A Complete Guide to Diagnosing and Managing Post-Trauma Stress: A PLAB 2 Mock Scenario

examiner mla
Jun 15
2 min read

Summary:

This PLAB 2 case scenario involves a 35-year-old male IT consultant presenting to a GP surgery, expressing concern that he might have Post-Traumatic Stress Disorder (PTSD) following a car accident two months ago. The consultation involves identifying PTSD symptoms, assessing mental health risk factors (including depression and self-harm), and formulating a safe and supportive management plan.

Key Points:

Presenting Complaint:

Male patient (John Smith), aged 35, suspects he has PTSD after a car accident.
Symptoms: nightmares, flashbacks, hypervigilance ("on edge").

History and Symptoms:

No physical injuries from the accident.
Flashbacks occur without warning; feels like reliving the trauma.
Emotional distress is evident during the consultation.

Medical and Social History:

No known past medical history, medication, surgery, allergies, or family disease.
Drinks alcohol occasionally; non-smoker; reports low exercise levels post-accident.
Reports work-related difficulties—struggles to concentrate due to stress.
Isolative behavior—potential for emotional numbing and social withdrawal.

Psychiatric Symptoms (Highlighting PTSD Components):

Re-experiencing: Nightmares, involuntary flashbacks.
Avoidance: Reluctance to go out post-incident (possible driving avoidance).
Hyperarousal: Constantly feeling "on edge."
Emotional numbing and negative cognition: Potential signs through detachment and work-related issues.

Important Considerations:

Assess for depression using mood scaling and anhedonia questions.
Rule out self-harm or suicidal ideation—ask gently using signposting.
Understand differences between flashbacks and hallucinations.
Evaluate impact on social, occupational, and daily functioning.
Ensure a structured mental state examination if appropriate.

Diagnostic Approach:

Explore presenting symptoms thoroughly.
Identify PTSD criteria (flashbacks, avoidance, arousal, mood changes).
Assess for comorbid depression—mood scale and interest questions.
Screen for red flags—suicidal thoughts or intent.
Evaluate functional impairment—work, social life, sleep.
Mental state examination and vitals check (standard in psych scenarios).

Management:

Non-Medical:

Cognitive Behavioral Therapy (CBT)—gold standard for PTSD.
Lifestyle advice and psychoeducation about PTSD.
Avoid “just try to forget” suggestions; provide structured coping strategies.
Safety netting and reassurance.

Medical:

Consider SSRIs if symptoms persist or worsen (e.g., sertraline).
Refer to psychiatrist if severe or non-responsive to initial therapy.
Schedule follow-up in 4–6 weeks to monitor progress.

Communication Skills:

Show empathy and validation of patient’s experience.
Avoid over-rehearsed phrases—speak naturally.
Use open-ended questions and active listening cues.
Always signpost transitions in conversation logically.
Seek consent before discussing sensitive topics or examining.

Ethical Considerations:

Maintain confidentiality appropriately (no need to overstate it).
Provide clear, understandable information to support shared decision-making.
Respect autonomy—patient’s right to accept/refuse advice.
Avoid making false assurances; be realistic about management plans.

Additional Resources:

NICE Guidelines on PTSD
GMC's Good Medical Practice on psychiatric care and consent
PLAB 2 examiner tips on psychiatric station strategy
Understanding Your Results (PLAB 2) for feedback structure