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UK Clinical Guidelines & Prescribing Safety Flashcards

6 cards from real PLAB 1 practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. 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.

  2. According to NICE guidelines (NG28), which of the following patients with type 2 diabetes should be started on metformin as first-line therapy?

    Answer: A patient with no contraindications to metformin and HbA1c above the agreed target

    NICE recommends metformin as first-line pharmacological therapy for type 2 diabetes in patients who have no contraindications (renal impairment eGFR<30, hepatic failure, alcohol excess) and whose HbA1c is above their agreed target after lifestyle modification. It does not cause hypoglycaemia and aids weight neutrality.

  3. According to the BNF and NICE, what is the recommended first-line treatment for uncomplicated lower urinary tract infection (UTI) in a non-pregnant woman?

    Answer: Nitrofurantoin for 3 days (if eGFR >45) or trimethoprim for 3 days

    PHE/NICE guidelines recommend nitrofurantoin (3 days, if eGFR >45) or trimethoprim (3 days, if low local resistance) as first-line for uncomplicated lower UTI in women. Ciprofloxacin should be reserved for complicated UTIs or resistant organisms to preserve its effectiveness.

  4. A 72-year-old man has an acute exacerbation of COPD. Arterial blood gas shows: pH 7.29, PaCO2 8.5 kPa, PaO2 7.0 kPa, HCO3 26 mmol/L. His oxygen saturations are 82% on air. What is the target oxygen saturation for this patient according to BTS guidelines?

    Answer: 88–92%

    BTS guidelines for COPD exacerbation recommend a target SpO2 of 88–92% for patients at risk of hypercapnic respiratory failure (type 2 respiratory failure, as shown here by elevated PaCO2). High-flow oxygen can suppress the hypoxic ventilatory drive in these patients, worsening CO2 retention.

  5. According to NICE stroke guidelines, which antiplatelet regimen should be started within 24 hours of a confirmed ischaemic stroke (not thrombolysed)?

    Answer: Dual antiplatelet therapy: aspirin 300mg for 2 weeks, then clopidogrel 75mg monotherapy

    NICE NG128: After ischaemic stroke, start aspirin 300mg immediately (if haemorrhage excluded), continue for 2 weeks, then switch to clopidogrel 75mg monotherapy for long-term secondary prevention. NICE (2023) updated guidance recommends clopidogrel as first-line long-term antiplatelet over aspirin.

  6. A 55-year-old man has had a myocardial infarction. According to NICE guidelines (NG185), which combination of medications should he be prescribed for secondary prevention?

    Answer: Aspirin + P2Y12 inhibitor (e.g., ticagrelor) + high-intensity statin + ACE inhibitor + beta-blocker

    Post-MI secondary prevention (NICE NG185): dual antiplatelet (aspirin + ticagrelor/clopidogrel/prasugrel for 12 months), high-intensity statin (atorvastatin 80mg), ACE inhibitor (or ARB if intolerant), and beta-blocker. All four classes are indicated unless contraindicated.