PLAB 1 General Practice Questions: 10 Free Practice MCQs

Ten PLAB 1-style general practice questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 155 general practice questions and many more across every topic.

1. 1 / 10

   A 32-year-old woman receives her routine cervical screening results. The report states that high-risk Human Papillomavirus (HR-HPV) was detected, but the reflex cytology is negative (normal, no abnormal cells).

   What is the correct next step in her screening management according to NHS guidelines?

   • A. Repeat the cervical screening test in 12 months
   • B. Refer directly for colposcopy
   • C. Return to routine 3-yearly recall
   • D. Refer for an urgent Loop Electrosurgical Excision Procedure (LLETZ)
   Show answer

   Answer: A. Repeat the cervical screening test in 12 months

   Why: The NHS Cervical Screening Programme uses primary HPV screening. (1) HPV negative: routine recall (3 or 5 years). (2) HPV positive, cytology abnormal: refer for colposcopy. (3) HPV positive, cytology negative: repeat test in 12 months. If the 12-month repeat is HPV positive (cytology negative), repeat again in another 12 months. If positive at 24 months, refer to colposcopy regardless of cytology.

   • B. Colposcopy referral is only indicated if cytology is abnormal, or if the patient has persistent HR-HPV positive results with negative cytology for 2 consecutive years (or 24 months).
   • C. Returning to routine recall is only appropriate if the screening sample is HR-HPV negative. Since she is HPV positive, she cannot return to routine recall.
   • D. LLETZ is a treatment for confirmed high-grade cervical dysplasia (CIN2/3) found on colposcopy biopsy, not for screening results with normal cytology.

   Sources: NHS Cervical Screening Programme guidelines; NICE CKS

2. 2 / 10

   A 28-year-old woman is diagnosed with Irritable Bowel Syndrome (IBS). Her predominant symptoms are abdominal cramping and bloating, which are relieved by defecation. She has no red flags and her stool calprotectin and coeliac serology are normal.

   What is the recommended first-line pharmacological treatment for her abdominal pain according to NICE guidelines?

   • A. A tricyclic antidepressant (e.g. Amitriptyline 10mg nightly)
   • B. Oral Codeine phosphate 30mg as required
   • C. Lactulose syrup 15ml twice daily
   • D. An antispasmodic (e.g. Mebeverine or Buscopan)
   Show answer

   Answer: D. An antispasmodic (e.g. Mebeverine or Buscopan)

   Why: NICE guideline CG61 outlines the management of IBS. First-line pharmacotherapy is tailored to symptoms: (1) Pain/Spasms: Antispasmodics (Mebeverine, Buscopan, Peppermint oil). (2) Constipation: Bulk-forming laxative (Ispaghula husk; avoid Lactulose). (3) Diarrhoea: Loperamide. Second-line for pain: low-dose TCAs (Amitriptyline 5-10mg).

   • A. TCAs are second-line treatments for IBS pain if first-line antispasmodics, laxatives, or antidiarrheals fail to provide relief, not first-line.
   • B. Opioids like Codeine are contraindicated in IBS as they cause constipation, worsen abdominal spasms, and carry a risk of dependence.
   • C. Lactulose is osmotic and causes fermentation, significantly worsening bloating and gas in patients with IBS. It should be avoided.

   Sources: NICE CG61

3. 3 / 10

   A 51-year-old woman attends the GP surgery for a routine check-up. She has no family history of breast cancer and has not noticed any breast changes or lumps.

   According to the NHS Breast Screening Programme guidelines, what is the correct age range and screening frequency for routine mammography in the UK?

   • A. Offered to women aged 50 to 70 years, every 3 years
   • B. Offered to women aged 40 to 60 years, every year
   • C. Offered to women aged 50 to 75 years, every 5 years
   • D. Offered to women aged 45 to 70 years, every 2 years
   Show answer

   Answer: A. Offered to women aged 50 to 70 years, every 3 years

   Why: The NHS Breast Screening Programme routinely invites eligible women aged 50 to 70 for mammograms every 3 years to detect breast cancer early. Women aged over 70 are not automatically sent invitations but can self-refer for free mammograms by contacting their local screening unit.

   • B. Routine screening does not start at 40 in the UK for average-risk women, and the interval is 3 years, not annual.
   • C. The standard upper age limit for automatic invitation is 70, and the interval is 3 years.
   • D. The routine age starting range is 50, and the screening interval is 3 years.

   Sources: NHS Breast Screening Programme guidelines

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5. 4 / 10

   A 66-year-old with female reproductive organs has persistent abdominal distension and early satiety. Primary-care CA125 is 24 IU/ml.

   What does the 2026 NICE NG12 age-specific threshold indicate?

   • A. Repeat CA125 in one year before imaging, as a single value of 24 IU/ml is within normal limits
   • B. Arrange urgent, direct-access ultrasound of the abdomen and pelvis because the threshold for ages 60 to 69 is 24 IU/ml
   • C. No further assessment because the threshold is 35 IU/ml for every age, so a value of 24 IU/ml is reassuring
   • D. Refer directly to gynaecological oncology based on CA125 alone
   Show answer

   Answer: B. Arrange urgent, direct-access ultrasound of the abdomen and pelvis because the threshold for ages 60 to 69 is 24 IU/ml

   Why: NICE NG12 recommendations 1.5.8 and 1.5.9 and table 1 (2026) advise measuring CA125 in persistent suggestive symptoms from age 40 onward and arranging urgent direct-access ultrasound when the age-specific threshold is met. For ages 60 to 69 the threshold is 24 IU/ml or greater.

   • A. The age-specific threshold is met and NICE advises urgent direct-access ultrasound.
   • C. NG12 replaced the single threshold with age-specific thresholds in 2026.
   • D. The pathway uses CA125 to guide ultrasound; referral follows if ultrasound suggests ovarian cancer.

   Sources: NICE NG12 recommendations 1.5.8 and 1.5.9, table 1

6. 5 / 10

   A 34-year-old avid hiker presents with a circular, spreading red rash on his calf, which started 10 days after he returned from a walking holiday in the New Forest. The rash has a 'bull's-eye' appearance and is about 8 cm in diameter. He has mild flu-like symptoms but is otherwise well.

   What is the most likely diagnosis, and what is the recommended management?

   • A. Lyme disease; perform ELISA serology and wait for results before initiating antibiotics, because the rash alone cannot confirm the diagnosis
   • B. Cellulitis; prescribe oral Flucloxacillin 500mg four times daily for 7 days and mark the edge of the rash to monitor spread
   • C. Lyme disease; diagnose clinically based on the presence of erythema migrans, and initiate a 21-day course of oral Doxycycline immediately without ordering serology
   • D. Tinea corporis (ringworm); prescribe topical Clotrimazole cream
   Show answer

   Answer: C. Lyme disease; diagnose clinically based on the presence of erythema migrans, and initiate a 21-day course of oral Doxycycline immediately without ordering serology

   Why: NICE guideline NG95 states that Lyme disease should be diagnosed clinically and treated without laboratory testing in patients presenting with erythema migrans (a rash that appears 3-30 days after a tick bite, increases in size, and is >5 cm in diameter). For patients with suspected Lyme disease but *no* erythema migrans, an ELISA test is performed first. First-line antibiotic is oral Doxycycline (or Amoxicillin in pregnant women) for 21 days.

   • A. Serological tests (ELISA) can be falsely negative in the first 4-6 weeks of infection. Treatment for erythema migrans must not be delayed for lab testing.
   • B. Cellulitis is characterized by painful, hot, expanding erythema without the typical target-like central clearing of erythema migrans, and is caused by Staph/Streptococcus, not Borrelia.
   • D. While tinea corporis is ring-like, it is typically scaly, itchy, smaller, and does not present with systemic flu-like symptoms following tick-exposure risk.

   Sources: NICE NG95

7. 6 / 10

   A 58-year-old man has had two gout flares in the past 12 months. Both were troublesome and disrupted walking and work. He has recovered from the latest flare and has no chronic kidney disease or diuretic use.

   Which feature most strongly supports offering long-term urate-lowering therapy?

   • A. The absence of chronic kidney disease
   • B. One mild flare several years ago
   • C. Multiple or troublesome recurrent gout flares that disrupt daily activities
   • D. A raised serum urate result by itself, without considering symptoms or preferences
   Show answer

   Answer: C. Multiple or troublesome recurrent gout flares that disrupt daily activities

   Why: NICE recommends offering treat-to-target urate-lowering therapy to people with multiple or troublesome gout flares. This patient has both recurrent and troublesome episodes. CKD, diuretic treatment, tophi and chronic gouty arthritis are other indications, but are not needed to justify offering treatment here.

   • A. Chronic kidney disease is one possible indication, but its absence does not negate his recurrent troublesome flares.
   • B. A remote isolated mild flare is less compelling than the recurrent troublesome flares described here.
   • D. A serum urate value alone is not the feature in this case that supports the offer; NICE also recommends discussing ULT after any flare.

   Sources: NICE NG219: Gout, recommendations 1.5.1 and 1.5.2

8. 7 / 10

   An 82-year-old woman with a history of osteoarthritis, mild cognitive impairment, and urinary urge incontinence is reviewed. Her current medications are: Paracetamol 1g QDS, Naproxen 250mg TDS, Amitriptyline 25mg at night, and Oxybutynin 5mg twice daily.

   Which of her medications should be targeted for discontinuation or replacement during a medication review due to high anticholinergic burden and risk of cognitive decline in the elderly?

   • A. Paracetamol and Naproxen
   • B. Paracetamol only
   • C. Oxybutynin only
   • D. Amitriptyline and Oxybutynin
   Show answer

   Answer: D. Amitriptyline and Oxybutynin

   Why: Polypharmacy in the elderly is managed using tools like the STOPP/START criteria. Anticholinergic medications block acetylcholine, causing cognitive impairment, delirium, dry eyes/mouth, constipation, urinary retention, and tachycardias. Amitriptyline and Oxybutynin are key offenders. For urinary incontinence in older adults, non-anticholinergic drugs (like Mirabegron) or less centrally-acting antimuscarinics (like Solifenacin) are preferred. Amitriptyline for chronic pain should be replaced with safer alternatives.

   • A. Naproxen has GI and renal risks in the elderly (and requires a PPI), but it is not anticholinergic and does not cause the specific cognitive side effects seen with Amitriptyline/Oxybutynin.
   • B. Paracetamol is generally well-tolerated in the elderly and is not anticholinergic.
   • C. While Oxybutynin should be stopped, Amitriptyline also has high anticholinergic burden and must be addressed; both are inappropriate.

   Sources: NICE NG22: Medicines optimisation; STOPP/START criteria

9. 8 / 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?

   • A. Begin a treat-to-target urate-lowering therapy discussion and offer treatment
   • B. Use an NSAID continuously to prevent further crystal formation
   • C. Refer automatically to rheumatology because he has had two flares
   • D. Take colchicine continuously as the only long-term urate-lowering treatment
   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

10. 9 / 10

    A 64-year-old man with crystal-proven gout has had three troublesome attacks over 18 months. His latest flare has settled, and he asks whether a daily medicine can reduce the chance of another attack.

    What is the purpose of offering long-term urate-lowering therapy after recurrent gout flares?

    • A. Suppress the pain and inflammation of an active flare within hours
    • B. Treat coexisting CKD by improving the eGFR
    • C. Lower serum urate to target and reduce future flares over the long term
    • D. Prevent peptic ulcer recurrence while allowing NSAID use
    Show answer

    Answer: C. Lower serum urate to target and reduce future flares over the long term

    Why: NICE recommends offering ULT to people with gout who have multiple or troublesome flares. Treatment is titrated to a serum urate target and usually continues long term to reduce future flares. It does not treat the inflammation of an acute attack, and should usually start 2 to 4 weeks after the flare settles.

    • A. ULT lowers urate over time and is not a rapid anti-inflammatory treatment for an acute flare.
    • B. Urate-lowering therapy is used to manage gout and does not reverse chronic kidney impairment.
    • D. ULT does not protect the stomach from NSAID-related ulceration; gastroprotection is a separate decision.

    Sources: NICE NG219: Gout, diagnosis and management, 2022

11. 10 / 10

    A healthy 40-year-old man with no known cardiovascular disease receives an invitation to attend an NHS Health Check. He asks his GP whether he is expected to attend.

    What is the most appropriate response by the GP?

    • A. Tell him that attendance is compulsory because he is eligible
    • B. Advise him that declining will result in a charge from the NHS
    • C. Explain the check and its potential benefits, then support his informed choice
    • D. Arrange a specialist referral because a health check invitation indicates suspected disease
    Show answer

    Answer: C. Explain the check and its potential benefits, then support his informed choice

    Why: The NHS Health Check is offered to eligible adults as a preventive risk assessment, not as a compulsory appointment or a diagnosis of disease. The GP should explain what it involves and allow the patient to decide whether to attend. This supports informed choice and respects the patient’s autonomy.

    • A. Eligibility makes the check available, but patients are not obliged to attend.
    • B. There is no charge for declining or missing an NHS Health Check.
    • D. An invitation is a preventive offer and does not itself indicate suspected disease or require specialist referral.

    Sources: NHS Health Check programme: eligibility and frequency, Department of Health and Social Care, current guidance

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