PLAB (PSYCHIATRY) Sample Questions Set-5
Categories: U.K. PLAB (Professional and Linguistic Assessments Board)
Question. A 64 year old man believes a female newscaster on the television is communicating directly to him when she turns a page and when she looks at the camera. 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: (d) [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 29 year old man has been severely depressed over the last 3 years now believes that he does not exist and never existed in this world. He has poor eye contact and speaks softly. He says that people around him are unable to listen and see him because he is inaudible and invisible. 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 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 64 year old man has recently suffered from a myocardial infarction 5 months ago. He has been having trouble sleeping and seems depressed. His regular medications include aspirin, atorvastatin and ramipril. What is the SINGLE most appropriate medication to start him on?
A. Lofepramine
B. Dosulepin
C. Citalopram
D. Amitriptyline
E. Phenelzine
ANSWER: (c) [For majority of patients with moderate depression, selective serotonin reuptake inhibitors (SSRIs) are considered first-line. If the question gives you options of SSRIs, sertraline would be the best answer to pick as sertraline has a good safety profile with patients with myocardial infarction. The other antidepressants have not been studied enough in context of myocardial infarction however citalopram has gained popularity and is also considered safe for use in patients with depression with a history of myocardial infarction. Both sertraline and citalopram are safe options for patients who have had a recent MI. If both were present as options, pick Sertraline as there is more evidence for its safe use for patients who have had recent MI. Citalopram and fluoxetine are the preferred SSRIs if there is no relevant past medical history.]
Question. A 38 year old man has disturbing thoughts about his house being infected by germs. He is anxious about safety and checks the locks of his doors repeatedly before going to bed. He has been washing his hands every time he touches the lock. This can be 5 go 10 times an hour. What is the SINGLE most appropriate management?
A. Antidepressant
B. Antipsychotic
C. Anxiolytic
D. Cognitive behavioural therapy
E. Psychodynamic psychotherapy
ANSWER: (d) [The diagnosis here is obsessive-compulsive disorder (OCD). Exposure and response prevention (ERP) is included in cognitive behavioural therapy (CBT) in treatment for those who present with OCD. The method is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears and discontinue their escape response. In this case, the patient would be exposed to his feared stimulus, and would refuse to respond with any safety behaviors.
SSRIs are also a treatment choice for OCD. But as this is only a mild functional impairment, ERP would be a more appropriate answer. NICE CKS has very specific guidelines for obsessive-compulsive disorder (OCD). In the initial treatment of adults with OCD, low intensity psychological treatments (including Exposure and Response Prevention (ERP) should be offered if the patient's degree of functional impairment is mild and/or the patient expresses a preference for a low intensity approach. Low intensity treatments include brief individual or group CBT (including ERP). Adults with OCD with mild functional impairment who are unable to engage in low intensity CBT (including ERP), or for whom low intensity treatment has proved to be inadequate, should be offered the choice of either a course of an SSRI or more intensive CBT (including ERP).]
Question. A 33 year old woman is brought into the Emergency Department with coarse tremors, nausea, vomiting, and abdominal pain. She is known to have bipolar affective disorder and is currently taking 600 mg of lithium carbonate twice a day. She has been feeling lethargic for the past week. She has a temperature of 38.1 C and a heart rate of 85 beats/minute. On examination, she looks drowsy with impaired concentration. Her blood results show:
Sodium 140 mmol/L
Potassium 4.5 mmol/L
Urea 7 mmol/L
Creatinine 140 micromol/L
eGFR 60
Calcium 2.9 mmol/L
What is the SINGLE most likely cause of her presentation?
A. Malignant hyperthermia
B. Neuroleptic malignant syndrome
C. Hyperparathyroidism
D. Hyperthyroidism
E. Lithium toxicity
ANSWER: (e) [Lithium is still used for bipolar disorder and has been proven to be a very effective treatment. In this stem, we see bloods that show hypercalcaemia. It is important to remember that lithium toxicity can cause hypercalcaemia. Medical professionals who deal with lithium monitoring are trained to look out for side effects of lithium toxicity such as severe or coarse hand shaking or tremors, blurred vision, abdominal pain with diarrhoea, slurred speaking, muscle twitching, confusion and muscle weakness. We can see some of the symptoms here in this stem. Patients need regular blood tests to monitor lithium levels every 3 months and regular liver function tests and urea and electrolytes every 6 months. The dose of lithium varies. For example, lithium carbonate is normally started at doses of 450 to 675 mg twice daily and the lithium plasma concentration is checked in a week from starting. The doses are then adjusted according to the amount of serum lithium concentration. Blood tests are repeated and again the doses may be changed. This is done until serum lithium concentration is in an appropriate range. While there are reports of lithium causing neuroleptic malignant syndrome, the symptoms of this stem do not fit as well. It is usually associated with pyrexia, rigidity and tachycardia of which only pyrexia is seen in this stem. Neuroleptic malignant syndrome is more commonly associated with antipsychotics.
Hyperparathyroidism is a much more common cause of hypercalcaemia when compared with lithium toxicity however with calcium levels of less than 3, symptoms that are described in this stem (confusion, lethargy, nausea, vomiting, abdominal pain) are unlikely. Furthermore, hypercalcaemia does not cause coarse tremors.]