PLAB (Psychiatry) Sample Questions Set-22

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

Question. A 74 year old man is depressed after his wife’s death 6 months ago. He has been neglecting himself and is not eating well. He has lost 11 kg in the last 3 months. At times, he has thought about self harm but has never done it. His son found him in a very miserable state when he went to visit him last night. Unfortunately, the son is unable to care for his father due to work and other family related issues. What is the SINGLE most appropriate management?

A. Review his mental status in 2 weeks

B. Refer to a social worker

C. Suggest the option of his son to moving in with his father

D. Send patient to a care home

E. Voluntary admission to the psychiatry ward

 

Answer: (e) [The first question to ask yourself is, is this a suitable environment for a person with a depressive illness? Obviously not, and thus he should be admitted to the psychiatry ward. Admission should be to a ward where close observation and monitoring are possible,whenever there is significant risk of harm to self (or others)The ward environment is often not the quiet sanctuary patients hope for and this may lead to difficult decisions in balancing the risk of self-harm against the use of compulsory admission.

Common reasons for hospital admission:

i. Serious risk of suicide

ii. Serious risk of harm to others

iii. Significant self-neglect

iv. Severe depressive symptoms

v. Severe psychotic symptoms

vi. Lack or breakdown of social supports

vii. Initiation of electroconvulsive therapy

viii. Treatment-resistant depression (where inpatient monitoring may be helpful).]

 

Question. A 29 year old teacher was run down by a drunk driver a year ago. Since then, she has been afraid to cross the road. She suffers from nightmares about that incident and gets a startled response every time she hears loud sounds. What is the SINGLE most appropriate initial management?

A. Cognitive behavioural therapy (CBT)

B. Diazepam

C. Citalopram

D. Dosulepin

E. Sertraline

 

ANSWER: (a)

 

Question. A 62 year old man has uncontrollable lip smacking, puckering, repetitive chewing movements and tongue thrusting. He also has uncontrollable slow writhing movements of his fingers. He has been on long-term antipsychotic medications for the past 15 years as part of the management of his schizophrenia. What is the SINGLE most likely diagnosis?

A. Shy-Drager syndrome

B. Parkinsonism

C. Huntington’s chorea

D. Tardive dyskinesia

E. Akathisia

 

Answer: (d) [Tardive dyskinesia occurs especially in patients with long-term treatments with antipsychotic agents. The word “tardive” means delayed, and “dyskinesia” means abnormal movement. Put together “tardive dyskinesia” refers to the delay between the first use of offending medication and the onset of abnormal movements. It takes several months to years to develop the symptoms of tardive dyskinesia from the use of antipsychotics. It is characterized by continuous involuntary movement of the tongue and lower face. The disorder can also affect the fingers, arms and legs causing either rapid, jerking movements or slow, writhing movements. Huntington’s disease usually presents at an earlier age with tremors and choreiform movements. Parkinsonism can also be caused by antipsychotic medications however it is characterised by resting tremors, rigidity and bradykinesia. The onset of parkinsonism as an extrapyramidal side effect of antipsychotics usually occurs after 1 week of administration of the offending antipsychotic drug. Akathisia like tardive dyskinesia and Parkinson’s can be caused by the use of antipsychotic medications but the symptoms involve motor restlessness. These are restlessness of the lower limbs where the patient would have the urge to move. The word “akathisia '' is derived from Greek and it means “not to sit still”. Patients would be seen pacing constantly, rocking back and forth or constantly crossing and uncrossing legs. The symptoms usually occur after a month of initiating the offending antipsychotic drug.]

 

Question. A 41 year old male patient was rushed to Accident & Emergency (A&E) with a Glasgow Coma Scale (GCS) of 13/15 following an incident that happened during a long haul flight. The patient was flying from Thailand to the United Kingdom when he started feeling nauseous followed by having a tremor and becoming confused. He has been taking regular ibuprofen 400 mg for his lower back pain for the past week. The patient’s past medical history is significant for bipolar disorder. He has been taking lithium for the past 10 years and is well controlled on it. What is the SINGLE most appropriate test to do for this patient?

A. Serum lithium concentration

B. Urea and electrolytes (U&E)

C. Thyroid function test (TFT)

D. Liver function test (LFT)

E. Capillary blood glucose

 

Answer: (a) [The single best test to do for this patient would be to confirm his suspicion of lithium toxicity with a serum lithium level. Lithium is mostly excreted by the kidneys, and drugs such as NSAIDs increase renal reabsorption of lithium thus increasing serum lithium levels. Chronic accumulation of lithium such as in this case would usually result in mild to moderate symptoms. Although a full battery of tests such as a full blood count, typically blood glucose and renal function test would be done in real life, if asked for “the most APPROPRIATE test” the examiners would like you to consider lithium toxicity as a diagnosis and request a serum lithium concentration.

Lithium poisoning causes:

i. Therapeutic overdosage (common)

ii. Drug interactions with either a diuretic or NSAID (common)

iii. Deliberate self-harm (less common)]

 

Question. A 25 year old female has just been diagnosed with bipolar disorder. The psychiatric team is considering commencing her on lithium carbonate treatment. Before being commenced on lithium, the patient is required to go for a variety of blood tests. A blood request form has been given to her for calcium levels and a renal function test. What is the SINGLE most appropriate test to send this patient for in addition to the ones listed?

A. Home blood pressure monitoring

B. Thyroid function test (TFT)

C. Chest X-ray

D. Ultrasound kidney, ureter and bladder (KUB)

E. Serum lithium concentration

 

Answer: (b) [Before treatment with lithium is commenced, tests are needed to assess both kidney function and thyroid function. The kidneys mostly excrete lithium with minimal metabolism by the liver. In addition, it can also cause long term kidney damage, so kidney monitoring is done at regular intervals. A thyroid function test is done initially because abnormal levels of thyroid hormones can mimic or precipitate mania and depression. It is also good practice to have a baseline prior to starting lithium. Thyroid monitoring is done at regular intervals because lithium can induce hypothyroidism. Following the initial test, anyone on lithium should have their lithium levels checked 3 monthly, and TSH and renal function checked at least 6 monthly if not more frequently.]


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.


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