PLAB 2 Clinical History-Taking & Communication 2

Question 1

During a psychiatric history, what does 'MSE' stand for and what does it assess?

Accepted Answer

Mental State Examination — a systematic assessment of appearance, behaviour, speech, mood, affect, thought, perception, cognition, insight, and judgement

Answer

The MSE is the psychiatric equivalent of a physical examination. It assesses: Appearance and behaviour; Speech (rate, volume, form); Mood (subjective) and Affect (objective); Thought (form, content — including suicidal ideation); Perception (hallucinations, illusions); Cognition (orientation, memory); Insight; Judgement.

Question 2

A 55-year-old man presents with 3 weeks of low mood. Which specific questions should you ask to assess suicide risk?

Accepted Answer

Directly ask about suicidal ideation ('Have you had thoughts of harming yourself or ending your life?'), and if present: frequency, intent, plans, means, and protective factors

Answer

Directly asking about suicidal ideation does not increase risk — it may provide relief. A complete suicide risk assessment includes: passive ideation ('life not worth living') → active ideation → plan → means → intent → previous attempts → protective factors (family, religion, hope). Risk stratification guides management.

Question 3

Which of the following best describes a 'systematic inquiry' (systems review) in clinical history-taking?

Accepted Answer

Screening questions about symptoms in body systems not already covered, to avoid missing important diagnoses

Answer

The systems review (or systematic inquiry) asks brief screening questions about common symptoms in major body systems (cardiovascular, respiratory, GI, neurological, etc.) that haven't already been covered. It serves as a safety net to catch symptoms the patient has forgotten to mention or doesn't connect with their main complaint.

Question 4

A patient presents with headache. Which 'red flag' features require urgent investigation to exclude dangerous causes?

Accepted Answer

Thunderclap onset ('worst headache of life'), associated neurological deficit, fever + photophobia + neck stiffness, waking from sleep, new onset in >50 years, or following head trauma

Answer

Red flags for headache (SNOOP4): Systemic symptoms/signs (fever, weight loss); Neurological symptoms; Onset sudden (thunderclap); Onset after 50; Positional (worse lying down); Papilloedema; Progressive worsening; Prior headache history change. These require urgent investigation (CT, LP) to exclude SAH, meningitis, or intracranial mass.

Question 5

When taking a social history, which four key areas should always be covered?

Accepted Answer

Occupation, smoking, alcohol, recreational drugs, living situation, social support, functional status, and relevant travel

Answer

A thorough social history covers: Occupation (current and past — exposure risks, sick leave), Smoking (pack years), Alcohol (units per week — use CAGE or AUDIT if concerned), Illicit drugs, Home situation (who they live with, housing conditions), Social support, Functional status (ADLs), and recent travel (for infectious disease screening).

PLAB 2 Practice Test

PLAB 2 Practice Test

PLAB 2 Clinical History-Taking & Communication 2