Professional and Linguistic Assessments Board (PLAB) Medicine and Acute Care Syllabus

Medicine and Acute Care syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Medicine and Acute Care in Professional and Linguistic Assessments Board (PLAB), not a summary of it.

1. 1

   Cardiovascular Medicine

   6 topics

   • Acute Coronary Syndromes
     • STEMI recognition and immediate management
     • NSTEMI and unstable angina risk stratification (GRACE)
     • Antiplatelet and anticoagulation therapy
     • Post-MI complications and secondary prevention
   • Heart Failure
     • Acute pulmonary oedema management
     • Chronic heart failure with reduced ejection fraction
     • Diuretics, ACE inhibitors and beta-blockers
   • Arrhythmias
     • Atrial fibrillation rate vs rhythm control
     • CHA2DS2-VASc and HAS-BLED anticoagulation decisions
     • Bradyarrhythmias and heart block
     • Tachyarrhythmias and ALS algorithms
   • Hypertension
     • NICE staging and ambulatory monitoring
     • Stepwise pharmacological management
     • Hypertensive emergencies
   • Valvular Heart Disease
     • Murmur interpretation
     • Aortic stenosis and mitral regurgitation
     • Infective endocarditis and prophylaxis
   • Venous Thromboembolism
     • DVT diagnosis and Wells score
     • Pulmonary embolism assessment and PERC
     • Anticoagulation duration
2. 2

   Respiratory Medicine

   6 topics

   • Asthma
     • Acute severe and life-threatening asthma
     • Chronic stepwise management
     • Inhaler technique and adherence
   • Chronic Obstructive Pulmonary Disease
     • Acute exacerbation management
     • Long-term oxygen therapy criteria
     • Spirometry interpretation
   • Pneumonia
     • CURB-65 severity scoring
     • Community vs hospital-acquired pathogens
     • Empirical antibiotic selection
   • Pulmonary Embolism and Pleural Disease
     • Pneumothorax classification and management
     • Pleural effusion and Light's criteria
   • Lung Cancer
     • Red flag presentations and two-week wait referral
     • Staging principles
   • Interstitial and Occupational Lung Disease
     • Idiopathic pulmonary fibrosis
     • Sarcoidosis
3. 3

   Gastroenterology and Hepatology

   6 topics

   • Upper GI Bleeding
     • Glasgow-Blatchford and Rockall scores
     • Variceal vs non-variceal management
     • Resuscitation and endoscopy timing
   • Inflammatory Bowel Disease
     • Crohn's vs ulcerative colitis distinction
     • Acute severe colitis and toxic megacolon
   • Liver Disease
     • Cirrhosis and decompensation
     • Hepatic encephalopathy and ascites
     • Viral hepatitis serology
   • Pancreatic and Biliary Disease
     • Acute pancreatitis and Glasgow score
     • Gallstone disease and cholangitis
   • Functional and Common GI Disorders
     • Irritable bowel syndrome
     • GORD and peptic ulcer disease
     • Coeliac disease
   • Colorectal Cancer
     • Screening programme and referral criteria
     • Iron deficiency anaemia workup
4. 4

   Renal, Endocrine and Metabolic Medicine

   6 topics

   • Acute Kidney Injury
     • Pre-renal, intrinsic and post-renal causes
     • Staging and fluid management
     • Hyperkalaemia emergency treatment
   • Chronic Kidney Disease
     • eGFR staging and complications
     • Renal anaemia and bone disease
   • Diabetes Mellitus
     • Diabetic ketoacidosis management
     • Hyperosmolar hyperglycaemic state
     • Type 2 diabetes pharmacological ladder
     • Diabetic complications screening
   • Thyroid Disorders
     • Hyperthyroidism and thyroid storm
     • Hypothyroidism and myxoedema
   • Adrenal and Pituitary Disorders
     • Addisonian crisis
     • Cushing's syndrome
   • Fluid, Electrolyte and Acid-Base Balance
     • Hyponatraemia assessment
     • Arterial blood gas interpretation
5. 5

   Neurology and Acute Presentations

   6 topics

   • Stroke and TIA
     • ROSIER and FAST assessment
     • Thrombolysis and thrombectomy windows
     • Secondary prevention
   • Headache Disorders
     • Subarachnoid haemorrhage red flags
     • Migraine, cluster and tension headache
     • Giant cell arteritis
   • Seizures and Epilepsy
     • Status epilepticus management
     • First seizure assessment and driving advice
   • Neuromuscular and Movement Disorders
     • Parkinson's disease
     • Guillain-Barre syndrome
     • Myasthenia gravis
   • Altered Consciousness and Meningitis
     • Glasgow Coma Scale assessment
     • Bacterial meningitis and sepsis
   • Sepsis and Acute Deterioration
     • Sepsis Six and NEWS2 escalation
     • Recognition of the deteriorating patient

Medicine and Acute Care flashcards for Professional and Linguistic Assessments Board (PLAB)

24 of 65 cards from the Medicine and Acute Care deck — real questions with worked answers.

1. What ECG changes distinguish STEMI from NSTEMI in acute coronary syndrome?

   STEMI: ST elevation $\geq 1$ mm in $\geq 2$ contiguous limb leads or $\geq 2$ mm in chest leads, or new LBBB. NSTEMI: ST depression, T-wave inversion, or no ECG changes, but with raised troponin. Unstable angina has the ischaemic symptoms but a normal troponin.

2. What is the immediate initial management (first-line drug therapy) for a patient with suspected acute coronary syndrome?

   MONA + dual antiplatelet: Morphine (if in pain), Oxygen (only if $\text{SaO}_2 < 94\%$), Nitrates (GTN), Aspirin 300 mg, plus a second antiplatelet (e.g. ticagrelor/clopidogrel). STEMI requires primary PCI within 120 minutes, or thrombolysis if PCI unavailable.

3. Which coronary artery territory corresponds to ECG leads II, III and aVF, and what is a key complication to watch for?

   Inferior MI, usually from the right coronary artery (RCA). Watch for bradycardia/heart block and right ventricular infarction — give nitrates cautiously as RV infarcts are preload-dependent and can cause profound hypotension.

4. How are the four New York Heart Association (NYHA) functional classes of heart failure defined?

   Class I: no limitation of activity. Class II: slight limitation, comfortable at rest, ordinary activity causes symptoms. Class III: marked limitation, comfortable only at rest. Class IV: symptoms at rest, unable to carry out any activity without discomfort.

5. What is the first-line pharmacological management of chronic heart failure with reduced ejection fraction (HFrEF)?

   An ACE inhibitor (or ARB if intolerant) PLUS a beta-blocker, titrated to maximally tolerated doses. Add a mineralocorticoid receptor antagonist (e.g. spironolactone) if symptoms persist. Loop diuretics (furosemide) are used for congestion/symptom relief but do not improve prognosis.

6. What blood test is used to help diagnose and risk-stratify heart failure, and what does a high value indicate?

   BNP (B-type natriuretic peptide) or NT-proBNP. It is released by ventricular myocytes under stretch; a raised level suggests heart failure and prompts echocardiography. NICE: NT-proBNP $> 2000$ ng/L warrants urgent (2-week) specialist assessment and echo.

7. What is the CHA₂DS₂-VASc score used for, and what does each component represent?

   It estimates stroke risk in atrial fibrillation to guide anticoagulation. Congestive HF (1), Hypertension (1), Age $\geq 75$ (2), Diabetes (1), prior Stroke/TIA/thromboembolism (2), Vascular disease (1), Age 65-74 (1), Sex category female (1). Anticoagulate if score $\geq 2$ (or $\geq 1$ in men).

8. How is the management of haemodynamically unstable atrial fibrillation different from stable AF?

   Unstable AF (shock, syncope, myocardial ischaemia, severe heart failure) requires immediate synchronised DC cardioversion. Stable AF is managed with rate control (beta-blocker or rate-limiting calcium channel blocker) and a decision on rhythm control plus anticoagulation based on CHA₂DS₂-VASc.

9. What is the ECG hallmark of complete (third-degree) heart block, and what is the definitive treatment?

   Complete AV dissociation — P waves and QRS complexes occur independently with no relationship, and the ventricular rate is slow (escape rhythm). Definitive treatment is a permanent pacemaker; atropine or transcutaneous pacing is used acutely if symptomatic.

10. What are the UK (NICE) thresholds defining Stage 1 and Stage 2 hypertension by clinic and ambulatory/home readings?

    Stage 1: clinic $\geq 140/90$ mmHg and ABPM/HBPM average $\geq 135/85$ mmHg. Stage 2: clinic $\geq 160/100$ mmHg and ABPM/HBPM $\geq 150/95$ mmHg. Severe (stage 3): clinic systolic $\geq 180$ or diastolic $\geq 120$ mmHg.

11. According to NICE, how does first-line antihypertensive choice depend on age and ethnicity?

    Age $< 55$ and not of Black African/Caribbean origin: ACE inhibitor or ARB (A). Age $\geq 55$ OR Black African/Caribbean of any age: calcium channel blocker (C). Step 2 combines A + C; step 3 adds a thiazide-like diuretic (D).

12. What is the most common cause of secondary hypertension, and what biochemical clue suggests it?

    Primary hyperaldosteronism (Conn's syndrome). Suspect it with hypertension plus hypokalaemia (or refractory hypertension); screen with the aldosterone-to-renin ratio (raised aldosterone with suppressed renin).

13. What is the classic auscultation finding of aortic stenosis, and where does the murmur radiate?

    An ejection-systolic (crescendo-decrescendo) murmur loudest at the right second intercostal space (aortic area), radiating to the carotids. Severe AS features: slow-rising pulse, narrow pulse pressure, soft/absent S2, and symptoms of syncope, angina or dyspnoea.

14. Contrast the murmurs of mitral regurgitation and mitral stenosis.

    Mitral regurgitation: pansystolic murmur loudest at the apex, radiating to the axilla. Mitral stenosis: mid-diastolic rumbling murmur with an opening snap, best heard at the apex in the left lateral position, often associated with a malar flush and AF.

15. What are the components of the Wells score for DVT, and how does the result guide investigation?

    Items include active cancer, paralysis/immobilisation, recent bedridden/surgery, localised tenderness, entire leg swollen, calf swelling $> 3$ cm, pitting oedema, collateral veins, and prior DVT (each scoring); alternative diagnosis subtracts 2. Score $\geq 2$ = DVT likely $\to$ proximal leg vein ultrasound; $\leq 1$ = unlikely $\to$ D-dimer.

16. What is the first-line anticoagulant treatment for confirmed DVT or PE, and the standard treatment durations?

    A DOAC (e.g. apixaban or rivaroxaban) is first-line. Duration: 3 months if provoked by a transient reversible factor; at least 3-6 months and often long-term/indefinite if unprovoked or due to active cancer or ongoing risk factors.

17. List the features used to assess acute asthma severity, distinguishing moderate, severe and life-threatening attacks.

    Moderate: PEF 50-75% predicted, no severe features. Severe: PEF 33-50%, RR $\geq 25$, HR $\geq 110$, unable to complete sentences. Life-threatening: PEF $< 33\%$, $\text{SpO}_2 < 92\%$, silent chest, cyanosis, poor effort, exhaustion, hypotension, arrhythmia, altered consciousness, or a normal/rising $\text{PaCO}_2$.

18. Outline the stepwise acute drug management of a severe asthma attack in the emergency setting.

    Oxygen to keep $\text{SpO}_2$ 94-98%; nebulised salbutamol (back-to-back); oral prednisolone or IV hydrocortisone; nebulised ipratropium bromide if severe/life-threatening; consider IV magnesium sulfate; escalate to senior/ICU for aminophylline or ventilation if not responding.

19. What spirometry result confirms airflow obstruction in COPD, and how is severity graded?

    Post-bronchodilator $\text{FEV}_1/\text{FVC} < 0.7$ confirms obstruction. Severity by FEV₁ % predicted: Stage 1 (mild) $\geq 80\%$, Stage 2 (moderate) 50-79%, Stage 3 (severe) 30-49%, Stage 4 (very severe) $< 30\%$.

20. What is the target oxygen saturation range when giving controlled oxygen to a patient with a COPD exacerbation, and why?

    88-92%, delivered via a controlled (e.g. 24-28% Venturi) mask. This avoids loss of hypoxic respiratory drive and worsening type 2 respiratory failure (hypercapnia) in CO₂ retainers; adjust based on ABG.

21. What scoring system is used to assess severity of community-acquired pneumonia, and what do the components stand for?

    CURB-65: Confusion (AMT $\leq 8$/new disorientation), Urea $> 7$ mmol/L, Respiratory rate $\geq 30$, Blood pressure ($< 90$ systolic or $\leq 60$ diastolic), age $\geq 65$. Each scores 1; 0-1 home treatment, 2 consider hospital, $\geq 3$ severe/consider ICU.

22. What are the most common causative organisms of community-acquired pneumonia, and which is most common overall?

    Streptococcus pneumoniae is the most common overall. Others: Haemophilus influenzae, Mycoplasma pneumoniae (atypical, younger patients), Staphylococcus aureus (often post-influenza), Legionella pneumophila (hyponatraemia, recent travel), and Chlamydophila species.

23. How does Light's criteria differentiate an exudative from a transudative pleural effusion?

    An effusion is an exudate if any one applies: pleural/serum protein ratio $> 0.5$; pleural/serum LDH ratio $> 0.6$; or pleural LDH $>$ two-thirds the upper limit of normal serum LDH. Transudates (e.g. heart failure, hypoalbuminaemia) fail all criteria; exudates suggest infection, malignancy or inflammation.

24. What are the components of the Wells score for PE outcome categories, and how do PERC and D-dimer fit in?

    Wells $> 4$ (PE likely) $\to$ CTPA; Wells $\leq 4$ (PE unlikely) $\to$ D-dimer, with CTPA only if positive. Items include clinical DVT signs, PE most likely diagnosis, HR $> 100$, immobilisation/surgery, prior DVT/PE, haemoptysis, and malignancy. The classic ECG finding $S_1Q_3T_3$ is uncommon; sinus tachycardia is most frequent.

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