Anorexia nervosa — RACGP Fellowship MCQ

Correct answer: D — Assess medical risk and arrange family-based eating disorder care with close monitoring

Option D is correct. The clinical presentation meets criteria for restrictive-type anorexia nervosa in an adolescent, with medical red flags (bradycardia at 52/min, significant weight loss over 4 months, functional decline) requiring urgent assessment and evidence-based intervention. Family-based treatment (FBT) is the first-line and best-supported intervention for adolescent anorexia nervosa, proven to achieve superior outcomes including greater weight gain, shorter treatment duration and reduced costs. Medical assessment must occur immediately to evaluate cardiac risk and electrolyte status. Distractors: Option C is dangerously incorrect—the absence of purging does not exclude serious medical risk; restrictive anorexia nervosa carries significant cardiac and metabolic complications. Option B misses the core disorder (psychological food restriction, not appetite loss) and bypasses proven psychosocial treatment. Option E contradicts all evidence that family involvement is essential in adolescent eating disorder treatment. Option A delays necessary early intervention until greater physical deterioration occurs, contrary to best-practice principles of early identification and treatment.

Reference: RACGP: Clinical practice guide 'Eating disorders in adolescence – an approach to diagnosis and management', Australian Family Physician 2007; 36(8):614–620, https://www.racgp.org.au/getattachment/8d09686d-f100-465c-b99b-cc1b2af0cef6/attachment.aspx. Endorsed by Couturier J et al. (2017) Family-based treatment of eating disorders in adolescents, Eating and Weight Disorders, 22(2):1–12; and operationalised in Australian paediatric services (Children's Health Queensland FBT-AN program, Royal Children's Hospital Melbourne).