, PLAB 1 Revision Notes
Revision notes for PLAB 1, organised by system. Each topic focuses on the discriminating clinical feature, the first
and definitive investigation, and the immediate management step.
Approaching the questions: Read the last line of the stem first. It usually asks for the most likely diagnosis,
the most appropriate initial investigation, the definitive investigation, or the next management step. "Initial" is
not the same as "most accurate", and in an acutely unwell patient the next step is usually A-to-E and
resuscitation before any scan. When two options look right, choose the one that is safest, earliest in the
pathway, and actually changes management.
Recent UK guideline changes (2024–2026) - high-yield:
• Asthma (BTS/NICE/SIGN NG245, Nov 2024): SABA-only relievers are no longer recommended for
ages 12+. Newly diagnosed → as-needed low-dose ICS/formoterol (AIR). Not controlled → low-dose
MART → moderate-dose MART → add LTRA/LAMA → specialist.
• Type 2 diabetes (NICE NG28 update): Most patients start on metformin MR + an SGLT2 inhibitor
together (cardio-renal benefit), not metformin alone. Metformin-intolerant → SGLT2 alone. GLP-1/
tirzepatide expanded for under-40s/obesity.
• AF (NICE NG196): DOAC first-line (warfarin only if valvular/specific). Anticoagulate if CHA₂DS₂-VASc ≥2
(consider in men scoring 1); apixaban preferred if no specific reason otherwise. HAS-BLED replaced by
ORBIT for bleeding risk.
• Hypertension (NICE NG136): Stage 1 = clinic 140/90 (ABPM/HBPM 135/85); Stage 2 = clinic 160/100
(ABPM/HBPM 150/95). Treat stage 1 under-80 if target-organ damage, CVD, renal disease, diabetes or
10-year CVD risk ≥10%. Target <140/90 (under 80), <150/90 (over 80). Inter-arm difference now significant
at ≥15 mmHg.
• Stroke: thrombolysis <4.5h; mechanical thrombectomy up to 24h in selected large-vessel occlusion.
Contents
1. Cardiology 10. Obstetrics & Gynaecology
2. Respiratory 11. Paediatrics
3. Endocrine & Metabolic 12. Psychiatry
4. Gastroenterology & Hepatology 13. Dermatology
5. Nephrology & Urology 14. Ophthalmology & ENT
6. Neurology 15. Surgery & Trauma
7. Infectious Diseases 16. Pharmacology & Prescribing
8. Haematology & Oncology 17. Ethics, Consent & Statistics
9. Rheumatology & MSK • High-Yield Recalls (rapid fire)
1. Cardiology
Acute Coronary Syndrome
• STEMI: ST elevation ≥1mm in 2 contiguous limb leads or ≥2mm in chest leads, or new LBBB. Immediate:
aspirin 300mg + a second antiplatelet (ticagrelor/prasugrel/clopidogrel), morphine, O2 only if SpO₂<94%, GTN.
Primary PCI if deliverable within 120 min of when fibrinolysis could be given; otherwise thrombolyse.
Revision notes for PLAB 1, organised by system. Each topic focuses on the discriminating clinical feature, the first
and definitive investigation, and the immediate management step.
Approaching the questions: Read the last line of the stem first. It usually asks for the most likely diagnosis,
the most appropriate initial investigation, the definitive investigation, or the next management step. "Initial" is
not the same as "most accurate", and in an acutely unwell patient the next step is usually A-to-E and
resuscitation before any scan. When two options look right, choose the one that is safest, earliest in the
pathway, and actually changes management.
Recent UK guideline changes (2024–2026) - high-yield:
• Asthma (BTS/NICE/SIGN NG245, Nov 2024): SABA-only relievers are no longer recommended for
ages 12+. Newly diagnosed → as-needed low-dose ICS/formoterol (AIR). Not controlled → low-dose
MART → moderate-dose MART → add LTRA/LAMA → specialist.
• Type 2 diabetes (NICE NG28 update): Most patients start on metformin MR + an SGLT2 inhibitor
together (cardio-renal benefit), not metformin alone. Metformin-intolerant → SGLT2 alone. GLP-1/
tirzepatide expanded for under-40s/obesity.
• AF (NICE NG196): DOAC first-line (warfarin only if valvular/specific). Anticoagulate if CHA₂DS₂-VASc ≥2
(consider in men scoring 1); apixaban preferred if no specific reason otherwise. HAS-BLED replaced by
ORBIT for bleeding risk.
• Hypertension (NICE NG136): Stage 1 = clinic 140/90 (ABPM/HBPM 135/85); Stage 2 = clinic 160/100
(ABPM/HBPM 150/95). Treat stage 1 under-80 if target-organ damage, CVD, renal disease, diabetes or
10-year CVD risk ≥10%. Target <140/90 (under 80), <150/90 (over 80). Inter-arm difference now significant
at ≥15 mmHg.
• Stroke: thrombolysis <4.5h; mechanical thrombectomy up to 24h in selected large-vessel occlusion.
Contents
1. Cardiology 10. Obstetrics & Gynaecology
2. Respiratory 11. Paediatrics
3. Endocrine & Metabolic 12. Psychiatry
4. Gastroenterology & Hepatology 13. Dermatology
5. Nephrology & Urology 14. Ophthalmology & ENT
6. Neurology 15. Surgery & Trauma
7. Infectious Diseases 16. Pharmacology & Prescribing
8. Haematology & Oncology 17. Ethics, Consent & Statistics
9. Rheumatology & MSK • High-Yield Recalls (rapid fire)
1. Cardiology
Acute Coronary Syndrome
• STEMI: ST elevation ≥1mm in 2 contiguous limb leads or ≥2mm in chest leads, or new LBBB. Immediate:
aspirin 300mg + a second antiplatelet (ticagrelor/prasugrel/clopidogrel), morphine, O2 only if SpO₂<94%, GTN.
Primary PCI if deliverable within 120 min of when fibrinolysis could be given; otherwise thrombolyse.
