PLAB 1 tests UK clinical practice. UK clinical practice is defined by NICE guidelines. The connection is direct: if you know the NICE recommendation for a condition, you can answer the PLAB question about that condition. If you rely on international textbooks or US-centric resources without verifying against NICE, you will get questions wrong — not because your clinical knowledge is wrong, but because the exam expects the UK answer.
These 10 NICE guidelines appear with disproportionate frequency across PLAB 1 sittings. Knowing them well is among the highest-yield investments of your study time.
1. NICE NG136: Hypertension in Adults
Hypertension questions appear in almost every PLAB 1 sitting. The key testable points: clinic BP threshold of 140/90 mmHg triggers ambulatory or home monitoring for confirmation. Treatment thresholds differ by age and ethnicity — under 55 or non-Black: ACE inhibitor first. Over 55 or Black African/Caribbean: calcium channel blocker first. Target is below 140/90 for most; below 150/90 for over-80s. Step 2 adds ACE inhibitor + CCB. Step 3 adds thiazide-like diuretic. Step 4 (resistant hypertension) requires specialist review with consideration of spironolactone.
The exam frequently tests the ethnicity-specific first-line choice and the step-wise escalation pathway. Use Ask iatroX to verify the current thresholds instantly.
2. NICE NG28: Type 2 Diabetes
The most frequently tested chronic disease management guideline. Key points: metformin is first-line. Second-line options depend on cardiovascular risk, weight, and renal function — SGLT2 inhibitor if established cardiovascular disease or high risk; DPP-4 inhibitor or sulfonylurea otherwise. HbA1c target of 48 mmol/mol (6.5%) on single-agent; 53 mmol/mol (7.0%) on dual therapy. The 8 care processes (HbA1c, BP, cholesterol, creatinine, urine ACR, foot exam, BMI, smoking) are now a QOF indicator and frequently tested.
3. NICE NG106: Chronic Heart Failure
The "four pillars" are now central to PLAB questions: ACE inhibitor (or ARB, or sacubitril/valsartan), beta-blocker, MRA (spironolactone or eplerenone), and SGLT2 inhibitor (dapagliflozin or empagliflozin). The exam tests whether you know all four pillars and the sequence of initiation. Also tested: when to refer to specialist heart failure services, monitoring requirements (renal function, potassium), and the distinction between HFrEF and HFpEF management.
4. NICE NG12: Suspected Cancer Recognition and Referral
Tested through clinical vignettes where you must recognise which symptoms warrant a 2-week-wait urgent referral. The exam does not expect you to memorise every referral criterion — but you must know the headline red flags: unexplained weight loss, unexplained lump, persistent change in bowel habit over 60, haematuria over 45, post-menopausal bleeding, persistent hoarseness, and dysphagia. Safety-netting (what to tell the patient if symptoms persist) is also tested.
5. NICE NG191: COVID-19 and Respiratory Infection Management (Updated Pneumonia Guidance)
Respiratory infection management remains heavily tested. Community-acquired pneumonia: amoxicillin first-line (doxycycline or clarithromycin if penicillin-allergic). CURB-65 scoring for severity assessment and admission decisions. Hospital-acquired pneumonia has different empirical antibiotic choices. The exam tests antibiotic selection, severity scoring, and when to escalate.
6. NICE CG181: Cardiovascular Risk Assessment and Lipid Modification
Statin prescribing is one of the most commonly tested topics. Key points: QRISK3 score of 10% or greater triggers statin discussion. Atorvastatin 20mg for primary prevention. Atorvastatin 80mg for secondary prevention (established CVD). Non-HDL cholesterol reduction of greater than 40% expected at 3 months. Lifestyle modification first; statins are offered in addition, not instead.
7. NICE NG51: Sepsis Recognition and Management
Updated sepsis guidance is critical and safety-relevant. The exam tests recognition of sepsis using the NEWS2 score and specific red flag indicators. Management: blood cultures before antibiotics, IV antibiotics within 1 hour of recognition, fluid resuscitation, lactate measurement, urine output monitoring. The "Sepsis Six" bundle is frequently tested.
8. NICE CG185: Bipolar Disorder (and Mental Health Guidelines Generally)
Mental health questions appear more frequently in the MLA-aligned exam. For bipolar: lithium or valproate for prophylaxis (valproate contraindicated in women of childbearing potential), antipsychotics for acute mania, SSRIs not used alone in bipolar depression. The exam also frequently tests capacity assessment (Mental Capacity Act principles), depression management (NICE CG90/NG222), and psychosis management (NICE CG178).
9. NICE NG133: Hypertension in Pregnancy
Pre-eclampsia and gestational hypertension are tested in every sitting. Key points: pre-eclampsia is hypertension plus proteinuria after 20 weeks. Labetalol first-line (nifedipine if contraindicated). Magnesium sulfate for seizure prophylaxis in severe pre-eclampsia. Aspirin 150mg from 12 weeks for women at risk. Delivery is the definitive treatment. sFlt-1/PlGF ratio as a diagnostic aid.
10. NICE NG128: Stable Angina / NICE NG185: Acute Coronary Syndromes
Acute coronary syndrome management is a perennial PLAB favourite. STEMI: primary PCI within 120 minutes (or thrombolysis if PCI not available within timeframe). NSTEMI: risk stratification using GRACE score, dual antiplatelet therapy, fondaparinux, early invasive strategy for high-risk. Stable angina: GTN for acute relief, beta-blocker or CCB for prophylaxis, secondary prevention with aspirin, statin, ACE inhibitor.
How to Use This List
Do not memorise these summaries. Use them as a map to the full guidelines. For each one, query Ask iatroX to access the complete, current NICE recommendation with citations. The exam tests details — specific drug choices for specific patient profiles, contraindications, monitoring requirements — that a summary cannot capture.
Use the iatroX Knowledge Centre for structured guideline browsing across all conditions. Use the Q-Bank to test your knowledge of these guidelines through clinical scenarios. The adaptive algorithm will automatically identify which guidelines you know well and which need more work.
These 10 guidelines will not cover every PLAB question. But knowing them thoroughly — not just the headlines, but the specific recommendations for specific patient scenarios — gives you a foundation that covers a disproportionate share of the exam.