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Below is a complete RANZCP-style MEQ case — clinical stem, staged questions with mark allocations, model answers, and the marking rubric itself — plus three single-best-answer MCQs with explanations. Everything here is original practice content written for this page. For the real thing, the free trial gives you 3 full MEQ cases and 10 MCQs, marked.
The MEQ case
You are the psychiatry registrar reviewing Daniel, a 21-year-old university student, on a general adult inpatient unit two days after his admission. His flatmates called an ambulance after he barricaded himself in his room, convinced that a tracking device had been implanted in his phone and that his lecturers were coordinating surveillance of him. Collateral suggests six months of gradual withdrawal from friends, declining grades, and increasingly odd statements, with daily cannabis use since starting university. On the ward he is settled but guarded, denies that he is unwell, and asks repeatedly when he can go home. His urine drug screen was positive for cannabinoids only, and physical examination and initial investigations are unremarkable.
Question 1 — What further assessment would you prioritise, and why? (6 marks)
Show model answer & rubric
A strong answer is organised and specific — history, mental state, collateral, and organic screen, each tied to a reason:
- Detailed psychotic phenomenology — content and fixity of the persecutory beliefs, perceptual disturbance, passivity phenomena, and mood symptoms, to characterise the syndrome.
- Risk assessment — thoughts of harm to self or others (including anyone incorporated into the persecutory system), and risk of absconding given he wants to leave.
- Substance history — quantify cannabis use, other substances, temporal relationship to symptoms.
- Premorbid functioning and family history of psychotic illness — prognostic and diagnostic weight.
- Completion of the organic work-up appropriate to a first episode of psychosis.
- Collateral from family and flatmates on the six-month prodrome.
| Awardable point | Marks |
|---|---|
| Phenomenology of the psychosis explored and characterised | 1.5 |
| Risk assessment: self, others, absconding | 1.5 |
| Substance use quantified and temporally related to symptoms | 1 |
| Premorbid function and family history | 1 |
| First-episode organic screen and collateral history | 1 |
Question 2 — Outline your management for the admission and the weeks that follow. (10 marks)
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- Setting and legal framework — he lacks insight and wants to leave; if risk assessment supports containment, treatment under the relevant mental health legislation, using the least restrictive option that is safe.
- Biological — commence an antipsychotic at the low doses appropriate to a first episode, chosen with him where possible; monitor metabolic baseline and side effects; attend to sleep.
- Substance use — psychoeducation on the relationship between cannabis and psychosis, motivational interviewing, and a plan for abstinence support — a central modifiable prognostic factor here.
- Psychological and family — engagement first; psychoeducation for Daniel and his family; formal psychological intervention for psychosis once settled.
- Continuity — referral to an early-psychosis service for sustained follow-up, relapse-prevention planning, and attention to study re-entry and social recovery.
- Review — explicit reassessment points for risk, response and side effects, with duration-of-treatment discussion once the picture is clear.
| Awardable point | Marks |
|---|---|
| Setting addressed with legal framework and least-restrictive reasoning | 2 |
| Antipsychotic commenced appropriately (first-episode dosing, monitoring) | 2 |
| Cannabis addressed as a modifiable prognostic factor | 2 |
| Psychoeducation and family involvement | 1.5 |
| Early-psychosis service referral and relapse-prevention planning | 1.5 |
| Defined review points for risk, response, side effects | 1 |
Question 3 — Daniel's parents ask: "Is this schizophrenia? Will he get better?" How do you respond? (6 marks)
Show model answer & rubric
- Check what Daniel has consented to share, and involve him in the conversation where possible.
- Communicate honestly and without jargon: this is a first episode of psychosis; diagnostic labels at this stage are provisional, and time and treatment response will clarify the picture.
- Give balanced prognostic information — many people recover well from a first episode, and outcomes are improved by staying in treatment and stopping cannabis; avoid both false reassurance and fatalism.
- Acknowledge the family's distress, invite questions, and offer written information and carer support services.
- Frame the early-psychosis service follow-up as the plan for whatever the diagnosis turns out to be.
| Awardable point | Marks |
|---|---|
| Consent and Daniel’s involvement addressed before disclosure | 1.5 |
| Honest, jargon-free framing of a provisional first-episode diagnosis | 1.5 |
| Balanced prognosis including modifiable factors (adherence, cannabis) | 1.5 |
| Empathic acknowledgement, questions invited, carer supports offered | 1.5 |
In the real product you write your answers under exam timing, and the marking is done on what you actually wrote — point by point against rubrics like these.
Start free — no card required →What the marking feedback looks like
After you submit an MEQ answer, it is marked against the rubric and you get feedback in this format — an example of the kind of report a submission receives:
Missed points also become spaced-repetition flashcards, so your weak spots come back for review.
Three sample MCQs
Single best answer — decide before you reveal. In the product these run in timed blocks with instant marking, explanations, and per-domain accuracy tracking.
Show answer & explanation
Correct answer: A — Arrange an urgent full blood count
Fever and sore throat in the first 18 weeks of clozapine treatment must be treated as agranulocytosis until a neutrophil count excludes it — an urgent FBC is the single most appropriate immediate action. Antibiotics or reassurance without a count miss the diagnosis; dose reduction does not address it. Myocarditis is also an early clozapine risk and may need evaluation, but the discriminator in this stem (sore throat and fever) points first to neutropenia, and continuing clozapine "unchanged" before any results is unsafe.
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Correct answer: C — Inducible clonus with hyperreflexia
Hyperthermia, autonomic instability and altered mental state occur in both syndromes, so none of them discriminates. Neuromuscular excitability — clonus and hyperreflexia — is the hallmark of serotonin syndrome, whereas NMS produces lead-pipe rigidity and hyporeflexia. Rapid onset is suggestive of serotonin syndrome but is a weaker discriminator than the neuromuscular findings; clonus is the best answer.
Show answer & explanation
Correct answer: A — Electroconvulsive therapy
This is psychotic depression with life-threatening food and fluid refusal — an established indication for ECT as first-line treatment, given its speed and efficacy in exactly this presentation. A two-week antidepressant trial is too slow when renal function is already deteriorating; CBT is not a treatment for this acuity; an antipsychotic alone under-treats the depressive syndrome. Her decision-making is driven by nihilistic delusions, so treatment should proceed under the relevant mental health and guardianship frameworks rather than being deferred.
The full bank: timed MEQ cases and MCQ mock exams, examiner-style marking on your written answers, and spaced review of everything you miss. Start with 3 free MEQ cases and 10 free MCQs.
Start free — no card required →All content on this page is original practice material written for Fellowship Ready. It is not reproduced from any examination and is provided for education, not clinical advice. Fellowship Ready is not affiliated with the RANZCP.