Medical Licensing Assessment (UKMLA) AKT Questions

The Applied Knowledge Test (AKT) is a multiple choice exam, taken as part of the UK Medical Licensing Assessment. The AKT is a multiple-choice exam using single best answer (SBA) questions. There are two papers, each with 100 questions. 

This post contains ten SBA questions from our AKT question bank. Answer each question, and then scroll to the end of the page to check your answers and read our question explanations. Good luck!

Example AKT questions

Question 1

A 32 year old woman with pelvic inflammatory disease has pain in the right upper quadrant of the abdomen which radiates to the right shoulder. There is a friction rub on auscultation of the anterior costal margin.

Which complication has this patient most likely developed?

• A. Aortitis
• B. Fitz-Hugh-Curtis syndrome
• C. Lymphogranuloma venereum
• D. Pericarditis
• E. Reiter’s syndrome

Question 2

A 32 year old woman has had headaches for several months. These are a throbbing sensation over the right eye, associated with nausea. She takes the combined oral contraceptive pill and uses ibuprofen weekly for analgesia. 

Which is the most appropriate initial management option?

• A. Amitriptyline
• B. Carbamazepine
• C. Codeine
• D. Propranolol
• E. Sumatriptan

Question 3

A 16 year old girl has vomiting and a purpuric non-blanching rash. She has neck stiffness.

Her temperature is 38.2°C, pulse rate 98 bpm, BP 129/87 mmHg, respiratory rate 22 breaths per minute and oxygen saturation 97% breathing air.

Which is the most likely complication of this condition?

• A. Arrhythmias
• B. Avascular necrosis of the jaw
• C. Hearing loss
• D. Otitis externa
• E. Trigeminal neuralgia

Question 4

A 7 year old boy with cerebral palsy has chronic drooling.

Which is the most appropriate initial management?

• A. Botulinum toxin injections
• B. Enteral tube feeding
• C. Oral baclofen
• D. Oral glycopyrronium bromide
• E. Surgical management

Question 5

A 92 year old man with Alzheimer’s disease and ischaemic heart disease has had dyspnoea and a productive cough for 1 week. He has poor mobility, profound cognitive impairment and occasional difficulties swallowing.

His temperature is 38.2°C, pulse rate 85 bpm, BP 125/86 mmHg, respiratory rate 26 breaths per minute and oxygen saturation 95% breathing air. Coarse crackles are heard over his right lung base.

Which is the most likely diagnosis?

• A. Acute bronchitis
• B. Aspiration pneumonia
• C. Bronchiectasis
• D. Left ventricular failure
• E. Pulmonary embolism

Question 6

A 36 year old woman with Addison’s disease has a fever, shortness of breath and chest pain. She takes 20 mg hydrocortisone PO and 100 micrograms fludrocortisone PO daily. There are focal crackles at the left lung base. Antibiotics are prescribed.

Which is the most appropriate management regarding her steroids?

• A. Add dehydroepiandrosterone 6.5 mg PO
• B. Emergency hydrocortisone 100 mg IV
• C. Extra dose of hydrocortisone 20 mg PO
• D. Increase fludrocortisone to 200 micrograms PO
• E. Increase hydrocortisone to 40 mg PO

Question 7

A 17 year old boy has felt anxious since he was involved in a road traffic accident 3 months ago. He has flashbacks and nightmares about the accident and has avoided driving ever since. He gets startled by loud noises.

Which is the most appropriate initial management?

• A. Eye movement desensitisation and reprocessing (EMDR)
• B. Group trauma-focused CBT
• C. Individual trauma-focused CBT
• D. Sertraline
• E. Venlafaxine

Question 8

A 60 year old man has had progressive memory difficulties for 3 months. He has had a few episodes of urinary incontinence and is noticed to have an unsteady, wide-based gait when walking into the examination room.

Which is the most likely diagnosis?

• A. Alzheimer’s disease
• B. Cauda equina syndrome
• C. Lewy body dementia
• D. Normal pressure hydrocephalus
• E. Parkinson’s disease

Question 9

A 14 year old girl with penicillin allergy has had a sore throat for 3 days. She denies having a cough or coryzal symptoms.

Her temperature is 38.2°C, pulse rate 80 bpm, BP 124/60 mmHg, respiratory rate 13 breaths per minute and oxygen saturation 98% breathing air. There is tonsillar exudate and tender cervical lymphadenopathy.

Which is the most appropriate management option?

• A. Clarithromycin
• B. Dexamethasone
• C. Erythromycin
• D. Phenoxymethylpenicillin
• E. Supportive management

Question 10

A 70 year old woman has severe cramping abdominal pain and vomiting for 12 hours. 

Her body mass index is 18kg/m². Her abdomen is generally distended with no focal tenderness or peritonism. There is a small, tender irreducible swelling in the right groin, located below and lateral to the pubic tubercle.

Which is the most likely diagnosis?

• A. Femoral hernia
• B. Inguinal hernia
• C. Obturator hernia
• D. Richter’s hernia
• E. Spigelian hernia

AKT question answers

Question 1

Areas of clinical practice: Sexual health, Obstetrics & Gynaecology

Answer: B

This patient has features of Fitz-Hugh-Curtis syndrome, a complication of pelvic inflammatory disease (PID). This is perihepatitis caused by adhesions between the liver and the anterior abdominal wall or diaphragm. It typically affects women of reproductive age and presents with right upper quadrant pain and friction rub on auscultation. The pain may radiate to the shoulder due to irritation of the diaphragm.

Pericarditis is inflammation of the pericardial sac which is most commonly caused by viruses such as coxsackieviruses A and B, echovirus and adenoviruses. This usually presents with chest pain relieved by sitting forwards, cough, dyspnoea and pericardial friction rub on auscultation.

Reiter’s syndrome is a reactive arthritis which typically develops within 4 weeks of an infection such as chlamydia, salmonella or campylobacter. It causes a triad of arthritis, conjunctivitis and urethritis.

Lymphogranuloma venereum is a complication of certain strains of chlamydia infection. This can cause proctitis, leading to bloody anal discharge or tenesmus.

Aortitis is inflammation of the aorta, which can be caused by tertiary syphilis. This may present with pain in the chest, back or abdomen, fever and fatigue.

Question 2

Areas of clinical practice: General practice and primary healthcare, Neurosciences

Answer: E

This woman is likely experiencing migraines given the history of unilateral throbbing headaches lasting several hours, which are associated with nausea, and the presence of a risk factor for migraines (combined oral contraceptive pill). Sumatriptan is recommended (either alone or in combination with paracetamol or an NSAID) for the acute management of migraines that are not relieved by simple analgesia alone.

Codeine is an opioid which may be used for short-term relief of mild-moderate pain. However, opioids are not recommended for the management of migraines.

Propranolol may be used as a preventive treatment for migraines if symptoms are having a significant impact on quality of life and daily function or if acute treatments are contraindicated or ineffective.

Amitriptyline is a tricyclic antidepressant which may be considered as a preventive treatment for migraines.

Carbamazepine is an anti-epileptic drug which can be used to manage trigeminal neuralgia. Trigeminal neuralgia usually causes episodes of unilateral shooting pains. They last seconds to minutes and are often triggered by light touch over the branches of the trigeminal nerve, eating or talking.

Question 3

Areas of clinical practice: Child health, Neurosciences

Answer: C

This patient likely has meningococcal meningitis given the clinical picture of fever, purpuric non-blanching rash, vomiting and neck stiffness. Meningitis can cause hearing loss due to inflammation of the vestibulcochlear nerve, or damage to hair cells of the cochlea. All children and young people should have a hearing test and paediatrician review 4-6 weeks after discharge from hospital, and urgent assessment for cochlear implants if indicated.

Arrhythmias are not typically associated with meningitis. Common complications of meningitis include hearing loss, seizures, motor deficit and cognitive impairment.

Otitis externa is not a complication of meningitis. However, otitis media (infection of the middle ear) can cause meningitis.

Avascular necrosis of the jaw is associated with long term use of medications which affect bone density, such as corticosteroids.

Trigeminal neuralgia is not a typical complication of meningitis, however it may be caused by other pathologies such as brain tumours or multiple sclerosis.

Question 4

Areas of clinical practice: Child health

Answer: D

Drooling in cerebral palsy is common and can be managed with an anti-muscarinic drug such as oral or enteral glycopyrronium bromide. It is important that drooling is managed in cerebral palsy patients, as pooling of saliva in the throat can cause aspiration and lung infections, and saliva remaining on the chin can cause skin irritation.

Botulinum toxin injections can be used if anti-muscarinic drugs are not tolerated or provide insufficient benefit. However, they are not used first-line as they can, rarely, cause breathing and swallowing difficulties.

Surgical management can be used in drug-resistant cases if a patient has failed to respond to non-invasive management. Surgery would not be recommended first-line.

Baclofen is a GABA agonist which is commonly used in cerebral palsy to manage spasticity. 

Enteral tube feeding could be required if the patient’s oral intake is insufficient to provide adequate nutrition or if there are swallowing difficulties. However, drooling itself is not an indication for enteral tube feeding.

Question 5

Areas of clinical practice: Medicine of older adult, Respiratory

Answer: B

This patient likely has aspiration pneumonia caused by dysphagia. Eating problems are a common complication in people living with advanced dementia. When food is aspirated into the lungs, bacteria can collect and cause pneumonia.

Left ventricular failure is an important differential for patients with cough and dyspnoea on a background of cardiovascular disease. Patients may also present with bibasal lung crepitations and peripheral oedema (with right ventricular failure).

Pulmonary embolism is an important differential in patients with dyspnoea who may have been immobile, such as this patient with poor mobility. However, since this patient has a productive cough and fever, pneumonia is the most likely diagnosis.

Acute bronchitis may present with a productive cough, sore throat and rhinorrhoea. Auscultation of the lungs may reveal wheeze, but acute bronchitis would be unlikely to cause an area of coarse crackles.

Bronchiectasis is a long-term condition characterised by chronic cough and purulent sputum production. Given that this patient has only had symptoms for 1 week, a diagnosis of pneumonia is more likely.

Question 6

Answer: E

Areas of clinical practice: Endocrine and metabolic

This woman likely has pneumonia, given the history of fever, dyspnoea, chest pain and focal crackles on auscultation. During moderate intercurrent illness (e.g. fever >37.5°C, illness requiring bedrest or antibiotics), people with Addison’s disease should double the glucocorticoid dose until recovered. This is because endogenous glucocorticoid production normally increases during illness, so it is important to mimic this natural response in people taking replacement steroids. For this patient, this would involve increasing hydrocortisone to 40 mg until recovered.

Emergency hydrocortisone 100 mg IV may be required if there is severe intercurrent illness (such as significant vomiting, persistent diarrhoea or other severe illness). This can help to reduce the risk of adrenal crisis (acute exacerbation of adrenal insufficiency), which can be precipitated by intercurrent illness.

Increasing fludrocortisone to 200 micrograms is not required during intercurrent illness. Fludrocortisone is a mineralocorticoid used to replace aldosterone.

Dehydroepiandrosterone 6.5 mg (DHEA) is a sex steroid hormone precursor made in the adrenal cortex, so therefore, levels are decreased in Addison’s disease. This is not required during intercurrent illness, but may be prescribed in certain circumstances, such as persistent fatigue.

Giving an extra dose of 20 mg hydrocortisone may be recommended if patients have mild vomiting.

Question 7

Answer: C

Areas of clinical practice: Child health, Mental health

This boy likely has post-traumatic stress disorder (PTSD). Diagnostic criteria for PTSD include over one month of re-experiencing the traumatic event (e.g. through flashbacks or nightmares), deliberate avoidance of reminders of the event, and persistent perceptions of heightened current threat (e.g. enhanced startle reactions). Individual trauma-focused CBT should be considered for children and young people with a diagnosis of PTSD or clinically important symptoms of PTSD. This is typically provided over 6 to 12 sessions and involves processing trauma-related emotions such as shame, guilt, loss and anger.

Group trauma-focused CBT can be considered for the prevention of PTSD in children and young people aged 7 to 17 years if there has been an event within the last month leading to large‑scale shared trauma.

Eye movement desensitisation and reprocessing (EMDR) may be considered for children and young people with PTSD only if they do not respond to or engage with trauma-focused CBT.

Venlafaxine is a serotonin noradrenaline reuptake inhibitor (SNRI) which may be used as a drug treatment for adults with PTSD. However, drug treatments are not recommended for the management of PTSD in children and young people under 18 years old.

Sertraline is a selective serotonin reuptake inhibitor (SSRI) which can be used for adults with a diagnosis of PTSD if they have a preference for drug treatment.

Question 8

Answer: D

Areas of clinical practice: Medicine of older adult, Neurosciences

This patient likely has normal pressure hydrocephalus, which is characterised by a triad of dementia, gait disturbance and urinary incontinence. It is a reversible cause of dementia, which can be managed with ventriculoperitoneal shunting.

Parkinson’s disease typically presents with bradykinesia, rigidity, tremor and postural instability. Patients often take slow, shuffling steps while walking.

Alzheimer’s disease is the most common cause of dementia and is characterised by features such as memory loss, poor concentration, confusion and mood changes.

Lewy body dementia is a Parkinson-plus syndrome characterised by fluctuating cognitive impairment and visual hallucinations.

Cauda equina syndrome can present with urinary dysfunction and gait disturbance. However, cauda equina syndrome typically presents acutely and may have other features such as leg or back pain, saddle paraesthesia and decreased anal tone.

Question 9

Answer: A

Areas of clinical practice: Infection, Child health

This patient likely has tonsillitis with a Centor score of 4 (tonsillar exudate, tender anterior cervical lymphadenopathy, fever over 38°C, absence of cough), which increases the likelihood of a bacterial cause. NICE Guidelines recommend clarithromycin as the first-choice antibiotic if the patient has a penicillin allergy or intolerance.

Phenoxymethylpenicillin is the first-choice antibiotic for children and young people with tonsillitis. However, this patient has a penicillin allergy, so this is not an appropriate option.

Erythromycin may be used if a macrolide is indicated for the management of tonsillitis in a pregnant patient, such as if there is a true penicillin allergy and the benefits of antibiotic treatment outweigh the risks.

Supportive management only, such as analgesia and hydration, may be indicated if the patient is unlikely to benefit from an antibiotic, e.g. if their Centor score is 0, 1 or 2.

Dexamethasone may be given to children with croup (inflammation of the larynx). This typically presents in infants and toddlers with fever and sore throat, along with stridor and a barking cough.

Question 10

Answer: A

Areas of clinical practice: Surgery

This patient has presented with cardinal features of small bowel obstruction and an irreducible groin swelling. The most likely diagnosis in this case is an obstructed femoral hernia. Femoral hernias pass through the femoral canal into the upper medial thigh. They pass behind the inguinal ligament and are typically located below and lateral to the pubic tubercle. They are at very high risk of obstruction or strangulation, as the femoral canal is a narrow space bordered medially by the sharp edge of the lacunar ligament. Femoral hernias are much more common in older women. A low BMI is an important risk factor as it results in decreased amounts of fatty tissue within the femoral canal, creating an empty space which increases the likelihood of herniation. 

Inguinal hernias pass through the inguinal canal into the groin. They run along the upper edge of the inguinal ligament and are typically located above and medial to the pubic tubercle. As the tissues around the neck of the hernia are softer, they have a relatively low risk of obstruction or strangulation. They are the most common type of groin hernia but are much more likely to affect men. 

Obturator hernias are very rare. They pass through the obturator foramen of the bony pelvis into the upper medial thigh. They typically present with small bowel obstruction but are often impalpable on clinical examination due to their small size and deep location within the tissues.

Spigelian hernias are a type of anterior abdominal wall (or ventral) hernia. They pass through the Spigelian fascia lateral to the rectus sheath. They are usually very small and present with localised pain or a lump immediately lateral to the rectus abdominis muscle. They have a fairly high risk of obstruction or strangulation due to the tight fascial layers around the hernia neck. 

A Richter’s hernia involves the partial herniation of one edge of the bowel wall instead of its whole circumference. This phenomenon can affect any type of hernia and can result in serious complications, as the herniated portion of the bowel wall can rapidly become strangulated and ischaemic. However, Richter’s hernias do not obstruct the lumen of the bowel.