PLAB (PSYCHIATRY) Sample Questions Set-4
Categories: U.K. PLAB (Professional and Linguistic Assessments Board)
Question. A 19 year old man accuses his friend of making his right arm swing out to hit a stranger at the park. There is no evidence of this as his friend was at home at that time. What is the SINGLE most appropriate term to describe this condition?
A. Delusion of control
B. Persecutory delusion
C. Grandiose delusions
D. Delusion of reference
E. Thought insertion
Answer: (a) [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.
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 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.
Thought insertion → The delusional belief that thoughts are being placed in the patient’s head from outside.]
Question. A 44 year old man is very depressed and miserable after wife’s death 6 months ago. He sees no point in living now that his wife is not around. He feels regret and wishes he never existed. He refuses any medical help offered. His son has brought him to the emergency department. The son mentions that he cannot deal with the father’s depression any longer as he has a job and family to attend to.
What is SINGLE most appropriate next step?
A. Voluntary admission to psychiatric ward
B. Compulsory admission under Mental Health Act
C. Refer to social services
D. Alternate housing
E. Electroconvulsive therapy
Answer: (b) [This patient is refusing any help offered thus voluntary admission to psychiatric ward is not possible. Compulsory admission under Mental Health Act is the most appropriate answer. The Mental Health Act 1983 is the law in England and Wales that allows people with a ‘mental disorder’ to be admitted to hospital, detained and treated without their consent – either for their own health and safety, or for the protection of other people.]
Question. A 30 year old man who served in the army 6 months ago presents with a lack of interest in enjoyable activities and feeling low. He often wakes up in the middle of the night because of nightmares of gun fire. He feels irritable and has difficulty concentrating. He tries not to watch the news as it reminds him of war. What is the SINGLE most appropriate initial therapy?
A. Citalopram
B. Lofepramine
C. Cognitive behavioural therapy (CBT)
D. Chlordiazepoxide
E. Desensitization
Answer: (c) [This man is suffering from post-traumatic disorder. Post-traumatic disorder (PTSD) develops following a traumatic event. In this case, it was war that stimulated PTSD.]
Question. A 14 year old girl was found by her mother collapsed on the floor at home and brought to the Emergency Department. She was found on the floor at home but regained consciousness just before the paramedics arrived. She gives a history of increasing fatigue and intolerance to cold over the past few weeks since joining the gym 2 months ago. On further questioning, her mother says that she found laxatives and diuretics in her daughter’s room and is concerned about it being the cause of her collapse. She denies her weight being an issue despite having a body mass of 15 kg/m2. She has a systolic blood pressure of 85 mmHg and a heart rate of 55 beats/minute. During examination, it is noted that she finds it difficult to get up from a lying position without using her hands. What is the SINGLE most likely reason for her symptoms?
A. Abuse of recreational drugs
B. Overdose of laxatives
C. Diagnosis of anorexia nervosa
D. Diagnosis of hyperthyroidism
E. Diagnosis of anaemia
Answer: (c) [This girl has clinical features of anorexia nervosa. Over exercising, diuretics and laxatives over several weeks could cause a rapid weight loss which has detrimental effects to the cardiovascular system leading to syncope. Young girls with anorexia nervosa often feel fatigue and intolerance to cold due to their low BMI. Their muscle power is decreased so they may find it more difficult to sit up without using their hands to support them.]
Question. A 30 year old woman complains of feeling restless, muscle tension and sleep disturbance on the majority of the days over the last 9 months. She worries excessively about a number of everyday events and activities and is unable to control these feelings which are impairing her ability to hold down her job. What is the SINGLE most likely diagnosis?
A. Panic disorder
B. Generalized anxiety disorder (GAD)
C. Pheochromocytoma
D. Acute stress reaction
E. Social phobia
ANSWER: (b) [There is a fine line between Generalised Anxiety Disorder (GAD) and Panic attacks. They both can present similarly. The major difference is panic attacks are Usually short lived (lasting no longer than 20–30 min (rarely over 1 hour). ‘Excessive worry’ and feelings of apprehension about everyday events like in this case points towards the diagnosis of GAD. Acute stress reaction is a transient disorder (lasting hours or days) that may occur in an individual as an immediate (within 1 hour) response to exceptional stress (e.g. natural catastrophe, major accident, serious assault, warfare, rape, fire). Symptoms tend to be mixed with an initial state of daze, followed by depression, and anxiety. As in this case, the symptoms were going on for 9 months, it is not an acute stress reaction.
GENERALIZED ANXIETY DISORDER (GAD): ‘Excessive worry’ and feelings of apprehension about everyday events, with symptoms of muscle and psychic tension, causing significant distress and functional impairment.
Symptoms of GAD: (present most days for at least 6 months)
i. Restlessness
ii. concentration difficulties or ‘mind going blank’
iii. irritability
iv. muscle tension
v. sleep disturbance
vi. palpitations/tachycardia
vii. sweating
viii. Trembling or shaking
ix. breathing difficulties; choking sensation; chest pain or discomfort;
x. fear of losing control, ‘going crazy’, passing out, dying.
Management: i. Cognitive behavioural therapy or applied relaxation or drug treatment. ii. NICE suggests sertraline should be considered the first-line SSRI.
iii. Alternative SSRI options are escitalopram or paroxetine.]