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

High-risk features for completed suicide include: evidence of planning (not impulsive), writing a suicide note or final arrangements, precautions against discovery, use of a violent method, and ongoing suicidal intent. These features indicate high intent and require urgent psychiatric assessment and safety planning.

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

Lithium has a narrow therapeutic index. NICE requires baseline renal function (U&Es, eGFR), thyroid function (lithium can cause hypothyroidism), calcium, and ECG. Serum lithium levels should be checked 12 hours post-dose, weekly until stable, then every 3 months. Target range for maintenance is 0.6-0.8 mmol/L.

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

Bulimia nervosa is characterised by recurrent episodes of binge eating followed by compensatory behaviours (self-induced vomiting, laxative misuse, excessive exercise) at least once per week for 3 months. Unlike anorexia nervosa, BMI is typically normal or above normal. NICE recommends CBT-ED as first-line treatment.

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

Serotonin syndrome occurs due to excess serotonergic activity, often when two serotonergic drugs are combined (SSRI + tramadol). Features include agitation, tremor, hyperthermia, hyperreflexia, clonus, and diarrhoea. It differs from neuroleptic malignant syndrome (which has rigidity and bradyreflexia). Treatment involves stopping the causative drugs and supportive care.

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 CTO (introduced by the 2007 amendments to the MHA) allows a patient detained under Section 3 to live in the community under specific conditions (e.g., medication compliance, contact with services). The responsible clinician can recall the patient to hospital if conditions are breached or their mental health deteriorates.

PLAB 1 Practice Test

PLAB 1 Practice Test

PLAB 1 Psychiatry 2