Question. A 19 year old female is brought to the hospital by her parents. They are concerned about her weight. Her body mass index is 12.1 kg/m2. She has a mildly depressed mood and has low self-esteem. She has amenorrhoea. She has reduced her food intake in the past couple of months. She has a blood pressure of 70/50 mmHg and a heart rate of 44 beats/minute. What is the SINGLE most appropriate management?
A. Start antidepressants
B. Family counseling
C. Inform social service
D. Admission to the psychiatric ward
E. Admission to the medical ward
Answer: (e) [It is clear that she is suffering from anorexia nervosa. Her BMI is critically low thus medical admission is warranted to provide her with proper nutrition. A pulse rate lower than 45 beats/minute and hypotension raises great concern and is definitely a criteria for hospital admission. The most common cause of death in patients with anorexia nervosa is due to cardiac complications. This is why they are admitted to medical wards and not psychiatry wards when the condition is severe.
BMI <15kg/m2, rapid weight loss + evidence of system failure: requires urgent referral to eating disorder unit (EDU), medical unit (MU) or paediatric medical wards.
In moderate anorexia (BMI 15–17.5, no evidence of system failure): routine referral can be to the local community mental health team or eating disorder unit (EDU) if available.
In mild anorexia (BMI >17.5): focus on building a trusting relationship and encouraging use of self-help books and a food diary.]
Question. A 25 year old woman has had several sudden onset episodes of palpitations, sweating, and fear. She notices her hands shake when they occur. These episodes occur almost every day and sometimes can wake her from her sleep. She has no previous psychiatric disorder and is not on any medications. What is the SINGLE most likely diagnosis?
A. Pheochromocytoma
B. Panic disorder
C. Generalized anxiety disorder
D. Agoraphobia
E. Acute stress disorder
Answer: (b)
Question. A 32 year old woman is brought to the Emergency Department by ambulance in an agitated state. The ambulance crew gives you the handover that her neighbours had seen her roaming around the streets throwing money and shouting she is going to die. She refuses to let any health care come close to her to perform observations or to take her bloods. She is unable to answer any of your questions. At the end of every question, she laughs hysterically and repeatedly shouts that she smokes, drinks and walks amongst aliens. It is deemed that she does not have capacity to make decisions and a compulsory admission under Mental Health Act is performed. She continues to be agitated and attempts to run away from the hospital but is stopped by security. Which is the SINGLE most appropriate medication to administer?
A. Chlordiazepoxide orally
B. Lorazepam intramuscularly
C. Diazepam intramuscularly
D. Clozapine intramuscularly
E. Chlorpheniramine intravenously
Answer: (b) [This patient is suffering from acute psychosis. No matter the reason, once she is sectioned, sedation would be the next step as to calm her down for further investigations such as observations and blood tests. There are a few drugs used for rapid tranquilization. NICE recommends using lorazepam, olanzapine or haloperidol. In this context, it is usually appropriate to administer intramuscular lorazepam 2 mg. If she continues to be agitated, she may require haloperidol intramuscularly. The reason lorazepam is preferred over the other benzodiazepines is that it is short-acting with a short half life and respiratory depression is unlikely with the prescribed doses. Diazepam on the other hand should not be used intramuscularly for rapid tranquilisation as it has prolonged and erratic absorption.]
Question. A 22 year old man was found overdosed on heroin. He has decreased respiratory rate and has lost consciousness. What is the SINGLE most appropriate management?
A. Benzodiazepines
B. Diazepoxide
C. Naloxone
D. Methadone
E. Disulfiram
Answer: (c) [Opiates overdose is treated with naloxone. It is given intravenously and repeated every 2 minutes until the patient's breathing is adequate.]
Question. A 23 year old man comes to the emergency department with a history of drug misuse. 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. Judgement
B. Thought insertion
C. Thought block
D. Mood
E. Insight
Answer: (e)
Question. A 26 year old political refugee has sought asylum in the UK. He complains of poor concentration. He keeps getting thoughts of his family whom he saw was killed in a political coup. He is unable to sleep well and feels hopeless. In the past month, he has had 3 brief episodes lasting a few minutes of feeling detached from his surroundings, as if he was watching the world through misty glass. He is worried that he is going mad. What is the SINGLE most likely diagnosis?
A. Acute stress disorder
B. Post traumatic disorder
C. Adjustment disorder
D. Delirium
E. Psychosis
Answer: (b) [The phenomenon where he feels detached from surroundings as if he is an observer of oneself is called depersonalization. It is a phenomenon where subjects feel that the world has become dreamlike and vague. It is seen in individuals who have experienced a severe trauma. It can be one of the symptoms of post traumatic stress disorder (PTSD)]
Question. A 28 year old woman presents with feeling anxious for most days throughout the past 6 months. She feels distressed when thinking about money and her job. She is unable to sleep well and finds it difficult to concentrate at work. On occasion, she panics and she feels she is about to die. On examination, her blood pressure is 120/80, pulse rate is 90 beats/minute. What is the SINGLE most appropriate medication to prescribe?
A. Selective serotonin reuptake inhibitors (SSRIs)
B. Propranolol
C. Monoamine Oxidase Inhibitors (MAOIs)
D. Mood stabilizers
E. Benzodiazepines
Answer: (a) [The patient is suffering from generalized anxiety disorder. If medications were to be prescribed, the first line would be an SSRI.]
Question. A 30 year old woman who has been feeling low and having difficulty in concentrating since her mother passed away 2 months ago. She feels lethargic and has been crying more often lately. What is the SINGLE most likely diagnosis?
A. Adjustment disorder
B. Post traumatic disorder
C. Panic disorder
D. Generalized anxiety disorder
E. Major depression
Answer: (a) [Adjustment disorders: An adjustment disorder occurs when an individual is unable to adjust to or cope with a particular stress or a major life event. They must occur within 1 (ICD-10) or 3 months (DSM-IV) of a particular psychosocial stressor, and should not persist for longer than 6 months after the stressor (or its consequences) is removed.]
These questions cover various aspects of medical knowledge, clinical reasoning, and professional skills. Remember to refer to the PLAB exam syllabus and guidelines for a comprehensive understanding of the exam content and format.
The PLAB test is a prerequisite for international medical graduates who want to practise medicine in the UK. Passing both parts of the exam is also a requirement. To receive a licence to practise medicine in the UK after passing the exam, you might need to complete additional exams, such as the GMC registration process and securing a job offer or training placement.
In order to practise medicine in the United Kingdom, international medical graduates must pass the PLAB (Professional and Linguistic Assessments Board) exam. The General Medical Council (GMC), which oversees medical practitioners in the UK, is in charge of administering it.
The PLAB exam is divided into two parts:
PLAB Part 1: This written, multiple-choice exam gauges your knowledge and comprehension of clinical practise and medical principles. It has 180 single-best-answer questions and covers a variety of subjects, such as surgery, psychiatry, paediatrics, obstetrics and gynaecology, and more. The PLAB Part 1 exam is available in many different nations.
PLAB Part 2: This practical test evaluates your clinical abilities, communication abilities, and ethical standards. There are 18 situations in all, all of them take place in the UK and include interacting with fictitious patients. Your capacity to gather data, generate accurate diagnoses, and create treatment plans is evaluated by the examiners.
You must fulfil specific requirements, such as holding a primary medical certification recognised by the GMC and possessing the appropriate English language proficiency, in order to be qualified to take the PLAB exam. The GMC's website should be checked for the most recent and comprehensive qualifying requirements.
A strong foundation in clinical expertise and medical knowledge is necessary for PLAB exam preparation. Many applicants prepare by combining self-study, books, online sources, and practise tests. Additionally, a number of for-profit businesses provide training programmes and resources created expressly for the PLAB exam.