Membership of the Royal College of General Practitioners (MRCGP) Applied Knowledge Test (AKT): Clinical Medicine Syllabus

Applied Knowledge Test (AKT): Clinical Medicine syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Applied Knowledge Test (AKT): Clinical Medicine in Membership of the Royal College of General Practitioners (MRCGP), not a summary of it.

1. 1

   Cardiovascular and Respiratory Medicine

   6 topics

   • Cardiovascular risk and primary prevention
     • QRISK3 scoring and statin thresholds
     • Hypertension diagnosis, ABPM/HBPM and NICE targets
     • Lipid management and familial hypercholesterolaemia
   • Ischaemic heart disease and heart failure
     • Stable angina and secondary prevention
     • Chronic heart failure with reduced vs preserved ejection fraction
     • Natriuretic peptide testing pathways
   • Atrial fibrillation and anticoagulation
     • CHA2DS2-VASc and ORBIT/HAS-BLED
     • Rate vs rhythm control; DOAC choice
   • Asthma diagnosis and management
     • Objective testing (FeNO, spirometry, peak flow)
     • Stepwise pharmacological treatment and MART
   • COPD assessment and exacerbation management
   • Venous thromboembolism in primary care
2. 2

   Endocrinology, Metabolic and Renal Medicine

   6 topics

   • Type 2 diabetes management
     • HbA1c targets and glycaemic stepwise therapy
     • SGLT2 inhibitors and GLP-1 agonists indications
     • Diabetic complications screening
   • Type 1 diabetes and insulin regimens
   • Thyroid disorders
     • Hypothyroidism and levothyroxine titration
     • Hyperthyroidism and subclinical thyroid disease
   • Chronic kidney disease classification and monitoring
     • eGFR/ACR staging and referral criteria
     • Nephrotoxic drugs and sick-day rules
   • Adrenal, pituitary and calcium disorders
   • Obesity and metabolic syndrome
3. 3

   Gastroenterology, Infectious Disease and Haematology

   6 topics

   • Dyspepsia, GORD and H. pylori eradication
   • Inflammatory bowel disease and coeliac disease
   • Irritable bowel syndrome and functional gut disorders
   • Liver disease and abnormal LFT interpretation
     • Non-alcoholic fatty liver disease
     • Viral hepatitis screening
   • Common infections and antimicrobial stewardship
     • UTI, cellulitis and respiratory tract infections
     • Antibiotic resistance and prescribing guidance
   • Anaemia investigation and management
     • Iron deficiency vs anaemia of chronic disease
     • B12 and folate deficiency
4. 4

   Neurology, Musculoskeletal and Dermatology

   6 topics

   • Headache classification and red flags
     • Migraine prophylaxis and acute treatment
     • Cluster, tension and medication-overuse headache
   • Epilepsy, Parkinson's disease and tremor
   • Stroke and TIA assessment and prevention
   • Common joint and back problems
     • Osteoarthritis and inflammatory arthritis distinction
     • Low back pain and sciatica red flags
   • Rheumatoid arthritis, gout and polymyalgia rheumatica
   • Common dermatological conditions
     • Eczema, psoriasis and acne management
     • Skin cancer recognition and 2-week-wait referral

Applied Knowledge Test (AKT): Clinical Medicine flashcards for Membership of the Royal College of General Practitioners (MRCGP)

20 of 69 cards from the Applied Knowledge Test (AKT): Clinical Medicine deck — real questions with worked answers.

1. In UK primary prevention of cardiovascular disease, what QRISK3 10-year risk threshold triggers an offer of a statin?

   A 10-year CVD risk of $\geq 10\%$ (QRISK3). Offer atorvastatin 20 mg once daily for primary prevention.

2. What is the recommended target reduction in non-HDL cholesterol after starting a statin for primary prevention, and when is it checked?

   Aim for a $> 40\%$ reduction in non-HDL cholesterol; check a lipid profile at 3 months after starting/changing therapy.

3. For secondary prevention of cardiovascular disease (established CVD), what initial statin and dose does NICE recommend?

   Atorvastatin 80 mg once daily (high-intensity), unless contraindications, drug interactions, or high risk of adverse effects.

4. In stable angina, what two drug classes are recommended as first-line anti-anginal therapy?

   A beta-blocker or a calcium channel blocker (rate-limiting CCB if used alone, e.g. diltiazem/verapamil). Combine a beta-blocker with a dihydropyridine CCB if one alone is insufficient.

5. In chronic heart failure with reduced ejection fraction (HFrEF), what are the four pillars of guideline-directed medical therapy?

   ACE inhibitor (or ARB/ARNI), beta-blocker, mineralocorticoid receptor antagonist (e.g. spironolactone/eplerenone), and an SGLT2 inhibitor (e.g. dapagliflozin).

6. What ejection fraction value defines heart failure with reduced ejection fraction (HFrEF)?

   Left ventricular ejection fraction $\leq 40\%$.

7. Which natriuretic peptide blood test is used in primary care to triage suspected heart failure, and what level mandates specialist referral within 2 weeks?

   NT-proBNP. A level $> 2000\ \text{ng/L}$ ($\approx 236\ \text{pmol/L}$) requires urgent referral and echocardiography within 2 weeks; $400\text{--}2000\ \text{ng/L}$ within 6 weeks.

8. What scoring tool estimates annual stroke risk in non-valvular atrial fibrillation, and what is the male/female threshold for offering anticoagulation?

   CHA$_2$DS$_2$-VASc. Offer anticoagulation at a score of $\geq 2$; consider it in men with a score of $1$ (a score of $1$ in women due to sex alone does not warrant anticoagulation).

9. List the components and point values of the CHA$_2$DS$_2$-VASc score.

   Congestive heart failure (1), Hypertension (1), Age $\geq 75$ (2), Diabetes (1), Stroke/TIA/thromboembolism (2), Vascular disease (1), Age 65–74 (1), Sex category female (1).

10. Which bleeding risk tool does NICE recommend for atrial fibrillation, and what does it predict?

    ORBIT (preferred over HAS-BLED). It predicts the risk of major bleeding to inform decisions and identify modifiable risk factors, not to withhold anticoagulation.

11. In AF, what is the first-line anticoagulant class per NICE, and name two examples?

    A direct oral anticoagulant (DOAC) is first-line, e.g. apixaban, rivaroxaban, edoxaban or dabigatran. A vitamin K antagonist (warfarin) is used if DOACs are unsuitable.

12. What spirometry result confirms airflow obstruction, used in both asthma and COPD?

    A post-bronchodilator $\text{FEV}_1/\text{FVC}$ ratio $< 0.7$ (i.e. $< 70\%$).

13. Under the 2024 BTS/NICE/SIGN guidance, what is first-line maintenance therapy for adult asthma?

    A combined low-dose inhaled corticosteroid/formoterol inhaler used as anti-inflammatory reliever (AIR) therapy, or as maintenance and reliever therapy (MART).

14. Name two objective tests used to support a diagnosis of asthma in adults in primary care.

    Fractional exhaled nitric oxide (FeNO; raised $\geq 40\ \text{ppb}$ supports eosinophilic inflammation) and bronchodilator reversibility on spirometry (an increase in $\text{FEV}_1$ of $\geq 12\%$ and $\geq 200\ \text{mL}$). Peak flow variability is also used.

15. In a life-threatening asthma attack, what oxygen saturation, PEF, and PaCO$_2$ findings are typical?

    SpO$_2 < 92\%$, PEF $< 33\%$ of best/predicted, a silent chest, exhaustion, and a normal or raised PaCO$_2$ ($4.6\text{--}6.0\ \text{kPa}$ is normal — a normal value is concerning in an acute attack).

16. How is the severity of airflow obstruction in COPD graded by FEV$_1$ (% predicted)?

    GOLD/NICE stages: Stage 1 mild $\text{FEV}_1 \geq 80\%$; Stage 2 moderate $50\text{--}79\%$; Stage 3 severe $30\text{--}49\%$; Stage 4 very severe $< 30\%$ predicted.

17. In COPD, what inhaled therapy is offered first-line, and what determines stepping up to triple therapy?

    First-line: a LABA + LAMA combination. Step up to LABA + LAMA + ICS (triple therapy) if there are persistent exacerbations or asthmatic features/steroid responsiveness (e.g. eosinophilia, diurnal variation).

18. What is the standard antibiotic-plus-steroid regimen for an acute infective COPD exacerbation managed in the community?

    Oral prednisolone 30 mg once daily for 5 days, plus an antibiotic (e.g. amoxicillin, doxycycline or clarithromycin) if sputum is purulent or there are clinical signs of pneumonia. Increase bronchodilator use.

19. What is the two-level Wells score cut-off for ruling DVT "unlikely", and what test follows?

    A Wells score of $\leq 1$ means DVT is "unlikely" — perform a D-dimer; if negative, DVT is excluded. A score of $\geq 2$ ("likely") warrants a proximal leg vein ultrasound within 4 hours (or interim anticoagulation plus D-dimer).

20. What is first-line anticoagulation for confirmed DVT/PE in primary care, and the usual minimum treatment duration for a provoked event?

    A DOAC (apixaban or rivaroxaban). Treat for at least 3 months; a provoked VTE is usually stopped at 3 months, while unprovoked VTE is reviewed for longer-term (often $\geq 3\text{--}6$ months or indefinite) treatment.

See more Applied Knowledge Test (AKT): Clinical Medicine flashcards →

Planning Applied Knowledge Test (AKT): Clinical Medicine for Membership of the Royal College of General Practitioners (MRCGP)

Applied Knowledge Test (AKT): Clinical Medicine (Membership of the Royal College of General Practitioners (MRCGP)) FAQ