NICE Guidelines Most Tested in PLAB 1 (2025–2026)

The 12 NICE guidelines that come up most frequently in PLAB 1, with key prescribing points and exam traps.

Why NICE Guidelines Matter for PLAB 1

Every correct answer in PLAB 1 should be justifiable by a UK guideline. When the correct answer seems counterintuitive, it is usually because the UK guideline differs from global practice. Knowing the key guidelines prevents losing marks on management and prescribing questions.

The 12 Most-Tested Guidelines

1. NICE NG196 — Atrial Fibrillation (2021, updated 2023)

Key points:

• Rate control first for stable AF (bisoprolol, diltiazem, digoxin for sedentary)
• DOACs (apixaban, rivaroxaban) preferred over warfarin for non-valvular AF
• CHA₂DS₂-VASc score for anticoagulation decisions
• Rhythm control considered in symptomatic patients or if AF < 48 hours

Common trap: Warfarin is no longer first-line. DOACs are preferred unless contraindicated (e.g., antiphospholipid syndrome → warfarin).

2. NICE NG28 — Type 2 Diabetes in Adults (2015, updated 2024)

Key points:

• First-line: metformin (if tolerated and eGFR ≥ 30)
• Add SGLT-2 inhibitor (empagliflozin/dapagliflozin) if cardiovascular disease, heart failure, or CKD
• GLP-1 receptor agonists if BMI ≥ 35 or cardiovascular risk
• HbA1c target: 48 mmol/mol (6.5%) for newly diagnosed; 53 mmol/mol (7%) if on drugs causing hypoglycaemia

Common trap: SGLT-2 inhibitors are now first-choice add-on in patients with established cardiovascular disease — not just third-line.

3. NICE NG136 — Hypertension in Adults (2019, updated 2023)

Key points:

• Stage 1 HTN: treat if < 80 years and target organ damage, established CVD, renal disease, diabetes, or 10-year CV risk ≥ 10%
• Step 1: ACE inhibitor (or ARB if intolerant) for < 55 years or diabetes; CCB for ≥ 55 years or Black African/Caribbean
• Add CCB or thiazide-like diuretic at Step 2
• Resistant HTN at Step 4: consider spironolactone

Common trap: CCB is first-line in patients ≥ 55 years, not ACE inhibitor. Race/ethnicity guides initial choice.

4. NICE NG58 — Sepsis (2016)

Key points:

• Sepsis-6 within 1 hour: blood cultures, IV antibiotics, IV fluids, urine output monitoring, oxygen, lactate measurement
• NEWS2 score to identify at-risk patients
• Escalate all patients with suspected sepsis immediately

Common trap: "IV fluids" in sepsis — 500 mL crystalloid bolus, reassess after each bolus.

5. NICE NG51 — Suspected Cancer Recognition (2015, updated 2023)

Key points:

• Urgent 2-week wait referral criteria for each cancer type
• PSA testing in men with lower urinary tract symptoms
• Unexplained haemoptysis: immediate chest X-ray
• Postmenopausal bleeding: urgent ultrasound

Common trap: Unexplained rectal bleeding without high-risk features in patients > 40 years = still 2-week wait referral.

6. NICE CKS — Asthma (updated 2024)

Key points:

• Step 1: SABA (salbutamol) PRN
• Step 2: Add ICS (low dose)
• Step 3: Add LABA (formoterol/salmeterol) — switch to MART if needed
• MART (Maintenance And Reliever Therapy) available at Step 3
• If not controlled: consider LTRA, theophylline, omalizumab

Common trap: LABA must NOT be started without ICS.

7. NICE NG28 — Chronic Kidney Disease (CKD)

Key points:

• eGFR < 60 for > 3 months = CKD regardless of cause
• Avoid NSAIDs and nephrotoxic drugs
• ACE inhibitor/ARB for diabetic nephropathy and CKD with proteinuria
• Refer for dialysis planning when eGFR < 20 (or deteriorating)

8. NICE NG185 — COVID-19 (updated)

Key points:

• Antivirals (nirmatrelvir/ritonavir) for high-risk groups within 5 days of symptom onset
• Dexamethasone for hospitalised patients requiring supplemental oxygen

9. NICE NG152 — Stroke and TIA

Key points:

• TIA: aspirin 300mg immediately, then specialist assessment within 24 hours (ABCD2 score ≥ 4 = same day)
• Ischaemic stroke: thrombolysis within 4.5 hours if eligible
• AF-related stroke: anticoagulate; not antiplatelet

10. NICE NG10 — Chest Pain Assessment

Key points:

• Troponin at 0 and 3 hours (high-sensitivity)
• HEART or EDACS score for risk stratification
• Stable angina: refer for CT coronary angiogram first-line

11. NICE NG12 — Head Injury

Key points:

• CT head within 1 hour if GCS < 13, or specific risk factors present
• CT head within 8 hours if on anticoagulants or > 65 years with amnesia
• Do NOT do skull X-ray (not recommended)

12. NICE NG27 — Depression

Key points:

• SSRI (sertraline) first-line for moderate-severe depression
• PHQ-9 for monitoring
• CBT combined with antidepressant for moderate-severe depression
• Do not use antidepressants for mild depression or in children < 18 without specialist input (fluoxetine is exception for > 12 years)

The Golden Rule

When in doubt: what would NICE recommend for a UK NHS patient? That is always the correct answer, even if it differs from practice elsewhere.

MedReadyUK is part of StudyCoach AI — an independent study resource, not affiliated with the GMC, RCGP or NHS. Guideline references reflect guidance at the time of writing; always confirm against the current source.