PLAB Psychiatry & Mental Health 2 — Questions and Answers
Question 1: A 25-year-old describes intrusive thoughts about contamination, spends hours washing hands, and recognizes these thoughts as irrational. What is the diagnosis?
- Generalized anxiety disorder
- Obsessive-compulsive disorder (Correct answer)
- Specific phobia
- Illness anxiety disorder
Correct answer: Obsessive-compulsive disorder
OCD is defined by ego-dystonic obsessions and compulsions; the patient's insight into irrationality is a classic feature.
Question 2: Which psychological intervention has the strongest evidence base for the treatment of PTSD according to NICE guidelines?
- Psychodynamic therapy
- Supportive counseling
- Trauma-focused CBT or EMDR (Correct answer)
- Mindfulness-based stress reduction
Correct answer: Trauma-focused CBT or EMDR
NICE guidelines recommend trauma-focused CBT and Eye Movement Desensitization and Reprocessing (EMDR) as first-line psychological treatments for PTSD.
Question 3: A 70-year-old develops sudden-onset confusion and visual hallucinations fluctuating throughout the day, 2 days after hip replacement surgery. What is the most likely diagnosis?
- Alzheimer's dementia
- Delirium (Correct answer)
- Acute psychosis
- Lewy body dementia
Correct answer: Delirium
Delirium is characterized by acute onset, fluctuating consciousness, and is a common postoperative complication, particularly in elderly patients.
Question 4: A 55-year-old woman presents with low mood, early morning waking, anorexia, weight loss, and feelings of worthlessness. Which antidepressant class is the recommended first-line treatment?
- Tricyclic antidepressants (TCAs)
- Selective serotonin reuptake inhibitors (SSRIs) (Correct answer)
- Monoamine oxidase inhibitors (MAOIs)
- Benzodiazepines
Correct answer: Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are first-line antidepressants because of their efficacy and superior safety and tolerability profile compared to TCAs and MAOIs.
Question 5: A 22-year-old is brought in 2 hours after taking 30 paracetamol tablets. She is calm and denies current suicidal intent. What is the most important immediate action?
- Discharge with urgent outpatient psychiatry referral
- Administer N-acetylcysteine (Correct answer)
- Perform gastric lavage
- Refer to psychiatry only and observe
Correct answer: Administer N-acetylcysteine
N-acetylcysteine is the antidote for paracetamol overdose and must be administered urgently to prevent potentially fatal hepatotoxicity.
Question 6: Under the Mental Health Act in England, which section specifically allows compulsory admission for treatment of a patient with schizophrenia who poses a risk to themselves or others?
- Section 2
- Section 3 (Correct answer)
- Section 4
- Section 5(2)
Correct answer: Section 3
Section 3 allows compulsory admission for treatment for up to 6 months when the patient has a mental disorder and poses a risk to themselves or others.
Question 7: According to DSM-5, which symptom is essential (i.e., must be present) for a diagnosis of major depressive disorder?
- Significant weight change
- Insomnia or hypersomnia
- Depressed mood or anhedonia (Correct answer)
- Suicidal ideation
Correct answer: Depressed mood or anhedonia
DSM-5 requires that at least one of the five or more symptoms must be either depressed mood or anhedonia to meet the MDD diagnostic criteria.
PLAB Psychiatry & Mental Health 2
A 25-year-old describes intrusive thoughts about contamination, spends hours washing hands, and recognizes these thoughts as irrational.
What is the diagnosis?