PLAB 1 Stroke Questions: 10 Free Practice MCQs

Ten PLAB 1-style stroke questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 99 stroke questions and many more across every topic.

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1. 1 / 10

   A 74-year-old is admitted with acute ischaemic stroke. Their oxygen saturation is 97% on room air and they are not in respiratory distress.

   What oxygen treatment is recommended?

   • A. Start high-flow oxygen routinely to protect the brain
   • B. Give supplemental oxygen only if saturation falls below 95%
   • C. Maintain saturation above 100% with a non-rebreather mask
   • D. Give oxygen only if the patient has a prior asthma diagnosis
   Show answer

   Answer: B. Give supplemental oxygen only if saturation falls below 95%

   Why: NICE NG128 recommendation 1.5.1 advises giving supplemental oxygen after stroke only if oxygen saturation falls below 95%. Routine oxygen is not recommended in people with acute stroke who are not hypoxic. The patient's saturation is 97% on room air, so supplemental oxygen is not indicated on the facts given.

   • A. NICE does not recommend routine supplemental oxygen in acute stroke when the patient is not hypoxic.
   • C. NICE recommends treating hypoxaemia rather than targeting saturation above 100% with routine high-flow oxygen.
   • D. The recommendation is based on oxygen saturation, not asthma history.

   Sources: NICE NG128 recommendation 1.5.1

2. 2 / 10

   A 63-year-old presents after a 10-minute episode of unilateral weakness diagnosed as a suspected TIA. A clinician proposes using ABCD2 to decide whether the specialist appointment can be delayed.

   What does NICE advise about using this score to determine referral urgency?

   • A. Use ABCD2 and refer within 1 week if the score is low, or within 24 hours if it is 4 or more
   • B. Use ABCD2 only in people under 60
   • C. Use ABCD2 to decide whether aspirin should be started before the clinic
   • D. Do not use ABCD2 to determine risk or referral urgency; refer immediately for assessment within 24 hours
   Show answer

   Answer: D. Do not use ABCD2 to determine risk or referral urgency; refer immediately for assessment within 24 hours

   Why: NICE NG128 recommendation 1.1.6 says not to use scores such as ABCD2 to assess the risk of a subsequent stroke or to inform urgency of referral for suspected or confirmed TIA. Recommendation 1.1.5 calls for immediate specialist referral and assessment within 24 hours of symptom onset. A low score must not delay that pathway.

   • A. NICE advises against using ABCD2 to assess subsequent stroke risk or urgency of referral after suspected TIA.
   • B. NICE does not recommend this score to decide referral urgency in suspected TIA.
   • C. ABCD2 should not be used for that purpose; NICE recommends immediate aspirin unless contraindicated.

   Sources: NICE NG128 recommendations 1.1.5 and 1.1.6

3. 3 / 10

   A 73-year-old with acute ischaemic stroke received aspirin 300 mg after imaging excluded haemorrhage. They ask how long this acute dose is continued before long-term secondary prevention is started.

   What is the NICE recommended timing?

   • A. Continue aspirin 300 mg daily until 2 weeks after stroke onset, then start definitive long-term antithrombotic treatment
   • B. Stop aspirin after one dose and never start secondary prevention unless the stroke recurs during follow-up
   • C. Continue aspirin 300 mg indefinitely in all patients
   • D. Wait 6 months before deciding on long-term prevention, continuing aspirin 75 mg meanwhile until the clinic review
   Show answer

   Answer: A. Continue aspirin 300 mg daily until 2 weeks after stroke onset, then start definitive long-term antithrombotic treatment

   Why: NICE NG128 recommendation 1.4.9 advises aspirin 300 mg daily until 2 weeks after stroke symptom onset, then starting definitive long-term antithrombotic treatment. Start long-term treatment earlier if the person is discharged before 2 weeks. The initial high-dose course is time-limited and should not be confused with the selected long-term secondary-prevention regimen.

   • B. NICE recommends continuing acute aspirin to 2 weeks and then starting definitive long-term treatment.
   • C. NICE specifies the 300 mg acute course to 2 weeks, followed by definitive long-term antithrombotic treatment.
   • D. NICE specifies transition at 2 weeks after onset, or earlier if discharged before then.

   Sources: NICE NG128 recommendation 1.4.9

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5. 4 / 10

   A 66-year-old has acute ischaemic stroke with a blood pressure of 198/108 mmHg. They have no hypertensive encephalopathy, renal emergency, acute heart failure, myocardial infarction, aortic dissection or pre-eclampsia.

   What is the NICE approach to antihypertensive treatment at this stage?

   • A. Lower blood pressure rapidly in every patient with acute ischaemic stroke
   • B. Give repeated intravenous antihypertensives until blood pressure is below 140/90 mmHg within the first hour to protect the penumbra
   • C. Do not treat under any circumstances, even if a hypertensive emergency develops or the patient becomes a thrombolysis candidate
   • D. Do not routinely lower it unless a qualifying hypertensive emergency is present; consider reduction if they become a thrombolysis candidate
   Show answer

   Answer: D. Do not routinely lower it unless a qualifying hypertensive emergency is present; consider reduction if they become a thrombolysis candidate

   Why: NICE NG128 recommendations 1.5.9 and 1.5.10 state that antihypertensive treatment in acute ischaemic stroke is recommended only when a hypertensive emergency is accompanied by a specified serious problem. For people who are candidates for intravenous thrombolysis, blood pressure reduction to 185/110 mmHg or lower should be considered. The case excludes the listed emergency features and does not state thrombolysis candidacy.

   • A. NICE limits antihypertensive treatment during acute ischaemic stroke to a hypertensive emergency with specified serious concomitant conditions.
   • B. This is not the routine acute ischaemic stroke approach in the absence of a qualifying hypertensive emergency or thrombolysis consideration.
   • C. NICE allows treatment when a hypertensive emergency with specified serious concomitant problems is present.

   Sources: NICE NG128 recommendations 1.5.9 and 1.5.10

6. 5 / 10

   A 66-year-old is brought to the emergency department with sudden facial weakness and difficulty speaking that began 40 minutes ago. Capillary glucose has not yet been checked.

   Which immediate assessment is specifically needed to exclude a stroke mimic?

   • A. Measure blood glucose
   • B. Order a fasting lipid profile
   • C. Calculate ABCD2 before checking vital signs
   • D. Wait for a routine outpatient MRI
   Show answer

   Answer: A. Measure blood glucose

   Why: NICE NG128 recommendation 1.1.2 says to exclude hypoglycaemia as the cause of sudden-onset neurological symptoms. Hypoglycaemia can produce focal deficits and requires prompt recognition and treatment. It does not replace the urgent stroke assessment or indicated brain imaging when stroke remains possible.

   • B. A lipid profile is relevant to prevention, but it does not exclude the urgent reversible mimic of hypoglycaemia.
   • C. ABCD2 should not be used to decide TIA urgency, and it does not exclude a metabolic mimic.
   • D. Urgent initial assessment is needed; do not defer evaluation of a possible stroke for routine outpatient imaging.

   Sources: NICE NG128 recommendation 1.1.2

7. 6 / 10

   A 75-year-old had a fall after briefly losing consciousness. The person is otherwise stable and there is no focal neurological deficit.

   Which stroke-related distinction should guide the immediate assessment?

   • A. Assume the event was a TIA and prescribe aspirin without further assessment of the loss of consciousness
   • B. Use ABCD2 to decide whether the person needs assessment
   • C. Consider alternative causes of transient loss of consciousness and refer urgently if a TIA is suspected
   • D. Discharge without investigation because symptoms resolved
   Show answer

   Answer: C. Consider alternative causes of transient loss of consciousness and refer urgently if a TIA is suspected

   Why: NICE NG128 supports prompt assessment and referral when TIA is suspected, but transient loss of consciousness after a fall has a broader differential. Recommendation 1.1.5 calls for immediate specialist assessment within 24 hours for suspected TIA, while recommendation 1.1.6 rejects ABCD2 for urgency decisions. The case should not be labelled TIA solely from a brief blackout.

   • A. The event requires assessment for transient loss of consciousness and alternative diagnoses; a brief blackout is not automatically a TIA.
   • B. ABCD2 is not recommended to assess TIA risk or urgency of referral.
   • D. Transient loss of consciousness and a possible vascular event need appropriate clinical assessment even after recovery.

   Sources: NICE NG128 recommendations 1.1.5 and 1.1.6

8. 7 / 10

   A 59-year-old experienced sudden left hand weakness and slurred speech that resolved after 20 minutes. They have no aspirin allergy or active bleeding.

   What should be offered while arranging specialist assessment for suspected TIA?

   • A. No medicine until outpatient imaging is completed
   • B. Aspirin 300 mg daily, started immediately unless contraindicated
   • C. Aspirin 75 mg once weekly
   • D. A direct oral anticoagulant before confirming the diagnosis
   Show answer

   Answer: B. Aspirin 300 mg daily, started immediately unless contraindicated

   Why: For suspected TIA, NICE NG128 recommendation 1.1.4 advises aspirin 300 mg daily immediately unless contraindicated. This should happen alongside immediate referral for specialist assessment, not after a period of watchful waiting. The recommendation is different from acute stroke management, where brain imaging first excludes intracerebral haemorrhage before aspirin is given.

   • A. NICE recommends immediate aspirin for suspected TIA unless contraindicated; assessment should still be expedited.
   • C. This is not the immediate dose recommended by NICE for suspected TIA.
   • D. NICE recommends immediate aspirin for suspected TIA; anticoagulation is not started empirically for every suspected TIA.

   Sources: NICE NG128 recommendations 1.1.4 and 1.1.5

9. 8 / 10

   A 70-year-old develops disabling aphasia and arm weakness 90 minutes ago. The stroke team considers intravenous thrombolysis, but no brain imaging has been done.

   What must happen before thrombolytic treatment is given?

   • A. Give aspirin first and image only if symptoms worsen over the next few hours, as most strokes are ischaemic
   • B. Wait for a routine outpatient MRI
   • C. Obtain urgent brain imaging to exclude intracranial haemorrhage and assess eligibility within an organised stroke service
   • D. Start intravenous heparin and observe for 24 hours before deciding whether brain imaging or thrombolysis is needed at all
   Show answer

   Answer: C. Obtain urgent brain imaging to exclude intracranial haemorrhage and assess eligibility within an organised stroke service

   Why: NICE NG128 recommendations 1.4.1 to 1.4.4 state that thrombolytic treatment is an option within the relevant licensed time window only when intracranial haemorrhage has been excluded, and it must be delivered within a well-organised stroke service with trained staff and immediate access to imaging and interpretation. A suspected stroke should not be treated with a thrombolytic before imaging.

   • A. Antiplatelet treatment is not given for acute stroke until brain imaging has excluded intracranial haemorrhage.
   • B. A thrombolysis candidate needs immediate acute stroke assessment and imaging, not delayed outpatient imaging.
   • D. Routine anticoagulation is not recommended as acute stroke treatment and does not replace urgent imaging.

   Sources: NICE NG128 recommendations 1.4.1 to 1.4.4

10. 9 / 10

    A 67-year-old woman develops sudden left facial and arm weakness with expressive dysphasia 70 minutes ago. Non-contrast CT shows no intracranial haemorrhage, and the deficit persists on examination.

    What is the most likely diagnosis?

    • A. Transient ischaemic attack
    • B. Primary intracerebral haemorrhage
    • C. Acute ischaemic stroke
    • D. Focal seizure with a postictal deficit
    Show answer

    Answer: C. Acute ischaemic stroke

    Why: The sudden persistent focal deficit and CT without haemorrhage support acute ischaemic stroke. The onset time is clinically important for urgent reperfusion assessment, but does not by itself establish eligibility for thrombolysis.

    • A. Persistent focal deficit means the event has not resolved as required for a TIA diagnosis.
    • B. The initial CT shows no intracranial haemorrhage, making primary haemorrhage less likely.
    • D. There is no witnessed seizure or fluctuating postictal course to support this diagnosis.

    Sources: NICE NG128, recommendations 1.1 and 1.4

11. 10 / 10

    A 65-year-old presents with sudden-onset unilateral weakness and visual field loss. The emergency department is considering stroke and has not yet established the diagnosis.

    Which tool may be used to support rapid assessment of suspected stroke in the emergency department?

    • A. A validated tool such as ROSIER
    • B. ABCD2 to rule out acute stroke
    • C. A home blood-pressure diary
    • D. A falls prediction scale
    Show answer

    Answer: A. A validated tool such as ROSIER

    Why: NICE NG128 recommendation 1.1.3 says that for people admitted to the emergency department with suspected stroke or TIA, the diagnosis should be established rapidly using a validated tool such as ROSIER. This supports, but does not replace, clinical assessment and appropriate imaging. Do not use ABCD2 as a shortcut to defer urgent TIA assessment.

    • B. ABCD2 is not a diagnostic tool for acute stroke and NICE advises against its use for TIA urgency.
    • C. A home diary is not a validated acute diagnostic tool for suspected stroke in the emergency department.
    • D. A falls tool is unrelated to acute stroke diagnosis.

    Sources: NICE NG128 recommendation 1.1.3

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