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MARSIPAN Highest Risk — MRCPsych Paper B MCQ

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HardEating DisordersMARSIPAN Highest RiskMRCPsych Paper B

A 24-year-old woman with anorexia nervosa has a BMI of 13.0 kg/m² and a corrected QT interval (QTc) of 500 ms. Serum potassium, magnesium and phosphate are currently within their reference ranges, she takes no QT-prolonging medication, and there is no known congenital long-QT syndrome. According to the current MEED risk framework, which is the best interpretation and immediate response?

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Correct answer: E — High impending risk; arrange urgent acute medical assessment and monitored stabilisation and refeeding

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · A = shown as D · B = shown as E

The correct answer is B. In an adult, a BMI of exactly 13.0 kg/m² lies in the MEED amber range of 13–14.9, but the QTc of 500 ms exceeds the red threshold for an adult woman (>450 ms). This therefore represents high impending risk to life despite normal electrolytes. Prolonged QT can be associated with ventricular arrhythmia and sudden death, so urgent acute medical assessment, investigation of reversible causes and cardiac monitoring are required, alongside specialist-supervised refeeding and biochemical monitoring. Option C incorrectly classifies the patient using BMI alone. Normal electrolytes do not make options A or D safe because the marked ECG abnormality is independently high risk. Option E invents a BMI threshold and ignores the immediate cardiovascular risk.

Reference: Royal College of Psychiatrists. Medical Emergencies in Eating Disorders: Guidance on Recognition and Management (MEED), CR233, risk-assessment framework and clinical-management tables, 2022. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr233-medical-emergencies-in-eating-disorders-%28meed%29-guidance.pdf?sfvrsn=2d327483_59