PLAB 1 Chronic Disease Management Questions: 10 Free Practice MCQs
Chronic disease management tests the long game: review intervals, targets, adherence and self management. The MLA content map expects you to run a structured review for asthma, COPD, diabetes, hypertension or heart failure, and to spot the patient who is deteriorating between appointments. Questions often ask what to do at a routine review, where the answer is to optimise treatment and agree a plan rather than to refer.
Where candidates lose marks
- Reviewing one condition in isolation when the patient has several and the drugs interact.
- Forgetting to check adherence and inhaler or injection technique before intensifying treatment.
- Missing the red flag that turns a routine review into an urgent assessment.
- Setting a target that is unrealistic for a frail older patient.
Guideline to follow: PLAB 1 follows NICE quality standards and the RCGP guidance for long term condition reviews in UK general practice.
Ten PLAB 1-style chronic disease management questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 18 chronic disease management questions and many more across every topic.
1 / 10
A 58-year-old man with two troublesome gout flares in the past year is symptom-free three weeks after his latest flare. He had a myocardial infarction five years ago and wishes to start urate-lowering therapy.
Which urate-lowering medicine is recommended first-line for this patient?
Show answer
Answer: B. Allopurinol 100 mg daily, titrated using monthly serum urate measurements
Why: The patient has multiple troublesome flares, so NICE recommends offering urate-lowering treatment. Because he has major cardiovascular disease, NICE specifically recommends allopurinol first-line. Begin at a low dose and titrate monthly toward a serum urate below 360 micromol/L, with flare prophylaxis discussed during titration.
- A. Febuxostat is an option for some people, but NICE recommends allopurinol first-line in major cardiovascular disease.
- C. Benzbromarone is not a routine NICE first-line choice for this situation.
- D. Probenecid is a uricosuric medicine, not a xanthine oxidase inhibitor or the NICE-preferred first-line choice here.
Sources: NICE NG219: Gout, recommendations 1.5.1, 1.5.5, 1.5.6 and 1.5.9
2 / 10
A 58-year-old man has had two gout flares in the past year and is now symptom-free three weeks after the latest one settled. He has no kidney disease or contraindication to urate-lowering treatment and agrees to a treat-to-target plan.
Which long-term treatment should be started to lower his serum urate?
Show answer
Answer: A. Start allopurinol at a low dose and titrate to target serum urate
Why: NICE recommends offering urate-lowering therapy to people with multiple or troublesome flares. Start at a low dose and use monthly serum urate measurements to guide titration toward a target below 360 micromol/L. Colchicine can be offered to prevent flares during titration, but it does not replace urate-lowering treatment.
- B. Colchicine may prevent flares during ULT initiation but does not lower serum urate.
- C. Recurrent gout without diagnostic uncertainty or treatment difficulty does not require routine specialist referral before starting ULT.
- D. NICE recommends offering ULT for multiple or troublesome flares; another flare is not required before discussing treatment.
Sources: NICE NG219: Gout, recommendations 1.5.1, 1.5.4 to 1.5.6 and 1.5.12
3 / 10
A 58-year-old man has had two troublesome gout flares in the past year and is symptom-free three weeks after the latest flare settled. He has a previous myocardial infarction and no chronic kidney disease. He wants long-term urate-lowering treatment.
Which treatment is most appropriate to start?
Show answer
Answer: D. Start allopurinol at a low dose and titrate to the serum urate target
Why: Multiple or troublesome flares are an indication to offer urate-lowering therapy. NICE recommends allopurinol first-line for people with major cardiovascular disease, starting at a low dose and titrating against serum urate. The flare has settled and more than 2 weeks have passed, so treatment can be started now.
- A. Naproxen treats an acute flare but is not long-term urate-lowering therapy.
- B. Primary care can start treatment; referral is considered when diagnosis or treatment is uncertain, ineffective or poorly tolerated, or with specified comorbidity.
- C. Colchicine may be offered to prevent flares during ULT titration but does not lower serum urate.
Sources: NICE NG219: Gout, recommendations 1.5.1, 1.5.4, 1.5.5 and 1.5.9
- Like these? UK.med has a bank of 1999 questions, plus timed mock exams. Free to start: App Store · Google Play
4 / 10
A 52-year-old man with no diagnosed cardiovascular disease attends an NHS Health Check after a workmate was found to have hypertension. He feels well and asks what the appointment is intended to identify and prevent.
Which outcome is the NHS Health Check designed to support?
Show answer
Answer: C. Estimating cardiovascular risk and helping the person reduce modifiable risk
Why: The NHS Health Check is offered to eligible adults aged 40 to 74 without known cardiovascular disease, generally every 5 years. It assesses cardiovascular risk and supports changes or treatment to reduce that risk. It is not a substitute for the separate national cancer screening programmes.
- A. Cancer screening is delivered through separate NHS programmes; the Health Check focuses on cardiovascular risk.
- B. The Health Check does not primarily diagnose CKD or plan dialysis; it assesses vascular risk and related factors.
- D. Vaccination review is not the purpose of this adult preventive cardiovascular check.
Sources: NHS Health Check programme, Department of Health and Social Care, 2022
5 / 10
A 65-year-old man has confirmed above-target blood pressure despite amlodipine 5 mg daily. He developed angioedema with an ACE inhibitor and marked hyperkalaemia with an ARB. Increasing amlodipine is not tolerated because of ankle oedema.
Which antihypertensive should be added next?
Show answer
Answer: D. Add a low-dose thiazide-like diuretic, such as indapamide
Why: For people aged 55 or over whose blood pressure is uncontrolled on a calcium-channel blocker, NICE step 2 allows adding an ACE inhibitor, ARB or thiazide-like diuretic. ACE inhibitors and ARBs have caused serious adverse effects in this patient, and amlodipine cannot be increased, making a thiazide-like diuretic the best option. Blood pressure and electrolytes should be monitored after starting it.
- A. He has already developed dose-limiting oedema, which may worsen if amlodipine is increased.
- B. A beta-blocker is not the routine next choice for uncomplicated primary hypertension.
- C. A suitable additional class remains available in primary care, so referral is not required for this reason alone.
Sources: NICE NG136: Hypertension in adults, recommendations 1.4.32 to 1.4.39, current guidance
6 / 10
A 70-year-old man with a 10-year history of chronic kidney disease stage 4 (eGFR 22 mL/min/1.73m2) secondary to diabetic nephropathy is reviewed in primary care. He is currently taking erythropoietin and iron supplements.
Which of the following is the most appropriate next step in the management of this patient's chronic kidney disease?
Show answer
Answer: D. Refer the patient to a nephrologist for further evaluation and management
Why: The patient's eGFR is below the target range, and he is currently taking erythropoietin and iron supplements. Referral to a nephrologist for further evaluation and management is an appropriate next step in his management.
- A. High-dose erythropoietin without specialist nephrology oversight carries cardiovascular risks in severe CKD stage 4 (UK-GP-060).
- B. Phosphate binders are guided by serum phosphate levels, not initiated empirically in CKD 4 without lab evidence (UK-GP-060).
- C. High-dose oral iron can cause GI toxicity; nephrology assessment for IV iron or ESA optimization is preferred (UK-GP-060).
Sources: NICE Guideline NG13
7 / 10
A 71-year-old woman with diabetic kidney disease has an eGFR of 24 mL/min/1.73 m2, stable over the past year. She remains independent and asks what treatment can realistically achieve at this stage.
Which statement best describes the goals of ongoing CKD management for this patient?
Show answer
Answer: A. Reduce symptoms and prevent complications while preserving quality of life
Why: CKD management aims to slow progression where possible, reduce cardiovascular and other complications, and manage symptoms in line with the person's priorities. Dialysis planning is individualised and an eGFR value alone does not trigger its immediate start. Kidney replacement options are discussed and assessed when appropriate.
- B. Established stage 4 CKD is not generally reversible to normal kidney function; treatment aims to reduce risk and manage consequences.
- C. An eGFR of 22 alone is not an indication to start dialysis; symptoms, complications and patient preferences inform planning.
- D. Transplantation may be an option for selected people, but requires assessment and is not an automatic response to stage 4 CKD.
Sources: NICE NG203: Chronic kidney disease, assessment and management, 2021
8 / 10
A 71-year-old woman with hypertension asks how amlodipine lowers her blood pressure. She takes 5 mg once daily and has no other antihypertensive medicines.
Which mechanism best describes amlodipine?
Show answer
Answer: A. It blocks L-type calcium channels in vascular smooth muscle, causing arteriolar dilatation
Why: Amlodipine is a dihydropyridine calcium-channel blocker. It reduces L-type calcium entry into vascular smooth muscle, causing arteriolar dilatation and lower peripheral resistance. The other options describe beta-blockers, thiazide-like diuretics and alpha-blockers.
- B. Beta-1 receptor blockade describes medicines such as bisoprolol, not the action of amlodipine.
- C. Inhibition of this renal transporter is the mechanism of thiazide-like diuretics, not amlodipine.
- D. Alpha-1 receptor blockade can cause vasodilatation, but it is not how amlodipine works.
Sources: BNF: Amlodipine, mechanism of action, current monograph
9 / 10
A 65-year-old man with a 10-year history of hypertension is reviewed in primary care. His blood pressure is 160/90 mmHg, and he is currently taking amlodipine 5 mg once daily.
Which of the following is the most appropriate next step in the management of this patient's hypertension?
Show answer
Answer: B. Add a diuretic to his current medication regimen
Why: The patient's blood pressure is above the target range, and he is currently taking amlodipine. Adding a diuretic to his current medication regimen is an appropriate next step in his management.
- A. Increasing amlodipine to 10mg once daily is one step, but combining CCB with an ACEi/ARB or thiazide-like diuretic is step 2 per NICE (UK-GP-058).
- C. Cardiology referral is unnecessary for uncomplicated step 2 hypertension manageable in primary care (UK-GP-058).
- D. Amlodipine is dosed once daily; twice daily dosing is non-standard and inappropriate (UK-GP-058).
Sources: NICE Guideline NG136
10 / 10
A 58-year-old man has had two troublesome gout flares in the past year. The latest flare settled 3 weeks ago. He has no CKD, tophi or major cardiovascular disease and asks about a preventive medicine.
What long-term treatment should now be offered for his gout?
Show answer
Answer: A. Begin a treat-to-target urate-lowering therapy discussion and offer treatment
Why: NICE recommends offering urate-lowering therapy to people with multiple or troublesome flares, using a treat-to-target strategy. ULT is usually started 2 to 4 weeks after a flare has settled, and this patient's flare settled 3 weeks ago. Discuss the treatment choice and titration plan; prophylaxis can be offered while reaching the urate target.
- B. NSAIDs may treat an acute flare but do not lower urate or serve as long-term ULT.
- C. Two flares support offering ULT; they do not by themselves require automatic specialist referral.
- D. Colchicine can be used to prevent flares while titrating ULT, but it does not lower serum urate as ULT does.
Sources: NICE NG219: Gout, diagnosis and management, 2022
Explore the 1999-question bank in UK.med
Timed practice, spaced repetition and AI clinical simulations that grade you like an examiner. Free to start.
More topics
- General Practice155 questions in the app
- Diabetes55 questions in the app
- Hypertension93 questions in the app
- Obstetrics & Gynaecology334 questions in the app
Free PLAB 1 Practice Questions by Topic · Free timed mock exam
The PLAB and GMC registration pathway
Exam-style questions written by MedHub for practice. They are not official exam questions.