PLAB Part 1 NICE Guideline Scenarios Practice Questions
NICE (National Institute for Health and Care Excellence) guidelines are central to clinical practice within the NHS and are frequently tested in PLAB Part 1. These questions assess your ability to apply evidence-based recommendations to common clinical scenarios, ensuring safe and effective patient management.
A 52-year-old man presents with an 8-week history of a persistent dry cough. He also describes a sour taste in the mouth and burning retrosternal discomfort that is worse after meals and when lying flat at night. He has no wheeze, breathlessness, haemoptysis, fever or weight loss, and is a lifelong non-smoker. Chest examination is normal and a recent chest X-ray was clear. According to NICE guidelines, what is the most appropriate initial management?
A 68-year-old man with type 2 diabetes and hypertension remains hypertensive (clinic BP 156/94 mmHg, confirmed on home readings) despite a maximally-tolerated dose of ramipril. He has a history of recurrent gout. His latest eGFR is 58 mL/min/1.73m2. According to NICE guidelines, what is the most appropriate next step in his antihypertensive treatment?
A 32-year-old woman is brought to the Emergency Department by ambulance after experiencing her first tonic-clonic seizure. The seizure lasted approximately 3 minutes and she is now post-ictal but rousing. There is no personal or family history of epilepsy. She is not pregnant. What is the most appropriate initial investigation to be arranged in the ED, according to NICE guidelines?
A 78-year-old man presents to his GP with a 3-month history of progressive memory loss, difficulty with daily tasks, and occasional confusion. His wife reports he has become more withdrawn. He has no focal neurological deficits. His routine blood tests, including full blood count, urea and electrolytes, liver function tests, and thyroid function tests, are all normal. What is the most appropriate next step in his assessment according to NICE guidelines?
A 55-year-old woman with a history of recurrent urinary tract infections (UTIs) presents to the GP with dysuria, frequency, and suprapubic pain. A urine dipstick test is positive for nitrites and leucocytes. She has no fever or loin pain. She is not pregnant and has no known drug allergies. What is the most appropriate antibiotic to prescribe as first-line treatment according to NICE guidelines?
NICE Guideline Scenarios — frequently asked
Why are NICE guidelines so important for PLAB Part 1?
NICE guidelines represent the standard of care within the NHS. PLAB Part 1 tests your ability to practise safely and effectively within the UK healthcare system, making adherence to NICE recommendations crucial for correct answers. Deviating from these guidelines can lead to incorrect management and patient harm, which the exam aims to prevent.
Do I need to memorise every single NICE guideline?
No, it's impractical to memorise every detail of every guideline. Focus on the key principles, first-line treatments, diagnostic algorithms, and red flags for common and important conditions. Understand the 'why' behind the recommendations, especially for conditions frequently encountered in general practice and acute settings.
How can I effectively study NICE guidelines for the exam?
Instead of reading full guidelines, focus on summaries like NICE Clinical Knowledge Summaries (CKS) or reputable PLAB revision resources that distil the key recommendations. Practice applying these guidelines to clinical vignettes, paying attention to patient demographics, comorbidities, and specific clinical findings that influence management choices. Pay particular attention to drug choices and dosages (from BNF) as recommended by NICE.
What if different guidelines conflict or there are multiple options?
PLAB questions are designed to have a single best answer. If there are multiple acceptable options in real-world practice, the question will often include a specific clinical constraint (e.g., 'patient has a penicillin allergy', 'eGFR is 30 mL/min') that makes one option clearly superior according to NICE. Always look for these discriminators in the vignette.
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