UK PLAB (PSYCHIATRY) Sample Questions Set-1
Categories: U.K. PLAB (Professional and Linguistic Assessments Board)
Question. A 16 year old girl was brought to Accident and Emergency with the complaint of sudden loss of consciousness. This occurred while shopping with her mother a few hours ago. The episode lasted for less than a minute followed by full recovery. There was no head injury. The mother informed the staff that her daughter had not eaten anything for the last four days because she is extremely fanatic about losing weight. She began a strict diet and exercise regimen to lose weight a few months ago. Her mother appears distressed as she has tried everything to get her daughter to eat, but to no avail. The patient herself is adamant that she is fat and that her goal is to lose weight until she is 35 kg. The patient has no past medical history of note and is not taking any regular medications. On examination, the patient was found to be sweaty and wearing a baggy dress.
Weight 49 kilograms
Height 165 centimetres
BMI 18 kg/m2
Capillary blood glucose 2.1 mmol/L
It was proposed that the patient be admitted but when the subject was broached to the patient, she began to scream and demanded to be released. What is the SINGLE best treatment option in this patient?
A. Compulsory admission
B. Refer for cognitive behavioural therapy
C. Refer to psychiatrist as outpatient
D. Seek legal advice
E. Allow home after signing self discharge
Answer: (a) [Regardless of the BMI, if there are medical complications such as electrolyte disturbances, hypoglycaemia or bradycardia, you should admit the patient. Since this patient has a history of loss of consciousness, a low blood glucose, lacks insight and is refusing voluntary admission, admission under the Mental Health Act would be appropriate. An official assessment of her mental capacity would need to be performed to look for an impairment or disturbance that leaves the patient unable to make a decision.
ANOREXIA NERVOSA: Anorexia nervosa is the most common cause of admissions to child and adolescent psychiatric wards. It is most commonly seen in young women in which there is marked distortion of body image, pathological desire for thinness, and self-induced weight loss by a variety of methods. Majority of those with eating disorders are women and so in the exam you should expect a teenage female in the stem.
Features:
i. BMI <17.5kg/m2 or < 85% of that expected
ii. Self-induced weight loss → reduce food intake, vomiting, purging, excessive exercise.
iii. Intense fear of being obese
iv. Disturbance of weight perception
v. Endocrine disorders such that cause amenorrhoea, reduced sexual interest/impotence, raised GH levels, raised cortisol, altered TFTs, abnormal insulin secretion
vi. Bradycardia
vii. Hypotension
viii. Fatigue
ix. Muscle weakness
x. Intolerance to cold]
Question. A 22 year old woman thinks she is overweight. She has a body mass index of 21.8 kg/m2. She often has constipation and abdominal pain. She eats uncontrollably and feels guilty resulting in a self-induced vomiting. Sometimes to compensate for her big meal, she would exercise intensively. What is the SINGLE most likely diagnosis?
A. Anorexia nervosa
B. Pituitary tumour
C. Hypothyroidism
D. Bulimia nervosa
E. Prader Willi syndrome
Answer: (d) [Bulimia nervosa: Bulimia nervosa is an eating disorder characterised by repeated episodes of uncontrolled overeating (binges) followed by compensatory weight loss behaviours.
Features:
i. Excessive preoccupation with body weight and shape
ii. Compensatory weight control mechanisms which can be:
iii. Self-induced vomiting
iv. Fasting
v. Intensive exercise
vi. Abuse of medication such as laxatives, diuretics, thyroxine or amphetamines
Examination:
i. Salivary glands (especially the parotid) may be swollen.
ii. Russell's sign may be present (calluses form on the back of the hand, caused by repeated abrasion against teeth during inducement of vomiting).
iii. There may be erosion of dental enamel due to repeated vomiting.]
Question. A 34 year old patient was admitted for severe depression and suicidal thoughts. He attempted to commit suicide. He has been on sertraline for the past year which he had stopped a month ago. He had been admitted to the psychiatric ward two years ago for mania. On discharge, the patient wishes to know if he can be started on long-term medication to alleviate his symptoms. What SINGLE medication will be most useful for his disorder?
A. Amitriptyline
B. Lithium
C. Diazepam
D. Haloperidol
E. Fluoxetine
Answer: (b) [The patient is suffering from bipolar disorder. Long-term management requires mood stabilisers and therefore lithium is the best option. Bipolar affective disorder (commonly known as manic depression)
Classically, periods of prolonged and profound depression alternate with periods of excessively elevated and irritable mood, known as mania. Most people who battle with the effects of the disorder would rather live a normal life, free from the unpredictability of mood swings, which most of us take for granted.
The symptoms of mania characteristically include:
i. Decreased need for sleep
ii. Pressured speech
iii. Increased libido
iv. Reckless behaviour without regard for consequences
v. Grandiosity
vi. More talkative than usual
These symptoms of mania would alternate with depression
Treatment
Mood stabilizers (Lithium)- Despite problems with tolerability, lithium still remains the gold standard in the treatment of bipolar affective disorder.]
Question. A 24 year old depressed man has neglected his personal hygiene and physical health. He denies the existence of his bowels and believes that his bowels are blocked. He also believes that his limbs are missing and that no one cares about it. What SINGLE kind of delusion is he suffering from?
A. Nihilistic delusions
B. Delusion of guilt
C. Persecutory delusion
D. Fregoli delusion
E. Clang association
Answer: (a) [Nihilistic delusions → is the delusional belief that the patient has died or no longer exists or that the world has ended or is no longer real. Nothing matters any longer and continued effort is pointless. It is a feature of psychotic depressive illness. Patient may believe that he/she is dead and may ask people to bury them.
Delusion of guilt → involves feeling guilty or remorseful for no valid reason. An example would be someone that believes they were responsible for a war in another country or hurricane damage in another state. The object of delusion believes that they deserve to be punished for their sins.
Persecutory delusion → is a delusional belief that one’s life is being interfered with in a harmful way. It refers to false beliefs or perceptions in which a person believes that they are being treated with malicious intent, hostility, or harassment despite significant evidence to suggest otherwise. This may occur in the context of being tormented, followed, or spied on.
Frégoli delusion → is when a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise.
Clang association → is an abnormality of speech where the connection between words is their sound rather than their meaning. May occur during a manic flight of ideas. Clang associations generally sound a bit like rhyming poetry, except that the poems don't seem to make any sense. Example, one may say “systematic, sympathetic, quite pathetic, apologetic, paramedic, your heart is prosthetic”.]
Question. A 6 year old child is brought to the clinic by his mother. She says that his teacher complains that he is easily distracted and interruptes others when it is their turn to answer questions. His mother says that he is not able to do a particular task for a long time and cannot play quietly. He is careless and often breaks things.
What is the SINGLE most likely diagnosis?
A. Autism spectrum disorder
B. Dyslexia
C. Attention deficit hyperactivity disorder (ADHD)
D. Antisocial personality disorder
E. Oppositional defiant
Answer: (c) [Attention deficit hyperactivity disorder (ADHD) is characterized by the three core symptoms of inattention, hyperactivity, and impulsiveness.
Clinical features
i. Inattention: Careless with detail, fails to sustain attention, appears not to listen, fails to finish tasks, poor self organization, loses things, forgetful, easily distracted, and avoids tasks requiring sustained attention.
ii. Hyperactivity: fidgets with hands or feet, leaves seat in class, runs/climbs about, cannot play quietly, ‘always on the go’.
iii. Impulsiveness: Talks excessively, blurts out answers, cannot await turn, interrupts others, and intrudes on others.]
Question. A 26 year old man strongly believes that every elderly man he meets is likely to be his father. Although they look different, he is sure that it is his father wearing a different disguise. What is the SINGLE most likely kind of delusion this man is suffering from?
A. Persecutory delusion
B. Erotomania
C. Grandiose delusions
D. Frégoli delusion
E. Delusion of reference
Answer: (d) [Frégoli delusion → is when a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise.
Persecutory delusion → is a delusional belief that one’s life is being interfered with in a harmful way. It refers to false beliefs or perceptions in which a person believes that they are being treated with malicious intent, hostility, or harassment despite significant evidence to suggest otherwise. This may occur in the context of being tormented, followed, or spied on.
Erotomania → is the delusional belief that another person, usually of higher social status, is secretly in love with them. The sufferer may also believe that the subject of their delusion secretly communicates their love through seemingly innocuous acts, or if they are a public figure through clues in the media. The object of the delusion usually has little or no contact with the sufferer.
Grandiose delusions → or delusions of grandeur are the fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. They believe that they have exceptional abilities or talents and keep praising themselves.
Delusion of reference → is the false belief that insignificant remarks, events, or objects in one's environment have personal meaning or significance. Example, someone constantly gives him or her special messages through the newspaper.]
Question. A couple attends a marriage counselling session because of marital problems. The wife states that her husband is having affairs although she has no proof of this. The husband states that she is “insane” because she is having him followed by a private detective and she is overly preoccupied about him being unfaithful. She goes through his personal belongings almost every day to look for signs of infidelity. Her actions are putting considerable strain on their marriage. What is the SINGLE most likely syndrome she is suffering from?
A. Frégoli delusion
B. Cotard syndrome
C. Capgras syndrome
D. Ekbom syndrome
E. Othello syndrome
Answer: (e) [Othello Syndrome → is a type of delusional jealousy, marked by suspecting a faithful partner of infidelity like cheating, adultery or having an affair. The patient may attempt monitoring his spouse or partner.
Frégoli delusion → is when a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise.
Capgras syndrome → A type of delusional misidentification in which the patient believes that a person known to them has been replaced by a ‘double’ who is to all external appearances identical, but is not the ‘real person’.
Cotard syndrome → is a presentation of psychotic depressive illness characterised
By a combination of a severely depressed mood with nihilistic delusions. The patient may state that he is already dead and should be buried. He may state that his insides have stopped working and are rotting away, or that he has stopped existing altogether.
Ekbom syndrome → Also known as restless legs syndrome. An unpleasant, often painful sensation in the legs, particularly on sleep onset. Significantly interferes with the ability to get to sleep.]
Question. A 48 year old man attends his GP surgery. He started on fluoxetine 8 weeks ago for depression and is now requesting to stop his medication as he feels well and does not think he is depressed any longer. What is the SINGLE most appropriate advice to give to him in regards to his treatment?
A. Stop fluoxetine right away
B. Continued fluoxetine for at least another 6 months
C. Fluoxetine dose should be gradually reduced over a 4 week period
D. Fluoxetine dose should be gradually reduced over a 1 week period
E. Change to a different SSRI
Answer: (b) [If a patient makes a good response to antidepressant therapy they should continue on treatment for at least 6 months after remission as this reduces the risk of relapse. When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine as it has a long half life).
Question. A 29 year old male presents to Accident & Emergency with the complaint of neck stiffness. The patient’s past medical history is significant for schizophrenia, diagnosed a few months ago. His notes mention that his psychiatrist had just started him on a new drug called clozapine due to his previous medication not working. He is on no other medication and denies the use of over the counter medications or illicit drugs. He smokes around five cigarettes a day but does not drink alcohol. Upon physical examination, the patient appears to be working hard to breathe. Active and passive flexion and extension of his neck is extremely difficult to achieve. The patient’s face also appears red and flushed. He also appears to be confused. His vital signs are as follows:
Blood pressure 168/98 mmHg
Heart rate 114 beats per minute
Temperature 39.2 C
Oxygen saturation on room air 95%
What is the SINGLE most likely diagnosis?
A. Bacterial meningitis
B. Drug overdose
C. Encephalitis
D. Neuroleptic malignant syndrome
E. Organophosphate poisoning
Answer: (d) [This patient has neuroleptic malignant syndrome (NMS). NMS describes a rare and unusual reaction to antipsychotic drugs. The cause of NMS in this case is the patient’s use of clozapine. Clozapine is a potent antipsychotic drug that is only used in patients in whom traditional antipsychotics have failed. Symptoms of NMS usually include high fevers, confusion, agitation, muscle rigidity, sweating and tachycardia. The onset of these symptoms usually occurs after a few weeks of starting the medication but the symptoms can occur at any time. Although bacterial meningitis and encephalitis are possibilities and should still be ruled out given the patient’s signs and symptoms, it is unlikely given the glaring history of antipsychotic drug use. Organophosphate poisoning presents with pinpoint pupils, confusion and agitation and copious secretions. Occasionally, arrhythmias will be seen on ECG.]
Question. A 33 year old schizophrenic says the following. “Life is unfair, I eat air, law chair, I like fairs, fairs have feet, it must be good, in adulthood, I misunderstood”. What term describes this patient’s speech?
A. Neologism
B. Pressure of speech
C. Broca’s aphasia
D. Wernicke’s aphasia
E. Clang association
Answer: (e) [Clang association: Clang association is an abnormality of speech where the connection between words is their sound rather than their meaning. May occur during a manic flight of ideas. Clang associations generally sound a bit like rhyming poetry, except that the poems don't seem to make any sense. Example, one may say “systematic, sympathetic, quitepathetic, apologetic, paramedic, your heart is prosthetic.]
These questions cover various aspects of medical knowledge, clinical reasoning, and professional skills. Remember to refer to the PLAB exam syllabus and guidelines for a comprehensive understanding of the exam content and format.
The PLAB test is a prerequisite for international medical graduates who want to practise medicine in the UK. Passing both parts of the exam is also a requirement. To receive a licence to practise medicine in the UK after passing the exam, you might need to complete additional exams, such as the GMC registration process and securing a job offer or training placement.
In order to practise medicine in the United Kingdom, international medical graduates must pass the PLAB (Professional and Linguistic Assessments Board) exam. The General Medical Council (GMC), which oversees medical practitioners in the UK, is in charge of administering it.
The PLAB exam is divided into two parts:
PLAB Part 1: This written, multiple-choice exam gauges your knowledge and comprehension of clinical practise and medical principles. It has 180 single-best-answer questions and covers a variety of subjects, such as surgery, psychiatry, paediatrics, obstetrics and gynaecology, and more. The PLAB Part 1 exam is available in many different nations.
PLAB Part 2: This practical test evaluates your clinical abilities, communication abilities, and ethical standards. There are 18 situations in all, all of them take place in the UK and include interacting with fictitious patients. Your capacity to gather data, generate accurate diagnoses, and create treatment plans is evaluated by the examiners.
You must fulfil specific requirements, such as holding a primary medical certification recognised by the GMC and possessing the appropriate English language proficiency, in order to be qualified to take the PLAB exam. The GMC's website should be checked for the most recent and comprehensive qualifying requirements.
A strong foundation in clinical expertise and medical knowledge is necessary for PLAB exam preparation. Many applicants prepare by combining self-study, books, online sources, and practise tests. Additionally, a number of for-profit businesses provide training programmes and resources created expressly for the PLAB exam.