PLAB MLA AKT — Sample Teaching Resources
Official GMC references, the anatomy of 2026-format clinical vignettes, and interactive sample questions demonstrating the shift from factual recall to applied clinical reasoning.
Anatomy of a 2026 PLAB MLA Clinical Vignette
The cornerstone of the new examination format — understanding how each component is structured and what it tests
👤 Patient Demographics
Sets the baseline risk profile — age, gender, ethnicity, occupation. Primes differential diagnosis from the outset.
🚨 Presenting Complaint
The clinical 'hook' — chief symptom, onset, duration, severity. Directs initial clinical reasoning.
📋 Clinical History
PMH, drug history, social history, family history. Layered complexity requiring synthesis of multiple data points.
🌡️ Physical Findings
Vital signs (ABCDE approach), targeted examination results. Tests pattern recognition and red flag identification.
🧪 Investigations
Bedside tests (ECG, urinalysis), bloods, imaging. Interpretation in clinical context, not isolation.
❓ The Lead-in Question
The clinical task — next investigation, next management step, most likely complication. Tests prioritisation and patient safety.
Official GMC References
📄 PLAB 1 AKT — Example Questions (GMC PDF)Traditional Format — Orientation Examples
Five questions derived from the official GMC example set — stems paraphrased for clarity
Q1: Chronic diarrhoea + weight loss + intensely itchy rash — small bowel biopsy finding?
A middle-aged man has long-standing diarrhoea and weight loss, plus an intensely pruritic erythematous rash on buttocks/thighs. Blood tests show anaemia with anisocytosis. What is the most likely histological feature on small bowel biopsy?
Reveal Answer
Q2: ED request for strong analgesia + malnourished/restless — key substance?
A young adult presents with abdominal pain requesting strong analgesia. She appears malnourished and restless/irritable. Which non-prescribed substance is most important to enquire about?
Reveal Answer
Q3: Painless jaundice + pale stools + weight loss — investigation?
An older patient has painless jaundice, pale stools and weight loss. Examination unremarkable. Which investigation is most appropriate?
Reveal Answer
Q4: Paracetamol overdose, level below NAC line — action?
A patient presents after an impulsive paracetamol overdose and now expresses regret. Level below treatment line. What is the most appropriate course of action?
Reveal Answer
Q5: Post-op hip fracture + pleuritic pain + haemoptysis — test?
Elderly inpatient post-hip surgery develops acute chest pain, breathlessness, haemoptysis. Mild hypoxia. Which diagnostic investigation is most appropriate?
Reveal Answer
2026 Clinical Vignette Format — Sample Questions
Full-length exemplars demonstrating the clinical reasoning depth required from September 2026
Women's Health: HRT & Breakthrough Bleeding
A 54-year-old woman presents to her GP with a 3-week history of unscheduled breakthrough vaginal bleeding. She has been on continuous combined HRT for six months. She admits non-compliance with the progestogen component for two months (unopposed oestrogen only). BMI 41, well-controlled hypertension, never had a smear test. No cervical or vaginal pathology. Pelvic ultrasound: endometrial thickness 9mm.
What is the most appropriate next investigation?
Reveal Answer & Clinical Reasoning
Original question by MD Acumen — not recalled exam material.
Primary Care: COPD Step-Up Management
72-year-old man, 10-year COPD history. Worsening breathlessness, mMRC 3, one recent exacerbation. On LAMA monotherapy. Eosinophils 350 cells/µL. CXR normal, BMI 24. Using salbutamol four times daily. Inhaler technique excellent.
What is the most appropriate next pharmacological step?
Reveal Answer & Clinical Reasoning
Original question by MD Acumen — not recalled exam material.