Reasoning GP · AKT practice

AKT practice questions for the MRCGP

Ten single-best-answer questions in the style of the Applied Knowledge Test, free to read, each with the answer and a worked explanation. They are taken from our bank of about 1,350 questions.

10
free questions on this page
1,399
questions in the full bank
23
categories
5
options per question

How to use these questions

Cover the answer, choose one option and say why the other four are wrong before you open the explanation. The explanation names the guideline the answer rests on, so you can read the source if you got it wrong for a reason you do not understand.

The ten below were chosen for spread: clinical medicine, a statistics calculation, a driving rule and a safeguarding decision. Guidance changes; each question was written against the guidance named in its explanation, and the full bank is reviewed with the rest of the site.

10 sample AKT questions

Question 1 Cardiovascular

A 47-year-old man has a clinic blood pressure of 152/94 mmHg on two readings. Ambulatory monitoring gives a daytime average of 139/87 mmHg. How should his blood pressure be classified?

  1. White-coat hypertension
  2. Stage 2 hypertension
  3. Normal blood pressure
  4. Stage 1 hypertension
  5. Masked hypertension
Show the answer and explanation

Answer: D. Stage 1 hypertension

NICE NG136 diagnoses hypertension when clinic BP is 140/90 or more and the ABPM daytime average is 135/85 or more; clinic 140/90–159/99 with a daytime average of 135/85–149/94 is stage 1. Stage 2 needs clinic BP of 160/100 or more and a daytime average of 150/95 or more. White-coat hypertension would mean a normal out-of-office average. Read the related page.

Question 2 Respiratory

A 35-year-old man has mild pleuritic chest pain after a viral illness. He is haemodynamically stable with normal saturations, and his two-level Wells score for PE is 1.5. What is the most appropriate investigation?

  1. D-dimer, with the result available within 4 hours
  2. Echocardiogram
  3. Thrombophilia screen
  4. No investigation is needed
  5. Same-day CTPA without a D-dimer
Show the answer and explanation

Answer: A. D-dimer, with the result available within 4 hours

In the Wells-unlikely group (4 or less), NICE NG158 recommends a D-dimer with a result within 4 hours (interim anticoagulation if delayed); negative makes PE unlikely, positive leads to same-day imaging. Thrombophilia testing is not routine in acute VTE. Read the related page.

Question 3 Endocrine

A 51-year-old woman has a routine HbA1c of 50 mmol/mol. She has no thirst, polyuria or weight loss. What is the most appropriate next step?

  1. Repeat the HbA1c to confirm before diagnosing diabetes
  2. Diagnose type 2 diabetes and start metformin
  3. Diagnose non-diabetic hyperglycaemia and recheck in a year
  4. Arrange a 75 g oral glucose tolerance test as the only valid confirmatory test
  5. Reassure and recheck in three years
Show the answer and explanation

Answer: A. Repeat the HbA1c to confirm before diagnosing diabetes

Under NICE NG28 an asymptomatic person needs two results of 48 mmol/mol or more (ideally repeated within 2 weeks) before diabetes is diagnosed; one result is enough only with classic osmotic symptoms. 42–47 mmol/mol is non-diabetic hyperglycaemia, which does not apply here. A repeat HbA1c or fasting glucose can confirm, so an OGTT is not the only route. Read the related page.

Question 4 Children

A 4-month-old has had 3 days of coryza, cough and wheeze. Which single finding is an indication for immediate 999 referral under NICE NG9?

  1. Respiratory rate of 62 breaths/minute
  2. A parent reports a pause in breathing (apnoea)
  3. Oxygen saturation persistently at 91% on air
  4. Taking about 60% of usual feeds
  5. Temperature of 38.2°C
Show the answer and explanation

Answer: B. A parent reports a pause in breathing (apnoea)

NICE NG9 advises 999 for apnoea (observed or reported), a seriously unwell appearance, severe respiratory distress (grunting, marked recession or a rate over 70) or central cyanosis. A rate over 60, feeding at 50 to 75% of usual and saturations persistently under 92% on air are consider-referral criteria, not 999 criteria on their own (since the 2021 update). Read the related page.

Question 5 Women’s Health

A 24-year-old woman on the combined pill reports two episodes in the past month of zigzag lines in her vision for 20 minutes followed by a headache. Her blood pressure is normal. What is the most appropriate action?

  1. Stop the combined pill today and switch to a progestogen-only or non-hormonal method
  2. Continue the pill and start a triptan
  3. Switch to a combined pill with a lower oestrogen dose
  4. Switch to the combined vaginal ring
  5. Continue the pill and review in 3 months
Show the answer and explanation

Answer: A. Stop the combined pill today and switch to a progestogen-only or non-hormonal method

Migraine with aura at any age is UKMEC 4 (an unacceptable risk) for all combined hormonal contraception, including the patch and ring, because oestrogen raises ischaemic stroke risk. A new aura on CHC means stopping the oestrogen immediately and switching the same day to a progestogen-only or non-hormonal method (UKMEC 2025). Read the related page.

Question 6 Mental Health

A 21-year-old woman starts sertraline for moderate depression. She has no current suicidal plans. When should she be reviewed?

  1. At 4 weeks
  2. Within 1 week of starting
  3. At 3 months
  4. Within 2 weeks of starting
  5. At 6 weeks
Show the answer and explanation

Answer: B. Within 1 week of starting

NICE NG222 advises review 1 week after starting an antidepressant for people aged 18–25 or at increased suicide risk, because of the possible early rise in suicidal thinking; otherwise review at 2 weeks. Read the related page.

Question 7 Evidence & Statistics

A blood test with sensitivity 90% and specificity 95% is used to screen 1000 asymptomatic adults for a condition with a prevalence of 2%. What is the positive predictive value?

  1. 90%
  2. About 27%
  3. 95%
  4. About 99.8%
  5. About 7%
Show the answer and explanation

Answer: B. About 27%

20 people have the condition: 18 test positive (90%). Of 980 without it, 5% (49) test falsely positive. PPV = 18 / (18 + 49) = 18 / 67, about 27%. The NPV is 931 / 933, about 99.8%; at low prevalence most positives are false even with a good test.

Question 8 Admin & Regulation

A 66-year-old car driver has a single TIA with full recovery and no residual deficit. What does the DVLA require?

  1. Must stop driving for 6 months and notify
  2. No restriction at all
  3. Must notify the DVLA immediately and stop for 12 months
  4. Must stop driving for 3 months and notify
  5. Must not drive for 1 month; need not notify the DVLA if there is no residual deficit after 1 month
Show the answer and explanation

Answer: E. Must not drive for 1 month; need not notify the DVLA if there is no residual deficit after 1 month

After a single TIA or stroke, Group 1 drivers must not drive for 1 month and may resume with satisfactory recovery without notifying, unless a deficit such as a visual field defect persists. Multiple TIAs in a short period mean notifying, with relicensing after 3 months free of events. Read the related page.

Question 9 Ethics & Safeguarding

A mother brings her 4-month-old son, who is not yet rolling, for a cough. You notice a small bruise on his cheek. She says he must have knocked himself in his cot. He is otherwise well. What is the most appropriate action?

  1. Accept the explanation, document it and review in a week
  2. Refer to children’s social care the same day and arrange assessment through the local child protection medical pathway
  3. Ask the health visitor to visit within the next month
  4. Arrange a full blood count and clotting screen and review the results first
  5. Discuss at the next practice safeguarding meeting
Show the answer and explanation

Answer: B. Refer to children’s social care the same day and arrange assessment through the local child protection medical pathway

Under NICE CG89, any bruise in a baby who is not independently mobile means you should suspect maltreatment and refer the same day under the local bruising protocol. Do not delay to gather proof or wait for a meeting; medical causes are considered within the child protection medical assessment. Read the related page.

Question 10 Musculoskeletal

A 48-year-old man has a typical acute first MTP flare. Serum urate taken during the attack is 310 µmol/L. Clinical suspicion of gout remains high. What is the most appropriate next step regarding the urate?

  1. Exclude gout because the urate is below 360 µmol/L
  2. Repeat the urate the following day
  3. Repeat the serum urate at least 2 weeks after the flare has settled
  4. Start allopurinol now to bring the urate down further
  5. Request HLA-B27
Show the answer and explanation

Answer: C. Repeat the serum urate at least 2 weeks after the flare has settled

Urate falls during a flare, so a level below 360 µmol/L does not exclude gout; if suspicion remains strong, repeat it at least 2 weeks after the flare settles (NICE NG219). A urate of 360 or more supports but does not prove the diagnosis, so it is never used alone to exclude or confirm. Read the related page.

Practise the full bank

The full AKT question bank has 1,399 questions with spaced repetition, so the ones you get wrong come back before you forget them. It is part of the Gold and Platinum plans, and a new account can try everything free for 7 days with no card.

Start a 7-day free trialOpen the full question bankSee plans
The 10 questions on this page stay free.

What is in the full bank

Every question has five options, one best answer, an explanation and, where there is one, a link to the protocol or pathway on this site. You can run a mixed test, pick one category, learn new questions or review the ones that are due.

  • Cardiovascular 80
  • Respiratory 65
  • Renal & Urology 55
  • Endocrine 80
  • Gastrointestinal 65
  • Cancer & Haematology 55
  • Neurology 60
  • Mental Health 70
  • Pain & Dependence 35
  • Older Adults 35
  • Children 85
  • Women’s Health 80
  • Sexual Health 35
  • Musculoskeletal 70
  • Dermatology 65
  • Eyes & ENT 65
  • Acute & Infection 69
  • Prescribing Safety 60
  • Palliative Care 35
  • Public Health 35
  • Evidence & Statistics 80
  • Ethics & Safeguarding 60
  • Admin & Regulation 60

Frequently asked questions

Are these real AKT questions?
No. They are original single-best-answer questions written for practice in the style of the exam. None is a recalled exam question.
How many AKT questions are in the full bank?
1,399 at the time this page was built, across 23 categories. Each has a worked explanation, and most link to the protocol or pathway the answer comes from.
Are the 10 questions on this page free?
Yes. They are on this page for anyone to read, with answers and explanations, and no account is needed.
What do I need to open the full question bank?
The AKT question bank is part of the Gold and Platinum plans. A new account has 7 days of full access first, with no card. Prices are on the plans page.
How does the spaced repetition work?
The bank keeps a schedule on your device. Questions you get wrong come back sooner and questions you get right come back later, so a session is weighted towards what you have not yet learned.
Where do I find the official AKT format and dates?
On the RCGP website. Reasoning GP is independent and is not affiliated with or endorsed by the RCGP. We do not publish exam dates, fees or format details for the AKT here; check the RCGP AKT pages.

Related

AKT question bankThe full bank with spaced repetitionMRCGP SCA preparationA self-paced 12-week courseFree SCA casesFive full cases, no accountGP calculators60 clinical scores, with their sourcesNICE and MHRA updatesRecent guidance changes for primary careProtocolsThe guidance the explanations cite

Reasoning GP is independent and is not affiliated with or endorsed by the RCGP. The AKT is run by the Royal College of General Practitioners; for anything official always check the RCGP AKT pages. These questions are original practice material, not exam recalls. They are written for learning and do not predict an exam result.