Infection, cancer and palliative care are an estimated 8% of PLAB 1, about 14 of 180 questions. Expect antibiotic choice and stewardship, HIV, malaria and travel fever, healthcare-associated infection, meningococcal public health action, notifiable disease, oncological emergencies, screening and two-week-wait referral, common cancers, symptom control, opioid prescribing, DNACPR and certification of death. The weight is an editorial estimate.
Scope and time budget
About fourteen questions is fourteen minutes. The domain splits into three parts that need different habits. Infection is about choosing the right antimicrobial and the right public-health action. Cancer is about emergencies, recognition and referral. Palliative care is about symptom control, communication and the legal and ethical framework at the end of life. Candidates from systems with different antibiotic policies or different end-of-life practice should read UK guidance carefully here.
What is tested
- Antimicrobials and infection control. Antimicrobial stewardship and antibiotic choice, healthcare-associated infection (MRSA, C. difficile), gastrointestinal infections and food poisoning, fungal and parasitic infections, infective endocarditis and bone and joint infection.
- Specific infections. HIV testing, antiretrovirals and opportunistic infections, malaria and travel-related fever, tuberculosis and latent infection, sexually transmitted and blood-borne infections.
- Public health. Meningococcal disease with public health action and prophylaxis, notifiable diseases and health protection duties.
- Oncology. Oncological emergencies (neutropenic sepsis, spinal cord compression, SVC obstruction, hypercalcaemia, tumour lysis), cancer screening and two-week-wait referral, common cancers (lung, breast, colorectal, prostate), tumour markers and paraneoplastic syndromes, chemotherapy and radiotherapy adverse effects.
- Palliative care. Symptom control for pain, nausea, breathlessness and agitation, opioid prescribing, conversion and syringe drivers, last days of life, DNACPR and advance care planning, breaking bad news, bereavement, and verification and certification of death.
UK points to anchor your answers
- Cancer screening: cervical at 25 to 64 every 5 years; breast at 50 to 70; bowel at 50 to 74 with a home kit every 2 years; lung screening for people aged 55 to 74 who have ever smoked in some parts of England; AAA screening for men at 65.
- Notifiable disease: doctors notify suspected cases to the local health protection team and do not wait for laboratory confirmation in urgent cases. Learn the rules from GOV.UK.
- Prescribing: the BNF is the authority for antibiotic choice, opioid doses and syringe-driver drugs. Write doses in micrograms and milligrams as the BNF does.
- Professional standards: Good medical practice 2024 and GMC ethical guidance apply to breaking bad news, DNACPR discussions and certification.
NICE sets the suspected cancer referral criteria and sepsis and antimicrobial guidance. We could not read NICE for this page, so confirm criteria and time frames at source.
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How the questions are framed
Infection stems give a clinical picture, sometimes a travel history or an exposure, and ask for the likely organism, the test or the first antimicrobial. Many stress stewardship: narrow the spectrum when the culture is back, choose the shortest effective course and avoid antibiotics when they are not indicated. Oncology stems describe a patient with cancer who becomes unwell, and ask for the emergency diagnosis and the immediate action. Palliative stems describe a patient near the end of life and ask for the best drug, route or conversation.
The communication items are as important as the clinical ones. Breaking bad news, discussing resuscitation status and responding to a distressed relative are tested as skills, and the best answer usually listens first, gives information in plain language, checks understanding and offers support.
What examiners ask about each group
- Antibiotics. Choose the first-line agent for common infections, adjust for allergy and kidney function, and know the key adverse effects and interactions.
- HIV and STIs. Understand testing principles, consent, partner notification and prophylaxis.
- Healthcare-associated infection. Apply isolation, hand hygiene and antibiotic review, and recognise C. difficile risk.
- Oncological emergencies. Neutropenic sepsis needs immediate antibiotics, cord compression needs urgent imaging and steroids as the guidance says, and hypercalcaemia needs fluids and further treatment.
- Cancer pathways. Recognise the red flag symptoms and refer on the correct urgent route.
- Palliative prescribing. Choose the drug for the symptom, convert between opioids safely and adjust for kidney function.
- End of life. Know the principles of DNACPR decisions, the process of verifying death and when a death must be referred to the coroner.
Time and exam technique
This domain has a high ratio of drug choices to facts, so most of the time you spend should go on reading the stem for allergy, kidney function, pregnancy and previous antibiotic use. Where an item asks about communication, slow down: the right answer is usually the one that is honest, kind and clear, and the wrong ones tend to be either evasive or blunt. For public-health items, remember that action on contacts and notification do not wait for the final result.
Three typical traps
- Waiting for confirmation before treating or notifying. In suspected meningococcal disease or neutropenic sepsis, early treatment and notification come first.
- Prescribing a broad antibiotic out of habit. Stewardship means choosing the narrowest effective agent according to UK guidance, not the agent used at home.
- Treating a DNACPR as a decision to withhold care. A DNACPR decision concerns resuscitation only. The stem may hide a patient who still needs active treatment. Read what the decision covers.
How to revise it
- Make an antibiotic grid of common infections with first-line choice, alternative for allergy and duration, from the current source.
- Write emergency cards for neutropenic sepsis, cord compression, SVC obstruction, hypercalcaemia and tumour lysis.
- Learn the screening programmes and attach the urgent route for symptomatic patients.
- Practise communication scripts for breaking bad news and discussing resuscitation. Say them aloud.
- Do 20-question timed blocks with prescribing items marked for separate review.
This domain connects to haematology for neutropenia, respiratory for tuberculosis and lung cancer, and the professional domain for certification and public health duties.
Sit a timed PLAB 1 mock exam
Blueprint-weighted questions under exam timing, then a breakdown of your result by domain.
Frequently asked questions
How many infection, cancer and palliative questions are in PLAB 1?
The GMC publishes no weights. Our editorial estimate is about 8%, roughly 14 of 180 questions. Infection and cancer content also appears in respiratory, gastro, haematology and professional-practice items.
What are the NHS cancer screening programmes?
The NHS lists cervical (25 to 64, every 5 years), breast (50 to 70), bowel (50 to 74, home kit every 2 years) and lung cancer screening (ages 55 to 74 who have ever smoked, in some parts of England). Abdominal aortic aneurysm screening is offered to men at 65.
Do doctors have a duty to notify infectious disease?
Yes, registered medical practitioners must notify suspected notifiable diseases to the local health protection team. We could not verify the details for this page, so learn the current rules and the list of notifiable diseases from GOV.UK.
Are DNACPR and last days of life examined?
They are in our subtopic list, with advance care planning, breaking bad news, bereavement and verification and certification of death. Learn the UK frameworks and GMC guidance for these.