RANZCP MEQ Example Question with Model Answer: A Full Walkthrough

This is a complete, original MEQ-style practice case in the RANZCP written-exam format — a clinical stem, staged questions with mark allocations, and a model answer for each. It is written for practice and is not a recalled exam question. To get the most from it, sit it before you read the answers: give yourself 35 minutes, write your responses in full sentences as you would in the exam, and only then compare against the model.

The clinical stem

You are the psychiatry registrar on call at a regional hospital. Sarah, a 34-year-old accountant, is brought to the emergency department by her husband, who found her late at night researching methods of suicide on her laptop, alongside what he describes as a farewell letter to their two young children. Over the past six weeks she has had persistent low mood, loss of interest in activities she previously enjoyed, early-morning waking, poor appetite with weight loss, and escalating guilt centred on a mistake she made at work. Her alcohol intake has increased from an occasional glass of wine to most of a bottle each evening. She has no prior contact with mental health services. In the department she is calm and cooperative, describes the episode as "a moment of weakness", and asks to go home.

Question 1 — "Outline the key components of your risk assessment for Sarah." (8 marks)

The rubric for a question like this rewards named, specific factors, organised so the marker can find them. A model answer covers:

• Suicidal ideation in detail — current thoughts, intent, and plan; the researching of methods and the farewell letter are preparatory acts and mark this as high-risk regardless of her presentation now.
• Dynamic risk factors — severe depressive symptoms with prominent guilt, hopelessness, early-morning waking, weight loss; escalating alcohol use (disinhibiting and independently associated with suicide); a recent precipitant (the workplace error).
• Static and demographic factors — first presentation with no prior attempts; family history of suicide or mental illness should be asked about.
• Protective factors — supportive husband who acted on his concern, two young children, employment, engagement with the assessment (each named, not assumed).
• Discrepancy between stated and observed risk — her minimisation ("a moment of weakness") against objective evidence of planning; guardedness itself elevates concern.
• Collateral history — the husband's account is essential and may differ from hers.
• Access to means — what methods she researched, and what she has access to at home.
• Risk to and of others — the children's welfare and who is caring for them; risk of self-neglect.

Question 2 — "Describe your initial management plan, including your choice of setting and its rationale." (10 marks)

• Immediate safety in the department — ensure she is in a safe area with appropriate observation while assessment is completed; do not allow her to leave before risk is characterised.
• Complete the assessment — full psychiatric history and mental state examination; physical examination and an organic screen (including bloods) given weight loss and alcohol use; quantify alcohol intake and dependence features; collateral from her husband.
• Setting — admission is justified — recent preparatory acts, ongoing severe depressive syndrome, alcohol use, and minimisation make community management unsafe as a first step. Seek voluntary admission first; if she declines and risk remains high, assessment under the applicable mental health legislation is indicated — framed in terms of risk, least-restrictive principles, and jurisdictional criteria.
• Biological — commence an antidepressant (an SSRI is a reasonable first-line choice) after discussion of benefits, side effects, and the time course of response; attend to sleep; monitor for and manage alcohol withdrawal.
• Psychological — supportive engagement initially; a structured psychological therapy (for example CBT or IPT) once she can engage; brief intervention for alcohol use.
• Social and family — psychoeducation for Sarah and her husband; clarify care arrangements for the children; begin planning around the workplace stressor.
• Documentation and communication — record the risk assessment and plan; hand over explicitly; involve the treating team early.
• Forward planning — safety planning and means restriction before any leave or discharge, with early follow-up.

Question 3 — "Sarah asks you not to tell her husband anything about her admission or care. How would you respond?" (6 marks)

• Acknowledge and respect her right to confidentiality, and explore her reasons — the request may reflect shame, relationship difficulty, or a plan to minimise scrutiny.
• Assess whether the request itself changes risk — cutting off her main support and source of collateral is clinically significant.
• Explain the limits of confidentiality: where there is serious risk to her safety (or to others, including the children), limited disclosure necessary for safety can be justified — ideally with her consent, so work to obtain it.
• Distinguish receiving information from the husband (always permissible) from disclosing to him.
• Negotiate what she is comfortable sharing, involve her in how it is framed, and revisit as the therapeutic relationship builds.
• Document the discussion, the decision, and its justification.

Where the marks actually live

• Safety and risk come first in both content and order — an answer that opens with antidepressant choice has misread what is being asked.
• Breadth beats depth: the rubric spreads marks across biological, psychological, social, setting, legal, and communication domains. One eloquent paragraph on sertraline cannot collect them.
• Alcohol appears in every question — as a risk factor, a management target, and a withdrawal risk. Missing it is the most common single-domain loss in a stem like this.
• The children are easy marks that most candidates miss: their welfare is part of risk, their care arrangements part of management.
• Specificity scores: name the preparatory acts, name the drug class, name the legislation pathway generically ("assessment under the relevant mental health act") rather than vaguely gesturing at "sectioning".

How to practise this

One walkthrough shows you the shape; the skill comes from repetition with feedback on your own writing. Fellowship Ready gives you a bank of original timed MEQ cases exactly like this one, marks what you actually wrote against a point-by-point rubric, and resurfaces the points you missed. Start free — 3 full MEQ cases with examiner-style marking, no card required.