PLAB 1 ENT Questions: 10 Free Practice MCQs

Ten PLAB 1-style ent questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 13 ent questions and many more across every topic.

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1. 1 / 10

   A 24-year-old with acute sore throat has a FeverPAIN score of 3. They are systemically well, have no complication, and prefer to avoid antibiotics if possible.

   Which prescribing strategy is consistent with NICE guidance?

   • A. Insist on immediate antibiotics for every patient with a FeverPAIN score of 2 or 3, to prevent quinsy and rheumatic fever
   • B. Give a back-up prescription but advise the person to start it immediately
   • C. Withhold all safety-netting because complications are impossible at a FeverPAIN score below 4 in a well adult
   • D. Offer no antibiotic or a back-up prescription, explaining to use it if symptoms do not start to improve within 3 to 5 days or worsen rapidly
   Show answer

   Answer: D. Offer no antibiotic or a back-up prescription, explaining to use it if symptoms do not start to improve within 3 to 5 days or worsen rapidly

   Why: NICE NG84 recommendation 1.1.8 supports either no antibiotic or a back-up prescription for FeverPAIN 2 or 3, taking account of modest symptom benefit, likely recovery within a week and adverse effects. Recommendation 1.1.9 says not to start the back-up prescription immediately; use it if symptoms do not start to improve within 3 to 5 days or worsen rapidly or significantly.

   • A. NICE says to consider no antibiotic or a back-up prescription at this score, taking benefits and harms into account.
   • B. A back-up prescription is not needed immediately; NICE advises use if symptoms do not begin improving within 3 to 5 days or worsen rapidly or significantly.
   • C. Complications are unlikely, but NICE still recommends advice about worsening symptoms and when to seek medical help.

   Sources: NICE NG84 recommendations 1.1.8 and 1.1.9

2. 2 / 10

   A 72-year-old woman presents with persistent left-sided nosebleeding for 30 minutes. She has no history of trauma. The GP has pinched the soft part of her nose and applied an ice pack for 15 minutes, but the bleeding continues. On rhinoscopy, no specific bleeding point can be identified due to blood pooling.

   What is the next most appropriate step in management?

   • A. Perform silver nitrate cautery blindly on the nasal septum
   • B. Insert an anterior nasal pack (e.g. Rapid Rhino or Merocel) and monitor her blood pressure
   • C. Arrange immediate transfer to interventional radiology for sphenopalatine artery embolisation
   • D. Prescribe oral Tranexamic acid and discharge home with a head-elevated sleeping position
   Show answer

   Answer: B. Insert an anterior nasal pack (e.g. Rapid Rhino or Merocel) and monitor her blood pressure

   Why: The management algorithm for epistaxis is: (1) First aid (pinch soft tissue, lean forward). (2) If visible bleeding point: topical anaesthetic + silver nitrate cautery. (3) If no bleeding point visible or cautery fails: anterior nasal packing (Rapid Rhino or Merocel). Left in place for 24-48 hours. If anterior packing fails, consider posterior packing (Foley catheter) and refer to ENT for surgical/radiological intervention.

   • A. Cautery should never be performed blindly. If a bleeding point cannot be visualized, cautery is ineffective and can cause mucosal ulceration or septal perforation.
   • C. Arterial embolisation or surgical ligation is a last-resort treatment for severe, refractory posterior epistaxis that fails bilateral packing, not a first-line hospital step.
   • D. Discharging a patient with active, uncontrolled epistaxis is unsafe. Packing is required to achieve haemostasis before discharge.

   Sources: ENT UK guidelines; NICE CKS Epistaxis

3. 3 / 10

   A 23-year-old with acute sore throat becomes systemically unwell and develops severe unilateral throat pain, trismus, a muffled voice and swelling beside the tonsil, raising concern for quinsy.

   What is the appropriate next step?

   • A. Offer no treatment because acute sore throat usually resolves spontaneously
   • B. Arrange urgent hospital assessment for a suspected severe suppurative complication
   • C. Use a FeverPAIN score and send the person home with routine self-care only
   • D. Arrange routine review in 1 week before considering referral
   Show answer

   Answer: B. Arrange urgent hospital assessment for a suspected severe suppurative complication

   Why: NICE NG84 recommendation 1.1.13 advises referral to hospital for acute sore throat associated with severe systemic infection or a severe suppurative complication such as quinsy. This presentation has trismus, muffled voice and unilateral swelling, so urgent hospital assessment is needed.

   • A. The self-limiting course of uncomplicated sore throat does not apply when a serious suppurative complication is suspected.
   • C. A suspected quinsy is a severe suppurative complication and requires hospital assessment.
   • D. Do not delay referral when a severe suppurative complication is suspected.

   Sources: NICE NG84 recommendation 1.1.13

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5. 4 / 10

   A 22-year-old student presents with a 2-day history of sore throat, fever, and painful swallowing. On examination, he has tonsillar exudates, tender anterior cervical lymphadenopathy, and a temperature of 38.5°C. He has no cough.

   What is his FeverPAIN score, and what is the recommended management according to NICE guidelines?

   • A. FeverPAIN score of 2; reassure and advise paracetamol only, with no antibiotic prescription
   • B. FeverPAIN score of 4; offer immediate or delayed antibiotic prescription (oral Phenoxymethylpenicillin)
   • C. Centor score of 1; offer oral Amoxicillin
   • D. FeverPAIN score of 5; refer for admission for IV fluids and intravenous Benzylpenicillin
   Show answer

   Answer: B. FeverPAIN score of 4; offer immediate or delayed antibiotic prescription (oral Phenoxymethylpenicillin)

   Why: NICE guideline NG84 recommends using the FeverPAIN or Centor scores to guide antibiotic decisions in acute sore throat. FeverPAIN points: Fever (past 24h), Purulence, Attend within 3 days, Inflamed tonsils, No cough. A score of 0-1 suggests 13-18% streptococcal probability (no antibiotics). Score 2-3 suggests 30-40% (no/delayed antibiotics). Score 4-5 suggests 62-65% (immediate/delayed antibiotics). First-line antibiotic is Phenoxymethylpenicillin (Penicillin V) for 5-10 days.

   • A. His score is 4, not 2. A score of 2 or 3 has a lower streptococcal probability (delayed prescribing is option), but 4 warrants active prescribing discussion.
   • C. His Centor score is 4 (fever, exudate, lymphadenopathy, no cough), but Amoxicillin is avoided in sore throat due to risk of maculopapular rash if they actually have Glandular Fever (EBV).
   • D. His score is 4. Admission is only required if they cannot swallow fluids or have airway compromise (e.g. stridor, quinsy).

   Sources: NICE NG84

6. 5 / 10

   A 30-year-old with acute sore throat has a FeverPAIN score of 5. They are not systemically very unwell and have no suppurative complication. They want to discuss whether an antibiotic is worthwhile.

   Which option should be discussed according to NICE?

   • A. Consider either an immediate or a back-up antibiotic prescription, explaining the likely benefits, harms and safety-net advice
   • B. Prescribe a back-up antibiotic and tell the person to start it now regardless of symptoms
   • C. Never prescribe an antibiotic for sore throat, even at a high FeverPAIN score, because most cases are viral
   • D. Prescribe antibiotics only after a positive rapid antigen test or throat swab culture
   Show answer

   Answer: A. Consider either an immediate or a back-up antibiotic prescription, explaining the likely benefits, harms and safety-net advice

   Why: NICE NG84 recommendation 1.1.10 says to consider an immediate antibiotic prescription or a back-up prescription for FeverPAIN 4 or 5, taking account of the unlikely event of complications if antibiotics are withheld and possible adverse effects. Recommendation 1.1.11 gives safety-net advice when an immediate prescription is chosen.

   • B. A back-up prescription is for delayed use if symptoms fail to improve within 3 to 5 days or worsen rapidly or significantly.
   • C. NICE says an immediate or back-up prescription can be considered for FeverPAIN 4 or 5.
   • D. NICE NG84 recommends using FeverPAIN or Centor and does not require a rapid antigen test in this pathway.

   Sources: NICE NG84 recommendations 1.1.10 and 1.1.11

7. 6 / 10

   A 21-year-old male presents with severe sore throat, difficulty swallowing, and inability to fully open his mouth (trismus). He has a muffled 'hot potato' voice. On examination, there is marked swelling and erythema of the right tonsillar area, with deviation of the uvula to the left.

   What is the most likely diagnosis?

   • A. Acute follicular tonsillitis
   • B. Epiglottitis
   • C. Peritonsillar abscess (Quinsy)
   • D. Glandular fever (Infectious Mononucleosis)
   Show answer

   Answer: C. Peritonsillar abscess (Quinsy)

   Why: A peritonsillar abscess (Quinsy) is a collection of pus behind the tonsillar capsule, usually arising as a complication of acute tonsillitis. Key diagnostic signs are severe unilateral throat pain, trismus (due to pterygoid muscle irritation), a 'hot potato' voice, and deviation of the uvula to the opposite side. Management involves needle aspiration or incision and drainage, along with IV antibiotics.

   • A. Acute tonsillitis presents with bilateral tonsillar enlargement and exudate, but does not cause trismus, hot potato voice, or uvular deviation.
   • B. Epiglottitis presents with severe stridor, drooling, and sitting in a 'sniffing' position, but does not cause uvular deviation or marked tonsillar swelling.
   • D. Glandular fever causes bilateral tonsillar enlargement, lymphadenopathy, and splenomegaly, but not unilateral uvular deviation or trismus unless complicated by Quinsy.

   Sources: NICE CKS Septic Sore Throat

8. 7 / 10

   A 19-year-old presents with a 2-day sore throat and mild discomfort on swallowing. They have a FeverPAIN score of 1, are systemically well and have no quinsy or other complication.

   What is the recommended antibiotic approach?

   • A. Give a 10-day course of clarithromycin to prevent rheumatic fever
   • B. Arrange a throat swab before deciding whether an antibiotic is needed
   • C. Do not offer an antibiotic; give self-care advice and explain when to seek further help
   • D. Give immediate phenoxymethylpenicillin because all sore throats are bacterial
   Show answer

   Answer: C. Do not offer an antibiotic; give self-care advice and explain when to seek further help

   Why: NICE NG84 recommendations 1.1.3 and 1.1.6 say to use FeverPAIN or Centor to identify people likely to benefit from antibiotics and not to prescribe an antibiotic when FeverPAIN is 0 or 1. Give self-care advice and explain when to seek further medical help.

   • A. NICE recommends no antibiotic for a FeverPAIN score of 0 or 1; clarithromycin is an alternative only when an antibiotic is indicated and penicillin is unsuitable.
   • B. NICE recommends using FeverPAIN or Centor to guide prescribing; routine throat swabbing is not required by this guideline for this low-score presentation.
   • D. Most acute sore throats are self-limiting and often viral. NICE says not to offer antibiotics at this low FeverPAIN score.

   Sources: NICE NG84 recommendations 1.1.3, 1.1.6 and 1.1.7

9. 8 / 10

   A 55-year-old experience short episodes of room-spinning vertigo when turning over in bed.

   What is the diagnostic manoeuvre?

   • A. Epley Manoeuvre
   • B. Romberg's Test
   • C. Head Impulse Test
   • D. Dix-Hallpike Manoeuvre
   Show answer

   Answer: D. Dix-Hallpike Manoeuvre

   Why: The Dix-Hallpike manoeuvre is the diagnostic test for Benign Paroxysmal Positional Vertigo (BPPV), provoking characteristic torsional nystagmus. The Epley manoeuvre is the therapeutic canalith repositioning procedure used once BPPV is diagnosed.

   • A. This is the treatment.
   • B. Tests proprioception.
   • C. For vestibular neuritis.

   Sources: CKS Vertigo

10. 9 / 10

    A 35-year-old with acute sore throat has a FeverPAIN score of 4. After discussing options, an immediate antibiotic is chosen. They are an adult, are not pregnant and have no penicillin allergy.

    What is a first-choice oral antibiotic regimen in NICE NG84?

    • A. Clarithromycin 500 mg four times daily for 10 days, as first choice in all adults
    • B. Co-amoxiclav 625 mg three times daily for 7 days
    • C. Phenoxymethylpenicillin 500 mg four times daily or 1,000 mg twice daily for 5 to 10 days
    • D. Amoxicillin 1 g three times daily for 14 days to ensure streptococcal eradication
    Show answer

    Answer: C. Phenoxymethylpenicillin 500 mg four times daily or 1,000 mg twice daily for 5 to 10 days

    Why: NICE NG84 recommendation 1.3.1 lists phenoxymethylpenicillin 500 mg four times daily or 1,000 mg twice daily for 5 to 10 days as first-choice oral therapy for adults. Five days may be enough for symptomatic cure, while 10 days may increase the chance of microbiological cure. Use the BNF and local policy for individual prescribing decisions.

    • A. Clarithromycin is an alternative first choice for penicillin allergy or intolerance, not the first choice in this person without allergy.
    • B. NICE NG84 recommends phenoxymethylpenicillin as the first-choice oral antibiotic for adults with acute sore throat.
    • D. NICE NG84 lists phenoxymethylpenicillin as first choice for adults when an antibiotic is prescribed for acute sore throat.

    Sources: NICE NG84 recommendation 1.3.1

11. 10 / 10

    A 4-year-old boy is brought to the emergency department by his mother. He has a 6-hour history of high fever, sore throat, and difficulty breathing. On examination, he is toxic-looking, sitting forward with his chin protruding (tripod position), drooling saliva, and has a soft inspiratory stridor.

    What is the most critical safety rule in the initial assessment and management of this child?

    • A. Perform a thorough examination of the throat with a tongue depressor to look for tonsillar exudates and a swollen epiglottis
    • B. Lay the child flat and attempt immediate peripheral IV cannulation
    • C. Administer intramuscular adrenaline and arrange an urgent lateral neck X-ray in the radiology department before any airway assessment
    • D. Keep the child calm in his mother's arms, do not examine the throat or use a tongue depressor, and call emergency ENT and anaesthetics
    Show answer

    Answer: D. Keep the child calm in his mother's arms, do not examine the throat or use a tongue depressor, and call emergency ENT and anaesthetics

    Why: Acute epiglottitis (inflammation of the epiglottis, historically due to Haemophilus influenzae type B) is a pediatric airway emergency. Clinical features: high fever, severe sore throat, drooling, stridor, and tripod positioning. Any examination of the pharynx or distress (such as from cannula attempts or lying flat) can precipitate complete laryngeal obstruction. Management is urgent airway stabilization in theatre under gas induction by senior ENT and anaesthetic staff.

    • A. Examining the throat of a child with suspected epiglottitis is strictly contraindicated, as it can cause sudden, fatal laryngospasm.
    • B. Laying the child flat will compromise their airway. Painful procedures like IV cannulation should be avoided as crying can trigger airway spasm. Keep the child in their preferred sitting position.
    • C. Neck X-ray ('thumbprint' sign) can confirm epiglottitis, but transferring an unstable child to radiology is dangerous. Airway securing is the absolute priority. IM adrenaline is for anaphylaxis, not epiglottitis.

    Sources: ENT UK guidelines; Advanced Paediatric Life Support (APLS)

Exam-style questions written by MedHub for practice. They are not official exam questions.