Acute, Emergency, Critical Care and Perioperative Medicine for PLAB 1

Why this domain carries more than its weight

The GMC says PLAB 1 covers common, important or acute conditions seen by an F2 doctor, including those common in emergency departments. That sentence puts acute care at the centre of the exam. The domain on its own is about 16 questions, but acute thinking runs through chest pain, breathlessness, abdominal pain, collapse and the unwell child. A doctor who masters the first ten minutes of an acute presentation gains marks in several other domains.

What the exam rewards is order. Which action comes first, who do you call, which test changes management now? Answers that are correct in principle but come too late in the sequence are wrong.

What is tested

Our blueprint lists twenty subtopics, which fall into five groups.

• Cardiac arrest and anaphylaxis. Adult advanced life support and post-ROSC care, and anaphylaxis recognition and adrenaline dosing.
• Sepsis and shock. Sepsis recognition and the first-hour bundle, shock of all four types, acute kidney injury in the unwell patient, early warning scores and escalation of the deteriorating patient.
• Trauma and environment. Primary survey (ATLS/ABCDE) and haemorrhage control, head injury and cervical spine assessment, burns, hypothermia, heat illness and drowning.
• Poisoning, fluids and gases. Overdose and poisoning (paracetamol, salicylate, opioids, tricyclics, carbon monoxide), hyperkalaemia, hyponatraemia and hypercalcaemia, and interpretation of acid-base results and arterial blood gases.
• Perioperative care. Pre-operative assessment, ASA grade and fasting, anaesthetic agents, airway management and local anaesthetic toxicity, post-operative complications, acute pain, blood transfusion and the acute abdomen. One subtopic covers decision-making when a patient lacks capacity in an emergency.

UK points to anchor your answers

The exam follows UK practice. For this domain, the main sources are the Resuscitation Council UK guidelines, NICE guidance on sepsis, acute kidney injury and anaphylaxis, the BNF for drug choice and the GMC guidance on consent and capacity. We could not read the NICE, BNF or Resuscitation Council UK sites when we compiled our facts, so we do not quote numeric thresholds or doses here. Confirm every figure on the source and note the date.

• Blood gas results use kPa, and other results use SI units such as mmol/L and micromol/L.
• Drug names are British Approved Names: adrenaline, paracetamol, furosemide, glyceryl trinitrate. Doses are in micrograms, not mcg.
• Questions use the term emergency department or A&E and describe the UK system, with consultants, registrars and F2 doctors, and an outreach or critical care team for deteriorating inpatients.
• Treatment without consent in an emergency must follow UK capacity law and GMC guidance. Learn the framework from the primary source and apply it to scenarios.

Three typical traps

1. Treating the investigation as the answer. In a collapsed patient the question is often about the next action, such as securing the airway, giving oxygen or starting treatment, not about requesting a scan. If the patient is unstable, treatment and escalation come before imaging.
2. Using a home protocol or drug name. A drug or sequence you learned elsewhere may not be the UK first choice. UK stems use adrenaline and other British Approved Names. If an option looks unfamiliar, check whether it is an old or non-UK protocol.
3. Forgetting the F2 role. The best answer may be to call for senior or critical care help, not to attempt a specialist procedure. Escalation is a clinical skill, and the exam treats it as one.

How the questions are framed

Acute stems tend to give a short story and a set of observations: heart rate, blood pressure, respiratory rate, oxygen saturation, temperature and level of consciousness. The task is usually one of four. Name the most likely diagnosis from the pattern. Choose the immediate action. Select the drug and route. Decide who needs to be called. Each type rewards a different habit, so practise them separately.

• Pattern items reward quick recognition. Practise reading a set of observations as a whole, so that you see shock before you see a number.
• Action items reward sequence. Airway problems come before breathing problems, and haemorrhage control before investigation.
• Drug items reward knowing the first-line drug, route and when not to give it. Check contraindications that the stem plants, such as a known allergy or a renal problem.
• Escalation items reward judgement. The correct answer is often to involve a senior doctor, the critical care outreach team or the anaesthetist, and to say so clearly using a structured handover.

Time and expected items

At about 16 expected questions, this domain should take about 16 minutes of your three hours if you keep to a minute each. Acute items often have longer stems, so allow a little more and make up the time on short recall items elsewhere. In practice, aim for 20-question timed blocks in which you finish a block in 20 minutes and spend the same time reviewing. If your blocks consistently run over, the cause is usually slow pattern recognition rather than lack of knowledge, so add interpretation drills.

Connections to other domains

Acute care overlaps with almost every other domain. Anaphylaxis and the unwell child appear in paediatrics. Overdose and self-harm appear in mental health. Haemorrhage and shock appear in obstetrics and surgery. Sepsis appears in infection. When you review a mixed block, tag each acute error with its home domain, so that you learn the system as well as the emergency.

How to revise it

1. Memorise the ABCDE sequence cold. For every acute scenario, say what you check and what you do at each letter.
2. Build one-page algorithms. One each for cardiac arrest, anaphylaxis, sepsis, shock, hyperkalaemia and overdose. Write the first action, the drug, the monitoring and the escalation point.
3. Do interpretation drills. Practise reading blood gases and ECGs daily for ten minutes, so that you spot the pattern before the options.
4. Revise perioperative care as a safety topic. Fasting, anticoagulants, diabetes and steroids around surgery are sensible themes to revise.
5. Do timed blocks of 20 questions. Aim for one minute each and review every error against the source guideline.

Pair this domain with cardiovascular, because arrest and acute coronary syndrome overlap, and with the professional domain for capacity and consent in emergencies. The high-yield guide shows where to start.