PLAB 1 exam technique

How the exam works

• 180 single best answer questions in 3 hours, on a computer.
• Each question is a short clinical scenario, a question and five options. You choose the one best answer.
• The questions follow the GMC's content map for PLAB 1, which covers the knowledge expected of a doctor starting the second year of UK foundation training.
• The GMC runs the exam and publishes the official rules, dates and booking details. Check them on the GMC website before you book.
• Wrong answers do not lose marks. Never leave a question unanswered.

Pacing

• 3 hours for 180 questions is one minute a question.
• Checkpoints: question 60 at about 60 minutes, and question 120 at about 120 minutes.
• If a question has taken more than about 90 seconds, choose your best answer, flag it if you can, and move on. The minute you save goes to a question you can answer well.
• Leave a few minutes at the end to make sure every question has an answer.
• PLAB Vault's full mocks are 180 questions in 3 hours with a pace line, so you learn what a minute a question feels like before the day.

Reading a question

1. Read the last line first. "Most likely diagnosis", "most appropriate next step", "most appropriate initial management" and "most appropriate investigation" are different questions with different answers.
2. Read the stem once, carefully. Note the age, the setting (GP surgery, emergency department, ward, community), the observations and the time course.
3. Predict the answer before you look at the options. If your prediction is there, it is usually right.
4. Then read every option. More than one can be partly right. Choose the best one for this patient, now.
5. Eliminate. Rule out options that are wrong, unsafe or not available in this setting, then choose between what is left.

Choosing between two good options

• An unstable patient: ABCDE and resuscitation come before tests and before definitive treatment.
• Next step or definitive treatment: if the question asks for the next step, the answer is often the action that has to come first, such as a test, a referral or a safety step.
• First line means first line. NICE gives a clear order for most conditions. Choose the first step, not the one you would reach later.
• The UK answer wins. Choose what current UK guidance would do: NICE and NICE CKS, the BNF, the Green Book, SIGN or BTS where NICE defers to them, and GMC guidance. Where the UK differs from where you trained, the UK answer is the right one.
• Who and where. A GP refers on a suspected cancer pathway; a foundation doctor escalates to a senior; the police and children's social care have defined roles. The right person often decides the answer.

Clues that decide answers

• Red flags turn a routine question into an urgent one: thunderclap headache, saddle numbness, a non-blanching rash, chest pain with a tearing quality.
• Age thresholds come from NICE referral guidance: 40 for lung and pancreatic symptoms, 45 for haematuria and hoarseness, 50 and 55 for some gynaecological and bowel pathways.
• Pregnancy, breastfeeding, kidney function and age change the drug. Look for them before choosing a medicine.
• Time matters: within 1 hour, within 24 hours, within 2 weeks. The question often turns on how fast something must happen.

Ethics, law and professionalism

• These questions are about the patient's safety and the GMC's standards, not about protecting yourself.
• A capable adult can refuse anything, including life-saving treatment, even when you disagree.
• Confidentiality can be broken only with consent, when the law requires it, or in the public interest to prevent serious harm.
• Patient safety comes first with a colleague who is unwell or impaired: protect patients, then support the colleague and tell a senior.
• Be honest when things go wrong: tell the patient, apologise and explain. An apology is not an admission of liability.

Common traps

• Choosing a correct answer that is not the best answer. Several options may be reasonable; only one fits the stem best.
• Treating before checking safety. Glucose in every unconscious patient, a pregnancy test in every woman of childbearing age with abdominal pain, an ECG in every blackout.
• Investigating when the diagnosis is clinical, such as a tension pneumothorax or an uncomplicated faint.
• Reaching for a second-line drug because it is newer or what you would use at home.
• Changing answers without a reason. Change only if you misread the stem or remember a specific rule.

In the weeks before

• Do full mocks under exam conditions, so 3 hours of concentration feels normal.
• Review every wrong answer and write down the rule that would have got it right.
• Revisit the areas that cost you most, not the ones you enjoy.
• Sleep well the night before. A rested mind reads stems more accurately than a tired one that knows more.