Medical Licensing (MD/DO) · Independent exam preparation
PLAB preparation guide and learning test Study Guide
An independently written, UK-focused PLAB learning resource linked to the GMC MLA content map applicable from September 2026. It contains 60 selected concepts, 20 practice questions and 20 flashcards.
By CertMedbry · Updated 13 October 2026
This resource supports preparation for the General Medical Council's Professional and Linguistic Assessments Board test (PLAB). It uses the GMC MLA content map published in October 2025 and applicable from September 2026. This is a selective 60-concept review, not the full syllabus. The official GMC MLA content map defines the full assessment scope; use it alongside this guide. The map indicates assessment scope, not clinical recommendations. Condition-specific advice is linked to relevant clinical sources where available. Use these materials as learning drills, not as a prediction of results or a simulation of either PLAB part.
Try 20 free practice questionsWhat is the exam format?
Check the question types, timing and outline before planning your revision.
What examination and pathway does this guide cover?
The GMC calls it the Professional and Linguistic Assessments Board test (PLAB), for doctors qualified abroad. This guide covers the UK GMC PLAB pathway. The GMC says PLAB retains its name while using the MLA content map. PLAB 1 meets the AKT requirements and PLAB 2 meets the CPSA requirements.
Professional and Linguistic Assessments Board · PLAB and the MLA
How many questions, choices and minutes does PLAB 1 have?
The current GMC guide states that PLAB 1 comprises 180 scenario-based questions, five answer choices and three hours. The four-option questions here are independent learning drills and do not reproduce the official format.
How is PLAB 2 structured?
The GMC describes PLAB 2 as a performance-based CPSA/OSCE with 16 scenarios lasting eight minutes each. Written materials cannot assess observed communication, examination technique or practical performance.
Which blueprint and effective date are used here?
The GMC MLA content map was published in October 2025 and applies to assessments from September 2026 onwards. The GMC describes it as a live document; the September 2026 terminology revision changes PCOS to PMOS. The inspected outline defines six interconnected domains but states no percentage weights.
MLA content map · MLA content map: applicable from September 2026 onwards
Are delivery mode, adaptivity or a scored-versus-pretest breakdown established here?
The supplied examination guidance establishes the PLAB 1 question count, answer choices and duration, but does not establish a scored-versus-pretest breakdown, delivery mode or adaptive testing. No such details are inferred. Check current GMC candidate guidance for operational information.
Does this guide give an official pass score or promise a pass?
No. The supplied examination guidance does not establish a pass score or a pass-prediction method. These original study materials are independently written and are not GMC-authored or GMC-approved.
The official examination name remains PLAB. The GMC says its questions and stations use the MLA content map: PLAB 1 meets AKT requirements and PLAB 2 meets CPSA requirements. PLAB 1 is written; PLAB 2 is a performance-based clinical and professional skills assessment. They are not interchangeable. PLAB 1 has five answer choices, whereas these original practice questions have four; written drills do not assess practical performance. The MLA content map is an assessment framework, not a separate examination name or replacement for PLAB.
Outline used: GMC MLA content map, published October 2025 and applicable to assessments from September 2026 onwards; current issuer guidance checked on 2026-10-10. The workbook's singular 'Assessment' maps to the officially named Professional and Linguistic Assessments Board test. The assigned slug is preserved. PLAB retains its name and uses the MLA content map: this is an evidenced syllabus relationship, not substitution of a different examination.
60 key concepts: understand, apply and avoid the traps
Work through the questions by exam domain. Explain the answer in your own words, try the example, then check the common pitfall.
Areas of clinical practicenot stated
1.How does an initial ABCDE assessment organize acute care?
ABCDE prioritises airway, breathing, circulation, disability and exposure according to immediate threat. Look for life-threatening abnormalities, address them as they are found, call for appropriate help and reassess after each intervention. The framework helps structure urgent assessment but is not a diagnosis or a complete condition-specific treatment protocol. The patient's response, observations and changing clinical state should determine what happens next.
Apply it
A pale, confused patient who is severely breathless needs immediate threat assessment and early escalation. Recheck observations and response rather than completing a routine history before acting.
Common pitfall: Do not delay action on a dangerous abnormality to finish the examination. ABCDE supports prioritisation but does not replace definitive care, senior support or relevant emergency guidance.
MLA content map: applicable from September 2026 onwards · Special circumstances Guidelines — Resuscitation Council UK 2025
2.Which clues make chest pain an urgent possible acute coronary syndrome?
Potentially ischaemic chest discomfort needs prompt assessment. Consider onset, duration, associated symptoms, risk factors and clinical stability; obtain an ECG and appropriate investigations without delaying urgent referral when the presentation is concerning. A normal or nondiagnostic first ECG does not by itself rule out acute coronary syndrome. Interpret results in the clinical context and reassess ongoing symptoms, especially if the patient's condition changes.
Apply it
For new central pressure with sweating and nausea, assess stability, obtain an ECG promptly and arrange urgent assessment rather than reassuring the patient on age or one test alone.
Common pitfall: Do not label pain non-cardiac solely because it is atypical, transient or accompanied by a normal initial ECG. Concerning ongoing symptoms still require appropriate assessment and a safe pathway.
Recent-onset chest pain of suspected cardiac origin — CG95 recommendations · MLA content map: applicable from September 2026 onwards
3.Why is supportive care central in uncomplicated bronchiolitis?
Assess breathing effort, oxygenation, feeding, hydration and the child's trajectory. Increasing work of breathing, apnoea, poor intake or exhaustion changes the urgency and calls for reassessment or escalation. NICE guidance supports avoiding routine investigations and treatments that are not indicated by the assessment. Supportive care still requires attention to age, risk factors, clinical change and the family's ability to seek help.
Apply it
For an infant with mild recession who is feeding adequately, assess severity and hydration, provide appropriate advice and arrange review according to the child's risk and progress.
Common pitfall: Do not reflexively request imaging or prescribe unsupported treatment. Conversely, do not use the usually self-limiting nature of bronchiolitis to dismiss deterioration or fail to reassess worsening feeding or breathing.
Bronchiolitis in children — NG9 recommendations · MLA content map: applicable from September 2026 onwards
4.How should thyroid tests be selected for suspected primary thyroid dysfunction?
For adults in whom pituitary disease is not suspected, NICE recommends measuring TSH first. If TSH is above the reference range, measure FT4 in the same sample; if TSH is below the reference range, measure FT4 and FT3 in the same sample. If secondary thyroid dysfunction is suspected, measure both TSH and FT4. Select and interpret tests in light of symptoms, treatment history and clinical context.
Apply it
For gradual fatigue without features suggesting pituitary disease, begin with the primary-thyroid testing pathway. Interpret any abnormality as a pattern and decide on follow-up in context.
Common pitfall: Do not diagnose from one nonspecific symptom or treat every borderline result as overt disease. Do not apply the primary-thyroid sequence when pituitary disease is suspected; use TSH and FT4 in that situation.
5.When should gastrointestinal symptoms prompt urgent escalation?
Assess abdominal or gastrointestinal symptoms for physiological instability, severe or escalating pain, bleeding, persistent vomiting, peritonism, dehydration and possible pregnancy. Establish the timeline, relevant history, examination findings and observations, then use current guidance for the suspected cause and the patient's acuity. This is a general assessment prompt, not a complete management recommendation for any single diagnosis. Reassessment matters when symptoms or observations are changing.
Apply it
A patient with abdominal pain who is clammy, tachycardic and repeatedly vomiting needs urgent assessment and escalation, not an assumption of uncomplicated gastroenteritis.
Common pitfall: Do not let a common benign explanation override abnormal observations or signs of deterioration. A symptom label is not a diagnosis; reassess the whole presentation and escalate when the patient's condition warrants it.
6.How should self-harm assessment separate immediate safety from longer-term formulation?
Assess physical injuries and immediate medical needs alongside current safety, circumstances, thoughts, supports and the person's priorities. NICE supports psychosocial assessment and collaborative safety planning. A numerical risk category should not replace an individual assessment or determine discharge by itself. Clarify immediate concerns, involve appropriate support and plan follow-up in a way that responds to the person's circumstances and preferences.
Apply it
For a medically stable person reporting recent self-harm and ongoing distress, address physical needs, explore immediate safety and supports, and arrange appropriate psychosocial assessment and planning.
Common pitfall: Do not equate a low-risk label with safety or assume one predetermined disposition for every disclosure. A score cannot substitute for thoughtful assessment, supportive conversation and practical follow-up.
Self-harm — NG225 recommendations · MLA content map: applicable from September 2026 onwards
7.Which back-pain features raise concern for cauda equina syndrome?
Back pain with new bladder or bowel dysfunction, saddle sensory change, bilateral symptoms or progressive neurological deficit raises concern for cauda equina compression and needs urgent assessment. Ask directly about urinary function, bowel control and sensation because patients may not volunteer these symptoms. Red flags raise suspicion but do not alone establish the diagnosis; urgent specialist assessment determines the cause and appropriate next step.
Apply it
Acute back pain with difficulty initiating urination and altered perineal sensation warrants immediate specialist assessment rather than routine physiotherapy or delayed review.
Common pitfall: Do not dismiss red flags because back pain is common, pain is the dominant symptom or leg power is preserved. A normal single examination finding does not settle the concern or justify delay.
Suspected neurological conditions — Recommendations for adults aged over 16 · MLA content map: applicable from September 2026 onwards
8.What should happen when sudden focal neurological symptoms resolve?
Sudden focal weakness, speech disturbance or visual loss may represent stroke or transient ischaemia even if symptoms resolve. Arrange urgent assessment through the appropriate pathway, establish the time of onset or last-known-well time, and assess current stability. Resolution changes the observed examination but does not erase the significance of a sudden focal episode or remove the need for prompt assessment.
Apply it
A person had unilateral weakness and slurred speech for ten minutes but is now normal. Arrange urgent assessment rather than advising observation at home.
Common pitfall: Do not treat symptom resolution as proof of safety or postpone assessment for routine testing. Avoid a reassuring diagnosis before considering time-sensitive causes and the full history of the episode.
Symptoms of a stroke · MLA content map: applicable from September 2026 onwards
9.When does pelvic pain require emergency assessment for ectopic pregnancy?
In anyone who could be pregnant, pelvic or abdominal pain warrants consideration of ectopic pregnancy even when pregnancy has not been confirmed. Severe pain, collapse or faintness requires emergency assessment because rupture can be life-threatening. Ask about menstrual history and bleeding, but do not let uncertainty about dates or lack of a prior positive test exclude pregnancy from the assessment.
Apply it
Possible early pregnancy with unilateral pelvic pain and faintness warrants emergency assessment for possible ectopic pregnancy or rupture.
Common pitfall: Do not reassure solely because symptoms are early, bleeding is slight or the patient has not tested for pregnancy. Lack of confirmation does not make an urgent cause safe to ignore; assess urgently when the presentation is concerning.
Ectopic pregnancy — Symptoms · MLA content map: applicable from September 2026 onwards
10.Which combination suggests acute angle-closure glaucoma rather than simple conjunctivitis?
Sudden painful red eye with blurred vision, halos, headache or nausea can indicate acute glaucoma and requires urgent assessment. Significant pain and visual change are warning features that need attention beyond redness or discharge. Ask about onset and vision, assess the patient's overall state and arrange an appropriate urgent eye pathway when the presentation is concerning.
Apply it
Sudden painful red eye with blurred vision and nausea warrants urgent eye assessment rather than routine conjunctivitis treatment or a delayed review.
Common pitfall: Do not let redness or discharge distract from substantial pain and visual change. Avoid routine treatment for an assumed benign cause when urgent features are present; explain the need for prompt assessment.
Glaucoma · MLA content map: applicable from September 2026 onwards
11.How can acute kidney injury be recognised from changing kidney function?
In adults, acute kidney injury criteria include a creatinine rise of at least 26 micromol/L within 48 hours, a rise of at least 50% within 7 days, or urine output below 0.5 mL/kg/hour for more than 6 hours. Interpret results against baseline and clinical context. Review urine output, volume status, medicines, infection and possible obstruction; consider timing and whether the patient is deteriorating.
Apply it
Reduced urine output and creatinine above a recent baseline warrant AKI assessment, review of relevant medicines and investigation of likely causes.
Common pitfall: Do not interpret creatinine without considering baseline or give fluid automatically without assessing volume status, overload risk and other causes. Use the patient's trajectory and current guidance to determine next steps.
12.How does spirometry help distinguish COPD from a symptom-based label?
NICE recommends post-bronchodilator spirometry to confirm COPD. Interpret the result with symptoms, exposure history, test quality and possible alternative diagnoses. Breathlessness or a risk factor alone does not establish persistent airflow obstruction. Use the result together with the clinical picture and current guidance before assigning a diagnosis or making longer-term decisions.
Apply it
For chronic cough and exertional breathlessness in a long-term smoker, arrange appropriate assessment and post-bronchodilator spirometry when the person is clinically suitable.
Common pitfall: Do not equate smoking with confirmed COPD or use an acute episode as a substitute for appropriate diagnostic testing. Avoid treating poor-quality spirometry as definitive; check quality and context.
Chronic obstructive pulmonary disease in over 16s — NG115 recommendations
40.How should clinicians discuss a possible diabetes diagnosis and ongoing care?
Consider symptoms, relevant history and appropriate testing when diabetes is suspected, and interpret results using current clinical guidance. Ongoing care should account for the individual's health, preferences and risks. The GMC content map identifies endocrine, diabetes and metabolic practice as assessment scope; it is not a source of diagnostic thresholds, treatment choices or monitoring protocols.
Apply it
For a patient with thirst and frequent urination, assess the presentation and arrange appropriate testing and follow-up rather than diagnosing from symptoms alone.
Common pitfall: Do not diagnose or prescribe from a single symptom or use the assessment outline as a clinical guideline. Explain the next step and make responsibility for result follow-up clear.
50.How should clinicians respond to possible hypoglycaemia in a person with diabetes?
Consider hypoglycaemia when symptoms and context suggest it, check glucose using an appropriate procedure and follow current local guidance for treatment and reassessment. The content map identifies diabetes and metabolic care as assessment scope; it does not provide a treatment protocol or dosing. Assess immediate safety and interpret a bedside result in the wider clinical context.
Apply it
For a confused patient taking glucose-lowering treatment, assess immediate safety, obtain an appropriate bedside glucose measurement and follow the applicable pathway.
Common pitfall: Do not assume confusion is psychiatric or interpret a device reading without the wider clinical context. Follow current guidance rather than inventing a treatment dose, and reassess the patient as appropriate.
MLA content map: applicable from September 2026 onwards · Practical skills and procedures
54.What is the importance of reassessment after an intervention?
Reassess symptoms and observations after an intervention, compare them with the initial state and revise the plan if the patient has not improved or has worsened. The response can reveal whether the problem is changing and whether more help is required. The content map establishes acute-care scope but does not prescribe a particular intervention or response threshold.
Apply it
After initial support for breathlessness, repeat observations and escalate if there is no improvement, the patient deteriorates or new concerns arise.
Common pitfall: Do not assume that carrying out an intervention means the problem is resolved. Reassessment and clear responsibility for the next step remain essential, particularly when the patient's condition is changing.
55.How should diabetes-related test results be connected to symptoms and follow-up?
Interpret results using the relevant test, clinical context and current guidance; arrange review and make responsibility for follow-up clear. Consider whether an unexpected result fits the presentation and whether confirmation or further assessment is needed. The content map establishes diabetes and metabolic care as assessment scope, not diagnostic thresholds or treatment rules.
Apply it
If a result is unexpected or does not fit the presentation, check its context, explain uncertainty and agree the appropriate next step and review.
Common pitfall: Do not diagnose or change treatment from an isolated value without considering context and follow-up. A test result without an accountable review plan can create avoidable risk, so make arrangements explicit.
59.What is the initial professional response to suspected anaphylaxis?
Suspected anaphylaxis is an emergency: call for help, assess airway, breathing and circulation, and give prompt intramuscular adrenaline as the key first-line action at first suspicion. Reassess the response and follow current age-appropriate resuscitation guidance for dosing and subsequent management. Treat the clinical presentation as urgent while continuing to monitor and obtain additional support.
Apply it
If a patient develops sudden breathing difficulty and circulatory symptoms after likely allergen exposure, call for help, assess ABC, give IM adrenaline promptly under the current protocol and monitor response.
Common pitfall: Do not wait for a rash or diagnostic certainty when serious features are present. Antihistamines are not a substitute for indicated first-line treatment; use current guidance for dosing and ongoing management.
Special circumstances Guidelines — Resuscitation Council UK 2025
Areas of professional knowledgenot stated
13.How do pre-test probability and test thresholds shape investigation?
Pre-test probability is the estimated chance of disease before testing, based on the presentation, examination and relevant risk factors. It helps determine which diagnostic pathway is appropriate and changes how a result should be interpreted. NICE uses clinical probability to guide investigation for suspected venous thromboembolism, illustrating a broader reasoning principle. A result cannot be interpreted in isolation from the clinical question and probability before testing.
Apply it
Before selecting a test, identify the suspected condition and estimate its likelihood from the whole presentation. Use the relevant pathway rather than treating the same result as equally decisive in every patient.
Common pitfall: Do not treat sensitivity or specificity as an individual diagnosis. Avoid ignoring pre-test probability or applying one disease-specific pathway indiscriminately to other conditions.
14.How should an imaging request answer a clinical question?
Communicate relevant history, examination findings, urgency and a specific diagnostic question so imaging can inform a decision. Select a modality with the responsible team and applicable pathway. Imaging does not replace stabilising an unstable patient, and its limitations matter: a test is useful only for conditions and questions it is suited to address. This is general educational reasoning, not a condition-specific imaging recommendation.
Apply it
State what decision a requested image will inform. For an unstable patient, escalate and stabilise while arranging any time-critical investigation through the appropriate pathway.
Common pitfall: Do not request imaging merely to look for everything or assume a normal scan excludes conditions it was not designed to assess. Clarify the question, urgency and ownership of reviewing the result.
15.Why should a medication review include indication, benefit and harm?
Review each medicine's purpose and benefit, and consider whether adverse effects, interactions, contraindications or changing organ function alter its balance. Reconcile what the patient actually takes with reliable records, and use current prescribing references. Seek senior or pharmacy input when uncertainty or risk is significant. Medication review is an ongoing safety task, not simply a check that a list exists.
Apply it
With new renal impairment, reconcile the medicines and consult authoritative prescribing guidance before changing treatment or deciding that an existing prescription remains appropriate.
Common pitfall: Do not assume a familiar medicine is safe for every patient or make an unverified dose adjustment from memory. Confirm allergies, indication and current context, and seek reliable advice when needed.
MLA content map: applicable from September 2026 onwards · Acute kidney injury — NG148 recommendations
16.What makes consent valid for a proposed intervention?
Consent requires a meaningful discussion and a voluntary decision by a person with capacity for that particular choice. Explain relevant benefits, material risks, alternatives and the option of no intervention; invite questions and check understanding. Tailor the discussion to the person and decision. A signed form may document part of the process, but it cannot replace communication and a valid choice.
Apply it
Pause when a patient is uncertain about a material risk. Explain it accessibly, invite questions, check understanding and confirm the patient's choice before proceeding.
Common pitfall: Do not treat consent as form-filling or presume incapacity because someone disagrees. Avoid rushing without providing relevant information, a genuine choice and a chance to ask questions.
The seven principles of decision making and consent · Consent to treatment
18.How can absolute effects clarify a treatment's reported benefit?
Absolute risk reduction is the difference between event risks over a stated period. If risks are 10% and 6%, the absolute reduction is 4 percentage points and the number needed to treat is 25 for that period. Relative effects can obscure baseline risk. Interpretation also depends on the population, comparator, follow-up, uncertainty and whether the outcome matters clinically.
Apply it
For event rates of 8% and 6%, the absolute reduction is 2 percentage points and the NNT is 50 over that follow-up period.
Common pitfall: Do not confuse a percentage-point reduction with a relative reduction or omit the population and follow-up period. Link NNT to the particular outcome and duration, and consider uncertainty and clinical relevance.
Cochrane Handbook, Chapter 15: Interpreting results and drawing conclusions
19.Why should population context inform prevention without stereotyping an individual?
Access, deprivation, environment, culture and exposure can affect health and care. Population evidence can help identify relevant risks and shape accessible support, but it cannot establish an individual's diagnosis, beliefs or preferences. Ask the person about their own circumstances and use respectful, non-judgmental communication. Practical barriers may be important to understanding health needs and whether a care plan is achievable.
Apply it
If transport and work prevent attendance, explore accessible alternatives and agree a realistic plan rather than interpreting missed appointments as lack of motivation.
Common pitfall: Do not infer beliefs, adherence or risk solely from demographic characteristics. Use population patterns to guide respectful questions, not to stereotype or replace individual assessment and shared planning.
42.How can medication reconciliation reduce prescribing risk?
Confirm the current medicine list, indication, prescribed dose, allergies, recent changes and relevant organ function. Resolve discrepancies using reliable records and discussion with the patient or appropriate carers. Seek senior or pharmacy advice when needed. The content map includes clinical pharmacology as assessment scope but does not provide drug-specific rules or replace current prescribing references.
Apply it
When a patient with renal impairment is admitted, reconcile medicines and consult current prescribing guidance before deciding whether a change is needed.
Common pitfall: Do not rely on an incomplete list or make an unverified dose change from memory. Check what the patient actually takes, document significant discrepancies and consult an authoritative source when uncertain.
MLA content map: applicable from September 2026 onwards · Acute kidney injury — NG148 recommendations
52.How should a medication allergy or adverse-reaction history inform prescribing?
Clarify the substance, reaction, timing and severity, and distinguish a recorded allergy from an uncertain or non-allergic adverse effect. Check reliable records and current prescribing information before making a decision. Ask what happened rather than relying only on an unclear label. Seek reliable advice when the reaction could materially affect safety or the appropriate treatment choice.
Apply it
Before prescribing, clarify an ambiguous allergy entry and seek reliable advice if the reported reaction could materially alter safety.
Common pitfall: Do not ignore a potentially serious reaction or perpetuate an unclear label without checking its history. Avoid assuming every recorded adverse effect is an allergy; document useful detail and consult current guidance.
58.How should a confidence interval inform interpretation of a study result?
A confidence interval expresses uncertainty around an estimate under the method used; a wider interval generally indicates less precision. Consider the plausible range of effects, study design and clinical importance. The interval is one part of interpretation and should be understood alongside the estimate, outcome, population and limitations of the evidence.
Apply it
If an estimate suggests benefit but its interval includes little effect, explain the uncertainty and interpret the finding alongside study quality and clinical context.
Common pitfall: Do not report only the point estimate or equate statistical significance with clinical importance. A confidence interval alone does not establish causality or applicability to an individual; consider study design and other evidence.
Cochrane Handbook, Chapter 15: Interpreting results and drawing conclusions
Clinical and professional capabilitiesnot stated
20.How do you choose investigations that can change a clinical decision?
Start by identifying the diagnosis, risk or uncertainty the investigation is intended to address and how a result will change the next step. Consider urgency, test limitations, pre-test probability and the patient's burden. Decide whether referral or immediate treatment must precede testing. Make a clear plan for result review and communicate what happens if the result is abnormal, delayed or unavailable.
Apply it
Select tests that distinguish plausible causes, identify who will review each result and explain what deterioration should prompt urgent help before results return.
Common pitfall: Do not order panels without a clinical question or leave results without an accountable reviewer. Testing does not replace escalation when immediate risk is present; make ownership and follow-up explicit.
21.What makes a clinical explanation understandable and useful?
Adapt language, pace and detail to the person's needs, invite questions and check understanding. Use an appropriate interpreter or communication support where needed. Explain the problem, uncertainty and next steps in a way the patient can use. Asking the person to describe the plan in their own words can reveal misunderstandings that a simple yes-or-no question may miss.
Apply it
If a patient cannot describe the next step, pause, simplify the explanation, offer suitable support and check understanding again before relying on the plan.
Common pitfall: Do not mistake silence, fluency or a signed form for understanding. Avoid blaming a patient for confusion when the explanation, language or communication method may need adjustment.
22.How is decision-making capacity assessed for a particular choice?
Assess capacity in relation to the specific decision and relevant time, and support the person to decide where possible. Explain information accessibly and address communication barriers. Apply the relevant law and professional guidance. A risky, unpopular or apparently unwise choice does not by itself demonstrate incapacity; the assessment must relate to the decision in question.
Apply it
Explore an adult's reasons for refusing an investigation, address communication barriers and assess capacity for that particular decision if there is reason for concern.
Common pitfall: Do not equate disagreement, disability or an unwise choice with incapacity. Avoid making a global judgement from a diagnosis or single observation; focus on the decision and applicable guidance.
The seven principles of decision making and consent · Consent to treatment
23.When may confidential information be shared with someone else?
For direct care, share relevant information with appropriate team members, respect patient preferences and explain how information is used. A relative's request does not itself authorise disclosure. Listen to information relatives provide, since it may matter to care. If an exception or wider disclosure may apply, seek appropriate advice and share only what is necessary for the purpose.
Apply it
When a relative asks for a diagnosis, listen to their concerns, check the patient's disclosure preferences and avoid confirming confidential details without an appropriate basis.
Common pitfall: Do not treat family involvement as blanket consent or ignore potentially important information from a relative. Receiving information and disclosing patient information are distinct acts; consider preferences and purpose before sharing.
24.What does ethical responsibility require after a clinical error?
Address immediate safety and be open and honest with the patient when things go wrong. Offer an appropriate apology and support, explain what is known and what remains uncertain, and cooperate with an investigation. Communicate without concealment or speculation. Candour does not remove the need to provide clinical care, report concerns through appropriate channels or learn from the event.
Apply it
If a result was not acted on and harm may have occurred, escalate the clinical concern, arrange appropriate assessment and support, and make an open, accurate communication plan.
Common pitfall: Do not delay action on immediate risk or present uncertain facts as established. Avoid withholding information merely because an investigation is ongoing; communicate accurately and continue to support the patient.
25.How does effective teamwork reduce risk during handover?
Communicate the concern, relevant findings, actions already taken, outstanding tasks and who is responsible for follow-up. Invite questions and confirm that the receiving clinician understands and accepts the plan. Escalate unresolved safety concerns rather than assuming they will be noticed. A useful handover transfers information clearly while making responsibility, urgency and timing explicit.
Apply it
For a pending investigation, state why it matters, when the result is expected, what action may be required and which named team member will review it.
Common pitfall: Do not assume that entering a task or sending a message transfers responsibility. Avoid leaving ownership, urgency or follow-up timing ambiguous; confirm the receiving person has the information needed to act.
26.Why should safety-netting specify triggers and actions?
Explain which changes should prompt further help, how urgently help is needed and where the patient should seek it. Tailor advice to uncertainty, the person's circumstances and ability to act. Safety-netting supports a management plan but does not replace appropriate investigation, referral, treatment or arranged follow-up when these are indicated. Make the next step understandable and practical.
Apply it
Describe which new symptoms require emergency help, which warrant prompt review and whom to contact if symptoms persist or the agreed plan cannot be followed.
Common pitfall: Do not say only 'return if worse' without defining what worse means. Safety-netting cannot compensate for an unsafe discharge or missing referral, so make the planned next step clear.
27.How should uncertainty be communicated without abandoning the patient?
State what is known, what remains uncertain and why the current plan is reasonable. Explain the next steps, who is responsible for them and what deterioration requires urgent care. Acknowledge the limits of tests and diagnosis while remaining attentive to the patient's concerns. Clear uncertainty paired with follow-up can support trust and safe decision-making.
Apply it
If initial tests are inconclusive, agree the next investigation or review, identify who will follow up and give specific advice about when to seek urgent help.
Common pitfall: Do not overstate certainty or use uncertainty as a reason to provide no plan. Acknowledge limits while still acting on immediate risks and assigning responsibility for further assessment.
28.When should a clinician seek senior help?
Seek senior support when a patient is unstable, the situation exceeds your competence, the plan remains unsafe or necessary resources are unavailable. State the concern, relevant observations, actions already taken and the help needed. Continue appropriate care, monitor the patient and communicate changes while support is being arranged. Escalation is part of safe practice, not a failure of independence.
Apply it
If a deteriorating patient does not respond as expected, call for support promptly rather than persisting alone with an uncertain plan.
Common pitfall: Do not delay escalation to appear independent. Calling for help does not remove your responsibility to monitor and provide appropriate care within your competence while support arrives.
48.How should an informed refusal be handled when an adult has capacity for the decision?
Respect an informed, voluntary refusal by an adult with capacity for that decision, even when clinicians disagree. Discuss relevant risks, alternatives and consequences without coercion, check understanding and document the discussion. Offer appropriate follow-up and explain what changes should prompt help. Respecting refusal does not prevent the clinician from continuing to provide information and appropriate care.
Apply it
Explore a patient's concerns about an investigation, confirm understanding and capacity, discuss alternatives and respect the decision while planning safe follow-up.
Common pitfall: Do not threaten or override a capacitated adult merely because refusal seems unwise. Do not end the interaction without considering safety, alternatives and ongoing needs or documenting the discussion.
The seven principles of decision making and consent · Consent to treatment
49.How should a patient be involved when capacity fluctuates?
Optimise communication and choose a time when the person can participate where feasible. Assess capacity for the specific decision at the relevant time, document the reasoning and follow applicable law if the person lacks capacity. Continue to involve the patient as much as possible and consider whether the decision can safely wait until barriers or reversible factors have been addressed.
Apply it
For a non-urgent intervention, address reversible barriers and reassess at a clearer time if safe; record the decision-specific assessment and the patient's involvement.
Common pitfall: Do not make a global judgement from one confused episode or assume a relative has decision-making authority. Capacity is specific to the decision and time, and involvement should continue where possible.
60.How should a clinician explore a patient's priorities when discussing management?
Ask what matters to the patient, what outcomes they hope for and what concerns shape their preferences. Present reasonable options, uncertainty and relevant alternatives clearly, then check understanding. Shared decision-making supports a plan that reflects the patient's values while retaining professional responsibility for appropriate care. Invite questions and revisit the discussion if new information changes the options.
Apply it
Explore a hesitant patient's priorities, explain trade-offs without pressure and agree a clinically appropriate plan that reflects their informed preferences.
Common pitfall: Do not assume preferences from age or background. Shared decision-making is not persuasion, and patient involvement does not remove the clinician's responsibility to explain risks and recommend appropriate care.
MLA content map: applicable from September 2026 onwards · The seven principles of decision making and consent
Practical skills and proceduresnot stated
29.How do you collect a specimen without compromising its usefulness?
Choose the correct specimen and container, identify the patient, explain the procedure and use appropriate infection-control precautions. Follow local instructions for collection, labelling, storage and transport so the specimen remains suitable for analysis. Confirm that the request and sample match. Follow the relevant supervision and competence requirements for the procedure, and document completion as required.
Apply it
Before a blood culture, confirm identity and request, prepare appropriate equipment and an aseptic field, collect and label correctly, then send promptly according to local procedure.
Common pitfall: Do not label away from the patient or assume correct filling compensates for uncertain identity. A mislabeled or unsuitable specimen can lead to unsafe interpretation, so follow the complete local handling process.
30.What makes a bedside urine dipstick result clinically useful?
Use an appropriate sample, follow the strip and timing instructions, and record the result accurately. Interpret findings against symptoms, patient group and the clinical question. A dipstick can contribute to assessment but does not establish every urinary diagnosis. Decide whether further assessment or testing is needed based on the whole presentation and relevant pathway, rather than the strip result alone.
Apply it
Perform and document the test correctly, then interpret it alongside history and examination findings rather than acting on a single result in isolation.
Common pitfall: Do not interpret a dipstick without clinical context or report a result obtained outside device instructions. Check sample quality and timing if the finding is unexpected, and arrange further assessment when appropriate.
31.How can ECG acquisition avoid preventable artefact?
Prepare the patient, place electrodes accurately, ensure good contact and record an identifiable trace. Maintain privacy and confirm identity. If the trace is technically poor or lead placement is uncertain, correct the problem and repeat it when appropriate. Acquisition is a practical skill; interpretation and urgent clinical review remain separate tasks requiring the relevant competence.
Apply it
If a tracing has artefact or uncertain lead placement, check connections and reacquire it. Escalate if symptoms or the repeat ECG remain concerning.
Common pitfall: Do not interpret artefact as disease or dismiss a concerning presentation because a poor-quality ECG appears normal. Technical adequacy matters, and an ECG should not delay urgent assessment when indicated.
32.Why does aseptic preparation require hand hygiene even when gloves are worn?
Gloves do not replace hand hygiene. Clean hands at appropriate moments, use protective equipment appropriately and avoid contaminating key parts or sites. Prepare equipment and the working area according to the procedure-specific protocol. If a critical part becomes contaminated, pause and correct the process rather than continuing with an unsafe setup. Follow the local procedure throughout.
Apply it
Perform indicated hand hygiene, prepare the field and equipment, and use suitable gloves without contaminating the key site during the procedure.
Common pitfall: Do not assume sterile gloves make unclean hands safe. Do not continue after contamination of a critical part; follow the relevant local procedure and restore a safe setup before proceeding.
World Hand Hygiene Day 2025 — Frequently asked questions · Practical skills and procedures
33.How should inhaler instruction confirm that a patient can use the device?
Demonstrate the prescribed device, observe the patient's technique and correct errors with a repeat demonstration. Devices differ, so teaching must match the particular inhaler and the patient's abilities. Check that the device corresponds to the prescription and that the person can manage its steps. Practical observation provides more useful evidence than verbal reassurance alone.
Apply it
Ask the patient to demonstrate their inhaler, identify a device-specific error, teach the correct technique and ask them to demonstrate it back.
Common pitfall: Do not assume a prescription means medicine is delivered effectively. Avoid teaching a technique for a different device or switching devices without considering suitability, prescription and patient ability.
34.What does the GMC practical-skills list say about competence and supervision?
The supplementary skills list identifies practical procedures and distinguishes supervision or simulation expectations for particular skills. Inclusion signals relevance to training; it does not automatically authorise independent practice. Competence, supervision, local policy and the needs of the patient all matter. A clinician should know their limits and ask for support where required.
Apply it
If a procedure is familiar only from simulation, explain the limitation and seek an appropriately qualified supervisor before undertaking it in practice.
Common pitfall: Do not interpret 'on the list' as 'competent to perform alone.' Do not proceed without required supervision or authorisation, even if you have observed or practised the skill before.
56.How should venepuncture be prepared and performed within competence?
Confirm patient identity, explain the procedure, obtain appropriate consent, prepare equipment and follow local infection-control, labelling and sharps procedures. Check the request and ensure the specimen is identified correctly. Seek supervision if not competent or authorised. Inclusion in the GMC practical-skills list does not by itself establish that a clinician may perform the procedure independently.
Apply it
Confirm the request and identity, explain the process and label specimens according to local policy; seek support if needed and dispose of sharps safely.
Common pitfall: Do not proceed merely because venepuncture appears on a skills list or compromise identification to save time. Follow local safety procedures throughout and seek supervision when required.
57.What should a clinician consider when checking a bedside capillary glucose?
Use correct patient identification, follow the device procedure and obtain the sample appropriately; document and interpret the result in context. Ensure the test is suitable for the clinical question and act on concerning findings through the relevant pathway. The GMC skills list does not itself establish diagnostic thresholds or treatment instructions.
Apply it
For acute confusion, perform an indicated glucose check, record the result and respond according to the wider clinical context and applicable guidance.
Common pitfall: Do not treat a device reading as infallible. Repeat or seek confirmation if it conflicts with the patient's condition or test quality is uncertain, and respond to immediate clinical concerns.
Patient presentationsnot stated
35.How should shock be recognised before its cause is known?
Consider shock when a concerning combination of altered mental state, poor perfusion, abnormal observations or deterioration suggests inadequate tissue perfusion. Seek urgent help, assess and reassess while considering possible causes. Blood pressure alone may not identify early danger, and a suspected cause should not distract from immediate instability. In suspected anaphylaxis with circulatory compromise, follow current resuscitation guidance.
Apply it
A patient with suspected anaphylaxis becomes confused, cool peripherally and deteriorates. Escalate and assess urgently while following the current anaphylaxis pathway.
Common pitfall: Do not wait for profound hypotension or anchor on one cause. Use current guidance for cause-specific management, monitor the response and reassess as the clinical picture changes.
MLA content map: applicable from September 2026 onwards · Special circumstances Guidelines — Resuscitation Council UK 2025
36.How does the pattern of breathlessness guide safe initial assessment?
Breathlessness may have respiratory, cardiac, metabolic or other causes. Assess work of breathing, oxygenation, circulation and mental state, then use onset, associated symptoms, risks and examination to guide investigation. Severe symptoms, hypoxia, exhaustion or instability require urgent action. Initial assessment should not assume that a known chronic condition explains every new episode.
Apply it
A patient unable to speak full sentences with worsening observations needs escalation and assessment of immediate threats, not a routine chronic-disease work-up.
Common pitfall: Do not assume all breathlessness in someone with COPD is an exacerbation. Assess severity, consider alternative or additional acute causes using current pathways, and reassess response.
MLA content map: applicable from September 2026 onwards · Chronic obstructive pulmonary disease in over 16s — NG115 recommendations
37.What should a limb-weakness history establish first?
Establish onset, last-known-well time, distribution and whether weakness is progressing or has resolved. Sudden focal symptoms need urgent stroke assessment; progressive weakness or associated sphincter symptoms may indicate other urgent neurological problems. Clarify speech, visual, sensory and balance changes while prioritising stability and timely escalation where appropriate.
Apply it
For sudden arm weakness, record onset, assess stability and activate urgent stroke assessment rather than arranging routine review or waiting for symptoms to recur.
Common pitfall: Do not delay escalation for a lengthy examination. Improvement does not prove the episode was harmless, and a normal current examination cannot erase the history or remove the need to consider urgent causes.
Symptoms of a stroke · Suspected neurological conditions — Recommendations for adults aged over 16
38.What makes a hot, swollen joint a problem requiring careful assessment?
A hot, swollen and painful joint can have important infectious, inflammatory or traumatic causes. Septic arthritis is an important time-critical possibility, particularly with a rapidly painful swollen joint and fever. This presentation warrants urgent clinical assessment and escalation through the appropriate pathway. Examine the overall condition and use current clinical guidance; the assessment outline itself does not provide diagnosis or treatment recommendations.
Apply it
A patient develops a rapidly painful swollen knee with fever. Treat the combination as concerning for septic arthritis and arrange urgent assessment rather than assuming a chronic joint problem.
Common pitfall: Do not assume a familiar musculoskeletal diagnosis without considering acute illness or the patient's overall condition. Do not delay assessment when the presentation is concerning; use appropriate clinical guidance for diagnosis and management.
39.What should initial assessment of vomiting and diarrhoea consider?
Consider duration, severity, oral intake, urine output, pain, blood, comorbidities and signs of dehydration or instability. Ask about relevant exposures and symptoms that may point to an alternative cause. Assess the person's overall state and trajectory, then use current guidance to determine investigation, treatment and escalation. This is a general educational assessment prompt, not a condition-specific management recommendation.
Apply it
Repeated vomiting with reduced urine and marked weakness warrants assessment of hydration and severity rather than an assumption of mild self-limiting illness.
Common pitfall: Do not overlook dehydration or serious alternative causes because gastrointestinal symptoms are common. Escalate according to the person's clinical state and trajectory, not simply the symptom label.
41.What makes gastrointestinal bleeding an urgent concern?
Vomiting blood or passing black or bloody stools can indicate gastrointestinal bleeding. Assess stability, associated symptoms and the overall clinical state promptly; concerning features may require urgent escalation. Follow current local emergency pathways and ensure assessment is not delayed by assumptions about the amount or duration of visible bleeding. This is an educational recognition prompt, not a complete management guideline.
Apply it
A patient with black stools and dizziness needs prompt assessment of stability and urgent escalation as appropriate to the clinical findings.
Common pitfall: Do not reassure based only on intermittent symptoms or delay action in someone who appears unstable. Do not assume apparently small visible blood means low risk; use the whole presentation to guide urgency.
43.How should clinicians respond when a patient has an acute change in attention and cognition?
Establish the patient's baseline and the onset or fluctuation of the change, assess for delirium and consider underlying causes. NICE supports appropriate assessment such as 4AT; a tool supports but does not replace clinical assessment. Seek information from relevant sources and review the patient's overall condition. A quiet or withdrawn presentation can still represent clinically important acute confusion.
Apply it
For a newly withdrawn, inattentive inpatient, seek baseline information, assess for delirium and look for causes rather than assuming quiet behaviour means improvement.
Common pitfall: Do not label an acute change as dementia without assessing for delirium. Hypoactive presentations can be missed if assessment focuses only on agitation; look for change from baseline and investigate context.
51.How does assessment of chronic joint symptoms differ from assessment of an acutely hot joint?
For persistent joint symptoms, establish duration, affected joints, stiffness pattern, functional impact, previous episodes and the person's goals. Clarify whether symptoms are stable or have changed, and consider relevant history. A new hot, swollen joint with systemic illness is a different, potentially urgent presentation and should not be folded into a routine chronic-pain assessment. Use appropriate clinical guidance for diagnosis and management.
Apply it
For longstanding knee pain affecting walking, explore function and symptom pattern. If the joint becomes acutely hot and swollen or the person is systemically unwell, reassess urgently rather than assuming the chronic problem explains it.
Common pitfall: Do not anchor on chronic osteoarthritis when the pattern has changed, but do not treat every chronic painful joint as an acute emergency without considering its course and the overall presentation.
53.How should dysphagia be handled as a gastrointestinal symptom?
Clarify onset, progression, associated symptoms and the person's ability to swallow safely. New or progressive swallowing difficulty needs appropriate clinical assessment and pathway-based investigation. Consider whether symptoms are affecting hydration, nutrition or immediate safety. This is a general educational prompt; the content map establishes assessment scope but does not provide specific referral criteria.
Apply it
For progressive difficulty swallowing, establish severity and arrange appropriate assessment rather than attributing it to uncomplicated indigestion.
Common pitfall: Do not dismiss persistent or progressive symptoms without considering their significance and appropriate follow-up. Do not assume a common benign explanation accounts for every presentation; assess immediate swallowing safety as well.
Conditionsnot stated
17.What should happen when bacterial meningitis is suspected in a seriously ill patient?
Prioritise urgent clinical assessment and escalation when the overall presentation suggests meningitis or another serious infection. Assess severity, communicate the concern clearly and follow current urgent guidance for investigation and management. Do not wait for every result before seeking appropriate help, and reassess while the plan is being implemented. Exact investigations and treatment depend on the clinical context and current pathway.
Apply it
For a febrile, confused and seriously ill patient, escalate promptly, communicate concern for serious infection and follow the appropriate urgent pathway while assessing other possible causes.
Common pitfall: Do not allow completion of a routine history or a pending test to delay escalation for a deteriorating patient. Use current condition-specific guidance rather than treating this general priority as a complete treatment protocol.
Meningitis and meningococcal disease — NG240 recommendations · MLA content map: applicable from September 2026 onwards
44.How should suspected pulmonary embolism be investigated using a probability-led pathway?
For suspected PE, assess clinical stability first; an unstable patient needs urgent action rather than routine sequencing. In a stable patient, estimate clinical probability using the appropriate pathway, then select investigations accordingly. Probability-led testing avoids applying the same sequence to everyone and helps interpret results in context. A symptom, risk factor or laboratory result alone does not establish the diagnosis.
Apply it
For a stable patient with new breathlessness and thrombotic risk, assess the whole presentation, estimate probability using the current PE pathway and select the indicated investigation.
Common pitfall: Do not treat one symptom, risk factor or biomarker as diagnostic, and do not use a probability estimate as a substitute for assessing instability. Follow current condition-specific guidance and interpret investigations in context.
45.How can meningitis remain a concern when the familiar symptom cluster is incomplete?
Consider meningitis when the overall presentation raises concern for serious infection, including systemic illness, headache, altered mental state or neurological features. Absence of one familiar sign does not safely exclude it. Assess age, clinical state and trajectory, and escalate when the overall picture is concerning. Recognition depends on the combined presentation rather than requiring every classic feature.
Apply it
A febrile, drowsy patient without neck stiffness still needs urgent assessment for meningitis or another serious infection if the overall presentation is concerning.
Common pitfall: Do not wait for every classic sign or a confirmatory result before escalating a seriously ill patient. One absent feature should not overrule deterioration or the combined clinical picture.
Meningitis and meningococcal disease — NG240 recommendations
46.How should a COPD exacerbation be approached when symptoms worsen?
Assess severity, trajectory and alternative or additional causes rather than attributing every symptom to COPD. Review observations, functional change and relevant history, and escalate if the patient is unstable or deteriorating. Use current COPD guidance and local pathways for condition-specific decisions. A pre-existing diagnosis can help frame assessment but should not close the differential diagnosis.
Apply it
Rapidly worsening breathlessness and new confusion in a patient with COPD require urgent assessment and consideration of other acute causes.
Common pitfall: Do not intensify treatment without assessing the presentation or let chronic disease obscure an emergency. Reassess the patient's response and condition over time, and use current condition-specific guidance.
Chronic obstructive pulmonary disease in over 16s — NG115 recommendations · MLA content map: applicable from September 2026 onwards
47.How should suspected hypothyroidism be assessed without over-interpreting symptoms?
Fatigue, cold intolerance, constipation and changes in weight can occur in hypothyroidism but are not diagnostic on their own. Consider the symptom pattern, history, medicines and appropriate thyroid tests. In adults without suspected pituitary disease, follow the NICE testing sequence beginning with TSH; suspected secondary dysfunction requires TSH and FT4. Interpret results using the clinical context and relevant guidance.
Apply it
For gradual fatigue and cold intolerance, ask about the wider history and arrange appropriate thyroid testing rather than diagnosing from symptoms alone.
Common pitfall: Do not treat nonspecific symptoms or a borderline result as proof of overt disease. Do not use the primary-thyroid testing sequence when pituitary disease is suspected; use the relevant pathway and follow-up.
What to focus on during revision
The following are CertMedbry study suggestions. Use the official outline to check the full scope of your examination.
- Study the six GMC domain names as connected lenses for clinical decisions, not percentage-weighted sections; the official outline gives no domain percentages.
- Practise UK Foundation Year 2-level reasoning: recognise common, important and acute presentations, stabilise immediate threats, investigate appropriately, communicate and escalate within competence.
- Distinguish a symptom or test result from a diagnosis by using clinical context, urgency, probability and follow-up rather than isolated clues.
- Prepare separately for both parts. PLAB 1 is a five-option written examination; PLAB 2 is observed performance in a CPSA/OSCE. These four-option questions are learning drills, not an official-format replica or performance assessment.
- Use the full official content map to understand assessment scope; the selected concepts are not an exhaustive syllabus. Use cited clinical sources for specific recommendations and confirm current guidance for practice.
A practical preparation plan
1. Anchor the correct examination
Use the official name PLAB and keep PLAB 1 and PLAB 2 distinct. The GMC says PLAB retains its name while using the MLA content map; do not study it as a renamed standalone MLA examination.
2. Map study to the applicable outline
Start with the October 2025 GMC MLA content map, applicable from September 2026. Learn its six domains and examples; do not invent weightings or assume its condition list is exhaustive.
3. Practise decisions, not isolated labels
For each presentation, identify immediate danger, discriminating clues, appropriate investigation or referral, and needed reassessment or safety-netting. Explain why tempting alternatives may be less safe.
4. Separate scope from clinical recommendations
Use the GMC map for assessment scope and relevant clinical sources for recommendations. Consult current guidance when a specific treatment decision or local pathway is needed.
5. Train each examination part with the right method
Use timed five-option written practice for PLAB 1 and observed, feedback-based clinical and professional skills practice for PLAB 2. These four-option written drills are neither an official question replica nor a performance simulator.
6. Review uncertainty and accountability
Practise explaining uncertainty, consent, confidentiality, capacity, escalation and ownership of follow-up. Check current GMC guidance and applicable UK jurisdictional law for real practice.
Use your sample score as a starting point
The free set contains 20 original practice questions. It is a small learning sample, not an official examination or a validated pass prediction. Review each explanation and its source before moving to another topic.
Start the free sampleOfficial sources and updates
- Professional and Linguistic Assessments Board
- PLAB and the MLA
- MLA content map
- MLA content map: applicable from September 2026 onwards
- What is the PLAB 1 exam?
- What is the PLAB 2 exam?
- Practical skills and procedures
- Special circumstances Guidelines — Resuscitation Council UK 2025
- Venous thromboembolic diseases — NG158 recommendations
- Recent-onset chest pain of suspected cardiac origin — CG95 recommendations
- Chronic obstructive pulmonary disease in over 16s — NG115 recommendations
- Acute kidney injury — NG148 recommendations
- Thyroid disease — NG145 recommendations
- Symptoms of a stroke
- Meningitis and meningococcal disease — NG240 recommendations
- Bronchiolitis in children — NG9 recommendations
- Ectopic pregnancy — Symptoms
- Suspected neurological conditions — Recommendations for adults aged over 16
- Glaucoma
- Self-harm — NG225 recommendations
- Delirium — CG103 recommendations
- The seven principles of decision making and consent
- Consent to treatment
- Using and disclosing patient information for direct care
- The professional duty of candour
- World Hand Hygiene Day 2025 — Frequently asked questions
- Cochrane Handbook, Chapter 15: Interpreting results and drawing conclusions
Confirm current eligibility, fees, scheduling and policies directly with the examination provider. CertMedbry is independent and is not endorsed by these organisations. How we handle content and corrections.