Mixed Deck — All PLAB 1 Topics Flashcards

A 30-year-old primigravida at 34 weeks' gestation has a blood pressure of 165/110 mmHg, proteinuria of 3+, and complains of a severe headache and visual disturbances. What is the most appropriate immediate management?

Answer: Admit, commence IV magnesium sulphate and IV labetalol, and plan urgent delivery

This presentation — severe hypertension, significant proteinuria, headache, and visual disturbances — constitutes severe pre-eclampsia with imminent risk of eclampsia. NICE guidelines (NG133) recommend IV magnesium sulphate for seizure prevention, IV labetalol for BP control, and planned delivery.

A 45-year-old woman has a urinalysis showing: blood 3+, protein 2+, red cell casts on microscopy. What does the presence of red cell casts indicate?

Answer: Glomerulonephritis

Red cell casts form in the renal tubules when red cells leak through a damaged glomerular basement membrane into the tubular lumen. Their presence is pathognomonic of glomerulonephritis (glomerular inflammation). Haematuria with red cell casts always requires urgent nephrology investigation.

A 5-year-old child presents with a widespread erythematous rash that started on the face ('slapped cheek' appearance) and has spread to the trunk and limbs in a lace-like pattern. What is the causative organism?

Answer: Parvovirus B19

Parvovirus B19 causes erythema infectiosum (fifth disease/slapped cheek syndrome). The characteristic 'slapped cheek' facial rash is followed by a lace-like reticular rash on the trunk and limbs. The child is no longer infectious once the rash appears. It can cause aplastic crisis in sickle cell disease and hydrops fetalis in pregnancy.

A 35-year-old man is brought to A&E by police under Section 136 of the Mental Health Act 1983. He is hearing voices telling him to harm himself. Which section of the Mental Health Act allows for assessment and admission for up to 28 days?

Answer: Section 2

Section 2 of the Mental Health Act 1983 (amended 2007) allows compulsory admission for assessment (and treatment necessary for assessment) for up to 28 days. It requires two medical recommendations and an approved mental health professional (AMHP) application.

A newborn infant is found to have bilateral undescended testes and ambiguous genitalia. What is the most important initial investigation?

Answer: Urgent serum 17-hydroxyprogesterone level to exclude congenital adrenal hyperplasia (CAH)

Bilateral undescended testes with ambiguous genitalia requires urgent investigation for congenital adrenal hyperplasia (CAH), which can cause a life-threatening salt-wasting crisis. Serum 17-hydroxyprogesterone is the key initial test. Electrolytes should also be checked urgently as hyponatraemia and hyperkalaemia can be fatal.

A 25-year-old woman presents with a 3-month history of fatigue, weight loss, mouth ulcers, and a butterfly-shaped facial rash worsened by sunlight. Blood tests show positive ANA and anti-dsDNA antibodies, lymphopenia, and proteinuria. What is the most likely diagnosis?

Answer: Systemic lupus erythematosus (SLE)

This is a classic presentation of SLE: the malar (butterfly) rash, photosensitivity, oral ulcers, positive ANA and anti-dsDNA (highly specific for SLE), lymphopenia, and renal involvement (proteinuria). Anti-dsDNA antibodies are highly specific for SLE.

According to NICE guidance (NG12), which patients should be referred on a 2-week wait (suspected cancer) pathway for colorectal cancer?

Answer: Patients aged 40 or over with unexplained rectal bleeding; OR aged 60 or over with change in bowel habit; OR aged 40 or over with iron deficiency anaemia without an obvious cause

NICE NG12 criteria for 2WW colorectal referral include: ≥40 with unexplained rectal bleeding; ≥50 with unexplained abdominal pain or weight loss; ≥60 with change in bowel habit; ≥60 with iron deficiency anaemia; any age with rectal mass/unexplained iron deficiency anaemia. Haemorrhoids are not an automatic exclusion for referral if other criteria are met.

What is the principle of 'Gillick competence' and how does it apply to children under 16?

Answer: A child under 16 has capacity to consent to treatment if they have sufficient maturity and understanding to fully comprehend what is proposed — the competence level must match the complexity of the decision

Gillick competence holds that a child under 16 may consent to medical treatment if they demonstrate sufficient intelligence and maturity to understand the nature and implications of the proposed treatment. The more complex or serious the decision, the higher the threshold of understanding required. Parents cannot overrule a Gillick-competent child's consent.

A patient on metformin 1g BD develops an eGFR of 28 mL/min. According to BNF guidelines, what should be done with the metformin?

Answer: Stop metformin — it is contraindicated when eGFR falls below 30 mL/min due to the risk of lactic acidosis

Metformin should be stopped when eGFR falls below 30 mL/min/1.73m2 due to the risk of lactic acidosis from impaired renal clearance. The dose should be reviewed when eGFR falls below 45, and reduced when below 30. An alternative glucose-lowering agent should be substituted.

A 68-year-old man presents with sudden onset severe pain, erythema, and swelling of the first metatarsophalangeal joint. Serum uric acid is elevated at 560 µmol/L. What is the most likely diagnosis?

Answer: Gout

Gout classically presents with acute monoarthritis of the first MTP joint (podagra) with hyperuricaemia, often triggered by alcohol, dehydration, or diuretics.

A 70-year-old man presents with back pain, weight loss, and fatigue. Blood tests show: Hb 85g/L, calcium 3.1 mmol/L, creatinine 185 µmol/L. X-ray of the spine shows lytic lesions. Serum protein electrophoresis shows a monoclonal band. What is the most likely diagnosis?

Answer: Multiple myeloma

Multiple myeloma classically presents with the CRAB criteria: hyperCalcaemia, Renal impairment, Anaemia, and Bone lesions (lytic). The monoclonal (M) band on serum protein electrophoresis confirms paraproteinaemia. All four CRAB criteria are present here.

A 28-year-old man presents with low back pain and stiffness worse in the morning and improving with exercise. HLA-B27 is positive and MRI shows bilateral sacroiliitis. What is the most likely diagnosis?

Answer: Ankylosing spondylitis

Ankylosing spondylitis presents in young males with inflammatory back pain, HLA-B27 positivity, and sacroiliitis on imaging, with characteristic improvement with exercise.

A foundation year doctor prescribes a medication and realises they have made an error that has not yet reached the patient. What should they do?

Answer: Report the error through the hospital incident reporting system, inform the supervising consultant, document the near-miss, and take steps to prevent recurrence

Near misses and errors should be reported through the hospital incident reporting system (e.g., Datix). The supervising consultant must be informed. Near-miss reporting is a key patient safety mechanism that allows system improvements. GMC guidance requires openness and honesty about errors.

According to NICE guidelines, what is the first-line antihypertensive for a 65-year-old Caucasian man with no other comorbidities?

Answer: Calcium channel blocker (e.g., amlodipine)

NICE hypertension guidelines (NG136): for patients aged 55 or over, or people of any age who are Black British/African/Caribbean, the first-line treatment is a calcium channel blocker (CCB). For under-55 non-Black patients, an ACE inhibitor or ARB is first line. At 65, a CCB is recommended.

A 10-year-old child presents 2 weeks after a sore throat with haematuria, facial oedema, hypertension, and dark ('cola-coloured') urine. What is the most likely diagnosis?

Answer: Post-streptococcal glomerulonephritis

Post-streptococcal glomerulonephritis typically presents 1-3 weeks after a Group A streptococcal pharyngitis or skin infection. Features include haematuria (cola-coloured urine), hypertension, oedema, and reduced urine output. Anti-streptolysin O (ASO) titre is elevated and complement C3 is low.

A 55-year-old man with long-standing GORD presents for review. He reports dysphagia to solids, odynophagia, and a 5kg weight loss over 2 months. What is the most appropriate next step?

Answer: Urgent 2-week wait (2WW) OGD referral

New dysphagia, odynophagia, and weight loss in a patient with long-standing GORD are urgent alarm symptoms suggesting possible oesophageal malignancy. NICE guidelines mandate an urgent 2-week wait referral for OGD. Barrett's oesophagus (a complication of GORD) is a risk factor for oesophageal adenocarcinoma.

A 30-year-old woman is newly diagnosed with SLE. Which medication is recommended as background therapy for virtually ALL SLE patients unless contraindicated, as it reduces flares and organ damage?

Answer: Hydroxychloroquine

Hydroxychloroquine is recommended for all SLE patients as it reduces disease flares, prevents organ damage, lowers cardiovascular risk, and is safe in pregnancy.

A 72-year-old woman presents with 3 months of bilateral shoulder and pelvic girdle aching and stiffness worse in the mornings, ESR 85 mm/hr, and CRP 45 mg/L. She responds dramatically to 15 mg prednisolone. What is the most likely diagnosis?

Answer: Polymyalgia rheumatica

Polymyalgia rheumatica presents in patients >50 years with bilateral girdle pain and stiffness, markedly elevated inflammatory markers, and a dramatic response to low-dose corticosteroids.

According to NICE guidance on sepsis (NG51), what is the 'Sepsis Six' hour-1 bundle for a patient with suspected sepsis?

Answer: High-flow oxygen, blood cultures, IV broad-spectrum antibiotics, IV fluid bolus, lactate measurement, and urine output monitoring

The Sepsis Six (to be completed within 1 hour): (1) High-flow O2; (2) Blood cultures; (3) IV broad-spectrum antibiotics; (4) IV fluid bolus (500ml crystalloid if hypotensive); (5) Serum lactate; (6) Urine output monitoring (catheterise if needed). Early completion reduces sepsis mortality significantly.

A clinical trial reports that a new drug reduces the relative risk of myocardial infarction by 50% compared to placebo. The absolute event rates are 2% (treatment) and 4% (control). What is the Number Needed to Treat (NNT)?

Answer: 50

NNT = 1 / Absolute Risk Reduction (ARR). ARR = 4% - 2% = 2% = 0.02. NNT = 1/0.02 = 50. The NNT of 50 means you need to treat 50 patients to prevent one MI. While the relative risk reduction (50%) sounds impressive, the NNT provides more clinically meaningful information.