skip to main content

Adrenal Crisis — MRCP Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardEndocrinologyAdrenal CrisisMRCP Part 1MRCEM SBAUKMLA

An adult with overactive bladder has persistent urgency and urge incontinence after bladder training. Oxybutynin, tolterodine and solifenacin caused unacceptable cognitive or anticholinergic adverse effects. Mirabegron and vibegron are both clinically suitable and have no practical advantage for this patient. Which prescribing principle follows NICE?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Select the least expensive clinically suitable beta-3 agonist

The best answer is “Select the least expensive clinically suitable beta-3 agonist”. Vibegron is a beta-3 agonist option when antimuscarinics are unsuitable, ineffective or unacceptable. When vibegron and another option such as mirabegron are both suitable after shared discussion, NICE requires the least expensive choice after administration, dose and commercial arrangements are considered. The question therefore tests both pathway position and cost-comparison rule, rather than implying an automatic preference for the newest medicine.

Reference: NICE TA999, Vibegron for overactive bladder syndrome: https://www.nice.org.uk/guidance/ta999/chapter/1-Recommendations