PLAB 1 Psychiatry 2

Question 1

A 45-year-old man presents after a suicide attempt by overdose.
He has a clear plan, wrote a suicide note, and took steps to avoid being found.
According to UK risk assessment guidelines, which features indicate the highest risk?

Accepted Answer

Evidence of planning, a suicide note, and precautions against discovery indicate high intent and high risk

Answer

The method used was an overdose rather than a violent method

Answer

The patient's age — younger patients are always higher risk

Answer

The time of day the attempt was made

Question 2

A 60-year-old woman is started on lithium for bipolar disorder. What monitoring is essential before and during lithium treatment?

Accepted Answer

Baseline renal function, thyroid function, and ECG, with regular serum lithium levels maintained at 0.6-0.8 mmol/L (maintenance)

Answer

No monitoring is required — lithium is a safe medication

Answer

Only serum lithium levels need to be checked once at the start

Answer

Annual liver function tests only

Question 3

A 30-year-old woman presents with episodes of binge eating followed by self-induced vomiting, occurring at least twice per week for the past 3 months. Her BMI is 22. What is the most likely diagnosis?

Accepted Answer

Bulimia nervosa

Answer

Anorexia nervosa, binge-purge subtype

Answer

Binge eating disorder

Answer

Rumination disorder

Question 4

A patient taking an SSRI presents with agitation, tremor, hyperthermia, hyperreflexia, clonus, and diarrhoea shortly after starting tramadol. What is the most likely diagnosis?

Accepted Answer

Serotonin syndrome

Answer

Neuroleptic malignant syndrome

Answer

Malignant hyperthermia

Answer

Anticholinergic toxicity

Question 5

Under the Mental Health Act 1983, what is a Community Treatment Order (CTO)?

Accepted Answer

A legal framework allowing a detained patient to be discharged from hospital under supervised conditions, with the option of recall if necessary

Answer

A court order requiring the patient to attend therapy sessions

Answer

An order preventing the patient from leaving their home

Answer

A voluntary agreement between the patient and their GP

Question 6

A 70-year-old man with Alzheimer's disease is prescribed donepezil. What is the mechanism of action of this drug?

Accepted Answer

Acetylcholinesterase inhibitor — it increases acetylcholine levels in the brain

Answer

NMDA receptor antagonist

Answer

Dopamine agonist

Answer

GABA receptor modulator