PLAB (Psychiatry) Sample Questions Set-15

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

Question. A 55 year old man is brought to the GP surgery by his wife for a review of a growth on his forehead. His wife wants the growth removed but he refuses and says that the growth helps him think clearly. What is the SINGLE most appropriate next course of action?

A. Assess his mental capacity to refuse treatment

B. Remove the lesion

C. Refer to A&E

D. Perform a Mini Mental Status Examination (MMSE)

E. Refuse surgery and review in 2 weeks

 

Answer: (a) [Assessment of his mental capacity to refuse treatment would be the most appropriate next course of action. If his state of mind is fine, we can follow his instructions and leave the lesion there. But obviously, his mental state is not fine as he believes that this growth helps him think clearly. Mini Mental Status Examination (MMSE) is to assess patients with dementia. All Patients with cognitive impairment should be assessed with a Mini Mental StatusExamination (MMSE) to identify the areas of cognitive impairment.]

 

Question. A 56 year old chronic alcoholic man wants to attend his daughter’s wedding in 2 weeks and does not want to be drinking during the wedding. He says he is determined to quit drinking alcohol but he wants extra help. What is the SINGLE most appropriate medication?

A. Acamprosate

B. Refer to clinical psychologist

C. Vitamin B12

D. Desipramine

E. Refer to community mental health support group

 

Answer: (c) [Acamprosate, in combination with counselling, may be helpful for maintaining abstinence in alcohol-dependent patients. It is useful for patients who are concerned that strong cravings will result in relapse. Clinical psychologists and mental health support groups are wrong places to refer to a chronic alcoholic.]

 

Question. A 32 year old female presents to her GP with feelings of low mood. It was determined during the consultation that she didn’t want to attend the appointment but came because her husband insisted. She describes a 4 month period of feeling low. In addition, she describes experiencing difficulty falling asleep at night and feeling lethargic all the time. She mentions not having much of an appetite anymore. She used to spend lots of her spare time writing children’s books but she says that she does not find pleasure in that anymore. She works as a financial consultant and says that her concentration at work has become impaired and that her work is suffering as a result. The GP made a diagnosis of moderate depression and started her on a four week course of fluoxetine. After four weeks, the patient returns with the same symptoms of low mood and no improvement in functional ability. What is the SINGLE next best step in management for this patient?

A. Prescribe lithium

B. Stop fluoxetine and prescribe mirtazapine

C. Prescribe sodium valproate

D. Refer for electroconvulsive therapy (ECT)

E. Prescribe short course of diazepam

 

Answer: (b) [If a patient with diagnosed depression has been taking first-line antidepressant therapy (SSRIs) at therapeutic dose for at least two to four weeks and presents with no improvement in symptoms after that period of time, there are steps that the clinician must take in order to manage the patient. These are as follows:

i. Check adherence and enquire about any adverse effects of the medication: Side effects are often the main reason that patients do not adhere to their medications.

ii. Increase the dose of the current medication

iii. Change medication: If one SSRI has been ineffective, try another SSRI. If the second SSRI is still ineffective, try an alternative class of antidepressants.

Since checking adherence, increasing the dose or changing to a different SSRI are not in the choices, the best way forward for this patient would be to switch to a different class of antidepressant. Mirtazapine is an atypical antidepressant. It is a presynaptic alpha-2 adrenoceptor antagonist which works by increasing central noradrenergic and serotonergic neurotransmission. It is licensed for use in severe depression or in cases in which selective serotonin reuptake inhibitors (SSRIs) do not work. It is not used first-line due to its many side effects. One of the side effects is it can make you feel sleepy. This can work as an advantage in this case since the patient has difficulty falling asleep. Lithium is a mood stabilizer. It is used in the treatment of bipolar disorder. Sodium valproate is an anti-epileptic.

Electroconvulsive therapy is a very controversial mode of treatment. It is almost never used in clinical practice and 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.

Diazepam is used for a variety of different reasons from anxiety to the treatment of muscle spasms. It is not licensed for the treatment of depression however it can be used for short term (less than 2 weeks) in combination with antidepressants if the patient has depression with symptoms of anxiety, agitation or insomnia. It would be appropriate to be given here as the patient does not have symptoms of anxiety.]

 

Question. A 68 year old man comes into A&E confused and with nausea, confusion and a coarse tremor. As the emergency doctor is taking a history, he slowly becomes unconscious. His wife gives a history that he took an overdose of a medication but she is unsure which medication it was. Which of the following medications could account for his symptoms?

A. Haloperidol

B. Diazepam

C. Fluoxetine

D. Imipramine

E. Lithium

 

Answer: (e) [Lithium is a mood stabilizing drug used in bipolar disorder. Its features include a coarse tremor (a fine tremor is seen in therapeutic doses), acute confusion and coma if severe.]

 

Question. A 33 year old man tries not to go outside his house because he thinks that people will look at him and talk about him. He finds difficulty when talking with his peers in a restaurant or under social settings. He sweats and feels palpitations when speaking to strangers. He dislikes going to malls as he fears strangers may criticise his looks. He avoids these situations as they cause him distress. What is the SINGLE most likely diagnosis?

A. Agoraphobia

B. Generalized anxiety disorder

C. Panic disorder

D. Adjustment disorder

E. Social phobia

 

Answer: (e) [Sufferers of social phobias (social anxiety disorders) can have anxiety when going out of the house and when seen in public. When doing so, they fear of doing something embaressing like looking incompetent, stupid or unentertaining. The distractor here is agoraphobia. Agoraphobia is the fear of open spaces which can also be seen when sufferers go to the shopping mall. However, the trigger for this fear is more of the inability to escape the open space rather than the fear of being criticized.]

 

Question. A 38 year old woman who gave birth 6 weeks ago presents to her local GP surgery with her husband. She describes ‘crying all the time’ and ‘not bonding’ with her baby. She is worried about the baby's health constantly and she is unsure if is able to cope with this new change in her life. What is the SINGLE most likely diagnosis?

A. Postpartum blues

B. Postnatal depression

C. Postpartum psychosis

D. Anxiety disorder

E. Obsessive compulsive disorder (OCD)

 

Answer: (b) [Postnatal depression is seen commonly among women affecting up to 10% of women giving birth. Crying, not bonding, worrying and feeling as if she cannot cope is a typical presentation of postnatal depression]

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