Free MRCGP AKT Practice Questions — AKT Navigator by Medexia

These are real single-best-answer (SBA) questions from the AKT Navigator question bank, built for UK GP trainees preparing for the MRCGP Applied Knowledge Test (AKT). Each question below includes the correct answer and a full structured explanation aligned to NICE, CKS and the BNF, plus the reasoning for why each incorrect option is wrong. No account is needed to try the demo.

Question 1 — Cardiology

Question: A 60-year-old with COPD on theophylline presents with SVT. Vagal manoeuvres fail. Regarding treatment, Which statement is true?

A. Theophylline potentiates adenosine—lower dose
B. Theophylline antagonises adenosine—higher dose may be required (correct answer)
C. Adenosine is contraindicated with theophylline
D. Use IV digoxin instead
E. Go straight to DC cardioversion

Understanding the Question

✅ Correct answer: B — Theophylline antagonises adenosine—higher dose may be required

🧩 Key Question Clues

60-year-old with COPD on theophylline → chronic theophylline therapy may interact with emergency drugs and suggests reactive airways disease is present.
Presents with SVT → this is an acute narrow-complex tachyarrhythmia where adenosine is commonly used after vagal manoeuvres fail.
Vagal manoeuvres fail → next step is pharmacological cardioversion rather than repeating vagal only.
Question asks about adenosine → focus on drug interactions, efficacy and safety in this patient.

🎯 What RCGP Examiners Expect You to Know / Are Testing

AKT candidates are expected to know that theophylline is an adenosine antagonist and can reduce the effect of adenosine, so higher doses may be needed to terminate SVT.
Adenosine is the first-line intravenous drug for regular SVT after unsuccessful vagal manoeuvres, but its effect and safety can be altered by co-prescribed drugs and lung disease.
Adenosine can provoke bronchospasm in patients with reactive airways disease, so use with caution in COPD/asthma and consider risks and benefits before administration.

🧠 AKT Learning Point

SVT — acute management

Adenosine is the drug of choice for acute regular SVT after failed vagal manoeuvres, but interactions like theophylline may reduce its effect.
Theophylline antagonises adenosine; a higher adenosine dose may be required, but monitor closely for bronchospasm in COPD.
If adenosine is unsuitable or ineffective, escalate to alternative pharmacological agents or electrical cardioversion as clinically indicated.

Key points to remember for your AKT exam

First-line in GP

For regular narrow-complex SVT: try vagal manoeuvres first; if ineffective and patient is stable, adenosine is the usual next step in a monitored setting.
Per current NICE/RCUK: adenosine is effective for AVNRT/AVRT termination; if unstable, synchronised DC cardioversion is indicated.

Prescribing & monitoring (BNF)

Methylxanthines antagonise adenosine; adenosine may be less effective and higher doses may be required.
Give adenosine as a rapid IV bolus with immediate flush under continuous ECG monitoring; expect transient AV block/asystole and brief chest discomfort/flushing.
Key interactions: theophylline/aminophylline reduce effect (may need higher dose); dipyridamole potentiates effect (use lower dose or avoid); carbamazepine increases risk of prolonged AV block.
Respiratory caution: risk of bronchospasm in asthma/active wheeze; COPD alone is not an absolute contraindication—assess for current wheeze.

When to add / switch / stop

If adenosine is contraindicated or ineffective after escalation, consider verapamil (avoid with beta-blockers, HFrEF, or WPW with AF), or seek urgent cardiology input.
If at any point the patient becomes haemodynamically unstable, proceed to immediate DC cardioversion.

Safety-net & review (GP)

Use adenosine only where advanced life support facilities and continuous ECG are available; otherwise arrange urgent transfer.
After termination, observe for recurrence; consider triggers (e.g., stimulants, theophylline levels) and arrange cardiology follow-up if recurrent episodes.

Why the other options are wrong

Option	Option text	Why wrong
A	Theophylline potentiates adenosine—lower dose	Opposite effect.
C	Adenosine is contraindicated with theophylline	Not absolute CI.
D	Use IV digoxin instead	Not effective for AVNRT termination.
E	Go straight to DC cardioversion	Not first-line if stable.

Question 2 — Statistics

Question: A primary prevention trial shows a statin reduces 5‑year myocardial infarction risk from 10% to 7%. What is the number needed to treat (NNT) to prevent one myocardial infarction? Select ONE option only.

A. 3
B. 0.03
C. 34 (correct answer)
D. 300
E. 33

Understanding the Question

✅ Correct answer: C — 34

🧩 Key Question Clues

Imagine 100 people on no statin; about 10 get an MI in 5 years, but with statin only 7 do.
Picture this: the drop is 3 out of 100, so we ask “how many to treat to help 1 person?”.
Imagine lining up patients one by one; NNT tells you how many you’d need to treat to stop one MI.

🎯 What RCGP Examiners Expect You to Know / Are Testing

AKT candidates are expected to know that NNT = 1 divided by the absolute risk reduction.

$\mathrm{NNT} = \frac{1}{ ext{absolute risk reduction}}$

First find the absolute risk reduction (the simple difference in risks), then invert it.
Imagine two groups over 5 years: 10% vs 7%; the difference is 3% (0.03), so 1 ÷ 0.03 ≈ 33.33, and we round up to 34.

$\frac{1}{0.03} \approx 33.33$

🧠 AKT Learning Point

Numbers needed to treat (NNT) — quick and safe method

Absolute risk reduction (ARR) is the simple drop in risk: control risk minus treatment risk.
NNT = 1 ÷ ARR (use proportions like 0.10 and 0.07, not percentages like 10 and 7).

$\mathrm{NNT} = 1 \div \mathrm{ARR}$

Always round NNT up to the next whole person to avoid overstating benefit (33.33 → 34).
State the time frame because NNT changes with time (here, 5-year NNT = 34).

$ ext{NNT} = 34$

Imagine 100 similar patients: without statin 10 have an MI; with statin 7 do; the 3 helped per 100 means about 1 helped per 34 treated.
Why 34 is best: it uses 1 ÷ 0.03 and rounds up; 3 and 0.03 are just the ARR, 300 is a scaling error, and 33 wrongly rounds down.

Key points to take away for your AKT exam

Step 1 — What is this question really asking?

Big idea: Turn the absolute risk drop into NNT by inverting it.
Find the risks: control 10% (0.10) and treatment 7% (0.07).
Subtract to get ARR: 0.10 − 0.07 = 0.03 (3%).

$0.10 - 0.07 = 0.03$

Step 2 — How to sort and answer the options

Convert to proportions before calculating: 10% → 0.10 and 7% → 0.07.
Invert the ARR: NNT = 1 ÷ 0.03 = 33.33.

$NNT = 1 \div 0.03 = 33.33$

Always round up: 33.33 becomes 34, not 33.

Common traps

Traps: Using 3% as NNT (it’s ARR) like calling a yard a mile; forgetting to invert like reading a map upside down; rounding down instead of up like counting 9.6 as 9 and overstating benefit

Applying this in practice

Say it clearly: “We’d treat 34 people for 5 years to prevent one MI.”
Use absolute terms to support shared decisions with patients.
Remember NNT depends on time frame and baseline risk.

Guideline Lens

Guideline lens: RCGP AKT Exam Blueprint — Statistics

Why the other options are wrong

Option	Option text	Why wrong
A	3	This is the size of the risk drop in percentage points (3%), not NNT. This is weaker than the correct answer because NNT must be 1 divided by this drop. Using 3 would mean only three people treated help one person, which is not true here.
B	0.03	This is the absolute risk reduction as a proportion (0.03). This is weaker than the correct answer because you must invert it to get NNT. Stopping at 0.03 misses the last step.
D	300	This looks like someone scaled the numbers wrongly (thinking per 1000). This is weaker than the correct answer because NNT = 1 ÷ 0.03 ≈ 33.33, not 300. It overstates how many need treatment by a lot.
E	33	This is the inverted value rounded down. This is weaker than the correct answer because NNT must be rounded up to avoid overstating benefit. 33.33 becomes 34, not 33.

Question 3 — genomic medicine

Question: A 28-year-old woman asks about genetic testing. Her father developed colorectal cancer aged 72 and her paternal aunt had endometrial cancer aged 68. Her paternal grandfather had colorectal cancer aged 74. There are no other affected relatives and no known polyposis. She is asymptomatic and asks if she should be referred for FAP testing now.

A. Reassure: FAP testing not indicated (correct answer)
B. Refer for Lynch syndrome assessment
C. Refer for FAP gene testing
D. Refer to genetics: moderate-risk CRC
E. Refer for BRCA testing

Understanding the Question

✅ Correct answer: A — Reassure: FAP testing not indicated

🧩 Key Question Clues

CRC in father at 72 → late-onset; not typical of FAP (usually much earlier)
Paternal grandfather CRC at 74 → another late-onset CRC; does not suggest a high-penetrance polyposis syndrome
Paternal aunt endometrial cancer at 68 → can be seen in Lynch syndrome, but age is relatively late and family pattern is not strongly suggestive
No known polyposis → key negative; FAP is characterised by multiple (often hundreds) of adenomatous polyps
Asymptomatic 28-year-old requesting FAP testing “now” → without clinical features or strong family history, FAP testing is not indicated in primary care

🎯 What RCGP Examiners Expect You to Know / Are Testing

AKT candidates are expected to know that FAP is unlikely when colorectal cancers occur at older ages and there is no history of multiple adenomatous polyps.
AKT candidates are expected to know the typical FAP phenotype: numerous colorectal adenomas (often from teens), very high CRC risk, and early-onset CRC if untreated.
AKT candidates are expected to recognise that genetic testing is guided by phenotype and family history; indiscriminate testing is not recommended.
AKT candidates are expected to differentiate polyposis syndromes (e.g., FAP) from non-polyposis hereditary CRC (e.g., Lynch) and from sporadic late-onset cancers.

🧠 AKT Learning Point

Cancer Genetics: when fap is NOT indicated

FAP testing is not indicated when there is no personal/family history of multiple adenomatous polyps and cancers are late-onset (e.g., CRC in 70s).
Classic FAP typically presents with numerous adenomas and/or early CRC; absent these features, reassure and manage based on standard familial CRC risk pathways rather than FAP testing.

Key points to remember for your AKT exam

When to refer (urgent / 2WW / routine)

Consider FAP/APC testing when there is a phenotype suggestive of polyposis, e.g. multiple colorectal adenomas (often >10–20), very early-onset CRC with polyposis, or a known familial APC variant.
A small number of late-onset CRC cases without polyposis features usually does not justify FAP testing in primary care.
Consider Lynch assessment when there is stronger suggestion: early-onset CRC/endometrial cancer, multiple Lynch-associated tumours, or clear multi-generational clustering at younger ages.

Patient counselling

Explain that most CRC is sporadic and that FAP is rare and typically presents with many polyps and/or earlier cancers.
Offer lifestyle risk reduction advice (weight, activity, alcohol, smoking) and advise to re-attend if family history changes (new diagnoses, younger ages, multiple polyps).
Watch for: rectal bleeding, persistent change in bowel habit, unexplained weight loss, iron-deficiency anaemia symptoms, abdominal mass.

Safety-net & review (GP)

Update the pedigree if any relative develops CRC/endometrial cancer at a younger age, multiple primaries, or if anyone is found to have multiple adenomas.
If she develops symptoms suggestive of CRC, manage via standard pathways (including 2WW where indicated), independent of genetic testing.

Guideline Lens

NICE NG151 Colorectal cancer (2020)

Why the other options are wrong

Option	Option text	Why wrong
B	Refer for Lynch syndrome assessment	Not indicated because the family cancers are late-onset and do not meet typical Lynch referral patterns; it would be correct with early-onset CRC/endometrial cancer or multiple Lynch-associated cancers across generations.
C	Refer for FAP gene testing	Not indicated because there is no personal history of multiple adenomas and no family history of polyposis; it would be correct if she or a close relative had >10–20 adenomas, confirmed FAP, or early-onset CRC with polyposis.
D	Refer to genetics: moderate-risk CRC	Not appropriate because this family history does not clearly meet moderate-risk CRC surveillance thresholds; it would be correct with stronger clustering (e.g., multiple close relatives with CRC, especially younger ages).
E	Refer for BRCA testing	Not relevant because the cancers described suggest bowel/uterine pathways rather than hereditary breast/ovarian cancer; it would be correct with breast/ovarian cancer patterns (e.g., young breast cancer, ovarian cancer, male breast cancer).

Question 4 — Statistics

Question: A device company has developed a fast-acting nasal spray for exercise-related rhinitis. They plan a study in healthy adult runners attending two sessions a fortnight apart. At each visit, participants are randomised to receive either the active spray or an identical placebo, with both participant and assessor masked. After a one‑week washout, they return to receive the alternative spray. The primary outcome is time to symptom relief after a standard treadmill run. Which clinical trial design best describes this study? Select one option only.

A. Case series
B. Case–control study
C. Crossover trial (correct answer)
D. Prospective cohort study
E. Parallel-group randomised controlled trial

Understanding the Question

✅ Correct answer: C — Crossover trial

🧩 Key Question Clues

Imagine each runner tries both sprays on different days, like testing two shoes one after the other.
Picture this: the order is shuffled by chance, and nobody knows which spray is which.
Imagine a pause week so the first spray’s effect fades before trying the second one.

🎯 What RCGP Examiners Expect You to Know / Are Testing

AKT candidates are expected to know that in a crossover trial, every person receives both treatments in a random order with a washout.
Here, runners get active spray once and placebo once, with order randomised and both blinded, which fits crossover design.
Imagine two sessions: first visit one spray, second visit the other, so each runner is their own control.

🧠 AKT Learning Point

Crossover vs parallel trials for treatment questions

A crossover trial means each person gets Treatment A and Treatment B, in random order, with a washout (a gap so the first treatment wears off).
It works best when the condition is stable and the treatment acts quickly and reversibly (like a fast-acting nasal spray after a run).
Picture this: 20 runners do two treadmill sessions; coin toss decides who gets active first; next week they swap; we compare each runner with themselves.
Benefits: each person is their own control, which reduces differences between people and needs fewer participants.
Risks: carryover (leftover effect leaking into the next period) and period effects (people perform differently just because it’s week 1 vs week 2).
Why it’s right here: randomised order, blinding (no one knows which spray), and a one‑week washout fit a classic crossover.
Why others are weaker: a parallel-group randomised controlled trial keeps people in one arm only; a cohort or case–control study only watches, it doesn’t assign treatments; a case series just describes cases without comparison.

Key points to take away for your AKT exam

Step 1 — What is this question really asking?

Big idea: Which study design uses the same people to try both treatments in random order?
Ask yourself: Is this an experiment that assigns treatments, or just watches?
Answer: Randomised and blinded assignment shows an experiment testing an intervention.
Ask yourself: Do participants switch to the other treatment after a gap?
Answer: Yes, they receive active then placebo (or vice versa) with a washout, so crossover trial.

Step 2 — How to sort and answer the options

Ask yourself: Is there randomisation and blinding to compare treatments fairly?
Answer: Yes, matching the design called "Crossover trial".
Ask yourself: Do people stay in one arm the whole time (parallel) or swap (crossover)?
Answer: They swap after a week, so not "Parallel-group randomised controlled trial".

Common traps

Traps: Don’t call it prospective cohort if treatments are assigned (like a trial); don’t call it case–control if it looks forward and tests an intervention (like a trial); don’t call it case series if there’s randomisation, placebo, and a comparator (like an RCT)

Applying this in practice

Look for clues: random order, washout, and the same people trying both treatments.
Check the condition is stable and treatment is short-acting and reversible.
If everyone stays in one arm only, think parallel-group, not crossover.

Guideline Lens

Guideline lens: RCGP AKT Exam Blueprint — Statistics

Why the other options are wrong

Option	Option text	Why wrong
A	Case series	A case series is a simple description of a few patients’ experiences. This is weaker than the correct answer because there is no randomisation, placebo, or swap-over. Imagine just writing up how five runners felt after a spray with no comparison.
B	Case–control study	A case–control study compares people with an outcome to those without and looks back at exposures (past things). This is weaker than the correct answer because it does not assign treatments or include a washout and swap. It is observational (just watching), not an experiment.
D	Prospective cohort study	A prospective cohort study follows groups forward without assigning treatments by chance. This is weaker than the correct answer because here treatments are randomised and alternated within the same people. Cohorts observe exposure; they don’t randomise or cross over.
E	Parallel-group randomised controlled trial	A parallel-group randomised controlled trial keeps each person in one arm for the whole study. This is weaker than the correct answer because in the stem each runner gets both active and placebo after a washout. Parallel means no swapping; crossover means deliberate swapping.

Question 5 — Children And Young People

Question: In a 4‐year‐old with persistent oppositional behaviour, which outcome is most directly improved by evidence‐based group parent‐training programmes over the next 6‐12 months? Select ONE option only.

A. Language delay
B. Parental stress
C. Disruptive behaviours at home and nursery (correct answer)
D. Core ADHD symptoms
E. School attendance

Understanding the Question

✅ Correct answer: C — Disruptive behaviours at home and nursery

🧩 Key Question Clues

4‑year‑old with persistent oppositional behaviour → think early disruptive behaviour/ODD-type problems in a preschool child that often respond to parenting interventions.
Group parent‑training programmes → focus is on changing parent strategies and child behaviour rather than treating language or ADHD core symptoms.
Outcome measured over the next 6–12 months → short‑to‑medium term behavioural change at home/nursery is the realistic target.
Question asks for the MOST directly improved outcome → choose the effect most closely linked to parent‑training (behavioural problems), not wider issues like school attendance or language.

🎯 What RCGP Examiners Expect You to Know / Are Testing

AKT candidates are expected to know that evidence‑based group parent‑training programmes primarily reduce disruptive and oppositional behaviours in young children.
These programmes teach consistent parenting strategies which directly change child behaviour at home and often generalise to nursery settings.
They are not interventions for core ADHD symptoms, language delay, or guaranteed to improve school attendance in the short term.

🧠 AKT Learning Point

Behavioural problems in children

Evidence‑based parent‑training (group or individual) is the first‑line intervention for young children with oppositional/disruptive behaviour.
The main measurable benefit over 6–12 months is reduction in disruptive behaviours at home and often at nursery.
Address parental techniques and consistency; other concerns (language, ADHD) need separate assessment and targeted interventions.

Key points to remember for your AKT exam

First-line in GP

Offer evidence‑based group parent‑training/education (e.g. Incredible Years, Triple P) for preschool conduct problems. Improves parenting skills, consistency and positive reinforcement.
Primary outcome within months: reliable reduction in observed disruptive behaviours across settings (fewer tantrums, aggression, non‑compliance at home and early‑years settings).
NICE/CKS: prioritise early identification, offer group programmes, and review progress.
Medications are not indicated for conduct problems in under‑5s.

When to refer (urgent / 2WW / routine)

Assess for comorbidities: ADHD, ASD, and language difficulties; consider safeguarding and family stressors.
Refer to CAMHS/early help if severe impairment, risk, or non‑response to parent‑training.
Language delay needs specific SALT assessment/therapy; not a primary outcome of parent‑training.
Core ADHD symptoms require targeted assessment/management; parent‑training for conduct alone will not reliably reduce inattention/hyperactivity.

Safety-net & review (GP)

Expect measurable improvement in disruptive behaviours within months (6–12 months horizon); review progress and engagement; escalate if persistent impairment or risk.
Watch for: escalating violence or aggression, risk of harm to self or others, suspected abuse or neglect, significant sleep disruption with daytime impairment, pervasive difficulties across settings (home and nursery), parental mental‑health crisis.

Prescribing & monitoring (BNF)

Do not start antipsychotics or other psychotropics in primary care for under‑5 conduct problems; no routine pharmacological role per current NICE.
School/nursery attendance is variably influenced and not a consistent direct outcome of parent‑training in this age group.
Parental stress may improve secondarily, but the most consistent measured effect is reduced child disruptive behaviour.

Guideline Lens

NICE CG158 (2013) Antisocial behaviour and conduct disorders in children and young people; CKS Behavioural problems in children

Why the other options are wrong

Option	Option text	Why wrong
A	Language delay	Parent‑training is not designed to remediate language deficits; suspected speech/language delay warrants assessment and SALT referral.
B	Parental stress	Parental wellbeing can improve, but reductions in child disruptive behaviour are the primary, most consistent effect; caregiver stress change is secondary and variable.
D	Core ADHD symptoms	ADHD symptoms require targeted assessment and management pathways; parent‑training for conduct problems does not reliably reduce core inattention/hyperactivity.
E	School attendance	Attendance is influenced by broader factors; in early years it is not a consistent, direct outcome of parent‑training for conduct issues.