Assessment is changing. The GMC is commencing a national Medical Licencing Assessment (starting academic year 24-25). You can read more here
Requirements for the MLA Applied Knowledge Test - GMC
Assessment Update (MLA nd Progress Testing), September 2023
From 2024 onwards, all medical students graduating from UK universities need to pass a national exam – the Medical Licensing Assessment (MLA). This entry requirement for inclusion on the medical register by the General Medical Council incorporates both written and practical components. QUB students will sit their MLA Applied Knowledge Test (AKT) – ‘written finals’ - after the end of Y4 and prior to starting Y5 rotations. QUB’s first cohort sit their AKT late June 2024. This comprises 200 Single Best Answer (SBA) questions, with around 40% of these questions tagged to primary care context.
The Content Map for the MLA includes A-Z lists of clinical presentations and conditions that graduating medical students are expected to apply their knowledge around. All of these could be encountered in GP!
Progress Testing
QUB students are familiar with AKT style questions from Progress Testing (computer delivered Single Best Answer written examinations) which are sat through Y1-4 of the QUB C25 curriculum.
The format and standard of the questions is aligned with the MLA AKT. More information on Progress Testing for anyone interested is available through the QUB Medical Education Portal – which all GP tutors can access this once registered. Students are aware how they are performing in relation to their peers in their Progress Tests; they also have feedback enabling them to see areas of relative strength/weakness.
Y4 students will all sit two Progress Tests through the academic year 2023/24 prior to their AKT – they will all be out of practice/clinical placements on these single dates, and are due back in practice for the remaining four days of these weeks: Monday 13 Nov 2023 and Monday 19 Feb 2024
Example Questions:
The following illustrative questions are from the Medical School Council’s Assessment Alliance website. They form part of 200 practice questions (available with and without answers!) designed to, “reflect the style and type of question that students will encounter when the MS AKT goes live in 2024-25.” The questions differ in their degree of difficulty and include diagnosis, management and relevant pathophysiology/basic science.
Example 1; straightforward ‘diagnosis’ question:
An 18 year old woman has had 3 years of intermittent zig-zagging and flashing lights in both eyes associated with headache. These episodes occur 2-3 times per month, last approximately half an hour, and are associated with nausea and vomiting. Her vision is affected at the time of each episode but returns to normal afterwards.
Which is the most likely diagnosis?
- Acute glaucoma
- Migraine
- Occipital lobe epilepsy
- Retinal detachment
- Tension-type headache
Correct Answer: B
Example 2; a ‘two-step’ question; need to work out the diagnosis then move on to identify the investigation:
A 75 year old man has had 3 days of intermittent headaches, blurred vision
and vomiting. For the past 24 hours he has had a severe left sided headache
and eye pain, accompanied by blurred vision and vomiting. His left eye is red
and the left pupil is dilated.
Which investigation is most likely to confirm the diagnosis?
- CT scan of head
- Erythrocyte sedimentation rate
- Fluorescein staining of the cornea
- Measurement of intraocular pressure
- MR scan of head
Correct Answer: D
Example 3; involves basic management/prescribing having interpreted results (note that normal ranges will always be provided for interpreting results)
A 32 year old woman has had palpitations and hot flushes for 4 weeks. She has noticed a painless swelling in her neck over the same time and her weight has decreased by 2 kg. She gave birth 4 months ago after a normal pregnancy. She is not breastfeeding. Her pulse rate is 120 bpm and BP 140/90 mmHg. She is tremulous and restless. She has a large smooth non-tender goitre.
Investigations:
Free T4 35.6 pmol/L (9–25)
Free T3 10.8 pmol/L (4.0–7.2)
TSH <0.01mU/L (0.3-4.2)
Thyroid peroxidase antibodies >1600 IU/L (<50)
Thyroid stimulating antibodies <1.0 IU/L (<1.75)
Which is the most appropriate initial treatment?
- Carbimazole
- Propranolol
- Propylthiouracil
- Thyroidectomy
- Thyrotropin alfa
Correct Answer: B
Example 4; involves appreciation of pathophysiology
A 64 year old man has developed a tremor in both arms over the last 6 months. It is worse on the right. He also reports difficulty sleeping due to restlessness. He appears emotionally flat and has a tremor at rest that is alleviated on movement.
Which neurotransmitter is most likely to be deficient?
- Acetylcholine
- Dopamine
- Glycine
- Norepinephrine (noradrenaline)
- Serotonin
Correct Answer: B
Example 5; core GP prescribing:
A 76 year old woman with hypertension is taking amlodipine 10 mg daily. A 24 hour BP measurement shows a mean BP of 168/90 mmHg.
Investigations:
Sodium 135 mmol/L (135–146)
Potassium 4.0 mmol/L (3.5–5.3)
Urea 7 mmol/L (2.5–7.8)
Creatinine 100 μmol/L (60–120)
eGFR 68 mL/min/1.73 m2 (>60)
Urinary albumin : creatinine ratio 50 mg/mmol (<3.5)
Which class of antihypertensive should be added?
- ACE inhibitor
- Alpha blocker
- Beta blocker
- Loop diuretic
- Thiazide-like diuretic
Correct Answer: A
Example 6; an appreciation of ‘normal’ – or an answer involving ‘not doing something’ – is perhaps unappealing in a question but important for students to understand:
A 72 year old woman has had inability to sleep well for the past 3 years. She gets to sleep by 23:00 but wakes up two or three times in the night and gets up by 07:00. Her husband says that she doesn't snore. Her BMI is 23 kg/m2 . She carries out her normal daytime activities with no daytime somnolence. She is otherwise well. Her MMSE (Mini Mental State Examination) score is 27/30.
Which is the most likely cause of her insomnia?
- Depression
- Early stages of dementia
- Hypomania
- Normal age related sleep pattern
- Obstructive sleep apnoea
Correct Answer: D
MCQ Writing
Have you ever wondered how MCQs are written for medical student examinations?
If you would like to have a go at writing a question, please follow the link below which will allow you to upload your MCQ in the required format.
You can submit as many as you like.
Please do not worry about trying to "perfect them" as all contributions will help to generate ideas.
You will find tips on how best to create an MCQ within the MS Form.
You will also find a template form and style guid below if you want to print them or refer to them
We will gratefully acknowledge all contributions.