PLAB (PSYCHIATRY) Sample Questions Set-9
Categories: U.K. PLAB (Professional and Linguistic Assessments Board)
Question. A 38 year old woman believes that a famous politician has been sending her flowers every day and is in love with her. She says that he drops hints that he loves her when he speaks publicly on television. The famous politician has had no contact with this lady. What is the SINGLE most likely diagnosis?
A. Pyromania
B. Erotomania
C. Rejected stalker
D. Trichotillomania
E. Grandiosity
Answer: (b) [Erotomaniac stalkers have the delusional belief that another person, usually of higher social status, is secretly in love with them. The sufferer may also believe that the subject of their delusion secretly communicates their love through seemingly innocuous acts, or if they are a public figure through clues in the media. The object of the delusion usually has little or no contact with the sufferer, who often believes the object initiated the fictional relationship. Erotomaniac delusions are typically found as the primary symptom of a delusional disorder, and in schizophrenia or mania.
Definitions of other options given in this question:
Pyromania → an impulse control disorder in which individuals repeatedly fail to resist impulses to deliberately start fires, in order to relieve tension or for instant gratification.
Rejected stalker → Pursues a victim in order to reverse, correct, or avenge rejection (e.g. divorce, separation, termination of relationship).
Trichotillomania → an impulse disorder characterized by the compulsive urge to
pullout one's hair, leading to noticeable hair loss and balding.
Grandiosity → An exaggerated sense of one’s own importance or abilities. Seen in manic illnesses.]
Question. A 27 year old man presents with symptoms characterized by alternating mood swings associated with flight of ideas, and over activity. Three months ago, he had low moods and a lack of energy. What is the SINGLE most likely diagnosis?
A. Bipolar affective disorder
B. Dysthymia
C. Mania
D. Hypomania
E. Cyclothymia
Answer: (a) [It is clear that this patient is having periods of depression with other periods of mania. Flight of ideas is thought that jumps from topic to topic. It is the subjective experience of one’s thoughts being more rapid than normal. Meaningful connections between thoughts are maintained. It occurs especially in the manic phase of bipolar disorder.]
Question. A 71 year old woman looks disheveled, unkempt and with poor eye contact. She has recently lost her husband 2 months ago. She feels hopeless and has been tearful all week. Which SINGLE option describes her condition?
A. Anxiety
B. Hallucinations
C. Mania
D. High mood
E. Low mood
Answer: (e) [She has symptoms of depression. Depressive symptoms: One of the most common referrals in liaison psychiatry is of patients with low mood. Patients may present with low mood, tearfulness, hopelessness regarding recovery, biological depressive features (poor sleep, appetite, energy, and concentration)]
Question. A 65 year old woman thinks she died 3 months ago and is very distressed that nobody has buried her up till now. She hears people’s voices which tell her that is evil and needs to be punished. She barely has any eye contact when speaking to the health care professionals. Her previous visits have included symptoms of feeling of guilt and personal inadequacy. What is the SINGLE most likely explanation for her symptoms?
A. Schizophrenia
B. Mania
C. Psychotic depression
D. Hysteria
E. Toxic confusional state
Answer: (c) [Some people who have severe clinical depression will also experience Hallucinations and delusional thinking, the symptoms of psychosis. 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 33 year old schizophrenic man hears people only when he is about to fall asleep. What is the SINGLE most likely phenomenon?
A. Hypnopompic hallucinations
B. Hypnagogic hallucinations
C. Hippocampal hallucinations
D. Delirious hallucinations
E. Auditory hallucinations
Answer: (b) [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.]
Question. A 37 year old woman was admitted for a femur fracture repair after a road traffic accident. On the fourth day post-op she becomes confused and starts picking on her bed sheets. She complains of seeing spiders all over her bed. What is the SINGLE most likely diagnosis?
A. Delirium tremens
B. Wernicke’s encephalopathy
C. Korsakoff’s psychosis
D. Psychotic depression
E. Electrolyte imbalance
Answer: (a) [Withdrawal of alcohol due to hospital admission often leads to delirium tremens. This is noted here by her confusion and picking on her bed sheets. This is seen a couple of days after consumption of alcohol is stopped as seen in this question. Wernicke's encephalopathy is unlikely as it presents with a triad of confusion, ataxia and ophthalmoplegia. Korsakoff’s psychosis is characterised by the addition of antero- and retrograde amnesia and confabulation in addition to the above classic triad of Wernicke’s encephalopathy. Psychotic depression may present with symptoms of delusions and hallucinations. But firstly, there is no history of depression here. Secondly, it is quite unlikely that the symptoms of this major depressive episode, just so happen to occur after being hospitalized. A picture of delirium tremens fits better. Electrolyte imbalance is again a possibility but there are no additional hints pointing towards electrolyte imbalance being a cause of confusion.]
Question. A 38 year old man keeps having intrusive thoughts about having dirt under the bed. He cannot keep himself from thinking about these thoughts. If he tries to resist, he starts having palpitations. What is the SINGLE most likely diagnosis?
A. Adjustment disorders
B. Obsessive-compulsive disorder (OCD)
C. Schizophrenia
D. Panic disorder
E. Acute stress reaction
Answer: (b)
Question. A 22 year old woman is brought to the local hospital by her mother with the primary complaint of recurrent depressive episodes. Her main symptoms during her depressive episodes are low mood, anhedonia, excessive somnolence, and weight loss secondary to poor appetite. Recently however, she has become overly happy and rarely sleeps. Her mother complains that she has mixed out all her credit cards and that she stays out all night drinking and partying. Some nights, she doesn’t even come home. She has had multiple sexual partners during the past week and her mother expresses a concern about contraception. The patient was also recently involved in an altercation with the police. Her grandmother passed away two days ago and the mother tearfully describes her daughter laughing loudly during her grandmother’s funeral. What is the SINGLE best descriptor for this patient’s behaviour?
A. Mood congruence
B. Mood incongruence
C. Clang association
D. Psychosis
E. Hypomania
Answer: (b) [In order to answer this question appropriately, we need to figure out what is the primary cause of this patient’s symptoms. This patient has bipolar disorder. Bipolar disorder is characterised by episodes of low mood alternating with episodes of high mood. Mood incongruence is a term used to describe a psychotic feature of bipolar disorder wherein the person’s belief or action does not match with his or her mood. An example would be laughing at the death of a loved one or believing that you have super powers while going through a depressive episode. Mood congruence also describes a psychotic symptom of bipolar disorder, but, in this case, the belief or action are consistent with that person’s mood. For example, feeling suicidal when a loved one dies or believing that you have super powers when going through a manic episode. Even though mood congruence and incongruence both describe psychotic features of bipolar disorder, psychosis is not correct as the question asks for the best descriptor of the patient’s behaviour. Psychosis encompasses a wide range of symptoms and a better descriptor for this patient’s behaviour is mood incongruence.]