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100+ Free MRCGP AKT Practice Questions

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A practice is setting up a recall system to ensure patients with chronic disease receive timely reviews. Which approach best uses the electronic health record to deliver effective, equitable chronic disease management?

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Sample MRCGP AKT Practice Questions

Try these sample questions to test your MRCGP AKT exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man with type 2 diabetes has a clinic blood pressure of 158/96 mmHg confirmed on ambulatory monitoring (average 150/92 mmHg). He has no contraindications. According to current NICE guidance, which is the most appropriate first-line antihypertensive?
A.Ramipril
B.Amlodipine
C.Bendroflumethiazide
D.Atenolol
Explanation: NICE recommends an ACE inhibitor (or ARB) as first-line antihypertensive for people of any age with type 2 diabetes, because of additional renoprotective benefit. Ramipril is therefore preferred regardless of age or ethnicity in diabetic hypertension.
2A 24-year-old woman presents with a 3-day history of dysuria, frequency and suprapubic discomfort. She is not pregnant, has no fever, loin pain or vaginal symptoms, and urinalysis shows nitrites and leucocytes. What is the most appropriate first-line antibiotic according to NICE?
A.Trimethoprim for 7 days
B.Amoxicillin for 5 days
C.Nitrofurantoin for 3 days
D.Ciprofloxacin for 3 days
Explanation: For uncomplicated lower UTI in non-pregnant women, NICE recommends nitrofurantoin 100 mg modified-release twice daily for 3 days as first-line (provided eGFR is adequate). This reflects local resistance patterns where trimethoprim resistance is now common.
3A 6-year-old child is brought in with a barking cough, hoarse voice and mild stridor only when upset. He is alert, well-perfused and feeding. He has no respiratory distress at rest. What is the most appropriate management of this croup?
A.Admit for nebulised adrenaline
B.Inhaled salbutamol via spacer
C.Oral amoxicillin for 5 days
D.Single oral dose of dexamethasone and discharge with safety-netting
Explanation: Mild croup (viral laryngotracheobronchitis) is managed with a single oral dose of dexamethasone (typically 0.15 mg/kg), which reduces airway oedema, plus clear safety-netting. Most children can be managed at home.
4A 45-year-old man requests a statin for primary prevention. His QRISK3 10-year cardiovascular risk is calculated at 14%. He has no established cardiovascular disease, diabetes or chronic kidney disease. Which statement best reflects current NICE guidance?
A.A statin is not indicated as risk is below 20%
B.Atorvastatin 20 mg should be offered as risk is 10% or above
C.Atorvastatin 80 mg should be started immediately
D.Lifestyle change only, with no role for statins
Explanation: NICE recommends offering atorvastatin 20 mg for primary prevention of cardiovascular disease when 10-year QRISK3 risk is 10% or greater, after discussing lifestyle modification. A risk of 14% therefore warrants the offer of a statin.
5A 30-year-old woman with no significant medical history presents with a 2-week history of low mood, anhedonia and poor sleep following a relationship breakdown. She has no suicidal ideation and functions at work. Using a stepped-care approach, what is the most appropriate initial management?
A.Immediate referral to secondary mental health services
B.Start sertraline and review in 2 weeks
C.Active monitoring and guided self-help / low-intensity psychological intervention
D.Commence diazepam to aid sleep
Explanation: For subthreshold or mild depression, NICE stepped care recommends low-intensity psychosocial interventions such as guided self-help, group CBT or active monitoring before considering antidepressants. Routine first-line drug treatment is not advised for mild depression.
6A 62-year-old smoker reports a single episode of painless visible (macroscopic) haematuria. He is haemodynamically stable with no UTI on culture. According to NICE suspected cancer referral guidance, what is the most appropriate action?
A.Refer urgently on a suspected cancer pathway (within 2 weeks)
B.Reassure and repeat urinalysis in 6 weeks
C.Start empirical antibiotics for presumed UTI
D.Arrange a routine ultrasound of the renal tract
Explanation: NICE advises an urgent (2-week-wait) suspected cancer pathway referral for adults aged 45 and over with unexplained visible haematuria without UTI, or that persists/recurs after UTI treatment. A 62-year-old smoker with painless visible haematuria clearly meets this.
7A 70-year-old man with COPD has an FEV1/FVC ratio of 0.58 and reports breathlessness on moderate exertion. He has had two exacerbations in the past year. He already uses a SABA as required. He has no asthmatic features or steroid responsiveness. What is the most appropriate next inhaled therapy per NICE?
A.Add an inhaled corticosteroid alone
B.Add a combined LABA + LAMA inhaler
C.Add a LABA + inhaled corticosteroid
D.Add oral theophylline
Explanation: In COPD without asthmatic/steroid-responsive features, NICE recommends adding a LABA + LAMA combination as the next step after short-acting bronchodilators. This improves symptoms and reduces exacerbations without the pneumonia risk of inhaled corticosteroids.
8A 28-year-old woman who is 8 weeks pregnant attends for booking. She is well with no symptoms. As part of routine antenatal care in the UK, which supplement should she be advised to take to reduce the risk of neural tube defects?
A.Vitamin D 10 micrograms daily only
B.Iron 200 mg daily from booking
C.Folic acid 5 mg daily throughout pregnancy
D.Folic acid 400 micrograms daily until 12 weeks
Explanation: Standard-risk women are advised to take folic acid 400 micrograms daily before conception and until 12 weeks of pregnancy to reduce neural tube defect risk. Vitamin D 10 micrograms daily is also recommended throughout, but folic acid is the key NTD-prevention supplement.
9A 55-year-old woman has an incidental finding of a TSH of 8.5 mU/L (raised) with a normal free T4. She is asymptomatic and thyroid peroxidase antibodies are negative. Which is the most appropriate next step?
A.Start levothyroxine 100 micrograms daily immediately
B.Commence carbimazole
C.Refer urgently to endocrinology
D.Repeat TSH and free T4 in 3 months before deciding on treatment
Explanation: This is subclinical hypothyroidism (raised TSH, normal free T4). With a TSH below 10 mU/L and no symptoms or positive antibodies, the appropriate approach is to repeat thyroid function tests in 2-3 months, as TSH often normalises and treatment may not be needed.
10A 19-year-old man presents with a 24-hour history of severe headache, photophobia, neck stiffness and a non-blanching petechial rash. He is febrile and drowsy. What is the most important immediate action in primary care?
A.Arrange an urgent outpatient CT head
B.Give intramuscular or intravenous benzylpenicillin and arrange emergency admission
C.Prescribe oral antibiotics and review the next day
D.Take blood cultures in the surgery before any treatment
Explanation: A non-blanching rash with meningism and fever suggests meningococcal disease. NICE advises giving parenteral benzylpenicillin (IM or IV) without delay and arranging emergency hospital transfer by 999 ambulance, as early antibiotics save lives.

About the MRCGP AKT Exam

The MRCGP Applied Knowledge Test (AKT) is a computer-based examination assessing the knowledge base behind independent UK general practice within the NHS context. From October 2025 it comprises 160 single best answer questions in 160 minutes, delivered at Pearson VUE test centres four times a year (January, April, July and October).

Assessment

160 single best answer questions split roughly 80% clinical knowledge, 10% evidence-based practice/critical appraisal and 10% primary care organisation and administration.

Time Limit

160 minutes (2 hours 40 minutes), from October 2025

Passing Score

No fixed percentage; the pass mark is criterion-referenced and set per sitting by standard setting. Recent diets have settled around 70%.

Exam Fee

£481 (from August 2025; applies to the October 2025 AKT onwards) (Royal College of General Practitioners (RCGP))

MRCGP AKT Exam Content Outline

80%

Clinical knowledge

Applied clinical medicine across UK general practice: diagnosis, NICE-aligned management, prescribing and safety, paediatrics, women's health, mental health, chronic disease and acute emergencies.

10%

Evidence-based practice and critical appraisal

Research interpretation and statistics, including study design, sensitivity and specificity, confidence intervals, p-values, number needed to treat, meta-analysis and bias.

10%

Primary care organisation and management

Health informatics and administration: information governance and data protection, fitness to drive, safeguarding, quality improvement, ethics, law and consent.

How to Pass the MRCGP AKT Exam

What You Need to Know

  • Passing score: No fixed percentage; the pass mark is criterion-referenced and set per sitting by standard setting. Recent diets have settled around 70%.
  • Assessment: 160 single best answer questions split roughly 80% clinical knowledge, 10% evidence-based practice/critical appraisal and 10% primary care organisation and administration.
  • Time limit: 160 minutes (2 hours 40 minutes), from October 2025
  • Exam fee: £481 (from August 2025; applies to the October 2025 AKT onwards)

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

MRCGP AKT Study Tips from Top Performers

1Anchor your revision in current NICE guidance, the BNF and CKS, as the AKT tests application of UK primary-care management rather than rote recall.
2Practise the statistics and critical-appraisal calculations (sensitivity/specificity, confidence intervals, NNT, p-values) until they are quick, as this 10% is high-yield and often neglected.
3Use timed question banks to build pace at roughly one minute per item, and revise admin topics such as DVLA fitness-to-drive rules, safeguarding, data protection and fit notes.

Frequently Asked Questions

How many questions are on the MRCGP AKT and how long is it?

From October 2025 the AKT has 160 single best answer questions answered in 160 minutes (2 hours 40 minutes), reduced from the previous 200 questions in 190 minutes.

What is the MRCGP AKT pass mark?

There is no fixed percentage pass mark. The cut score is criterion-referenced and set for each sitting by standard setting (a modified Angoff method); recent diets have settled around 70%.

How much does the AKT cost and where is it sat?

The AKT fee is £481 from August 2025 (it was £470 previously). It is a computer-based exam delivered at Pearson VUE test centres across the UK, four times a year in January, April, July and October.

How is the AKT content divided?

Approximately 80% of items test clinical medicine, 10% evidence-based practice and critical appraisal, and 10% health informatics and primary care administration.