MRCPCH Applied Knowledge in Practice (AKP) — Information & Free Practice

About MRCPCH Applied Knowledge in Practice (AKP)

MRCPCH Applied Knowledge in Practice (AKP) · GB

Key exam facts

Provider

The Royal College of Paediatrics and Child Health (RCPCH) runs the examination; computer delivery uses the TestReach platform.

Format

Computer-based best-of-five single best answer (BO5 SBA), taken in a test centre or by online invigilation; two papers on the same day.

Exam questions

Total questions: 120.

Time limit

150 minutes per paper, 300 minutes (5 hours) of answering time in total; check-in and the gap between papers are additional. Approved reasonable adjustments may provide extra time.

Passing score

Criterion-referenced Modified Angoff standard, rather than a fixed percentage pass score. From the 2025.2 diet, judges make two judgements; the mean final judgements determine the examination pass mark.

Exam fee

GBP: UK AKP £659 in 2026 and £680 in 2027; international AKP £929 in 2026 and £960 in 2027. The same fees apply to test-centre and online-invigilation delivery; payment is made for each examination application.

Topics covered

The authority publishes percentage ranges for each content area. The practice percentages below use the midpoint of each range, normalized to 100%; they are not exact percentages published by the authority. Practice question counts may differ slightly because of rounding.

• AKP blueprint group: 8–17% — Official range: 8–17% (Practice allocation: 14.62%)

  • Adolescent Health/Medicine
  • Manage transition of adolescents with chronic health needs to adult services
  • Assess and diagnose risk taking behaviours including non-adherence, self-harm, alcohol and substance misuse and refer to specialist services
  • Assess, diagnose and manage eating disorders; risks and complications of treatment
  • Assess, diagnose and manage sexual health problems including contraception, sexually transmitted disease and teenage pregnancy
  • Behavioural Medicine/Psychiatry
  • Effects of physical diseases on behaviour and vice versa including somatisation disorders in secondary care and when to refer
  • Role of Child and Adolescent Mental Health Services (CAMHS) and appropriate referral
  • Assess, diagnose and manage common emotional and behavioural problems in secondary care and understand when to refer
  • Signs, symptoms and principles of diagnosis and management of ADHD
  • Assess and diagnose important mental health problems including depression, psychosis and early onset schizophrenia; when to refer
  • Presentation of conduct disorders and antisocial behaviour
  • Identify anxiety disorders, phobias, panic attacks and obsessive-compulsive disorders; when to refer
  • Dermatology
  • Assess and diagnose ectodermal dysplasia and epidermolysis
  • Assess, diagnose and manage skin infections in children
  • Assess and diagnose systemic disorders involving the skin; when to refer
  • Assess, diagnose and manage birth marks, naevi and neurocutaneous lesions; appropriate referrals
  • Assess, diagnose and manage drug eruptions, urticaria and dermatitis
  • Aetiology, presentation and management of eczema
  • Ethics and Law
  • Apply legal rights of children and young people within the current UK legal framework
  • Genetics and Dysmorphology
  • Explain and provide advice regarding patterns of inheritance
  • Diagnose and manage common genetic and dysmorphological conditions and make appropriate referrals
  • Advise regarding pre-natal and post-natal screening; subsequent referral and management
  • Effects of environmental factors on development of the fetus, e.g. maternal health, drugs and alcohol
  • Musculoskeletal
  • Assess, diagnose and manage musculoskeletal disorders including systemic manifestations and acute and chronic arthritis; when to refer
  • Assess, diagnose and manage muscular dystrophies, neuropathies, myopathies and myalgia with appropriate specialist advice
  • Assess, diagnose and manage vasculitic disorders with appropriate referral
  • Assess, diagnose and manage specific bone disorders such as scoliosis, developmental dysplasia of the hip and Perthes disease; appropriate referral
  • Nutrition
  • Assess, diagnose and manage malnutrition, obesity and their complications
  • Assess, diagnose and manage specific vitamin, mineral and micronutrient deficiencies
  • Ophthalmology
  • Assess, diagnose and manage visual impairment
  • Assess, diagnose and manage ophthalmological conditions including glaucoma and papilloedema; when to refer
  • Presentation, diagnosis and management of eye tumours and cataract
  • Assess and diagnose ptosis and proptosis; when to refer
  • Assess and diagnose causes of abnormal eye movement including nystagmus and strabismus
  • Palliative Care and Pain Management
  • Ethics of palliative care in life limiting conditions and withdrawal or withholding of care
  • Apply pharmacological and non-pharmacological interventions in children
  • Patient Safety and Clinical Governance
  • Apply patient safety thinking
  • Understand how human factors can be minimised in practice
  • Lead safe and effective handover of key patient concerns, prioritisation of sick patients and allocation of resources
  • Current infection control strategies for epidemic and pandemic infections
  • Risk stratification in relation to prophylactic antiretrovirals
  • Science of Practice
  • Apply evidence based medicine to clinical practice
  • Interpret a research paper or systematic review appropriately

• AKP blueprint group: 25–33% — Official range: 25–33% (Practice allocation: 33.92%)

  • Cardiology
  • Presentations of congenital heart problems at all ages; assess, diagnose, manage and refer
  • Assess, diagnose and manage murmurs, chest pain, palpitations, cardiac arrhythmias and syncope
  • Assess, diagnose and manage heart failure, myocarditis and pericardial diseases
  • Cardiac investigations e.g. ECG, ECHO and catheterisation; appropriate selection in diagnosis and management
  • Assess, diagnose and manage pulmonary and systemic hypertension; appropriate referrals
  • Cardiac complications of other system disorders
  • Indications and common side-effects of drugs for cardiac conditions including duct dependent cyanosis, heart failure and arrhythmias
  • Assess, diagnose and manage infective endocarditis
  • Diabetes Mellitus
  • Assess, diagnose and manage diabetes and its complications including diabetic ketoacidosis
  • Diagnose and manage hypoglycaemia in the diabetic child
  • Endocrinology and Growth
  • Assess, diagnose and manage disorders of the adrenal, thyroid and parathyroid glands
  • Causes and management of pituitary and hypothalamic disorders
  • Identify endocrine complications of other diseases and refer appropriately
  • Causes of growth and puberty problems; assess, diagnose, manage and refer when appropriate
  • Emergency Medicine (including accidents and poisoning)
  • Assess, diagnose and manage shock and cardiac arrest; teach basic life support to a parent
  • Manage life threatening haemorrhage; principles of permissive hypotension, surgical referral, dilution of coagulation factors and early platelets and blood products
  • Assess and provide initial management for children presenting with burns and scalds
  • Assess, diagnose and manage anaphylaxis including acute life threatening upper airways obstruction
  • Assess, diagnose and provide initial management for acute seizures
  • Assess, diagnose and provide initial management for acute neurological emergencies e.g. coma and stroke
  • Manage childhood accidents including trauma and drowning; advise parents on prevention
  • Differentiate life or limb threatening injuries from injuries that can be managed less urgently
  • Initiate management of limb threatening injuries; when to refer urgently
  • Interpret basic trauma x-rays
  • Manage head and spine trauma according to APLS/ATLS guidelines
  • Identify causes and presentations of poisoning; initiate management and anticipate complications
  • Gastroenterology and Hepatology (including surgical abdominal conditions)
  • Assess, diagnose and manage acute abdominal pain; appropriate referrals
  • Assess, diagnose and manage chronic and recurrent abdominal pain
  • Assess, diagnose and manage vomiting and regurgitation
  • Assess, diagnose and manage acute diarrhoeal illness
  • Assess, diagnose and manage chronic diarrhoea and its complications
  • Assess, diagnose and manage food allergies and intolerances; role of the dietician
  • Assess, diagnose and manage constipation, encopresis and their complications
  • Assess, diagnose and manage liver diseases and disorders; appropriate referrals
  • Assess, diagnose and manage gastrointestinal bleeding; appropriate referrals
  • Assess, diagnose and provide initial management of congenital malformations of the gastrointestinal tract and liver
  • Assess and diagnose surgical disorders of the gastrointestinal tract
  • Assess, diagnose and manage malabsorption including coeliac disease
  • Assess, diagnose and manage diseases and disorders of the pancreas
  • Assess, diagnose and manage chronic inflammatory and autoimmune gastrointestinal diseases; when to refer
  • Assess, diagnose and initiate management of hepatitis and hepatic cirrhosis; appropriate referrals
  • Haematology and Oncology
  • Assess, diagnose and manage anaemia including bone marrow failure; when to refer
  • Risks, benefits and precautions involved in blood transfusion
  • Assess, diagnose and manage coagulation disorders, hypercoagulable states, purpura and bruising
  • Assess, diagnose and manage neutropenia
  • Assess, diagnose and refer leukaemias, lymphoproliferative disorders and solid tumours
  • Assess, diagnose and refer side-effects of malignancy treatment; risks and benefits of ionising radiation in investigation and treatment
  • Disease associations of syndromes with propensity to malignancy e.g. hemihypertrophy and Fanconi anaemia
  • Roles of individuals and services in shared care for oncological conditions
  • Practical application and potential complications of bone marrow transplantation and immunosuppressive therapy
  • Metabolism and Metabolic Medicine (including fluid management and acid base balance)
  • Biochemical features of metabolic diseases; undertake and interpret metabolic investigations
  • Assess, diagnose and manage fluid and electrolyte disturbances and disorders of acid-base balance
  • Clinical presentation and prognosis of metabolic diseases; assess, diagnose, initiate management and refer
  • Assess, diagnose and manage metabolic bone disease including rickets
  • Screening for inherited metabolic conditions and implications of positive tests
  • Nephro-urology
  • Assess, diagnose and manage congenital anomalies of the urogenital system
  • Assess, diagnose and manage nephro-urological disorders including systemic manifestations; appropriate referral
  • Assess, diagnose and manage urinary tract infection with appropriate referral
  • Assess, diagnose and manage nephritic and nephrotic syndromes with appropriate referral
  • Assess, diagnose and manage enuresis
  • Select imaging investigations of the urogenital system and interpret the results
  • Assess, diagnose and manage acute and chronic renal failure
  • Neurodevelopment and Neurodisability
  • Assess, diagnose and manage developmental disorders, learning difficulties and causes of disability including cerebral palsy and abnormal movement disorders
  • Speech and language disorders including autism spectrum disorder; when to refer
  • Assess a child with neurodisability and understand principles of management
  • Neurology
  • Indications and limitations of neurophysiological studies e.g. EEG, EMG, BAER and otoacoustic emissions; common abnormal EEG patterns
  • Investigation and management of headache including raised intracranial pressure
  • Assess, diagnose and manage acute infections of the nervous system
  • Assess, diagnose and understand management principles of microcephaly, macrocephaly and hydrocephalus
  • Recognise abnormalities on neuroimaging
  • Assess, diagnose and manage seizure disorders and conditions which may mimic them
  • Pharmacology
  • Initiate safe prescribing and drug prophylaxis
  • Adverse effects and interactions of drugs
  • Explain unlicensed and off-label prescription of drugs to parents
  • Safeguarding
  • Differentiate physical, emotional and sexual non-accidental injury, neglect and fabricated or induced illness from accidental injury, diseases and normal variation
  • Assess and manage physical and emotional abuse and fabricated and induced illness
  • Emotional and behavioural consequences of child abuse and neglect

• AKP blueprint group: 38–50% — Official range: 38–50% (Practice allocation: 51.46%)

  • Infection, Immunology and Allergy
  • Assess, diagnose and manage infections acquired in the UK and overseas including TB and HIV; when to refer
  • Follow UK national guidelines on notification of communicable diseases
  • Implement infection control including control of nosocomial infection
  • Advise primary care on immunisation in children with important medical conditions or unusual circumstances and when complications occur
  • Assess, diagnose and manage allergies
  • Causes and presentations of vulnerability to infection including primary and secondary immunodeficiency; when to refer
  • Assess, diagnose and manage auto-immune disorders with appropriate referral
  • Appropriate and judicious antimicrobials including treatment, prophylaxis and drug resistance
  • Neonatology
  • Advise parents and colleagues on prognosis and complications of high-risk pregnancy including alcohol or drug abuse
  • Assess, diagnose and manage congenital neurological malformations
  • Long-term outcome of high-risk neonates including chronic lung disease and retinopathy of prematurity
  • Manage neonatal feeding, nutrition, fluid and electrolyte disorders including hypoglycaemia
  • Assess, diagnose, manage and minimise congenital and acquired neonatal infection including HIV
  • Current newborn screening practices and management of abnormal results
  • Assess, diagnose and manage congenital anomalies presenting in the neonatal period; appropriate referral
  • Initiate and interpret diagnostic tests and plan initial management for neonatal jaundice
  • Assess, diagnose and manage neonatal neurological disorders; appropriate referral
  • Assess and manage neonatal resuscitation and its complications
  • Assess, diagnose and manage neonatal respiratory disorders with appropriate referral
  • Assess, diagnose and manage birth injury with appropriate referral
  • Assess, diagnose and manage neonatal surgical problems including NEC; appropriate referral
  • Respiratory Medicine with ENT
  • Assess, diagnose and manage hearing impairment
  • Assess, diagnose and manage ear, nose and throat conditions including epistaxis; when to refer
  • Assess, diagnose and manage lower respiratory tract infection in children
  • Assess and diagnose sleep disordered breathing and understand management principles
  • Assess, diagnose and manage wheezing illnesses
  • Assess, diagnose and manage stridor
  • Diagnosis and management of cystic fibrosis and common complications
  • Assess and manage chronic cough including arranging and interpreting investigations
  • Select and interpret respiratory investigations e.g. blood gases, lung function, bronchoprovocation and oximetry
  • Assess, diagnose and manage acute life-threatening events including sudden unexpected death in infancy
  • Indications for long term ventilation and respiratory support; assess and manage acute deterioration

How to prepare

Work through the topics, read the explanation after each answer, and revisit the areas where you miss questions. Use the official outline and reference materials below to guide your study.

These independent practice questions are not actual exam items and do not guarantee a passing result.

Frequently asked questions

Official sources and references

• MRCPCH Theory Examination Syllabi Version 3

  pp. 9–60, AKP column

• MRCPCH Theory Examination Syllabi Version 3

  p. 9, three merged percentage cells

• MRCPCH Theory Examination Syllabi Version 3

  p. 9, middle merged percentage cell

• MRCPCH Theory Examination Syllabi Version 3

  p. 9, bottom merged percentage cell

• RCPCH changes

  Applied Knowledge in Practice (AKP)

• RCPCH about

  What time do the exams start and finish?

• RCPCH results

  Pass marks and feedback

• RCPCH standard

  Standard setting process

• RCPCH about

  How much do the theory exams cost?; AKP UK and international rows

Confirm current exam arrangements with the exam provider.