients aged
55+ or those of African/Caribbean origin, according to NICE guidelines (step 1).
ACE inhibitors are first-line for patients under 55.
Q6. [Cardiology] A 60-year-old man with known ischaemic heart disease
develops a broad complex regular tachycardia at 180 bpm with haemodynamic
compromise. What is the immediate management?
Answer: Synchronised DC cardioversion (200J biphasic) immediately, as the
patient is haemodynamically unstable. This is ventricular tachycardia (VT) until
proven otherwise. If stable VT, amiodarone 300 mg IV over 20-60 minutes is
used.
Q7. [Cardiology] A patient with known heart failure has worsening dyspnoea
and bilateral ankle oedema. Their current medications are bisoprolol and ramipril.
What medication should be added for symptomatic relief?
Answer: A loop diuretic such as furosemide. Diuretics are the cornerstone of
symptomatic relief in heart failure with fluid overload. Spironolactone can also be
considered for additional mortality benefit in HFrEF (NYHA II-IV).
Q8. [Cardiology] An ECG shows a shortened PR interval and a delta wave. What
is the diagnosis and associated risk?
Answer: Wolff-Parkinson-White (WPW) syndrome. There is an accessory
pathway (Bundle of Kent) causing pre-excitation. The risk is that AF in WPW can
conduct rapidly via the accessory pathway, causing ventricular fibrillation. Avoid
AV nodal blockers (adenosine, verapamil, digoxin) in WPW with AF.
Q9. [Cardiology] A 50-year-old smoker has exertional chest tightness relieved by
rest. Exercise stress test shows ST depression. What is the diagnosis and first-line
management?
Answer: Stable angina. First-line symptomatic treatment: sublingual GTN
(glyceryl trinitrate) for acute episodes. Regular preventive therapy: beta-blocker
(e.g. atenolol) or calcium channel blocker. All patients should receive aspirin 75
mg and a statin.
Q10. [Cardiology] A 75-year-old woman is found unresponsive with no pulse.
Cardiac monitor shows ventricular fibrillation. What is the immediate action?
Answer: Immediate defibrillation with 200J biphasic shock (unsynchronised).
This is a shockable rhythm. Begin CPR if defibrillator not immediately available.
Follow ALS algorithm: CPR 30:2, shock every 2 minutes, adrenaline 1 mg IV
every 3-5 minutes after 3rd shock.
Q11. [Respiratory] A 30-year-old asthmatic presents with wheeze, RR 28,
unable to complete sentences, SpO2 93%, PEFR 40% predicted. How would you
classify this and what is the immediate management?
PLAB 1 / UKMLA Question Bank — 300 Questions & Answers | Page 2 of 63
,Answer: Severe acute asthma. Immediate management: high-flow oxygen (target
SpO2 94-98%), back-to-back salbutamol nebulisers (2.5-5 mg), ipratropium
bromide 0.5 mg nebuliser, oral prednisolone 40-50 mg or IV hydrocortisone 100
mg. Reassess frequently.
Q12. [Respiratory] A 65-year-old smoker has FEV1/FVC ratio of 0.65 and
FEV1 55% predicted. He has chronic productive cough. What is the diagnosis and
GOLD stage?
Answer: COPD (Chronic Obstructive Pulmonary Disease), GOLD Stage 2
(Moderate) — FEV1 50-79% predicted. Management: SAMA (ipratropium) or
SABA (salbutamol), with LAMA (tiotropium) or LABA for regular use. Smoking
cessation is the most important intervention.
Q13. [Respiratory] A 25-year-old man develops sudden onset pleuritic chest
pain and dyspnoea. He is tall and thin. Chest X-ray shows absence of lung
markings on the left. What is the diagnosis and management?
Answer: Left-sided spontaneous pneumothorax. If >2 cm from chest wall (large)
or symptomatic: aspiration with a 14-16G cannula at 2nd intercostal space, mid-
clavicular line. If aspiration fails, insert chest drain. Small (<2 cm, no dyspnoea):
observe and discharge with advice.
Q14. [Respiratory] A 70-year-old woman presents with progressive dyspnoea,
dry cough, and bilateral basal crackles. CT shows honeycombing and traction
bronchiectasis. What is the diagnosis?
Answer: Idiopathic Pulmonary Fibrosis (IPF). It is a progressive condition with
poor prognosis. Anti-fibrotic agents (pirfenidone or nintedanib) slow progression.
Lung transplantation is the only curative option. Steroids are not beneficial in IPF.
Q15. [Respiratory] A 45-year-old presents with haemoptysis, weight loss, and a
2 cm spiculated lesion on CT chest. He has a 40-pack-year smoking history. What
is the most important next step?
Answer: CT-guided biopsy or bronchoscopy with biopsy to obtain histological
diagnosis. This is suspicious for lung cancer (likely non-small cell). Staging CT of
chest, abdomen, and pelvis is also needed. Refer to lung cancer MDT.
Q16. [Respiratory] A patient with known COPD develops increased purulent
sputum, worsening dyspnoea, and fever. CRP is elevated. What antibiotic is first-
line?
Answer: Amoxicillin 500 mg TDS for 5 days (or doxycycline/clarithromycin if
penicillin allergic). This is an acute exacerbation of COPD (AECOPD). Add
prednisolone 30 mg for 5 days and increase bronchodilator use. Consider hospital
admission if severe.
PLAB 1 / UKMLA Question Bank — 300 Questions & Answers | Page 3 of 63
, Q17. [Respiratory] A 35-year-old woman is found to have a pleural effusion.
Pleural fluid analysis shows: LDH >200 IU/L, protein >30 g/L, and pleural:serum
LDH ratio >0.6. What type of effusion is this?
Answer: Exudate, based on Light's criteria. Causes include malignancy,
pneumonia (parapneumonic), TB, and pulmonary embolism. A transudate (protein
<25 g/L, LDH <200) would suggest heart failure, hypoalbuminaemia, or cirrhosis.
Q18. [Respiratory] A 50-year-old patient is on long-term home oxygen therapy
for COPD. What is the target SpO2 for patients with COPD during acute illness?
Answer: 88-92% SpO2. This is because patients with COPD who are chronic
CO2 retainers rely on hypoxic drive. Excessive oxygen can suppress this drive and
worsen hypercapnia. High-flow O2 is used in non-COPD patients (target 94-98%).
Q19. [Respiratory] A patient presents with signs of consolidation in the right
lower lobe: dullness to percussion, bronchial breathing, and increased vocal
resonance. CXR confirms right lower lobe opacity. What is the likely organism in
a community-acquired case?
Answer: Streptococcus pneumoniae is the most common cause of community-
acquired pneumonia (CAP). CURB-65 score guides severity and admission. Score
0-1: home treatment with amoxicillin. Score 2: consider admission. Score 3+:
hospital admission, dual antibiotics.
Q20. [Respiratory] A 60-year-old woman is found to have a PE on CTPA. She is
haemodynamically stable. What is the treatment?
Answer: Anticoagulation. First-line: direct oral anticoagulants (DOACs) such as
rivaroxaban or apixaban. Duration depends on provoked vs unprovoked PE. For a
first provoked PE: 3 months. Thrombolysis is reserved for massive PE with
haemodynamic instability.
Q21. [Gastroenterology] A 45-year-old man presents with epigastric pain
relieved by eating and worsened at night. Helicobacter pylori testing is positive.
What is the treatment?
Answer: Helicobacter pylori eradication therapy. First-line: triple therapy — PPI
(e.g. omeprazole 20 mg BD) + clarithromycin 500 mg BD + amoxicillin 1 g BD
for 7 days. Retest 4-6 weeks after completion to confirm eradication.
Q22. [Gastroenterology] A 70-year-old man presents with painless jaundice,
pale stools, dark urine, and weight loss. He has a palpable gallbladder. What is
Courvoisier's law and likely diagnosis?
Answer: Courvoisier's law: a palpable gallbladder with jaundice is unlikely to be
caused by gallstones (as chronic inflammation causes fibrosis). This picture
suggests carcinoma of the head of pancreas. Investigations: CA 19-9, CT pancreas
protocol, ERCP.
PLAB 1 / UKMLA Question Bank — 300 Questions & Answers | Page 4 of 63
