How to use these RANZCP practice questions
These questions practise applied psychiatric knowledge and clinical reasoning: the sort of thinking needed to link assessment findings to risk, formulation and a safe plan. They are original practice cases, not official examination questions. RANZCP Fellowship assessments typically include written and clinical or viva-style components; check the College website for current assessment information and requirements.
Answer each single-best-answer question as you reach it. The explanation follows the options and identifies why a tempting alternative is weaker. For clinical cases, keep returning to immediate safety, relevant collateral, uncertainty and what you would do next.
1. Suicidal thoughts and immediate safety
This question tests how to prioritise a direct assessment of suicide risk and immediate safety.
A 32-year-old presents with six weeks of low mood, anhedonia and early waking. They disclose thoughts of suicide and say they have considered using medication kept at home, but give no further detail. What is the best next step?
Clarify immediacy, intent, planning, access to means, history, supports and ability to remain safe; then agree a proportionate safety and disposition plan. A routine review or medication plan alone does not address immediate risk. A promise not to self-harm is not a substitute for assessment or safety planning.
A sound answer does not infer risk from one phrase or assign a fixed risk category without supporting evidence. It shows what information is missing and how the immediate plan will reduce danger.
2. Mania with psychotic symptoms
This question tests recognition of an acute manic presentation and the need to address safety as well as symptoms.
A 27-year-old has had several nights with little sleep, pressured speech, expansive plans and marked impulsive spending. They now believe they have a special mission and become hostile when challenged. What is the best immediate approach?
The combination suggests severe mania with psychotic symptoms, requiring urgent assessment of risk, physical health, capacity and safe disposition, followed by appropriate treatment. Antidepressant monotherapy may worsen mania and does not address the acute presentation. Confidence alone does not establish that a belief is culturally shared or not psychotic.
In a written response, name the working syndrome but leave room for alternatives and contributing causes. State how you will assess immediate risk, obtain collateral where possible and arrange a safe setting.
3. Acute confusion in hospital
This question tests whether you recognise delirium and investigate an acute change rather than assume a primary psychiatric disorder.
An 81-year-old admitted with pneumonia becomes inattentive and disoriented over one day. Their alertness fluctuates, and they report seeing insects on the wall. What is the best next step?
Acute, fluctuating inattention and altered awareness in a medically unwell older person point to delirium. Find and treat underlying contributors, review medicines and support safety. A primary psychotic disorder does not explain away the acute medical change; restraint is not a first-line response to hallucinations alone.
The key distinction is the acute, fluctuating disturbance in attention and awareness. A useful answer includes a medical review, medication review, appropriate investigation and practical measures to reduce distress and harm.
4. Possible serotonin toxicity
This question tests recognition of a potentially serious adverse drug effect and the immediate response.
A patient taking an SSRI has recently started another serotonergic medicine. They develop agitation, sweating, tremor, inducible clonus and hyperreflexia. What is the best immediate response?
The medication exposure plus clonus and hyperreflexia should raise concern for serotonin toxicity. Stop causative serotonergic medicines and obtain urgent medical assessment and supportive care. Neuroleptic malignant syndrome is a tempting alternative, but the drug history and neuromuscular findings here favour serotonin toxicity; do not give another potentially causative medicine.
When a medication reaction is possible, connect the timeline and examination findings to the suspected cause. State the urgent action and the medical support needed rather than offering a diagnosis alone.
5. First presentation of psychosis
This question tests a balanced first-episode assessment that includes physical health, substances, collateral and risk.
A 21-year-old is brought in after several weeks of social withdrawal and hearing a voice commenting on their actions. They have stopped attending university. What is the best assessment approach?
A first presentation calls for a structured assessment of symptoms, function, physical health, substance exposure, risk and history, with collateral where appropriate. A single symptom does not establish a final diagnosis. Substance use may contribute but should not be assumed to explain the entire presentation without assessment.
Avoid premature diagnostic certainty. A formulation should connect symptoms, context and possible mechanisms, while identifying what remains to be assessed and how that uncertainty changes the plan.
6. Alcohol withdrawal with a seizure
This question tests recognition of complicated alcohol withdrawal and the need for urgent medical care.
A person who has been drinking heavily stops abruptly. About a day later they have a generalised seizure and are tremulous and sweaty. What is the best next step?
A seizure during suspected alcohol withdrawal is a medical emergency: manage withdrawal using an appropriate clinical protocol, give thiamine and investigate other causes. An antipsychotic alone does not treat the underlying withdrawal or seizure risk. Do not delay urgent care or assume withdrawal excludes another cause.
The important points are urgent medical assessment, treatment of withdrawal and consideration of other causes. If hypoglycaemia is suspected, treat it promptly; thiamine should be given without delaying necessary emergency treatment.
7. Obsessive-compulsive disorder
This question tests a patient-centred first-line treatment discussion for OCD.
A patient describes intrusive contamination fears and spends several hours washing to reduce distress. They recognise that the rituals are excessive and ask about treatment. What is the best response?
Exposure and response prevention-based CBT is a relevant psychological treatment; an SSRI may also be considered through shared decision-making and individual assessment. Avoidance can maintain the cycle, while an unsupported instruction to stop rituals is not a treatment plan. Insight does not rule out OCD.
A complete answer would assess distress, impairment, comorbidity and risk, then discuss treatment choices and follow-up in language the patient can understand.
8. Capacity and an informed refusal
This question tests decision-specific capacity assessment and respect for autonomy within the applicable legal framework.
A patient with a psychiatric diagnosis refuses a proposed treatment. They can explain the main benefits and risks in their own words. What should the clinician do next?
Capacity is decision-specific and should be assessed under the law that applies in the relevant Australian jurisdiction. Support understanding and consider whether the person can use or weigh relevant information and communicate a choice under that framework. Diagnosis alone does not establish incapacity, and one assessment does not settle every later decision.
In an exam answer, describe the decision being assessed, how you will support the person and how you will document the discussion. Check the relevant state or territory legislation rather than assuming one legal rule applies everywhere.
9. Possible lithium toxicity
This question tests recognition of toxicity symptoms and the need for urgent medical assessment rather than simply adjusting a repeat prescription.
A person taking lithium develops vomiting, coarse tremor and an unsteady gait after several days of diarrhoea. What is the best next step?
Gastrointestinal illness, tremor and ataxia in a person taking lithium raise concern for toxicity. Withhold further doses pending urgent medical assessment, and review hydration, interacting medicines, lithium concentration and renal function. Continuing or increasing lithium risks worsening toxicity; do not assume the symptoms are psychiatric.
A strong management plan also identifies who will review the patient, how results will be acted on and how lithium can be restarted safely if appropriate.
10. Psychosis after childbirth
This question tests prioritisation of urgent assessment and safety for a parent and infant.
Ten days after giving birth, a patient has barely slept, speaks rapidly and says the infant has been chosen for a divine mission. They are increasingly disorganised. What is the best next step?
New psychotic symptoms and marked behavioural change soon after childbirth require urgent specialist assessment and attention to safety for both parent and infant. Involve supports and consider an appropriate level of care, including admission if indicated. A routine review or reassurance alone risks missing a serious, time-critical presentation.
Across the set, the strongest answers make the reasoning visible: summarise the problem, identify urgent risks, explain the assessment needed, give prioritised next steps and state follow-up or safety-netting. Avoid claims that go beyond the evidence in the vignette.
From a question to a written answer
Single-best-answer questions train recognition and prioritisation. Written responses also require you to organise a formulation and management plan. In the example below, the candidate makes a reasonable start but does not show enough detail about collateral information or alternatives. The marks shown are a practice-paper result, not an official examination score.
A marked response on first-episode mania could look like this:
A 24-year-old has two weeks of reduced need for sleep, increased activity, pressured speech and grandiose beliefs. They have spent their savings and are refusing assessment. Summarise your formulation, immediate risks and initial management plan.
3/4This is likely mania with psychotic symptoms. There is risk from impaired judgement and spending, and they need urgent psychiatric assessment. I would assess self-harm and harm to others, consider admission and discuss antipsychotic treatment. I would also check physical health and substance use.
Good recognition of a likely manic episode and appropriate attention to risk, admission and treatment. The response identifies physical health and substances but does not say how collateral history or the patient’s capacity and immediate safety will inform disposition.
Missed
−Specify collateral sources and clarify the timeline, baseline function and possible prior episodes.
−State how you will assess capacity, access to means, vulnerability and immediate safety while arranging care.
Model answerThe presentation is concerning for a first manic episode with psychotic symptoms, but I would confirm the timeline and seek collateral about baseline function, previous episodes, substances and medicines. I would assess self-harm, harm to others, vulnerability, capacity and ability to meet basic needs. I would arrange urgent specialist assessment in a safe setting and consider admission according to risk and the applicable legal framework. I would assess physical health and relevant causes, then agree an evidence-informed treatment plan with the patient where possible. I would document the rationale, involve supports appropriately and define follow-up and safety-netting.
That is a MySummaries paper, filled with RANZCP Exams material. Yours is written from your own notes. Start free
Review the marks you lose
Do not use a practice score only to decide whether you “know” a topic. Review the reasoning behind each lost mark. Was a risk domain omitted? Did you jump to a diagnosis without considering medical or substance-related causes? Did your plan name an action, a responsible person and a follow-up point?
A weak-area summary can help direct the next revision session:
Turn a repeated omission into a small retrieval prompt, then practise using it in a fresh case. For example, if your risk answers repeatedly omit access to means, make that a prompt to retrieve and apply, not a sentence to paste into every case.
A remediation prompt might read:
You lost this mark twice: in a suicide assessment, what do you ask about access to means, intent, planning, past behaviour, protective factors and immediate safety?
How MySummaries helps
Build a psychiatry revision board from your own notes, then use it to generate question practice, written mock papers marked against your material, and flashcards for facts or reasoning steps you repeatedly miss. Open MySummaries to start with the content you are revising.