Anorexia Nervosa — MRCPsych Paper B MCQ
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Correct answer: E — Arrange urgent paediatric medical admission for stabilisation, refeeding and ECG monitoring
The correct answer is E. Refusal of oral nutrition combined with marked bradycardia and a QTc of 480 ms indicates significant medical compromise requiring urgent, age-appropriate medical admission. Admission permits medical stabilisation, ECG and biochemical monitoring, and initiation of refeeding under an established protocol that addresses both undernutrition and refeeding syndrome risk. The BMI adds to the overall concern but must not be used as an absolute admission threshold. Anorexia-nervosa-focused family therapy is an important first-line psychological treatment for this age group, but immediate physical stabilisation takes priority. Routine outpatient referral is unsafe at this level of risk. Olanzapine is not an appetite-stimulant substitute for nutritional rehabilitation, and medication must be used cautiously where cardiac abnormalities exist. Fluoxetine is not a primary treatment for anorexia nervosa and would not address the acute medical risk.
Reference: National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (NG69), sections 1.10.3 and 1.11.1–1.11.10. Published 2017, updated 2020 and reviewed 2024. https://www.nice.org.uk/guidance/ng69/chapter/recommendations