# PLAB 1 Cardiology Questions: 10 Free Practice MCQs

> 10 free PLAB 1 cardiology questions with answers and explanations, from a bank of 217 cardiology questions. Try them now, no sign up.

Canonical: https://medhub.one/practice/plab-1/cardiology
Last updated: 2026-10-29

Ten PLAB 1-style cardiology questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 217 cardiology questions and many more across every topic.

1. 1 / 10  
A 74-year-old with persistent stage 1 hypertension has left ventricular hypertrophy consistent with target organ damage. There is no frailty.  
What is the appropriate next discussion?  
Show answer

**Answer: A.** Discuss antihypertensive drug treatment alongside lifestyle advice

**Why:** NICE NG136 recommends discussing medication for persistent stage 1 hypertension in adults under 80 with target organ damage. Discuss the individual cardiovascular risk, preferences and possible benefits and harms.

  * **B.** NICE includes target organ damage as a reason to discuss treatment before an event occurs.
  * **C.** Potassium supplements are not recommended as a blood pressure lowering method.
  * **D.** This stable outpatient scenario does not indicate emergency intravenous treatment.  
Sources: NICE NG136 recommendations 1.4.10 and 1.4.11
2. 2 / 10  
A 62-year-old male presents to the emergency department with a 2-hour history of acute, crushing central chest pain radiating down his left arm. He is sweating and tachycardic. The ECG shows ST-segment elevation in leads V2-V5\. The hospital has an on-site primary percutaneous coronary intervention (PCI) service.  
What is the most appropriate next step in management according to NICE guidelines?  
Show answer

**Answer: D.** Offer primary PCI if it can be delivered within 120 minutes of when fibrinolysis could have been started

**Why:** NICE guideline NG185 recommends offering primary PCI as the first-line reperfusion strategy for patients with acute STEMI who present within 12 hours of symptom onset, provided it can be delivered within 120 minutes of when fibrinolysis could have been started. If this timeline cannot be met, fibrinolysis should be offered unless contraindicated.

  * **A.** Fibrinolysis should be offered only if primary PCI cannot be delivered within the 120-minute target window.
  * **B.** Emergency CABG is reserved for patients with mechanical complications of MI or failed PCI, and is not the first-line reperfusion therapy.
  * **C.** In STEMI, reperfusion must not be delayed to wait for troponin results, as 'time is muscle'.  
Sources: NICE NG185
3. 3 / 10  
A 72-year-old with known atrial fibrillation has undergone successful cardioversion and is now in sinus rhythm. They ask whether they can stop their anticoagulant because the rhythm strip is normal.  
What should guide the decision about continuing or stopping anticoagulation?  
Show answer

**Answer: B.** Reassess stroke and bleeding risk using CHA2DS2-VASc and ORBIT and discuss the person's preferences; do not stop solely because AF is no longer detected

**Why:** NICE NG196 recommendations 1.11.1 and 1.11.2 say not to stop anticoagulation solely because AF is no longer detectable. Base any decision to stop on reassessment of stroke and bleeding risks using CHA2DS2-VASc and ORBIT, and discuss the person's preferences.

  * **A.** NICE does not recommend aspirin monotherapy solely for stroke prevention in AF.
  * **C.** NICE specifically advises not to stop anticoagulation solely because AF is no longer detectable.
  * **D.** NICE recommends reassessing stroke and bleeding risk and discussing the person's preferences when deciding whether to stop.  
Sources: NICE NG196 recommendations 1.11.1 and 1.11.2
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5. 4 / 10  
A 49-year-old attends urgent care with central chest discomfort that began 40 minutes ago. The discomfort is concerning for acute coronary syndrome, but the first resting 12-lead ECG shows no diagnostic ST-segment changes.  
How should the first ECG result affect the assessment?  
Show answer

**Answer: A.** It does not rule out acute coronary syndrome

**Why:** NICE CG95 recommendation 1.2.2.5 says not to exclude ACS when a person has a normal resting 12-lead ECG. A single ECG is one part of assessment and may not show evolving or intermittent changes. The ECG result must be considered alongside the history and clinical state, with referral and monitoring determined by the suspected diagnosis and the guideline pathway.

  * **B.** NICE explicitly advises not to exclude ACS when the resting 12-lead ECG is normal; ECG findings must be interpreted with the clinical presentation.
  * **C.** A normal initial ECG does not rule out ACS. Clinical assessment and the appropriate urgent pathway remain necessary.
  * **D.** A normal ECG alone cannot establish either conclusion in a person with recent potentially cardiac chest pain.  
Sources: NICE CG95 recommendation 1.2.2.5
6. 5 / 10  
A 75-year-old with atrial fibrillation is being considered for a DOAC. Their estimated renal function has declined since the last review, and they ask whether the usual dose can simply be continued.  
What is the safest next prescribing step?  
Show answer

**Answer: B.** Select or adjust the DOAC using current renal results and the relevant BNF and MHRA guidance

**Why:** NICE NG196 recommendation 1.6.2 says to consider contraindications and follow BNF and MHRA advice on DOAC doses in renal impairment, reversal agents and monitoring. Review current renal function and the specific medicine's licensed dosing criteria before prescribing or continuing a dose. There is no safe universal dose reduction that applies to every DOAC.

  * **A.** NICE highlights renal impairment as a factor that can affect DOAC choice, dose and monitoring.
  * **C.** Dose-reduction rules differ by medicine and patient factors; an arbitrary universal reduction is unsafe.
  * **D.** A change in renal function requires an individual anticoagulant review; aspirin is not a substitute for AF stroke prevention.  
Sources: NICE NG196 recommendation 1.6.2
7. 6 / 10  
A 72-year-old with atrial fibrillation lasting 2 months is being considered for elective long-term rhythm control. No TOE-guided plan has been selected and the patient is haemodynamically stable.  
How should elective cardioversion be timed in relation to anticoagulation?  
Show answer

**Answer: C.** Delay cardioversion until at least 3 weeks of therapeutic anticoagulation, using rate control as appropriate meanwhile

**Why:** NICE NG196 recommendation 1.8.6 says that if atrial fibrillation has lasted more than 48 hours or its duration is uncertain and long-term rhythm control is being considered, delay cardioversion until therapeutic anticoagulation has been maintained for at least 3 weeks. Offer rate control as appropriate during this period. This applies to elective cardioversion in a stable patient.

  * **A.** For AF longer than 48 hours, NICE advises delaying elective cardioversion until therapeutic anticoagulation has been maintained for at least 3 weeks.
  * **B.** Aspirin is not a substitute for the recommended therapeutic anticoagulation period before elective cardioversion.
  * **D.** NICE specifies at least 3 weeks of therapeutic anticoagulation, with rate control as appropriate during the delay.  
Sources: NICE NG196 recommendation 1.8.6
8. 7 / 10  
A 59-year-old has confirmed stage 1 hypertension, type 2 diabetes and no frailty. Their estimated 10-year cardiovascular risk is below 10%.  
What is the appropriate discussion about treatment?  
Show answer

**Answer: A.** Discuss starting antihypertensive medication as well as lifestyle changes

**Why:** For adults under 80 with persistent stage 1 hypertension, NICE NG136 recommends discussing drug treatment when diabetes, renal disease, established cardiovascular disease, target organ damage or a 10-year cardiovascular risk of at least 10% is present.

  * **B.** Diabetes independently qualifies for a discussion; the risk threshold is not the only criterion.
  * **C.** NICE calls for a shared discussion of risks, benefits and preferences before treatment.
  * **D.** The severe hypertension threshold is not the point at which treatment must first be discussed.  
Sources: NICE NG136 recommendations 1.4.10 and 1.4.11
9. 8 / 10  
A 58-year-old man has confirmed atrial fibrillation. He has no hypertension, diabetes, heart failure, vascular disease, previous stroke or other CHA2DS2-VASc risk factor.  
What does NICE recommend about anticoagulation for stroke prevention?  
Show answer

**Answer: C.** Do not offer anticoagulation solely for AF-related stroke prevention at this very low risk level

**Why:** NICE NG196 recommendations 1.2.1 and 1.6.7 say to assess stroke risk in paroxysmal, persistent or permanent AF and not to offer anticoagulation to people under 65 with no risk factors other than sex. Recommendation 1.6.14 says not to offer aspirin monotherapy solely for AF stroke prevention.

  * **A.** NICE does not recommend aspirin monotherapy solely for stroke prevention in AF.
  * **B.** NICE bases anticoagulation on stroke risk, not whether AF is paroxysmal or persistent.
  * **D.** NICE bases stroke prevention on individual stroke-risk assessment and does not recommend anticoagulation at this very low risk level.  
Sources: NICE NG196 recommendations 1.2.1, 1.6.7 and 1.6.14
10. 9 / 10  
A 48-year-old has persistent stage 1 hypertension confirmed outside clinic and established chronic kidney disease. They are not frail.  
What should be discussed with the patient?  
Show answer

**Answer: A.** Starting antihypertensive medication in addition to lifestyle advice

**Why:** NICE NG136 includes renal disease among the conditions for which drug treatment should be discussed in adults under 80 with persistent stage 1 hypertension. Offer lifestyle measures whether or not medication is chosen.

  * **B.** Chronic kidney disease already meets a criterion for a treatment discussion.
  * **C.** A confirmed diagnosis still requires ongoing management and monitoring.
  * **D.** Potassium salt substitutes are unsafe for many people with kidney disease and are not drug treatment.  
Sources: NICE NG136 recommendations 1.4.10 and 1.4.11
11. 10 / 10  
A 34-year-old is found to have persistent hypertension on repeated readings. No cause has yet been investigated.  
What additional step should be considered?  
Show answer

**Answer: A.** Specialist evaluation for secondary causes and a detailed benefit-risk review

**Why:** NICE NG136 recommends considering specialist evaluation of secondary causes and a more detailed assessment of long-term treatment benefits and risks for adults under 40 with hypertension.

  * **B.** Hypertension at a young age is a reason to consider assessment for secondary causes.
  * **C.** The under-40 recommendation supports earlier evaluation rather than delaying it.
  * **D.** Young age alone does not justify immediate multidrug treatment without assessment.  
Sources: NICE NG136 recommendation 1.4.14

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