PLAB (PSYCHIATRY) Sample Questions Set-2
Categories: U.K. PLAB (Professional and Linguistic Assessments Board)
Question. An 18 year old male washes his hands 6 times every time he uses the toilet. On his way out of the toilet, he has to switch off the light, turn it back on and turn it off once more. What is the SINGLE most appropriate management?
A. Psychodynamic therapy
B. Electroconvulsive therapy (ECT)
C. Antipsychotics
D. Cognitive behavioural therapy (CBT)
E. Psychotherapy
Answer: (d) [Obsessive-compulsive disorder (OCD): A common, chronic condition, often associated with marked anxiety and depression, characterized by ‘obsessions’. It is characterized by recurrent obsessions or compulsions that are recognized by the individual as unreasonable. Obsessions are anxiety-provoking, intrusive thoughts, commonly concerning contamination, doubt, guilt, aggression, and sex. Compulsions are peculiar behaviors that reduce anxiety, commonly hand-washing, organizing, checking, counting, and praying.
Management:
CBT is recommended by NICE, but essentially takes a behavioural approach, including exposure and response prevention (ERP).
SSRIs (licensed): escitalopram, fluoxetine, sertraline or paroxetine should be considered first-line (no clear superiority of any one agent). Other (unlicensed) agents include citalopram. For PLAB, electroconvulsive therapy (ECT) would be the answer for treatment of OCD, if the patient is suicidal or severely incapacitated.]
Question. A 55 year old man has a firm belief that the headlines in the newspapers are written especially for him. He believes that the authors of the newspaper articles whom he has never met are sending secret and significant messages that only he can understand. What is the SINGLE most likely type of delusion that this man is suffering from?
A. Persecutory delusions
B. Grandiose delusions
C. Delusion of control
D. Delusion of reference
E. Nihilistic delusions
Answer: (c) [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.
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.
Grandiose delusions → or delusions of grandeur is 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 control → is the false belief that another person, group of people, or external force controls one's general thoughts, feelings, impulses, or behavior.
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.]
Question. A 38 year old woman with a history of severe depression and bipolar affective disorder presents to the Emergency Department with coarse tremors and muscular twitching. She feels nauseous and drowsy. She had vomited three times a few hours before presenting to the Emergency Department. She has brought in a bag full of the medications she would normally take with one of the medication boxes completely empty. Which is the SINGLE most likely medication responsible for her symptoms?
A. Lithium
B. Levothyroxine
C. Amitriptyline
D. Methyldopa
E. Sodium valproate
Answer: (a) [Lithium toxicity is a frequently asked topic. Patients would present with symptoms of tremors, nausea, vomiting followed by drowsiness, confusion and later a coma. In these cases where lithium toxicity is suspected, urea and creatinine and lithium levels should be obtained. Sodium valproate is also another cause of tremors but it is seen commonly with therapeutic doses rather than an overdose. One should be very careful when choosing sodium valproate as the cause of tremors over lithium in a situation where overdose is suspected. With sodium valproate overdose, they may also present with nausea and drowsiness just like in this stem, however a coarse tremor is rarely seen.
LITHIUM TOXICITY CLINICAL FEATURES:
Mild:
i. Nausea
ii. Altered taste
iii. Diarrhoea
iv Blurred vision
iv. Polyuria
v. Fine resting tremor
Moderate:
i. Increasing confusion
ii. Increased deep tendon reflexes
iii. Myoclonic twitches and jerks
iv. Increasing restlessness followed by stupor
Severe;
i. Coma
ii. Convulsions
iii. Cardiac dysrhythmias
iv. Cerebellar signs]
Question. A 17 year old woman has been diagnosed with anorexia nervosa. She has mild depressive symptoms and has reduced her food intake in the last 8 months. She exercises daily and admits to inducing vomiting occasionally after a meal. Her body mass index is 16.8 kg/m2. She has a blood pressure of 95/65 mmHg and a heart rate of 70 beats/minute. What is the SINGLE most appropriate management?
A. Refer to eating disorder service
B. Refer to dietician
C. Admit to medical ward
D. Admit to psychiatric ward
E. Start antidepressants
Answer: (a) [She falls into the category of moderate anorexia. Admission to the hospital is not warranted because her blood pressure, heart rate are fine and her BMI is still above15. Referral to an eating disorder unit or service would be the most appropriate. No drug treatments for anorexia nervosa are validated by good randomized trials although fluoxetine prevents relapse in open trials. Nonetheless, do not pick antidepressants when it is the option for management of anorexia nervosa for this exam.
BMI <15kg/m2, rapid weight loss + evidence of system failure: requires urgent referral to eating disorder unit (EDU), medical unit (MU) or pediatric medical wards.
In moderate anorexia (BMI 15–17.5, no evidence of system failure: routine referral can be to the local community mental health team or eating disorder unit (EDU) if available.
In mild anorexia (BMI>17.5): focus on building a trusting relationship and encouraging use of self-help books and a food diary.]
Question. A 25 year old woman presents to the GP with a low mood. She has an increased appetite and has gone up 2 dress sizes. She also complains that she feels very tired and often only gets out of bed in the afternoon despite sleeping early. What is the SINGLE most likely diagnosis?
A. Pseudo depression
B. Moderate depression
C. Severe depression
D. Dysthymia
E. Atypical depression
Answer: (e) [Atypical depression is a subtype of major depression or dysthymic disorder that involves several specific symptoms, including increased appetite or weight gain, sleepiness or excessive sleep, marked fatigue or weakness.
Atypical depressive episode: Regarded as a subtype of depressive disorder, rather than a separate entity.
Clinical features: i. Mood is depressed, but remains reactive (able to enjoy certain experiences but not to ‘normal’ levels)
ii. Hypersomnia (sleeping more than 10 hours/day, at least 3 days/weeks, for at least 3 months)
iii. Hyperphagia (excessive eating with weight gain of over 3kg in 3 months)
iv. ‘Leaden paralysis’ (feeling of heaviness in the limbs)
Epidemiology Onset usually in late teens and early twenties
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.