MRCPCH AKP: question practice and revision.

Choose a topic for focused revision and check your plan against the official specification.

• Acute paediatric presentations — deteriorating child, complex resuscitation, post-arrest care
• Neonatology applied — preterm complications, NICU management, congenital syndromes
• Child neurology and neurodisability — paediatric epilepsy syndromes, NDD, CP
• Respiratory paediatrics applied — severe asthma, CF (incl. CFTR modulators), PCD, ILD
• Cardiology — congenital heart disease, post-operative, channelopathies
• Endocrinology and diabetes applied — DKA, CAH, growth disorders, IFG/IGT, MODY
• Gastroenterology, hepatology, nutrition applied — IBD, paediatric liver, intestinal failure
• Haematology and oncology — acute leukaemia, bleeding disorders, paediatric cancer urgent referral
• Genetics and metabolic — inborn errors of metabolism in the unwell neonate, sequencing strategies
• Infectious diseases applied — paediatric HIV, TB, tropical, immunocompromised host
• Mental health and adolescent care — eating disorders, self-harm, gender identity
• Safeguarding and child protection — complex scenarios, FII, sexual abuse, FGM

Mapped to the published RCPCH AKP blueprint and prioritised using item-density signals across the iatroX bank.

• Paediatric DKA — fluid resuscitation per BSPED 2021 update (10ml/kg if shocked, deficit calculation, insulin starting after 1 hour), cerebral oedema risk factors, hyperosmolar HHS variant
• Status epilepticus — APLS 2021 (lorazepam 0.1mg/kg, then phenobarbitone vs phenytoin vs levetiracetam vs sodium valproate based on epilepsy diagnosis, thiopentone induction)
• Severe asthma escalation — IV salbutamol vs IV magnesium vs aminophylline, NIV indications in children, intubation thresholds, post-arrest care
• Cystic fibrosis — newborn screening pathway, elexacaftor-tezacaftor-ivacaftor (Kaftrio/ETI) age and mutation eligibility, pulmonary exacerbation management, transplant referral indications
• Acute leukaemia presentation in children — recognising patterns (cytopenias, bone pain, organomegaly), urgent referral pathways, oncological emergencies (TLS, mediastinal mass)
• Inborn errors of metabolism in the unwell neonate — recognising acid-base patterns (organic acidaemia), hypoglycaemia patterns (MCAD, GSD), hyperammonaemia (urea cycle), initial stabilisation
• Congenital heart disease — duct-dependent lesions (prostaglandin E1), recognising cyanotic vs acyanotic, post-Fontan circulation considerations
• Safeguarding in MRCPCH — fabricated/induced illness (FII), recognition patterns, escalation framework, complex social-medical decisions, MCA-equivalent for under-16s

Observations from UK paediatric trainees and recent AKP candidates. Verify against current NICE, BSPED, APLS and BTS-paediatric guidance.

Candidate-reported observations — not official guidance.

1. Paediatric DKA fluid management — BSPED updated 2021 guidance changed deficit calculation thresholds (5% vs 10%) and shock fluid bolus volumes. Older revision sources teach the previous algorithm and will lose marks.
2. Anticonvulsant choice in status — sodium valproate now contraindicated in girls of childbearing potential. Choosing valproate in a female adolescent loses marks.
3. Recognising inborn errors of metabolism — pattern recognition (acidotic, ketotic, hypoglycaemic, hyperammonaemic) in the unwell neonate is a high-yield AKP skill but commonly under-prepared.
4. CFTR modulator eligibility — ETI now licensed down to age 2 in some jurisdictions. Side effects requiring monitoring (LFTs, mental health, lens opacities) are tested directly.
5. Distinguishing congenital cardiac lesions — duct-dependent vs non-duct-dependent, where prostaglandin is helpful vs harmful. The PDA-dependent vs PDA-supplied distinction is crucial.
6. Safeguarding — distinguishing FII (fabricated/induced illness) from genuine medical complexity, sexual abuse presentations (anogenital exam findings), FGM legal duty to report.
7. End-of-life decisions in paediatrics — capacity in older children, parental disagreement, role of court (best interests), withdrawal of life-sustaining treatment decisions.
8. Trial-data interpretation — paediatric RCT methodology (cluster randomisation, intention-to-treat in vaccine trials), composite endpoints, NNT for screening programmes.

A pragmatic phased approach used by recent ST3–ST5 paediatric AKP passers.

1. Weeks 1–6

   Foundation pass across all 12 blueprint topics. 30 questions/day with the iatroX adaptive engine. Review current authoritative paediatric emergency, endocrine, sepsis and respiratory guidance alongside weak topics.

2. Weeks 7–11

   Targeted weak-area drilling. Map every relevant NICE paediatric guideline. Pattern-recognition practice for inborn errors of metabolism, congenital heart disease, paediatric oncology presentations.

3. Weeks 12–14

   Two timed 120-SBA mock exams under exam conditions weekly (Paper 1 morning, Paper 2 after break). Practise the higher cognitive load — AKP items demand applied reasoning, not recall. Stamina across the day matters.

4. Weeks 15–16

   Bookmark review only. Targeted reading on safeguarding edge cases, recent CFTR modulator updates, 2025 NICE paediatric updates. Confirm booking. Sleep, hydrate, do not learn new material.

Dedicated MRCPCH AKP question practice with answer explanations, guided Tutor review and study planning.

• Focused question practice — Choose the relevant bank and use your answers to identify what to study next.
• Guided reasoning — Explore a difficult answer with Tutor, then apply the distinction independently.
• Review and timed practice — Return to important mistakes and choose a timed practice set where available.

Choose the relevant bank and use the official exam guidance to plan your preparation.

FOP (Foundation of Practice) is the entry-level theory paper covering core paediatric medicine — pitched at ST1-equivalent. TAS (Theory and Science) covers basic sciences applied to paediatrics — pitched similarly. AKP (Applied Knowledge in Practice) is the most advanced theory paper covering complex applied clinical paediatrics — pitched at middle paediatric training (ST3-equivalent).

Three diets per year. 2026/01: 22 January. 2026/02: 20 May. 2026/03: 16 September. AKP runs on a different day from FOP/TAS within each diet window — typically about 4 weeks earlier than FOP/TAS.

Two papers of 60 best-of-five SBA questions each, 2.5 hours per paper, sat on the same day with a break between. Total 120 questions across the day. Delivered via TestReach (since 2025). The time allowance is longer per paper than FOP/TAS because AKP questions are more complex.

There's no formal restriction — the three theory papers can be sat in any order. Most candidates sit AKP last because of its higher difficulty and clinical-application focus. AKP is typically taken in ST3 once the candidate has substantial clinical exposure.

From the 2024.3 diet onwards, candidates have a maximum of 6 attempts at each of the four MRCPCH parts (FOP, TAS, AKP, Clinical). Previously there was no formal limit.

Both. NICE paediatric guidelines (NG143 fever, NG9 bronchiolitis, NG217 sepsis, NG7 osteoporosis) are core. RCPCH-specific position statements (mental health in paediatrics, transition to adult services) are also examined. APLS 7th edition is essential for resuscitation algorithms.

Full MRCPCH AKP bank access is included in all-access. Up to 10 new sample questions per day are shared across exams, with no account required. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.