What We Learned from 10 Years of PLAB 1 Recalls

 

 

Over 2,000 recalls analysed to reveal the patterns, priorities, and pitfalls every PLAB 1 candidate should know. This analysis focuses specifically on the PLAB 1 single best answer (SBA) exam and reflects how the paper is structured in practice.

 

If you’re preparing for PLAB 1, you’ve probably had that same thought as every other candidate: what’s actually going to come up on the day?

 

You can skim through recalls, swap stories on Telegram groups, and scroll through question banks, but it never quite feels solid. You hear that cardiology is important, but how important? People say stroke comes up all the time, but is that really true? And what about ethics – is it worth much of your time?

 

We wanted to answer those questions properly. Not through guesswork or anecdotes, but through structured analysis. So, we reviewed more than two thousand candidate recalls from the last decade. These are not official GMC questions. They are personal recollections shared by candidates after sitting the exam.

 

We then categorised the recalls and mapped the themes against the MLA content map, which PLAB is now blueprinted to and which is publicly available via the GMC. The content map sets out what can be tested; our analysis shows what most often is.

 

Here’s what we found.

 

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The content map vs reality

 

The MLA content map sets out the knowledge, skills, and professional outcomes expected of doctors entering UK practice. It defines what can be tested, across systems and domains, but it does not show how frequently each topic appears in the exam.

 

On paper, very different conditions are given similar space. Common, high-impact problems sit alongside much rarer presentations, and minor conditions can appear to carry the same weight as life-threatening ones.

 

In reality, the weighting is very different.

 

Some systems and presentations appear repeatedly. Others feature regularly but in smaller numbers. And a few barely appear at all.

 

Understanding this gap between the content map and exam reality is one of the key differences between unfocused revision and effective PLAB preparation.

 

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Diagnosis is the backbone

 

Let’s start with the single most important finding.

 

Diagnosis is the backbone of PLAB 1.

 

Around half of all questions recalled by candidates are about recognising the correct condition from a stem. In some systems – cardiology, neurology, and haematology – it’s even higher.

 

That means your revision should put diagnosis front and centre. Pattern recognition, red flags, and classic clinical presentations should be your bread and butter.

 

For example, candidates frequently recall scenarios such as:

• A 22-year-old man presents with abdominal pain, diarrhoea, and weight loss. Colonoscopy shows skip lesions with areas of normal mucosa between. → Crohn’s disease.
• A 30-year-old man presents with cough, night sweats, weight loss, and haemoptysis. Chest X-ray shows upper lobe cavitating lesions. → Tuberculosis.
• A 60-year-old woman develops sudden painful red eye, blurred vision, headache, and halos around lights. Cornea appears cloudy. → Acute angle-closure glaucoma.

 

These aren’t obscure questions. They’re common presentations you must be able to spot quickly and confidently.

 

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Diagnoses that repeat

 

When we stripped out distractors and looked only at correct answers, the same conditions kept appearing:

• Stroke and TIA
• Pneumonia
• Pulmonary embolism
• Crohn’s and ulcerative colitis
• Tuberculosis and hepatitis
• Bronchiectasis
• Meningitis and encephalitis
• Asthma
• Diabetes emergencies
• Glaucoma
• Otitis externa and media

 

These aren’t obscure or niche topics – they’re the conditions that dominate the exam. If you want maximum return on your study time, make sure you can recognise and manage every one of them with confidence.

 

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The core systems

 

A handful of systems make up the majority of PLAB 1:

• Cardiovascular
• Neurology
• Respiratory
• Renal
• Digestive
• Skin
• Mental Health
• Emergency medicine

 

Together, they account for more than half the exam. These are the topics to master first. They’re not optional extras – they are the spine of the paper.

 

Put more of your revision time into stroke, heart failure, arrhythmias, seizures, and acute abdomen than into low-yield areas like rare ENT conditions. In respiratory medicine, don’t just think “pneumonia” – the exam often asks you to identify the type, severity, or complication. The same is true elsewhere: you’ll be expected to separate Crohn’s from ulcerative colitis, AKI from CKD, and cellulitis from DVT. If you only have a few weeks to revise, these higher-yield differentiations are where your hours should go.

 

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Systems that appear steadily

 

Next come the solid, medium-weight systems. Endocrine, musculoskeletal, and infectious disease show up consistently in every paper. They’re not as dominant as cardio or neuro, but they’re never absent either.

 

These are also the areas where management questions are particularly common. Think:

• DKA and HHS in diabetes
• Thyroid storm and myxoedema coma
• Addisonian crisis
• Sepsis protocols
• Common fractures and osteoporosis

 

A typical management stem might read:

• A 25-year-old man with type 1 diabetes presents with vomiting and abdominal pain. Capillary ketones are raised, venous pH is 7.1, and bicarbonate is low. What is the most appropriate next step in management?

 

It’s not enough to know that this is DKA. You need to know the order of management: IV fluids, insulin infusion, potassium replacement. That’s where candidates lose marks if they’ve only revised symptoms and not guidelines.

 

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The smaller but reliable systems

 

Then there are the smaller systems: eyes, ENT, urology, reproductive medicine, older adults, palliative care, and ethics.

 

Together, they don’t make up a huge slice, but they’re steady. Most sittings will have:

• A red eye question (conjunctivitis vs keratitis vs glaucoma)
• At least one otitis case
• A pregnancy complication or contraception scenario
• Dementia or capacity stem
• An ethics problem about consent or confidentiality

 

Breast surgery appears far less often in candidate recalls compared with other systems. It’s worth knowing the basics – especially recognition of breast lumps and referral pathways – but you don’t need to devote the same amount of time here as you would to cardiovascular, respiratory, or neurological topics.

 

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Question types

 

Across all systems, the exam breaks down into four main types of question:

 

1. Diagnosis – around 50%:

• These are the core of PLAB 1. You’ll be given a vignette with symptoms, signs, and sometimes investigation results. 
• Your task is to recognise the most likely condition. These aren’t usually obscure; the challenge is telling similar conditions apart. 
• Think stroke vs seizure vs migraine, Crohn’s vs ulcerative colitis, or asthma vs COPD.

 

2. Management – around 25%:

• A quarter of the paper tests what you do after you’ve made the diagnosis. These questions often ask for the first-line management in a UK setting, based on NICE guidance. 
• For example, what to prescribe in new-onset depression, how to treat acute alcohol withdrawal, or when to give thrombolysis in stroke. 
• Candidates often lose marks here if they know the diagnosis but don’t know the precise UK-first step.

 

3. Investigations – about 10–15%:

• These questions test whether you can choose the most appropriate initial test, or distinguish between the first-line and the definitive investigation. 
• For example, CT head vs MRI in stroke, ECG vs troponin in chest pain, or ultrasound vs CT in suspected gallstones. 
• This is one of the examiners’ favourite traps.

 

4. Other – the remainder; smaller but still important. It includes:

• Prognosis (e.g. five-year survival in cancer, complications of chronic disease)
• Risk factors (e.g. strongest predictors of stroke, osteoporosis, or ischaemic heart disease)
• Pathophysiology (e.g. inheritance patterns, mechanisms of drug action)
• Ethics and professionalism (e.g. confidentiality, consent, capacity, DNACPR decisions).

 

This balance is crucial. Diagnosis is the foundation of PLAB 1, but it isn’t the whole story. A full third of the exam tests what to do next – the immediate management step, the right investigation, or the safe application of core principles. Ignoring these areas is where many candidates slip. Getting them right is what turns a solid knowledge base into a confident pass.

 

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How the balance shifts by system

 

Each system has its own flavour:

• Cardio & Neuro: Diagnosis dominates. Arrhythmias, murmurs, strokes, seizures, and headache red flags appear often. These are the classic “pattern recognition” systems.
• Respiratory: Still diagnosis-led, but investigations feature heavily. Expect chest X-ray interpretation, ABGs, and CT chest to appear alongside pneumonia, PE, and asthma.
• Endocrine: Management-heavy. The focus is on immediate steps in DKA, HHS, thyroid storm, and Addison’s crisis. Knowing the order of interventions is key.
• Mental Health: Again, management-driven. You need to know first-line drug choices, alcohol withdrawal protocols, and how acute crises are handled in UK practice.
• GU/Repro: Dominated by pregnancy complications (ectopic, pre-eclampsia, obstetric emergencies) and contraception scenarios. Most questions are framed around management rather than recognition.
• Older Adults & Palliative: A balance of dementia recognition, end-of-life care, and ethics (capacity, consent, DNACPR).
• Ethics: Almost entirely principle-based. These questions test your application of GMC guidance, not clinical knowledge.

 

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Investigations – the examiner’s trap

 

One of the most consistent patterns in PLAB 1 is how often investigations are tested. Systems like cardiology, neurology, renal, respiratory, haematology, and emergency medicine all feature a heavy dose of investigation questions.

 

The trap isn’t about obscure knowledge. It’s about knowing the initial test versus the diagnostic test – the safe first step in UK practice, rather than jumping straight to the most sensitive or definitive investigation.

 

Examples from recalls include:

• Anaemia: initial = FBC and blood film; diagnostic = bone marrow biopsy.
• Haematuria: initial = urine dipstick and culture; diagnostic = cystoscopy.
• Gallstones/obstructive jaundice: initial = ultrasound; diagnostic = ERCP or MRCP.
• Ovarian torsion: initial = pelvic ultrasound; diagnostic = laparoscopy.

 

A typical stem might look like:

• A 60-year-old man presents with painless visible haematuria. He is otherwise well, with no history of trauma. What is the most appropriate initial investigation?
• The correct first step is urine dipstick and culture. Cystoscopy may confirm the diagnosis, but it is not the initial investigation.

 

This is one of the examiners’ favourite ways to separate candidates. Under pressure, many choose the definitive test because it feels more “complete.” But the exam rewards those who think safely, sequentially, and in line with UK-first practice

 

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Don’t underestimate ethics

 

Ethics is often overlooked, but it’s a consistent feature of PLAB 1. In every sitting, candidates recall questions on professionalism, capacity, confidentiality, and end-of-life care. In some papers, they’ve reported that ethics and professionalism together made up a significant chunk.

 

They’re rarely tricky if you’ve prepared. Most are about applying principles of consent, confidentiality, capacity, and end-of-life care. The kinds of scenarios you might face include:

• A patient with advanced dementia refuses medication. How do you decide whether to proceed?
• A 15-year-old girl asks for contraception without telling her parents. What is your duty of confidentiality?
• A patient with a DNACPR order collapses and becomes pulseless. What should you do?
• You notice a colleague on duty smells strongly of alcohol. What is your professional responsibility?

 

These aren’t about medical facts. They’re about knowing GMC’s Good Medical Practice and the Mental Capacity Act. The good news? Once you’ve read those guidelines, these are some of the easiest marks in the exam.

 

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Why this analysis matters

 

Most question banks and prep courses are built on fragments of recall and educated guesswork. What we’ve done here is different: a decade of recalls, categorised and matched to the MLA content map, then analysed line by line.

 

That means our insights aren’t hunches – they’re evidence.

 

For example, we can say with confidence:

• Cardiology questions focus heavily on myocardial infarction, heart failure, and arrhythmias.
• Respiratory questions repeatedly test pneumonia, PE, and bronchiectasis, often through investigations like CXR and ABGs.
• Endocrine is disproportionately about acute management: DKA, HHS, thyroid storm, Addisonian crisis.
• Ethics questions almost always centre on capacity, consent, confidentiality, and end-of-life care.

 

Clarity like this changes how you revise. Instead of spreading your time evenly, you know where to push harder, what the examiners actually test, and where the easy marks lie. And that’s the real value here: once you see the patterns, you can shape your revision around them. 

 

Here’s how to do it:

• Start by building a diagnosis-first foundation. Work through cardio, neuro, respiratory, renal, digestive, skin, mental health, and emergency. For each, practise spotting the classic presentations.
• Layer on management in the high-yield areas – endocrine, mental health, and obstetrics. Use NICE guidance to anchor your answers: what’s the first-line action, what’s safe, what’s UK practice.
• Next, drill the investigation favourites: ECG interpretation, chest X-rays, CT heads, blood films, ABGs, U&Es. Practise distinguishing initial vs definitive investigations.
• Finally, sweep through ethics and professionalism. Read GMC’s Good Medical Practice. Make sure you understand Gillick competence, capacity, DNACPR decisions, and duty of candour. These are straightforward once learned.

 

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The bottom line

 

PLAB 1 isn’t an exam you pass by knowing everything. It’s an exam you pass by knowing the right things.

 

The data shows:

• Diagnosis dominates – about half the paper.
• Management is key in endocrine, mental health, and obstetrics.
• Investigations matter most in cardio, neuro, renal, respiratory, and blood.
• Ethics is smaller in volume, but it’s easy, high-yield marks.

 

Get those priorities right, and your chances of passing first time go way up.

 

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Final thoughts

 

The exam isn’t random. It follows patterns, and those patterns repeat. Our review proves it.

 

So don’t just study harder – study smarter. Put your effort where the marks are. Master diagnosis, nail the high-yield management areas, learn the common investigations, and scoop up the easy ethics marks. That’s how you walk into PLAB 1 confident, prepared, and ready to pass.

 

This is the clearest map you’ll find of PLAB 1. Ten years of evidence shows the exam is about recognising common conditions, applying safe UK-first management, and knowing the right first-line investigations. Put your time where it counts

 

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Disclaimer

This analysis is based on candidate recollections of past PLAB 1 sittings. These recollections are personal accounts and are not official GMC material. The GMC does not publish past PLAB questions. This resource analyses recall patterns to identify general themes and areas of emphasis and does not reproduce or predict specific exam content. It is intended to support exam preparation alongside official guidance and recommended study resources.