Cardiovascular Medicine and Vascular Disease: What PLAB 1 Asks

Scope and time budget

Fourteen questions is roughly fourteen minutes of the exam. The domain is dense with common conditions that an F2 doctor sees every week: chest pain, breathlessness, palpitations, collapse and leg swelling. Questions are rarely about rare cardiology. They ask you to choose between tests, drugs and referral routes for an ordinary patient with a clear clinical picture.

What is tested

• Coronary disease. STEMI and NSTEMI management, stable angina and secondary prevention, lipid management and cardiovascular risk assessment with QRISK.
• Heart failure and hypertension. Diagnosis, drug therapy, acute pulmonary oedema, diagnostic thresholds and drug choice for hypertension.
• Rhythm. Atrial fibrillation (rate and rhythm control, anticoagulation), supraventricular and ventricular tachycardias, bradyarrhythmias and ECG interpretation including ischaemia, heart block, hyperkalaemia and QT problems.
• Structural and inflammatory disease. Valve disease and infective endocarditis, cardiomyopathies, myocarditis, pericarditis, tamponade and aortic dissection.
• Vascular disease. Peripheral arterial disease and acute limb ischaemia, abdominal aortic aneurysm screening and rupture, venous thromboembolism, varicose veins and leg ulcers.
• Other. Syncope and postural hypotension, congenital heart disease in adults and cardiac drugs: anticoagulants, antiplatelets, statins and antiarrhythmics.

UK facts to anchor your answers

These were verified on official pages on 21 October 2026. Always recheck before the exam.

• AAA screening: offered to men at age 65, and older men can self-refer.
• DVLA after ACS or MI: Group 1 may drive one week after successful PCI if conditions are met (no urgent revascularisation planned within 4 weeks and LVEF at least 40% before discharge), otherwise 4 weeks. Group 2 needs at least 6 weeks, and relicensing needs LVEF at least 40% and functional tests.
• DVLA for angina: Group 1 has no fixed period and must stop while symptomatic. Group 2 needs at least 6 weeks symptom-free.
• DVLA after pacemaker implant: Group 1 one week, Group 2 six weeks.
• DVLA with an ICD: for secondary prevention, Group 1 six months after implant and a permanent bar for Group 2. For prophylactic ICDs, Group 1 one month if asymptomatic, and a permanent bar for Group 2.
• DVLA for incapacitating atrial fibrillation or flutter: Group 1 at least four weeks off and resume four weeks after the last arrhythmic event once the cause is treated. Group 2 relicensing needs no incapacitating arrhythmia for at least three months and LVEF at least 40%.

For hypertension, type 2 diabetes with cardiovascular risk, lipids and resuscitation, the UK source is NICE and the Resuscitation Council UK. We could not read those sites for this page, so we give no numeric thresholds. Learn the current algorithm and note the date you read it.

How the questions are framed

A typical stem gives age, sex, symptoms, observations and one or two results such as an ECG description or a troponin. The question then asks for the most likely diagnosis, the immediate management or the best long-term drug. Many items hinge on a single feature that changes the answer: a patient on a particular drug, a contraindication hidden in the history, a renal result or an unstable rhythm. Read for that feature before you read the options.

Prescribing items ask for the first-line choice, the combination to avoid or the monitoring needed. Know the class, the common adverse effect and the main interaction for each cardiac drug, rather than the full list of brand names.

What examiners ask about each group

• Acute coronary syndrome. Recognise the presentation, read the ECG and troponin in context, give the immediate drugs, choose between reperfusion routes and plan secondary prevention. Know which drugs to avoid in particular patients.
• Heart failure and hypertension. Confirm the diagnosis, choose the first-line drug for the patient's age, ethnicity and comorbidities, manage acute pulmonary oedema, and monitor renal function and potassium after starting treatment.
• Atrial fibrillation. Decide between rate and rhythm control, assess stroke risk, choose the anticoagulant and recognise when urgent cardioversion is needed because the patient is unstable.
• Valve disease and infection. Link a new murmur, fever and risk factors to endocarditis, and know the investigations and the need for specialist input before antibiotics where the guideline says so.
• Emergencies. Pericardial tamponade, aortic dissection, acute limb ischaemia and ruptured AAA: the exam asks for the immediate action and the correct specialist, not a detailed operation.
• Venous thromboembolism. Assess probability, choose the first test, start treatment appropriately and consider prophylaxis in at-risk patients.

Across all groups, the questions expect you to read renal function, bleeding risk and interacting drugs before you prescribe. Build the habit of scanning the stem for these three features each time.

Three typical traps

1. Mixing Group 1 and Group 2 driving rules. The periods differ sharply, and the stem may mention a taxi, bus or lorry licence only once. Check the licence group before you choose the period.
2. Treating stable and unstable as the same. An unstable patient with a tachyarrhythmia needs urgent treatment, not a rate-control tablet. A stable patient needs assessment, ECG confirmation and a plan. Read the observations for instability first.
3. Choosing the investigation when the answer is a drug. In suspected acute coronary syndrome or pulmonary embolism, early treatment may come before the confirmatory test. Match the answer to the stage of the pathway the stem describes.

How to revise it

1. Learn pathways, not lists. For ACS, heart failure, AF and VTE, write a pathway card: presentation, first test, first drug, next step, follow-up.
2. Drill ECG patterns daily. Ten minutes a day on ischaemia, AF, heart block, hyperkalaemia and long QT. Say the pattern and the action aloud.
3. Group the drugs. Make one table each for antihypertensives, antiplatelets and anticoagulants, antiarrhythmics and lipid drugs, with indication, key adverse effect and main interaction.
4. Add the UK facts to flashcards. AAA screening age, DVLA periods and the Group 1 versus Group 2 contrast.
5. Take timed blocks of 20 questions and log every error by reason.

Connect this domain to acute and emergency care and to the diabetes content in endocrine and renal, where cardiovascular risk reduction overlaps. See UK guidelines you must know for the full list of verified rules.