PLAB (Psychiatry) Sample Questions Set-18
Categories: U.K. PLAB (Professional and Linguistic Assessments Board)
Question. A 21 year old man is seen in the Psychiatry clinic with the complaint of strange body movements. His mother describes his body movements as unconventional and inappropriate. They consist of lip-smacking, protrusion of his tongue and quick, shaking movements of his hands and feet. The patient cannot control these movements. His past medical history is significant for schizophrenia, diagnosed a year ago. The patient states that he was started on medication for his schizophrenia several months ag however he does not take his medication regularly as he sometimes forgets to take it. What is the SINGLE best treatment for this patient’s condition?
A. Depot haloperidol
B. Depot risperidone
C. Intravenous chlorpromazine
D. Oral clozapine
E. Intramuscular fluphenazine
Answer: (b) [The patient has tardive dyskinesia likely caused by his treatment with antipsychotic drugs. A common side effect of long term use of antipsychotic drugs is tardive dyskinesia which is a movement disorder characterised by continuous involuntary movement of the tongue and lower face. Patients are often unaware of these movements and they are reported by family members like in this case, his mother. Although all antipsychotics have the potential to cause movement disorders, the atypical antipsychotics (risperidone and olanzapine) are considered to be at lower risk of causing tardive dyskinesia than the other antipsychotics Although clozapine is also an atypical antipsychotic, it is less preferable to risperidone simply because of the method of delivery. A depot injection is preferred over oral medication in this case since this patient has compliance issues. Haloperidol is unlicensed for the use of movement disorders but it may be considered for the treatment of chorea in Huntington’s disease.]
Question. A 27 year old woman finds herself with palpitations and dizziness whenever she is in a meeting at the office. She is very self-conscious and feels that her colleagues are judging her in a harsh way in meetings. She has been asked to present in one of the meetings but she called in sick to avoid being criticized. What is the SINGLE most likely diagnosis?
A. Agoraphobia
B. Generalized anxiety disorder
C. Panic disorder
D. Depression
E. Social phobia
Answer: (e) [The phrase to pick up in this question stem is the fear of “being criticized”. This is a good example of social phobia (social anxiety disorder). Sufferers avoid situations like meetings, group events and public speaking as they may bring about the possibility of embarrassment.]
Question. A 28 year old female who delivered 6 weeks ago feels sad and has no interest in feeding the baby. She has been eating poorly and having difficulty sleeping. She feels weak throughout the day and has stopped taking the baby out of the house. She also says that the baby has evil eyes. What is the SINGLE most likely diagnosis?
A. Postpartum blues
B. Postpartum depression
C. Postpartum psychosis
D. Schizophrenia
E. Psychotic depression
Answer: (c) [She has features of depression: feels sad, not eating well, difficulty sleeping, feeling weak. On top of that she has delusional ideas: no interest in feeding the baby, she thinks the baby has evil eyes and not taking the baby out of the house. These points to postpartum psychosis. A key feature to look out for in PLAB is the words “evil eyes”. If a mother has recently delivered and thinks that her baby has evil eyes, pick the answer that has postpartum psychosis. You are most likely to be correct.
Postpartum psychosis: Usually starts with postpartum depression. Classically, they would have thoughts of harming their new born baby. She would have delusional ideas that the baby is deformed, evil or otherwise affected in some way and she has intent to kill or harm the baby Onset usually within the first 2-3 weeks following birth
Management: i. Admission to hospital (specialist mother–baby unit if possible) is usually required. ii. For major affective disorders there is good evidence for ECT.]
Question. A 35 year old is agitated and euphoric. He claims to be helping the prime minister with economic policies and describes himself to be a very powerful man. He believes that he has made important discoveries regarding international policies that have great impact towards the United Kingdom. On further investigation, these statements are untrue. What is the SINGLE most likely phenomenon?
A. Persecutory delusions
B. Delusion of control
C. Delusion of reference
D. Nihilistic delusions
E. Delusion of grandeur
Answer: (e) [His delusions describe a type of delusion called grandiose delusions which are usually found in patients with mania.]
Question. A 42 year old man with a history of bipolar disorder is noted to have high serum levels of lithium and profound hypokalemia on routine examination. He was recently diagnosed with essential hypertension and his GP had started him on an antihypertensive medication. What is the SINGLE most likely cause of the recent findings?
A. Atenolol
B. Captopril
C. Ramipril
D. Spironolactone
E. Bendroflumethiazide
Answer: (e) [The key here is to understand what medication can cause both hypokalemia and causes lithium levels to rise. Thiazides (e.g. bendroflumethiazide) can cause hypokalemia. Thiazide and related diuretics can cause a rapid rise in serum lithium levels leading to toxicity. NICErecommends avoiding concurrent use unless lithium levels can be closely monitored and the lithium dose adjusted as necessary. Advise patients to report lithium adverse effects (tremor, dysarthria, ataxia, confusion).
Atenolol → Is a beta blocker. There has been one study which suggests that atenolol might decrease the clearance of lithium. However, NICE guidelines state that no particular precautions are warranted. Thus being less likely the cause of lithium toxicity.
Ranitidine → is an H2 histamine receptor antagonist that works by blocking histamine. It is used in gastro-oesophageal reflux disease and is not an antihypertensive.
Captopril and Ramipril → are ACEi. They would cause hyperkalemia. Thus is no longer an option here.
Spironolactone →is a potassium sparing diuretic and causes hyperkalemia. Thus
is no longer an option here.]
Question. A 28 year old woman witnessed a tragic road traffic accident where a young boy was killed by a lorry. On the night of the event, she was not able to sleep as she had horrid thoughts of the event. The following morning, she woke up and was not able to see. She has no previous history of medical or psychological issues. What is the SINGLE most likely diagnosis?
A. Conversion disorder
B. Somatization
C. Posttraumatic stress disorder
D. Dissociation
E. Generalized anxiety disorder
Answer: (a) [Conversion (dissociative) disorders typically involves 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. Memory loss, seizures, loss of speech and paralysis can occur. In this case, she lost her vision. Remember that patients with conversion disorder are not feigning the signs and symptoms. Despite the lack of an organic diagnosis. The person’s distress is very real and the physical symptoms the person is experiencing cannot be controlled at will. Fortunately, good prognosis can be expected and she will likely recover from her visual symptoms.]
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.