Here’s an example AKT question related to COPD:
A 58 year old patient presents for a COPD review. They report frequent coughing episodes and have had 3 exacerbations in the last year. They currently use a salbutamol inhaler when needed for symptom relief, which they have had on prescription since childhood for asthma. What is the single best medication change for this patient?
What do you think are the most important words in this question?
Now look at it again, with some key words in bold – does this match what you thought?
A 58 year old patient presents for a COPD review. They report frequent coughing episodes and have had 3 exacerbations in the last year. They currently use a salbutamol inhaler when needed for symptom relief, which they have had on prescription since childhood for asthma. What is the single best medication change for this patient?
Note the last sentence is the actual question. In the AKT, questions are typically presented as a clinical case paired with a specific question. Whilst the case often helps you to identify the correct answer, sometimes you can answer the question immediately. In an exam where you have 56 seconds per question for 3 hours, reading the last sentence (the actual question) first can help you manage your time in the exam. If you don’t know the answer immediately, you then can read the clinical scenario looking for the answer – rather than reading the whole question, then reading it again once you know what you are supposed to be looking for.
The other highlighted words (COPD and asthma) give you the key to this specific question, which is testing your knowledge of COPD management – in the context of a patient with a history of asthma.
Top tip: at this stage, you may already know (or suspect) the answer. Ideally try to have an answer in mind, then look at the possible answers presented – hopefully your suspect is there. This is called a Cover Test, and is something the RCGP question setters use to check if a question is suitable for the AKT.
Now let’s move from the question to the answers. Here are the options:
Switch the salbutamol to a SAMA inhaler
Add a regular LABA inhaler
Add a regular LABA-LAMA combination inhaler
Add a regular LABA-ICS combination inhaler
Add prophylactic antibiotics
At this point, if you either don’t know the answer or are unsure, try to rule out some of the answers. Are there any that seem either wrong or unjustified by the clinical scenario?
You could rule out switching to a SAMA and prophylactic antibiotics, as neither seem justified by the information you’ve been given. Doing this reduces your odds from 1 in 5 to 1 in 3.
Looking at the remaining options, go back to the question and the key words. The information given by the question is included for a reason. This question is testing whether you know the different approaches for treating COPD patients who are potentially steroid sensitive and those who aren’t.
According to NICE, this patient would next be offered a LABA plus ICS.