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Clinical Sciences Flashcards

6 cards from real MRCP PART 1 practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A patient on warfarin has an INR of 8.5 with no active bleeding. According to NICE guidelines, what is the most appropriate management?

    Answer: Stop warfarin and give oral vitamin K 1-5 mg

    For an INR >8.0 without major bleeding, NICE recommends stopping warfarin and administering 1-5 mg of oral vitamin K. FFP or IV vitamin K at high doses is reserved for major bleeding. The INR should be rechecked within 24 hours.

  2. Which acid-base disturbance is most commonly seen in pyloric stenosis?

    Answer: Hypochloraemic hypokalaemic metabolic alkalosis

    Pyloric stenosis causes persistent vomiting of gastric acid (HCl), leading to loss of hydrogen and chloride ions. The kidneys compensate by retaining hydrogen ions and excreting potassium, resulting in hypochloraemic hypokalaemic metabolic alkalosis.

  3. In autosomal dominant polycystic kidney disease (ADPKD), which gene mutation accounts for approximately 85% of cases?

    Answer: PKD1 on chromosome 16

    PKD1 mutations on chromosome 16 account for approximately 85% of ADPKD cases and are associated with more severe disease and earlier onset of end-stage renal failure compared to PKD2 mutations on chromosome 4.

  4. Which cytokine is most important in the pathogenesis of septic shock?

    Answer: Tumour necrosis factor alpha (TNF-alpha)

    TNF-alpha is the key pro-inflammatory cytokine released by macrophages in response to bacterial lipopolysaccharide. It triggers the inflammatory cascade leading to vasodilation, increased vascular permeability, myocardial depression, and multi-organ failure in septic shock.

  5. A 55-year-old man has a plasma osmolality of 295 mOsm/kg but his urine remains maximally dilute at 80 mOsm/kg despite water deprivation. After desmopressin administration, urine osmolality rises to 600 mOsm/kg. What is the diagnosis?

    Answer: Cranial diabetes insipidus

    The failure to concentrate urine despite water deprivation (raised plasma osmolality) indicates diabetes insipidus. The response to desmopressin (synthetic ADH) confirms the kidneys can respond, meaning the problem is insufficient ADH production — cranial diabetes insipidus.

  6. Which HLA type is most strongly associated with ankylosing spondylitis?

    Answer: HLA-B27

    HLA-B27 is present in over 90% of patients with ankylosing spondylitis, making it one of the strongest HLA-disease associations known. However, only about 5% of HLA-B27 positive individuals develop the condition.