PLAB 2 History Taking Stations — Questions and Answers
Question 1: During a PLAB 2 history taking station, a 45-year-old woman presents with chest pain. Which of the following is the most important question to ask first to differentiate cardiac from non-cardiac chest pain?
- Do you smoke?
- Can you describe the character of the pain — is it a central, crushing or squeezing sensation, and does it radiate to the jaw, left arm, or back? (Correct answer)
- Have you had any recent surgery?
- Do you have any allergies?
Correct answer: Can you describe the character of the pain — is it a central, crushing or squeezing sensation, and does it radiate to the jaw, left arm, or back?
Characterising the pain using SOCRATES (Site, Onset, Character, Radiation, Associations, Timing, Exacerbating/relieving factors, Severity) is essential. Central crushing pain radiating to the jaw or left arm suggests cardiac origin. This is the most discriminating initial question.
Question 2: A patient presents with a 3-month history of weight loss. In the OSCE history, which system-specific red flag questions should you prioritise?
- Ask only about diet and exercise habits
- Screen for malignancy red flags across systems: night sweats, haemoptysis, change in bowel habit, haematuria, lumps, dysphagia, and post-menopausal bleeding (Correct answer)
- Focus exclusively on mental health screening
- Ask about travel history only
Correct answer: Screen for malignancy red flags across systems: night sweats, haemoptysis, change in bowel habit, haematuria, lumps, dysphagia, and post-menopausal bleeding
Unexplained weight loss is a red flag for malignancy. A systematic review of cancer-related symptoms across all body systems is essential — respiratory, GI, urological, gynaecological, and haematological. Night sweats and fatigue also suggest lymphoma. This approach ensures no serious cause is missed.
Question 3: In a PLAB 2 station, a 28-year-old man presents with headache. You need to assess for red flags. Which combination of features would be most concerning for a serious underlying cause?
- Headache after a long day at work, relieved by paracetamol
- Sudden-onset thunderclap headache, neck stiffness, photophobia, and fever (Correct answer)
- Mild bilateral frontal headache present for 2 years with normal neurological examination
- Headache triggered by bright lights and associated with nausea
Correct answer: Sudden-onset thunderclap headache, neck stiffness, photophobia, and fever
Sudden-onset thunderclap headache with meningism (neck stiffness, photophobia) and fever suggests subarachnoid haemorrhage or meningitis — both are life-threatening emergencies. These red flags mandate immediate investigation and should never be dismissed.
Question 4: During a history station, the patient mentions they drink alcohol. According to UK screening guidelines, which validated tool should you use to assess alcohol use?
- Ask them to estimate their weekly units only
- Use the AUDIT-C (Alcohol Use Disorders Identification Test) or full AUDIT questionnaire (Correct answer)
- Ask if they think they drink too much
- Use the PHQ-9 questionnaire
Correct answer: Use the AUDIT-C (Alcohol Use Disorders Identification Test) or full AUDIT questionnaire
The AUDIT-C (first 3 questions of AUDIT) or full AUDIT (10 questions) is the validated screening tool for alcohol misuse recommended by NICE. It assesses consumption, dependence symptoms, and harmful consequences. A score of 8+ on full AUDIT suggests harmful or hazardous drinking.
Question 5: A patient presents to a PLAB 2 station with symptoms of depression. Which validated screening tool should you use to assess severity?
- AUDIT questionnaire
- PHQ-9 (Patient Health Questionnaire-9) (Correct answer)
- GAD-7 only
- Mini-Mental State Examination
Correct answer: PHQ-9 (Patient Health Questionnaire-9)
The PHQ-9 is the validated screening and severity assessment tool for depression recommended by NICE. Scores range from 0-27: 5-9 (mild), 10-14 (moderate), 15-19 (moderately severe), 20-27 (severe). It also includes a question about suicidal ideation which must always be explored further.
Question 6: In a paediatric history station, a mother brings her 18-month-old child who has had a fever and is not feeding well. Which question is most important for assessing severity in a febrile child?
- What is the child's favourite food?
- Has the child had a non-blanching rash, reduced consciousness, or is unusually drowsy or unresponsive — features of meningococcal disease? (Correct answer)
- When was the child's last dental check-up?
- Does the child attend nursery?
Correct answer: Has the child had a non-blanching rash, reduced consciousness, or is unusually drowsy or unresponsive — features of meningococcal disease?
In a febrile child, the NICE traffic light system prioritises red flag features: non-blanching rash, reduced consciousness, neck stiffness, bulging fontanelle, seizures, and signs of meningococcal disease. These features indicate a life-threatening condition requiring immediate action.
PLAB 2 History Taking Stations
During a PLAB 2 history taking station, a 45-year-old woman presents with chest pain.
Which of the following is the most important question to ask first to differentiate cardiac from non-cardiac chest pain?