100+ Free MRCPCH AKP Practice Questions
Pass your MRCPCH Applied Knowledge in Practice (AKP) exam on the first try — instant access, no signup required.
A 6-year-old weighing 20 kg needs paracetamol for fever. The recommended oral dose is 15 mg/kg per dose, up to four times daily. What is the correct single dose and the maximum number of doses in 24 hours?
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Sample MRCPCH AKP Practice Questions
Try these sample questions to test your MRCPCH AKP exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 6-week-old infant presents with a 4-day history of coryza followed by paroxysmal coughing fits ending in vomiting, with episodes of apnoea and colour change. The infant is afebrile. A characteristic inspiratory whoop is not heard. Which single investigation is most likely to confirm the diagnosis at this stage?
2A 3-year-old child presents with fever for 6 days, bilateral non-purulent conjunctivitis, a polymorphous rash, cracked red lips, cervical lymphadenopathy and erythema of the palms. Which investigation is most important to arrange to assess for the principal complication of this condition?
3A 14-year-old returns from sub-Saharan Africa with fever, headache and rigors 10 days after arrival. A thick and thin blood film confirms Plasmodium falciparum with a parasitaemia of 3%. He is alert, with no acidosis and a normal lactate. According to UK guidance, what is the most appropriate first-line treatment?
4A 4-year-old boy has recurrent severe bacterial infections including two episodes of pneumococcal pneumonia and one of meningococcal sepsis, plus a Neisseria infection. Complement studies show a markedly reduced CH50 with normal C3 and C4. Which immunological abnormality best explains this pattern?
5A 2-year-old child develops generalised urticaria, facial swelling, wheeze and hypotension within minutes of eating peanut. The most appropriate immediate treatment is intramuscular adrenaline. What is the correct dose of 1:1000 adrenaline for this child?
6A previously well 8-year-old presents with a 3-week history of fever, malaise, anorexia and a new murmur. He had dental treatment 6 weeks ago. Blood cultures grow Streptococcus viridans and an echocardiogram shows a mitral valve vegetation. What is the most appropriate definitive antimicrobial approach?
7A 10-year-old presents with a 2-week history of fever, weight loss, night sweats and a chronic cough. A chest X-ray shows right hilar lymphadenopathy and a Mantoux test is strongly positive at 18 mm. There are no neurological signs. Which is the most appropriate initial standard treatment regimen for active pulmonary tuberculosis?
8A 5-year-old with sickle cell disease presents with fever 39.5C, lethargy and tachycardia. He had a fever 2 days ago. Considering the principal infective risk in functional asplenia, which is the single most important immediate management step?
9A 7-year-old develops a slapped-cheek facial rash followed by a lacy reticular rash on the limbs, having had a mild febrile illness. She has known hereditary spherocytosis. Her haemoglobin has fallen sharply with a low reticulocyte count. Which organism is responsible and what is the underlying mechanism?
10A 16-year-old presents with sore throat, fever, cervical lymphadenopathy and marked fatigue. Examination shows tonsillar exudates and splenomegaly. A monospot test is positive. Which advice is most important to give this patient?
About the MRCPCH AKP Exam
The MRCPCH Applied Knowledge in Practice (AKP) is the most advanced of the three RCPCH theory exams, testing applied clinical decision-making at the level of a doctor entering specialty training (ST4). It comprises 120 single best answer questions across two 2.5-hour papers and includes data interpretation, imaging, ECGs and evidence-based medicine.
Assessment
Two computer-based papers of 60 single best answer questions each (120 total), sat on the same day, formerly known as MRCPCH Part 2.
Time Limit
Two papers of 2 hours 30 minutes each (5 hours total), taken on the same day
Passing Score
Set per diet by modified Angoff standard setting; there is no fixed published percentage pass mark. The standard-setting process changed from the 2025.2 (April 2025) diet.
Exam Fee
International AKP fee around GBP 929 for 2026 diets; the UK and Ireland fee is lower and reviewed annually. Check the current fee on the RCPCH booking system. (Royal College of Paediatrics and Child Health (RCPCH))
MRCPCH AKP Exam Content Outline
High-weighting subspecialties (Infection/Immunology/Allergy, Neonatology, Respiratory Medicine with ENT)
The three most heavily tested areas: serious infection and sepsis, allergy/immunodeficiency, neonatal medicine, and acute and chronic respiratory and ENT disease.
Core subspecialties (Cardiology, Diabetes, Endocrinology/Growth, Emergency, Gastroenterology, Haematology/Oncology, Metabolism, Nephro-urology, Neurodisability, Neurology, Pharmacology, Safeguarding)
Twelve mid-weighting subspecialties covering acute presentations, chronic disease management, prescribing and child protection.
Supporting areas (Adolescent Health, Behavioural Medicine, Dermatology, Ethics and Law, Genetics, Musculoskeletal, Nutrition, Ophthalmology, Palliative Care, Patient Safety, Science of Practice)
Eleven lower-weighting areas including evidence-based medicine and statistics, ethics and consent, dysmorphology, and patient safety/quality improvement.
How to Pass the MRCPCH AKP Exam
What You Need to Know
- Passing score: Set per diet by modified Angoff standard setting; there is no fixed published percentage pass mark. The standard-setting process changed from the 2025.2 (April 2025) diet.
- Assessment: Two computer-based papers of 60 single best answer questions each (120 total), sat on the same day, formerly known as MRCPCH Part 2.
- Time limit: Two papers of 2 hours 30 minutes each (5 hours total), taken on the same day
- Exam fee: International AKP fee around GBP 929 for 2026 diets; the UK and Ireland fee is lower and reviewed annually. Check the current fee on the RCPCH booking system.
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
MRCPCH AKP Study Tips from Top Performers
Frequently Asked Questions
How many questions are in the MRCPCH AKP exam and how long is it?
The AKP has 120 single best answer questions, split into two papers of 60 questions each. Each paper lasts 2 hours 30 minutes and both are sat on the same day.
What is the pass mark for the MRCPCH AKP?
There is no fixed percentage pass mark. The pass mark is determined for each exam diet using a modified Angoff standard-setting process, and the method was updated from the 2025.2 (April 2025) diet.
Who runs the AKP and what standard does it test?
The AKP is run by the Royal College of Paediatrics and Child Health (RCPCH). It tests applied clinical knowledge and decision-making at the standard of a doctor entering core specialty (ST4) training and was formerly called MRCPCH Part 2.
Which topics carry the most weight in the AKP?
Per the RCPCH blueprint, Infection/Immunology/Allergy, Neonatology and Respiratory Medicine with ENT fall in the highest band (38-50%), followed by twelve core subspecialties (25-33%) and eleven supporting areas including ethics and evidence-based medicine (8-17%).