PLAB (PSYCHIATRY) Sample Questions Set-6
Categories: U.K. PLAB (Professional and Linguistic Assessments Board)
Question. A 52 year old woman has been depressed ever since her husband died half a year ago. She was started on amitriptyline by her GP 3 months ago to help battle her depression. She now feels much better and sleeps well. She still thinks about her husband occasionally and the thoughts bring her mood down but she has drastic improvements as compared to a few months ago. She wants to know if she can stop medication. What is the SINGLE best advice to give her?
A. Stop amitriptyline and start cognitive behavioural therapy (CBT)
B. Stop amitriptyline and start bereavement counselling
C. Stop amitriptyline and start psychoanalysis
D. Stop amitriptyline and review in 4 weeks
E. Continue amitriptyline for another 3 more months
Answer: (e) [Continuing therapy for at least 6 months is advised as to reduce risk of relapse even when patients are feeling “better”. Patients should be reassured that antidepressants are not addictive. Depression is an important feature of bereavement. We note a good response with this lady as she feels better and sleeps well, but antidepressant therapy should still be continued for another 3 more months (6 months in total) to reduce risk of relapse.]
Question. A 21 year old woman was brought to the Emergency Department by her boyfriend. She has many self-inflicted superficial lacerations on her forearm. She is distressed and constantly says her boyfriend is going to end the relationship. She denies trying to end her life. What is the SINGLe most likely diagnosis?
A. Acute psychosis
B. Antisocial personality disorder
C. Psychotic depression
D. Borderline personality disorder
E. Schizophrenia
Answer: (d) [Borderline Personality Disorder: Usually characterized by mood swings, marked impulsivity, unstable relationships, and inappropriate anger. They can be very dramatic. They are usually attention seekers and may have multiple self-inflicted scars. They may threaten to commit suicide.]
Question. A 22 year old man finds it difficult to come out of a room without having to turn the light switch off in 3 minutes. He has tried more than several times to go out of the room without having to do this particular compulsion however he still returns to the room feeling agitated that it was not done. He recognizes that he has a problem and is willing to see a psychiatrist. What is the SINGLE most accurate term that describes this situation?
A. Nihilistic delusions
B. Thought insertion
C. Thought block
D. Panic attack
E. Insight
Answer: (e) [Insight: In psychology and psychiatry, insight can mean the ability to recognize one's own mental illness. This form of insight has multiple dimensions, such as recognizing the need for treatment, and recognizing consequences of one's behavior as stemming from an illness. For example, people with obsessive compulsive disorder and various phobias tend To have relatively good insight that they have a problem and that their thoughts and/or actions are unreasonable, yet are compelled to carry out the thoughts and Actions regardless. In general, a patient with insight is a patient who knows that their symptoms represent abnormality and seeks their diagnosis and appropriate treatment.]
Question. A 32 year old woman complains of abdominal pain, shortness of breath, palpitations, unsteadiness, and numbness of the lower limbs. These symptoms have been ongoing for several months. An ECG, chest x-ray, abdominal ultrasound and neurological exam has returned with normal results. What is the SINGLE most likely diagnosis?
A. Somatization disorder
B. Hypochondriasis
C. Munchhausen’s syndrome
D. Conversion disorder
E. Malingering
Answer. (a) [Somatization disorder is the experience of bodily symptoms with no physical cause for them, with presumed psychological causation. All investigations would be normal.
Hypochondriasis → is the persistent belief in the presence of an underlying serious DISEASE, e.g. cancer or HIV. The patient again refuses to accept reassurance or negative test results.
Munchausen's syndrome →also known as factitious disorder. Patients intentionally falsify their symptoms and past history and fabricate signs of physical or mental disorder with the primary aim of obtaining medical attention and treatment. The diagnostic features are the intentional and conscious production of signs, falsification, or exaggeration of the history and the lack of gain beyond medical attention and treatment.
Conversion (dissociative) disorders → typically involve loss or disturbance of normal motor or sensory function which initially appears to have a neurological or other physical cause but is later attributed to a psychological cause. The patient does not consciously feign the symptoms or seek material gain. Patients may be indifferent to their apparent disorder.
Malingering → Deliberately falsifying the symptoms of illness for a secondary gain (e.g. for compensation, to avoid military service, or to obtain an opiate prescription).]
Question. A 38 year old man was brought to the hospital by his sister because he inflicted self harm earlier in the day. His sister says that he has been depressed for about a year since his girlfriend left him. He lost his job last month and feels that there is nothing worth living. The patient started experiencing suicidal thoughts about a month ago and two days ago he began to prepare a note for his suicide. His sister is concerned about his mental health as he had asked her to help him end his life earlier that day. She became extremely concerned after he had cut himself and convinced him to go with her to the hospital. He is seen to have multiple lacerations in both arms with multiple healed scars along the arm and forearm. During the consultation, the patient was noted to be in a state of self-neglect and had poor eye contact. He was listless with poverty of speech and his speech had a low volume. What is the SINGLE most appropriate course of action?
A. Voluntary admission into psychiatric ward
B. Compulsory admission in psychiatric ward
C. Prescribe mirtazapine and refer to outpatient psychiatry
D. Prescribe diazepam and refer to outpatient psychiatry
E. Electroconvulsive therapy
Answer: (b) [Admission should be to a ward where close observation and monitoring are possible, whenever there is significant risk of harm to self (or others). The patient depicted in this scenario has severe depression. He has obvious depressive symptoms with severe functional impairment (self neglect). In addition, he has begun to actively plan a suicide attempt. This is a red flag. If you have reason to believe that he will harm himself or others, you may detain him and admit him under the Mental Health Act. Mirtazapine is an atypical antidepressant. It is not the correct answer for this scenario. You cannot just give this patient an antidepressant and send him home because he is at high risk of suicide. In addition, antidepressants take weeks to take effect and this patient needs help now.
Electroconvulsive therapy (ECT) is a very controversial mode of treatment. The only people who would be making a decision to administer electroconvulsive therapy would be specialists and consultants. Electroconvulsive therapy is generally used in cases of severe depression that are not responding to antidepressants or other treatment. It is the absolute last step in management for depression.
General steps involved in hospital management of depression:
First Admission → Investigations → Treat with medications such as SSRI → Consider serotonin and norepinephrine reuptake inhibitors (SNRIs) → Consider augmentation with lithium with cognitive behaviour therapy → If nothing works, resort to ECT
Here are some common reasons for hospital admission
i. Serious risk of suicide
ii. Serious risk of harm to others
iii. Significant self-neglect
iv. Severe depressive symptoms
v. Severe psychotic symptoms
vi. Lack or breakdown of social supports
vii. Initiation of electroconvulsive therapy
viii. Treatment-resistant depression (where inpatient monitoring may be helpful).]