PLAB (Psychiatry) Sample Questions Set-10

Categories: U.K. PLAB (Professional and Linguistic Assessments Board)

Question. A 35 year old chronic alcoholic has been trying to stop his alcohol drinking habit. He has been going for support meetings. He wants to know if there is a medication that can help reduce his alcohol cravings. What is the SINGLE most appropriate medication?

A. Disulfiram

B. Acamprosate

C. Vitamin B12

D. Pabrinex

E. Chlordiazepoxide

 

Answer: (b) [Acamprosate is used in combination with psychological intervention in moderate to severe alcohol dependence. It reduces the risk of relapse by reducing the cravings of alcohol. It is started after a successfully assisted withdrawal. Other alternatives to acamprosate which are not mentioned here are naltrexone or nalmefene.

COMPARING ACAMPROSATE AND DISULFIRAM:

Disulfiram: i. Acts as a deterrent – Around 5 to 10 minutes after alcohol intake, patients may experience the effects of a severe hangover for a period of 30 minutes up to several hours. ii. It is used 24 hours after the last alcoholic drink.

Acamprosate: i. Reduces cravings ii. It is used after the patient has finished a planned withdrawal from alcohol.]

 

Question. A 28 year old woman has episodes of perioral tingling and carpopedal spasms every time she has to give a public talk. These symptoms also happen to her before interviews, exams and after arguments. She describes these episodes as short lasting only a couple of minutes but with intense fear. What is the SINGLE most appropriate management to prevent further episodes?

A. Diazepam

B. Rebreath into a paper bag

C. Congnitive behavioural therapy (CBT)

D. Buspirone

E. Propanolol

 

Answer: (c) [Cognitive behavioural therapy (CBT) should be used to treat panic disorders as there is really good evidence to support its use. Benzodiazepines should not be prescribed for the treatment of individuals with panic disorder as they have poor outcomes in the long term. Rebreath into paper bags is useful in acute settings but not as prevention. Buspirone is an anxiolytic drug and only used to manage anxiety short term. Beta blockers are not mentioned as part of the management for panic disorders in the NICE guidelines. This is probably because beta-blockers are used to control physical symptoms and to provide symptomatic relief rather than a means to cure or to prevent panic attacks. They work well as a short term fix but they should not be considered mainstay treatment. In this question, they specifically say “to prevent further episodes”. Beta blockers will not help prevent further episodes, they only help with the physical symptoms (e.g. palpitations) during the episode.

Management for panic disorder: There are really 2 options when it comes to treatment of panic disorder

Psychological treatment: i. Has the best evidence for giving the longest duration of effect. ii. Involves CBT for 1 to 2 hours a week

Medications:

i. SSRI (citalopram, sertraline, paroxetine, escitalopram but NOT fluoxetine).

ii. If SSRIs contraindicated or have no response after 12 weeks then imipramine or clomipramine should be offered.

iii. Do NOT use benzodiazepines.

The only pharmacological intervention that should be used in the long term for panic disorders is antidepressants. They have been shown to be effective in reducing the amplitude of panic, and reducing the frequency of panic attacks.]

 

Question. A 28 year old business man returned from a trip to Kenya 2 years ago. He attends a sexual clinic worried that he has contracted HIV. Antibody screening test for HIV has come back negative. There were 2 similar HIV tests performed 6 months and 9 months ago which have both come back as negative. This is his 5th visit to the clinic claiming that he is HIV positive. What is the SINGLE most likely diagnosis?

A. Somatization disorder

B. Hypochondriasis

C. Munchausen’s syndrome

D. Conversion disorder

E. Malingering

 

Answer: (b) [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.

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.

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 involves loss or disturbance of normal motor or sensory function which initially appears to have a neurological or

Other physical causes 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. An 18 year old girl with a body mass index of 17.8 kg/m2 has bilateral parotid swelling with thickened calluses on the dorsum of her hand. What is the SINGLE most likely diagnosis?

A. Bulimia nervosa

B. Anorexia nervosa

C. Crohn’s disease

D. Mumps

E. Sarcoidosis

 

ANSWER: (a) [This question is not entirely specific. Usually for a bulimia nervosa question to appear, the stem would give more of a history which includes either fasting, or intensive exercise. Self-induced vomiting would be too obvious for the question writers to give. Bilateral parotid swelling and thickened calluses on the knuckles from self-induced vomiting may be found on examination in bulimia nervosa.]

 

Question. A 33 year old man with a family history of panic disorder has palpitations, tremors, sweating and muscle tightness on 3 occasions in the last 6 weeks. His pulse rate is 85 beats/minute and his blood pressure is 120/80 mmHg. What is the SINGLE most appropriate long-term treatment for him?

A. Diazepam

B. Olanzapine

C. Haloperidol

D. Sertraline

E. Alprazolam

 

Answer: (d) [He is suffering from panic disorder. An SSRI or cognitive behavioural therapy would be appropriate. Sertraline is an SSRI.]

 

Question. A 33 year old man attends his appointment with the psychiatrist. He says that he is no longer alive. He wants his family to bury him. 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 involves loss or disturbance of normal motor or sensory function which initially appears to have a neurological or

Other physical causes 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 29 year old man has been found in the park, drunk and brought to the emergency department by ambulance. He recently lost his job and had a divorce 3 months ago. He has intense feelings of feeling worthless and being a failure. He also hears voices telling him he is worthless. What is the SINGLE most likely diagnosis?

A. Schizoid personality disorder

B. Borderline personality

C. Schizophrenia

D. Psychotic depression

E. Hypomania

 

Answer: (d) [This affected individual has lost his job and had a recent divorce. Depression should be something to consider. The auditory hallucinations are signs that this man is having some form of psychosis. The most probable diagnosis here is psychotic depression. Feeling worthless are in line with the delusions of guilt which are seen in psychotic depression.

The other answers are unlikely to be correct:

Schizoid personality disorder → is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle

Borderline personality disorder → Usually characterized by mood swings, marked impulsivity, unstable relationships, and inappropriate anger. They are usually attention seekers and may have multiple self-inflicted scars.

Schizophrenia → does not account for the history of the lost of job and divorce. Feelings of worthlessness are also more in line with depression rather than schizophrenia.

Hypomania → describes a mild degree of mania where there is elevated mood but no significant impairment of the patient’s day-to-day functioning.]

 

Question. A couple has just finished their detox regime and wants a drug with a pharmacological action to serve as a deterrent when they take alcohol. What is the SINGLE most appropriate medication to start?

A. Disulfiram

B. Acamprosate

C. Vitamin supplementD. Naloxone

E. Chlordiazepoxide

 

Answer: (a) [Disulfiram acts as a deterrent. It reacts with alcohol and causes the patient to feel flushed, nauseous, dizzy and faint. Because of these effects, patients would stay away from alcohol. Disulfiram works so well that it can even react with alcohol found in performes and aerosol sprays causing similar symptoms.]

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