PLAB 1 Neurology Questions: 10 Free Practice MCQs

Ten PLAB 1-style neurology questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 108 neurology questions and many more across every topic.

1. 1 / 10

   A 63-year-old woman has a suspected TIA with fully resolved weakness. There is no headache, seizure, trauma or other clinical suspicion of an alternative diagnosis that CT could detect.

   What is the recommended role of CT brain imaging at this stage?

   • A. Perform urgent non contrast CT brain in every person with suspected TIA, even when symptoms have resolved and no alternative diagnosis is suspected
   • B. Perform CT angiography before making the urgent specialist referral
   • C. Book routine CT brain imaging within 24 hours for all suspected TIA
   • D. Do not offer CT unless there is clinical suspicion of an alternative diagnosis that CT could detect
   Show answer

   Answer: D. Do not offer CT unless there is clinical suspicion of an alternative diagnosis that CT could detect

   Why: NICE advises against CT brain imaging for suspected TIA unless there is clinical suspicion of an alternative diagnosis that CT could detect. Urgent specialist referral remains necessary.

   • A. NICE advises against routine CT brain scanning for suspected TIA.
   • B. CT angiography is not required before the immediate specialist referral for suspected TIA.
   • C. A routine CT for every suspected TIA is not recommended when no alternative CT detectable diagnosis is suspected.

   Sources: NICE NG128, recommendation 1.2.1

2. 2 / 10

   A 68-year-old male presents with a severe unilateral headache and jaw claudication. ESR is 80 mm/hr.

   What is the most likely diagnosis?

   • A. Giant Cell Arteritis
   • B. Migraine
   • C. Tension headache
   • D. Trigeminal Neuralgia
   Show answer

   Answer: A. Giant Cell Arteritis

   Why: Giant Cell Arteritis (Temporal Arteritis) is a medical emergency due to risk of blindness. Key features are headache, scalp tenderness, jaw claudication, and elevated inflammatory markers.

   • B. Unlikely age of onset and jaw claudication is not a feature.
   • C. ESR would be normal.
   • D. Causes electric shock-like pain, usually without raised inflammatory markers.

   Sources: Oxford Handbook of Clinical Medicine

3. 3 / 10

   A 58-year-old is assessed in the emergency department for sudden facial droop and unilateral arm weakness. The initial assessment supports suspected stroke and they are clinically stable for transfer.

   Where should they be admitted after the initial assessment?

   • A. Directly to a specialist acute stroke unit
   • B. A general medical ward until an infarct is confirmed
   • C. Home with an outpatient neurology appointment
   • D. A cardiology ward because stroke is usually embolic
   Show answer

   Answer: A. Directly to a specialist acute stroke unit

   Why: NICE NG128 recommendation 1.3.1 says to admit everyone with suspected stroke directly to a specialist acute stroke unit after initial assessment, whether they arrive from the community, emergency department or an outpatient clinic. The unit provides specialist multidisciplinary assessment, monitoring and rehabilitation. Admission should not wait for proof of a particular stroke subtype.

   • B. NICE recommends a specialist acute stroke unit for suspected stroke, rather than waiting for final confirmation on a general ward.
   • C. Suspected acute stroke requires admission to a specialist stroke unit after initial assessment.
   • D. The recommended setting is a specialist acute stroke unit; cause does not change the initial admission pathway.

   Sources: NICE NG128 recommendation 1.3.1

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5. 4 / 10

   A 61-year-old man reports a 12-minute episode of right hand weakness and slurred speech that has fully resolved. A TIA is suspected and he has no aspirin allergy, active bleeding or other contraindication.

   What antiplatelet should be started immediately while urgent specialist assessment is arranged?

   • A. Aspirin 300 mg daily
   • B. Clopidogrel 75 mg daily as the initial dose without aspirin
   • C. No antiplatelet until MRI confirms an infarct
   • D. Aspirin 75 mg daily after a routine clinic appointment
   Show answer

   Answer: A. Aspirin 300 mg daily

   Why: Give aspirin 300 mg daily immediately for suspected TIA unless contraindicated, and refer for specialist assessment within 24 hours of symptom onset. Do not delay initial aspirin for routine imaging.

   • B. Clopidogrel is used for longer term secondary prevention in selected situations, not instead of the immediate suspected TIA aspirin dose.
   • C. NICE advises starting aspirin immediately and does not require brain imaging first for suspected TIA.
   • D. A lower maintenance dose after routine review would delay the recommended immediate treatment.

   Sources: NICE NG128, recommendations 1.1.4 and 1.1.5

6. 5 / 10

   A 69-year-old with acute stroke is adequately nourished on admission and has no evidence of weight loss or reduced intake. The team asks whether routine oral nutritional supplements prevent poor recovery.

   What is the recommended approach?

   • A. Provide routine supplements to all patients for the first month to support recovery
   • B. Screen nutritional status and give support if the person is at risk of malnutrition
   • C. Avoid all nutrition until mobility returns
   • D. Use tube feeding even if oral intake is adequate and safe
   Show answer

   Answer: B. Screen nutritional status and give support if the person is at risk of malnutrition

   Why: NICE NG128 recommendations 1.6.5 and 1.6.9 advise screening inpatients for malnutrition risk and not routinely providing nutritional supplements to people who are adequately nourished on admission. Recommendation 1.6.10 supports nutrition intervention when a person is at risk. The decision follows the individual's nutritional assessment and swallowing safety.

   • A. NICE does not recommend routine nutritional supplements when the person is adequately nourished on admission.
   • C. Nutrition should not be withheld; maintain appropriate intake and support people at risk of malnutrition.
   • D. Tube feeding is considered when adequate oral intake is not possible, not routinely when nutrition and swallowing are adequate.

   Sources: NICE NG128 recommendations 1.6.5, 1.6.9 and 1.6.10

7. 6 / 10

   A 59-year-old man presents 100 minutes after sudden onset aphasia and right sided weakness. CT brain has excluded haemorrhage and the stroke team confirms a disabling ischaemic stroke with no identified contraindication to reperfusion treatment.

   Which acute treatment is most appropriate?

   • A. Give aspirin 300 mg immediately and defer reperfusion treatment, even though imaging has excluded haemorrhage and the disabling stroke team assessment finds no contraindication
   • B. Offer intravenous thrombolysis with alteplase or tenecteplase through the acute stroke service
   • C. Give intravenous mannitol before transfer to the stroke unit
   • D. Give 100% oxygen despite normal oxygen saturation
   Show answer

   Answer: B. Offer intravenous thrombolysis with alteplase or tenecteplase through the acute stroke service

   Why: After imaging excludes haemorrhage, a patient with a disabling ischaemic stroke within the relevant time window should be assessed for intravenous thrombolysis by the organised stroke service. Aspirin is offered if thrombolysis is not given, after haemorrhage is excluded.

   • A. Aspirin is used when thrombolysis is not given; it is not the preferred treatment for this eligible disabling stroke.
   • C. Mannitol is not routine treatment for acute ischaemic stroke without raised intracranial pressure.
   • D. Supplemental oxygen is indicated for hypoxaemia, not routinely at 100% in a normoxic patient.

   Sources: NICE NG128, recommendations 1.4.1 to 1.4.9

8. 7 / 10

   A 64-year-old female attends her GP surgery. She reports that 4 hours ago, she experienced sudden onset weakness in her right hand and difficulty finding words. The symptoms resolved completely after 30 minutes. She is not on any anticoagulants.

   What is the most appropriate immediate management?

   • A. Start Clopidogrel 75mg daily and schedule an outpatient carotid Doppler scan within 1 week
   • B. Refer to the emergency department for immediate thrombolytic therapy
   • C. Reassure the patient that the symptoms have resolved and advise to return if they recur
   • D. Administer Aspirin 300mg orally and refer for specialist assessment within 24 hours
   Show answer

   Answer: D. Administer Aspirin 300mg orally and refer for specialist assessment within 24 hours

   Why: NICE guideline NG128 states that patients with a suspected TIA must receive Aspirin 300mg immediately (unless contraindicated) and be referred for specialist assessment (usually at a rapid-access TIA clinic) to be seen within 24 hours of symptom onset. The ABCD2 score is no longer recommended to determine referral urgency.

   • A. Aspirin 300mg is the immediate treatment; Clopidogrel 75mg is for long-term secondary prevention started after specialist review. Investigation must be expedited within 24 hours.
   • B. Thrombolysis is contraindicated once symptoms have completely resolved (TIA), as there is no salvageable penumbra and risk of intracranial hemorrhage.
   • C. TIA is a major risk factor for subsequent stroke. Patients require urgent secondary prevention and specialist assessment, not simple reassurance.

   Sources: NICE NG128

9. 8 / 10

   A 68-year-old man is diagnosed with Parkinson's disease. His main symptoms are a resting tremor of the right hand and slow movement (bradykinesia), which are beginning to interfere with his ability to write and feed himself.

   What is the recommended first-line pharmacological treatment for motor symptoms in patients whose symptoms interfere with their daily quality of life according to NICE guidelines?

   • A. A dopamine agonist (e.g. Ropinirole) as first line in all ages
   • B. An anticholinergic agent (e.g. Trihexyphenidyl)
   • C. Levodopa (combined with a dopa-decarboxylase inhibitor, e.g. Co-careldopa)
   • D. Amantadine as initial monotherapy for tremor
   Show answer

   Answer: C. Levodopa (combined with a dopa-decarboxylase inhibitor, e.g. Co-careldopa)

   Why: NICE guideline NG71 states that Levodopa (co-prescribed with a peripheral dopa-decarboxylase inhibitor like Carbidopa or Benserazide) should be offered first-line for patients whose motor symptoms affect quality of life. For patients whose motor symptoms do not impact quality of life, clinicians can choose between Levodopa, dopamine agonists (Ropinirole, Pramipexole), or monoamine oxidase B (MAO-B) inhibitors (Rasagiline, Selegiline). Impulse control disorders must be discussed before starting dopamine agonists.

   • A. Dopamine agonists can be offered as first-line therapy only if motor symptoms *do not* impact the patient's quality of life. They are associated with a higher risk of impulse control disorders than Levodopa.
   • B. Anticholinergics are rarely used first-line in modern practice, especially in older adults, due to significant cognitive side effects and urinary retention.
   • D. Amantadine is a weak dopamine agonist and NMDA antagonist, used mainly to treat Levodopa-induced dyskinesias in advanced disease, not as first-line therapy.

   Sources: NICE NG71

10. 9 / 10

    A 70-year-old has a confirmed TIA and has a clinic blood pressure of 168/92 mmHg. Their antihypertensive regimen has not been reviewed since the event.

    What is an appropriate part of secondary prevention?

    • A. Review and manage vascular risk factors, including blood pressure, as part of the secondary-prevention plan
    • B. Ignore blood pressure because symptoms have resolved and the event was transient
    • C. Use anticoagulation for every patient with TIA regardless of cause, in place of antiplatelet therapy
    • D. Use an ABCD2 score instead of treating risk factors
    Show answer

    Answer: A. Review and manage vascular risk factors, including blood pressure, as part of the secondary-prevention plan

    Why: NICE NG128 recommendation 1.1.7 supports prompt secondary prevention after a confirmed TIA. Recommendation 1.2.5 describes best medical treatment for relevant carotid disease, including blood-pressure control, antiplatelet treatment, cholesterol lowering and lifestyle advice. The precise antihypertensive plan should follow current hypertension guidance and the person's clinical circumstances.

    • B. A resolved TIA still requires secondary prevention and vascular risk management.
    • C. Anticoagulation is not indicated for every TIA; treatment depends on the diagnosed cause and risk profile.
    • D. NICE advises against ABCD2 for risk and urgency decisions; it does not replace secondary prevention.

    Sources: NICE NG128 recommendations 1.1.7 and 1.2.5

11. 10 / 10

    A 72-year-old is admitted to the stroke unit with acute stroke. They are thirsty and ask for water and their usual oral medicines before the swallowing screen is completed.

    What should the team do first?

    • A. Complete swallowing screening by an appropriately trained professional before oral food, fluid or medicine
    • B. Give water to assess swallowing informally at the bedside
    • C. Give tablets with a small amount of water and screen later, since the medicines are essential
    • D. Keep the person nil by mouth for the entire admission
    Show answer

    Answer: A. Complete swallowing screening by an appropriately trained professional before oral food, fluid or medicine

    Why: NICE NG128 recommendation 1.6.1 says that on admission, people with acute stroke should have swallowing screened by an appropriately trained healthcare professional before receiving oral food, fluid or medication. This prevents avoidable aspiration and informs safe route and consistency. It is a screening step, not an automatic instruction to withhold all oral intake throughout the admission.

    • B. Oral water should not be given before the trained swallowing screen because of aspiration risk.
    • C. NICE requires screening before any oral medication, not after it.
    • D. NICE requires screening first; if safe, oral intake can be considered according to the result and clinical advice.

    Sources: NICE NG128 recommendation 1.6.1

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