How presentations are examined in the AKT
The AKT is 150 single-best-answer questions in a four-hour paper sitting. In the 2026.1 sitting, 1,117 candidates sat the exam and 80.6% passed, with a pass mark of 67.1% set by the modified Angoff method. The RACGP notes that questions can have between five and ten options, that more than one option may be plausible, and that you must choose the most appropriate one for the scenario.
Presentation questions give a short vignette from the consulting room and ask for the most likely diagnosis, the next step or the most appropriate management. The skill being tested is the general practice one: separating the common and self-limiting from the serious and time-critical, using limited tests, and safety-netting well.
The general practice approach to an undifferentiated symptom
- Is the patient unwell now? Vital signs and appearance decide whether this is an ambulance call or a consultation.
- What must not be missed? Murtagh's diagnostic strategy asks for the probable diagnosis, the serious disorders not to be missed, the pitfalls, the masquerades and whether the patient is trying to tell you something.
- What is most likely? In general practice, common things are common and often self-limiting.
- Which test, if any? Choose tests that change management; avoid "routine bloods" without a question.
- Safety-net: tell the patient what to watch for, when to return and how to get help after hours.
The "masquerades" (depression, diabetes, drugs, anaemia, thyroid disease, spinal dysfunction, urinary infection) are a long-standing teaching tool in Australian general practice.
Chest pain and breathlessness
- Chest pain with ECG changes, ongoing pain, haemodynamic instability or high-risk features needs an ambulance to an emergency department, with aspirin unless contraindicated.
- A normal ECG in the clinic does not exclude acute coronary syndrome; troponin testing belongs in hospital pathways, not a delayed GP blood test.
- Consider pulmonary embolism with pleuritic pain, tachycardia or risk factors, and use a decision rule.
- Musculoskeletal and anxiety-related chest pain are diagnoses of exclusion.
- Breathlessness in older adults: heart failure, COPD, anaemia, AF and medicine side effects are common causes.
Headache, dizziness and neurological symptoms
| Symptom | Red flags | Common GP diagnoses |
|---|---|---|
| Headache | Thunderclap onset, new over 50, fever and neck stiffness, focal signs, papilloedema, pregnancy, immunosuppression | Tension-type headache, migraine, medication-overuse headache |
| Dizziness | New neurological signs, inability to walk, vertical nystagmus, new severe headache | Benign paroxysmal positional vertigo (Dix-Hallpike, then Epley manoeuvre), vestibular neuritis, postural hypotension |
| Transient weakness or speech change | Any: treat as TIA | Urgent same-day assessment, aspirin if no bleeding risk, carotid and brain imaging |
| Back pain | Saddle anaesthesia, retention, bilateral leg symptoms, fever, cancer history, weight loss | Non-specific low back pain: stay active, simple analgesia, avoid early imaging |
Abdominal pain, fever and the unwell child or adult
- Check a pregnancy test in women of reproductive age with abdominal pain.
- Older adults and people taking steroids or immunosuppressants may have serious pathology with few signs.
- Fever with no source in a young infant needs same-day hospital assessment.
- A non-blanching rash with fever is meningococcal disease until proven otherwise: give parenteral benzylpenicillin or ceftriaxone and arrange urgent transfer.
- Returned travellers with fever need malaria excluded the same day.
- Sepsis in general practice: recognise early with vital signs and call an ambulance; do not wait for test results.
Eyes, ENT and skin in the consulting room
| Presentation | Do not miss | Usual GP management |
|---|---|---|
| Red eye | Acute angle-closure glaucoma, keratitis, iritis, penetrating injury | Bacterial conjunctivitis: often self-limiting; chloramphenicol drops if needed |
| Sudden painless vision loss | Central retinal artery occlusion, retinal detachment, giant cell arteritis | Same-day ophthalmology referral |
| Sore throat | Quinsy, epiglottitis, rheumatic fever risk groups | Most are viral; penicillin V for strep in at-risk groups |
| Changing skin lesion | Melanoma | Dermoscopy, excision biopsy with narrow margin |
Emergencies in rural and remote practice
Many registrars train in rural towns where the GP is the emergency service. The AKT expects you to start definitive care while arranging retrieval.
- Anaphylaxis: IM adrenaline 0.5 mg into the lateral thigh for adults, repeated every 5 minutes as needed.
- Snake bite: pressure immobilisation bandage, keep the patient still, and transfer to a centre with antivenom and pathology.
- Acute asthma: salbutamol by spacer or nebuliser, oxygen to target saturations, oral prednisolone, and escalation for life-threatening signs.
- Retrieval: contact the state retrieval service early and stabilise while waiting.
Worked examples
Worked example 1 · Vertigo
A 58-year-old woman has 2 weeks of brief spinning episodes when she rolls over in bed. Neurological examination is normal. The Dix-Hallpike test to the right reproduces vertigo with torsional nystagmus. What is the most appropriate management?
- A Prochlorperazine three times daily for 4 weeks
- B Epley manoeuvre
- C Urgent MRI brain
- D Referral for vestibular rehabilitation only
- E Betahistine long term
Show the reasoning
Answer B. Brief positional vertigo with a positive Dix-Hallpike test and normal neurology is benign paroxysmal positional vertigo of the posterior canal. The Epley canalith repositioning manoeuvre is the most effective treatment. Vestibular suppressants delay compensation and imaging is not needed without red flags.
Worked example 2 · Chest pain
A 61-year-old man with diabetes has 40 minutes of central chest tightness that is now easing. His ECG in your clinic is normal and his observations are stable. What is the most appropriate next step?
- A Order a troponin for tomorrow and review
- B Arrange an outpatient stress test
- C Give aspirin and call an ambulance
- D Start a proton pump inhibitor trial
- E Reassure, as the ECG is normal
Show the reasoning
Answer C. Recent chest pain suggestive of acute coronary syndrome needs emergency assessment with serial ECGs and troponin, even when the pain is easing and the clinic ECG is normal. Give aspirin unless contraindicated and arrange ambulance transfer.
Common traps for registrars
- Ordering tests in the community that delay emergency care.
- Imaging non-specific back pain without red flags.
- Prescribing vestibular suppressants long term.
- Forgetting to safety-net and document it.
- Missing the masquerade: depression, medicines or thyroid disease behind vague symptoms.
Free sample common presentations questions
Questions from our GP AKT bank. Choose your answer, then open the explanation.
A 19-year-old has fever, headache and a non-blanching purpuric rash. The ambulance is 30 minutes away. What is the most appropriate immediate action?
- AGive IM or IV benzylpenicillin or ceftriaxone now
- BGive oral amoxicillin and send him home to rest
- CArrange a lumbar puncture in the clinic room today
- DTake blood cultures and wait for results before acting
- EObserve for 4 hours to see if the rash spreads further
Show answer and explanation
Answer A. Suspected invasive meningococcal disease needs parenteral antibiotics immediately, before transfer, as delay increases mortality. Give benzylpenicillin or ceftriaxone IV or IM, and notify public health.
Learning point: Suspected meningococcal disease: parenteral antibiotics immediately, then transfer.
Ten minutes after a vaccine, a 30-year-old has hives, wheeze and BP 82/50. What is the first drug and route?
- AIV hydrocortisone 200 mg
- BSubcutaneous adrenaline in the arm
- CIM adrenaline 0.5 mg (1:1000) into the thigh
- DOral antihistamine and observe
- ENebulised salbutamol only, repeated every 20 minutes
Show answer and explanation
Answer C. Adrenaline 0.01 mg/kg IM (maximum 0.5 mg; 0.5 mL of 1:1000 for adults) into the anterolateral thigh is the first-line treatment, repeated every 5 minutes if needed. Lie the patient flat (or sitting if breathless), call an ambulance and give oxygen and fluids.
Learning point: Anaphylaxis: IM adrenaline 0.01 mg/kg (max 0.5 mg) anterolateral thigh, repeat every 5 minutes.
A tradesman grinding metal has a red, painful eye. A small rust ring is visible on the cornea. What is appropriate?
- ARub the eye to remove it
- BPad the eye and review in a week, with oral antibiotics in the meantime
- CRemove it; check for penetration
- DSteroid eye drops only
- EIgnore it, as it will wash out
Show answer and explanation
Answer C. High-velocity injuries (grinding, hammering) can cause penetrating eye injury. Check visual acuity, use fluorescein, evert the lid and look for penetration (Seidel test, irregular pupil). Superficial foreign bodies and rust rings can be removed under topical anaesthetic; penetration needs urgent ophthalmology.
Learning point: Grinding injury: check acuity and penetration; remove superficial FB and rust ring; urgent review if penetrating.
Practise more common presentations questions free
Every common presentations subtopic in our bank
The bank holds 25 common presentations questions across 23 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Acute angle-closure glaucoma1
- Acute severe asthma in an adult1
- Acute urinary retention1
- Anaphylaxis in the clinic1
- Asthma first aid1
- Burns first aid2
- Chest pain in general practice1
- Corneal foreign body1
- Ectopic pregnancy1
- Epistaxis in an older patient1
- Epistaxis in general practice1
- Febrile seizure1
- Funnel-web spider1
- Head injury in a child1
- Hypoglycaemia at home1
- Hypoglycaemia in a conscious patient1
- Meningococcal disease in the clinic1
- Paediatric dose of adrenaline1
- Snake bite first aid1
- Snakebite first aid1
- Sudden vision loss1
- Testicular torsion2
- TIA management1
Common questions
Are AKT questions based on Australian general practice?
Yes. The RACGP states that questions are based on clinical presentations typically seen in an Australian general practice setting.
How many options do AKT questions have?
The RACGP reports that AKT questions have between five and ten answer options, with one correct answer.
Do I need to know drug doses for the AKT?
The RACGP notes candidates are not required to provide drug doses, but may need to know the route or frequency.
Which textbook helps with undifferentiated presentations?
Murtagh's General Practice is widely used for its diagnostic strategy, alongside Therapeutic Guidelines and RACGP resources.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.