PLAB (PSYCHIATRY) Sample Questions Set-8
Categories: U.K. PLAB (Professional and Linguistic Assessments Board)
Question. A 22 year old woman was brought to the A&E by her friends. She presents with tremors. On examination, she was found to have a temperature of 37.4 C and her pupils dilated. She says when she closes her eyes, she can see colours. What is the SINGLE most likely drug that she has taken?
A. Amphetamines
B. Lysergic acid diethylamide (LSD)
C. Cocaine
D. Heroin
E. Ecstasy
ANSWER: (b) [The immediate clue here is that she sees colours when she closes her eyes. These are effects of LSD. LSD can cause visual hallucinations, agitation, excitement, tachycardia and dilated pupils. You would need to admit this patient to a safe environment and provide symptomatic treatment of the agitation such as benzodiazepines. If the overdose is severe enough, she may go into a coma or have respiratory arrest which needs to be treated supportively.]
Question. A 29 year old woman has been taking selective serotonin reuptake inhibitors for the past 6 months for depression after the death of her husband 10 months ago. She feels her symptoms have improved and has decided to stop her medications. Several weeks after discontinuing her medications, she feels she has developed pancreatic cancer similarly to her late husband. What is the SINGLE most appropriate next step in management?
A. Restart selective serotonin reuptake inhibitors
B. Start on a tricyclic antidepressant
C. Neuropsychiatric analysis
D. Cognitive behavioural therapy
E. Start antipsychotics
ANSWER: (c) [This women requires a psychiatric referral i.e. Neuropsychiatric analysis. She is having a hypochondriacal delusion. Hypochondriasis can be defined as the persistent belief in the presence of an underlying serious DISEASE, e.g. cancer or HIV.
Examples:
i. A minor headache is caused by a brain tumour
ii. A mild rash is the start of skin cancer
iii. Tiredness is caused by HIV
Reassurance by a doctor will not help a hypochondriac as a hypochondriac would fear that the doctor has just not found the evidence of a serious disease yet.]
Question. A 44 year old alcoholic was admitted for alcohol intoxication. He has been treated and he is now planned for discharge. He admits to not being able to spend a day without drinking. Which of the following statements would show that this man is still dependent on alcohol?
A. Drinks 10 units of alcohol a week
B. Drunk driving
C. Does not feel remorse after drinking
D. Drinks wine to help him sleep
E. Drinking alcohol immediately after waking up
ANSWER: (e) [This question is testing your knowledge on the AUDIT questionnaire. There are many alcohol screening tools and questionnaires but the AUDIT questionnaire remains one of the top and a must know for the exam. The AUDIT questionnaire stands for Alcohol Use Disorders Identification Test questionnaire. The CAGE Questions is also another questionnaire but the AUDIT questionnaire remains the more detailed of the two.
AUDIT questionnaire involves questions like:
i. How often do you have a drink containing alcohol?
ii. How many units of alcohol do you drink on a typical day when you are drinking?
iii. How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
iv. How often during the last year have you found that you were not able to stop drinking once you had started?
v. How often during the last year have you failed to do what was normally expected from you because of drinking?
vi. How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
vii. How often during the last year have you had a feeling of guilt or remorse after drinking?
viii. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
ix. Have you or someone else been injured as a result of your drinking?
x. Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?
INFORMATION ON ALCOHOL:
The government currently recommends the following: Men and women are advised not to drink more than 14 units a week on a regular basis.
Fourteen units is equivalent to:
i. 6 pints of average-strength beer or
ii. 10 small glassses of low-strength wine.
Wine:
i. A small glass of wine (125 ml) is 1.5 units
ii. A standard glass of wine (175 ml) is 2.1 units
iii. A large glass of wine (250 ml) is 3 units
Beer:
i. A pint of beer (ABV 3.6%) is 2 units
ii. A pint of higher strength beer (ABV 5.2%) is 3 units
Spirits: Single measurement of gin, rum, vodka or tequila is 1.4 units.
Question. A 28 year old woman complains of hearing strange voices in her bedroom as she is falling asleep in the night. She says there is no one in the room except for her. She is otherwise healthy and without mental illness. What is the SINGLE most likely diagnosis?
A. Persecutory delusion
B. Cotard syndrome
C. Hypnagogic hallucinations
D. Capgras syndrome
E. Othello syndrome
ANSWER: (c) [Hypnagogic hallucination → is a transient false perception experienced while on the verge of falling asleep (e.g. hearing a voice calling one’s name which then startles you back to wakefulness to find no-one there). The same phenomenon experienced while waking up is called hypnopompic hallucination. Frequently experienced by healthy people and so not a symptom of mental illness.
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.
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.
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’.
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.
Question. A 38 year old woman presents with palpitations and sweating for most of the day throughout the year. She feels restless and unable to sleep well. She is irritable and finds it difficult to concentrate. She has occasional chest discomfort when thinking about everyday events. She reports no triggering factor. There is no previous psychiatric illness. On examination, her blood pressure is 120/80, pulse is 85 beats/minute. What is the most likely diagnosis?
A. Generalized Anxiety Disorder
B. Panic attack
C. Pheochromocytoma
D. Atrial fibrillation
E. Hyperthyroidism
ANSWER: (a) [There is a fine line between Generalized Anxiety Disorder (GAD) and Panic attacks. They both can present similarly. The major difference is panic attacks are usually short lived (lasting no longer)]
Question. A 35 year old man is seen by his psychiatrist for severe depression. He says that the world has ended and is no longer real. He thinks that he no longer exists in this world. He barely has eye contact with the psychiatrist. What is the SINGLE most appropriate diagnosis?
A. Somatization disorder
B Hypochondriasis
C. Conversion disorder
D. Nihilistic delusions
E. Capgras syndrome
ANSWER: (d) [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.
Somatization disorder →The experience of bodily symptoms with no physical cause for them, with presumed psychological causation.. The patient refuses to accept reassurance or negative test results.
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.
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.
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’.]
Question. A 33 year old female presents to her GP because of low moods. She has difficulty sleeping and feels tired at work. She refuses to go out with her friends and rather spends time resting on her bed. She is eating less and has lost 8 kg in the last 10 weeks. A year ago, she was productive, full of energy, optimistic, needed very little sleep and always wanted to go out. Her BMI is 27. What is the SINGLE most likely diagnosis?
A. Hypomania
B. Bipolar disorder
C. Borderline personality disorder
D. Depression
E. Mania
ANSWER: (b) [This stem portrays a good history of depression with a background of mania in the past. The symptoms of mania in this stem is very subtle and somewhat within normal limits but the real give away is when there is reduced need for sleep. This would be a classic scenario that PLAB would give when they would like you to pick Bipolar disorder.]
Question. A 48 year old woman who is always socially withdrawn has stopped going out of the house. It initially started when she felt distressed whenever she ate in front of strangers at work as she felt they were staring at her. This soon progressed to affect her work as she started to avoid business meetings because she fears that people will criticize her. What is the SINGLE most likely diagnosis?
A. Agoraphobia
B. Mixed depression and anxiety
C. Social anxiety
D. Obsessive compulsive disorder
E. Generalized anxiety disorder
ANSWER: (c) [The abnormal excessive fear of being criticized is seen in social anxiety disorder where sufferers would avoid these social events including business meetings.
SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA): Social anxiety disorder is the persistent fear and anxiety about one or more social Or performance situations. It is characterized by marked fear of one or more social Or performance-related situations where the person is exposed to scrutiny and in Which embarrassment may occur. Social anxiety can be seen when exposed to social situations causes an anxiety reaction (may be a panic attack) that is beyond the proportion to the actual threat posed by the situation. Thus situations are either avoided or endured with great discomfort.
Features: Social anxiety is a fear of being around people and having to interact with them. Sufferers fear being watched and criticised. Typical situations that may be anxiety provoking include:
i. Meeting people (especially strangers)
ii. Talking in meetings
iii. Talking to authority figures
iv. Talking to authority figures
v. Eating and drinking while being observed
vi. Going to school
vii. Going shopping
viii. Being seen in public
Physical symptoms include trembling, blushing, sweating and palpitations. While we all (the general population) have worries when in situations like these, sufferers of social anxiety disorder tend to worry excessively about them before, during and after the encounter.
There are two forms of the condition:
i. Generalised social anxiety which affects most, if not all areas of life. This is the more common type and affects around 70% of sufferers.
ii. Performance social anxiety, where these feelings only occur in a few specific situations such as public speaking, eating in public or dealing with figures of authority.]