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100+ Free UKMLA AKT Practice Questions

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A 9-year-old boy has a known diagnosis of asthma. He uses a salbutamol inhaler more than three times a week and has nocturnal symptoms. He is not currently on any preventer. Which is the single most appropriate next step in management?

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Sample UKMLA AKT Practice Questions

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

1A 63-year-old man has 2 hours of severe tearing chest pain radiating to his back. He has hypertension and a 60 pack-year smoking history. Pulse is 98 bpm; blood pressure is 192/94 mmHg in the right arm and 156/74 mmHg in the left. Which is the single most appropriate investigation to establish the diagnosis?
A.CT angiogram of the aorta
B.Coronary angiography
C.Exercise tolerance test
D.Transthoracic echocardiogram
Explanation: Tearing chest pain radiating to the back with an inter-arm blood pressure difference is the classic presentation of acute aortic dissection. CT angiography of the aorta is the first-line investigation in a haemodynamically stable patient because it is rapid and accurately defines the extent of the dissection flap.
2A 24-year-old woman presents with sudden breathlessness and pleuritic chest pain 10 days after a long-haul flight. She takes the combined oral contraceptive pill. Heart rate is 112 bpm, respiratory rate 24, and oxygen saturation 93% on air. Her chest X-ray is normal. Which is the single most appropriate next step?
A.Arrange a CT pulmonary angiogram
B.Calculate a Wells score and act on it
C.Start empirical amoxicillin
D.Reassure and discharge with analgesia
Explanation: In suspected pulmonary embolism, the two-level Wells score should be calculated first to stratify probability. A score above 4 makes PE likely and triggers a CTPA; a score of 4 or less prompts a D-dimer. Acting on the validated risk score is the correct structured next step recommended by NICE.
3A 19-year-old man is brought to the emergency department after a collapse at a music festival. He is drowsy with a temperature of 38.9°C, heart rate 130 bpm, blood pressure 88/50 mmHg and a non-blanching purpuric rash. Which is the single most important immediate management step?
A.Arrange an urgent CT head
B.Give intravenous benzylpenicillin or ceftriaxone immediately
C.Perform a lumbar puncture before any treatment
D.Take blood cultures and await results before treating
Explanation: Fever, hypotension and a non-blanching purpuric rash indicate meningococcal sepsis. Immediate broad-spectrum antibiotics (ceftriaxone, or benzylpenicillin in the community) are life-saving and must not be delayed for investigations. Delay to give antibiotics significantly increases mortality in meningococcal disease.
4A 30-year-old woman with known asthma presents acutely breathless. She is unable to complete sentences, has a respiratory rate of 28, heart rate 122 bpm and a peak expiratory flow rate that is 40% of her predicted best. Which feature, if present, would reclassify this as life-threatening rather than acute severe asthma?
A.Heart rate above 110 bpm
B.Inability to complete sentences in one breath
C.Peak flow between 33 and 50% predicted
D.Silent chest on auscultation
Explanation: A silent chest reflects airflow so limited that no wheeze is generated and is a marker of life-threatening asthma. Other life-threatening features include oxygen saturation under 92%, cyanosis, exhaustion, bradycardia, hypotension and an arterial pH abnormality. Acute severe asthma is defined by PEFR 33-50%, respiratory rate ≥25 or heart rate ≥110.
5A 55-year-old man collapses on a ward. He is unresponsive and not breathing normally. The cardiac monitor shows ventricular fibrillation. CPR is in progress and a defibrillator is attached. Which is the single most appropriate immediate action?
A.Deliver a single unsynchronised shock then resume chest compressions
B.Give intravenous adrenaline 1 mg before any shock
C.Give intravenous amiodarone 300 mg before any shock
D.Perform synchronised cardioversion
Explanation: Ventricular fibrillation is a shockable rhythm. In the adult ALS algorithm a single unsynchronised shock is delivered immediately, then chest compressions are resumed for 2 minutes before reassessing the rhythm. Adrenaline and amiodarone are given after the third shock.
6A 28-year-old woman with type 1 diabetes presents unwell. She is drowsy, breathing deeply, and ketotic. Blood glucose is 28 mmol/L, blood ketones 5.2 mmol/L, pH 7.18 and bicarbonate 12 mmol/L. Which is the single most appropriate first treatment?
A.Intravenous 0.9% sodium chloride
B.Intravenous 50% dextrose
C.Intravenous sodium bicarbonate
D.Subcutaneous rapid-acting insulin
Explanation: Diabetic ketoacidosis is treated first with intravenous fluid resuscitation using 0.9% sodium chloride to correct the profound volume depletion. A fixed-rate intravenous insulin infusion is then started, with potassium replacement guided by serum levels. Fluids precede insulin because rehydration alone improves perfusion and acidosis.
7A 40-year-old man is brought in after a paracetamol overdose. He took 30 tablets (500 mg each) as a single ingestion 6 hours ago. He weighs 70 kg. Which is the single most appropriate management decision?
A.Administer activated charcoal now
B.Discharge if he is asymptomatic
C.Start N-acetylcysteine guided by the 4-hour plasma paracetamol level
D.Wait for INR derangement before treating
Explanation: For a single acute overdose, the plasma paracetamol concentration is measured at 4 hours or more post-ingestion and plotted on the treatment nomogram. N-acetylcysteine is started if the level is above the treatment line. At 6 hours post-ingestion a level can be taken and acted upon immediately.
8A 70-year-old woman presents with sudden severe central abdominal pain that is out of proportion to her examination findings. She is in atrial fibrillation and has a raised lactate of 5 mmol/L. Which is the single most likely diagnosis?
A.Acute mesenteric ischaemia
B.Acute pancreatitis
C.Diverticulitis
D.Ureteric colic
Explanation: Pain out of proportion to examination findings, atrial fibrillation (a source of arterial emboli) and a raised lactate strongly suggest acute mesenteric ischaemia from a superior mesenteric artery embolus. CT angiography confirms the diagnosis and urgent surgical or radiological revascularisation is needed.
9A 35-year-old man develops widespread urticaria, lip swelling, wheeze and hypotension minutes after eating peanuts. Which is the single most appropriate first drug, and by which route?
A.Intramuscular adrenaline 500 micrograms
B.Intravenous adrenaline 1 mg
C.Intravenous chlorphenamine 10 mg
D.Intravenous hydrocortisone 200 mg
Explanation: This is anaphylaxis. The first-line treatment is intramuscular adrenaline, 500 micrograms (0.5 mL of 1:1000) into the anterolateral thigh, repeated after 5 minutes if there is no improvement. The IM route is safe and rapidly effective.
10A 22-year-old woman is found unconscious with a respiratory rate of 6 and pinpoint pupils. Her friends say she uses heroin. Which is the single most appropriate immediate pharmacological treatment?
A.Intravenous flumazenil
B.Intravenous glucose
C.Intravenous or intramuscular naloxone
D.Intravenous thiamine
Explanation: Respiratory depression with pinpuint pupils in a known opioid user indicates opioid toxicity. Naloxone, a competitive opioid antagonist, reverses respiratory depression and can be titrated; it has a short half-life so repeat doses or an infusion may be required.

About the UKMLA AKT Exam

The Applied Knowledge Test (AKT) is the written component of the UK Medical Licensing Assessment (UKMLA). It comprises 200 single-best-answer questions over two 100-item papers sat on consecutive days, each lasting two hours. Every item is blueprinted to the GMC MLA content map across 24 areas of clinical practice and 12 areas of professional knowledge.

Assessment

Two computer-based single-best-answer papers of 100 questions each (200 total), sat on consecutive days, each with five answer options and no negative marking.

Time Limit

2 hours per paper (4 hours total across two days)

Passing Score

Pass/fail; no fixed percentage. Each paper is independently standard-set so the cut score varies with question difficulty.

Exam Fee

No separate fee for UK medical students (sat as part of degree finals). International medical graduates take the MLA-compliant PLAB; PLAB 1 costs GBP 283 from 1 April 2026. (General Medical Council (GMC) / Medical Schools Council)

UKMLA AKT Exam Content Outline

10%

Acute and Emergency

Resuscitation, sepsis, anaphylaxis, poisoning and the management of acute cross-system presentations.

10%

Cardiovascular

Acute coronary syndromes, heart failure, arrhythmias, hypertension and valvular and vascular disease.

7%

Respiratory

Asthma, COPD, pneumonia, pulmonary embolism, tuberculosis and interstitial lung disease.

7%

Gastrointestinal including Liver

GI bleeding, inflammatory bowel disease, pancreatitis, liver disease and colorectal red flags.

7%

Neurosciences

Stroke, headache, epilepsy, Parkinson's disease, multiple sclerosis and neuromuscular disorders.

6%

Endocrine and Metabolic

Diabetes, thyroid and adrenal disorders, calcium homeostasis and metabolic emergencies.

6%

Child Health

Paediatric infection, respiratory disease, surgical presentations, oncology and safeguarding.

6%

Obstetrics and Gynaecology

Early pregnancy problems, pre-eclampsia, intrapartum care, contraception and menopause.

5%

Renal and Urology

Acute kidney injury, glomerular disease, hyperkalaemia, urinary tract disease and stones.

5%

Infection

Meningitis, malaria, sexually transmitted infections, antimicrobial choice and tropical disease.

5%

Musculoskeletal

Inflammatory and crystal arthropathies, fractures, back pain red flags and connective tissue disease.

4%

Cancer and Palliative Care

Suspected cancer pathways, staging, oncological emergencies and palliative symptom control.

4%

Mental Health

Depression, psychosis, bipolar disorder, suicide risk and the Mental Health Act.

3%

Clinical Haematology

Anaemias, leukaemias, sickle cell disease and clotting disorders.

3%

Dermatology

Eczema, skin cancers, shingles and common rashes.

3%

Ethics, Law and Professionalism

Consent, capacity, autonomy, the duty of candour and the Fraser guidelines.

2%

Ophthalmology

Acute red eye, glaucoma, visual loss and macular disease.

2%

Ear, Nose and Throat

Hearing loss, vertigo, Meniere's disease and ENT red flags.

2%

Medicine of the Older Adult

Delirium, falls, frailty and polypharmacy review.

2%

Prescribing and Clinical Pharmacology

Safe prescribing, interactions, drugs in pregnancy and adverse effects.

2%

Population Health and Research Methods

Evidence appraisal, screening, diagnostic accuracy and number needed to treat.

How to Pass the UKMLA AKT Exam

What You Need to Know

  • Passing score: Pass/fail; no fixed percentage. Each paper is independently standard-set so the cut score varies with question difficulty.
  • Assessment: Two computer-based single-best-answer papers of 100 questions each (200 total), sat on consecutive days, each with five answer options and no negative marking.
  • Time limit: 2 hours per paper (4 hours total across two days)
  • Exam fee: No separate fee for UK medical students (sat as part of degree finals). International medical graduates take the MLA-compliant PLAB; PLAB 1 costs GBP 283 from 1 April 2026.

Keys to Passing

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

UKMLA AKT Study Tips from Top Performers

1Use the GMC MLA content map as your blueprint: every question is mapped to one of its presentations or conditions, so work systematically through the 24 areas of clinical practice rather than revising paper 1 and paper 2 separately.
2Practise single-best-answer technique under timed conditions: with about 72 seconds per question, learn to identify the single best option among plausible distractors rather than recalling isolated facts.
3Anchor your revision in UK practice standards such as NICE guidance, the BNF and NICE CKS, and use placements to build the clinical reasoning the exam rewards.

Frequently Asked Questions

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

The AKT has 200 single-best-answer questions delivered as two 100-question papers on consecutive days. Each paper lasts two hours, giving roughly 72 seconds per question, and there is no negative marking.

What is the pass mark for the AKT?

The AKT is pass/fail with no fixed percentage. Each paper is independently standard-set by assessment experts, so the cut score varies between papers to account for differences in question difficulty.

Is there a fee to sit the UKMLA AKT?

UK medical students do not pay a separate fee because the AKT is embedded within their degree finals. International medical graduates meet the same standard through the GMC's PLAB test, with PLAB 1 costing GBP 283 from 1 April 2026.

Who has to pass the AKT?

All students graduating from UK medical schools in 2024-25 or later must pass the AKT and the Clinical and Professional Skills Assessment (CPSA) before joining the GMC register. International medical graduates demonstrate the standard via the MLA-compliant PLAB.