The Complete Doctor Academy

The AKT tests the emergency recognition and dose of anaphylaxis far more than the immunology behind it. Know the adult IM adrenaline dose cold (500 micrograms of 1:1000), the anterolateral thigh as the site, and the fact that a biphasic reaction is why patients are observed. Distinguish true IgE-mediated allergy from intolerance, and remember that a documented penicillin allergy changes antibiotic choice across the whole curriculum.

Cardiovascular is the single biggest chunk of Clinical Medicine, so marks here are decisive. Anchor to the current guideline changes: the four pillars of heart failure with reduced ejection fraction started together (NG106), DOACs first-line in AF with CHA₂DS₂-VASc and ORBIT/HAS-BLED (NG196), and the QRISK-driven statin threshold of 10%. Know step-wise hypertension therapy by age and ethnicity.

Dermatology is heavily image-based, so pair each described lesion with its diagnosis and first-line management. The examiners reward recognising 2-week-wait features of melanoma (the ABCDE and the 7-point checklist), the emollient-plus-topical-steroid ladder for eczema, and vitamin D analogue plus steroid for plaque psoriasis. Know which drugs (lithium, beta-blockers) worsen psoriasis.

ENT questions cluster around when NOT to give antibiotics. Use FeverPAIN or Centor for sore throat (NG84), know the delayed/no-antibiotic strategy for otitis media, and separate the vertigo syndromes: BPPV (seconds, positional, Dix-Hallpike/Epley), vestibular neuritis (days, no hearing loss) and Ménière's (hours, hearing loss and tinnitus). Unilateral persistent symptoms warrant referral.

The red-eye differential is a favourite because getting it wrong risks sight. Separate the emergencies — acute angle-closure glaucoma (painful red eye, haloes, fixed mid-dilated pupil), anterior uveitis and scleritis — from benign conjunctivitis. For sudden painless visual loss, know the vascular causes (central retinal artery/vein occlusion) and giant cell arteritis, which demands immediate high-dose steroids.

GI marks hinge on recognising red flags for urgent referral versus safe symptomatic management. Learn the dyspepsia/2-week-wait rules (dysphagia at any age; new dyspepsia ≥55 with weight loss), the positive diagnostic criteria for IBS, and when to check faecal calprotectin (to distinguish IBD from IBS). Test-and-treat H. pylori is the pathway for uncomplicated dyspepsia.

Genomics is a smaller but growing domain. Focus on recognising red-flag family histories that warrant referral — early breast/ovarian cancer (BRCA), young colorectal cancer (Lynch), and premature cardiac death or very high cholesterol (familial hypercholesterolaemia). Know the autosomal-dominant inheritance pattern and the practical point that FH needs early, aggressive statin therapy.

This area rewards knowing first-line treatments and referral triggers. For heavy menstrual bleeding with no structural cause, the LNG-IUS is first-line. Know the menopause/HRT rules — combined HRT if a uterus is present, and the small breast-cancer risk balanced against symptom control — plus 2-week-wait breast referral criteria for suspicious lumps.

Haematology in the AKT is mostly the anaemias and anticoagulation safety. Use the MCV to triage — microcytic (iron deficiency, always seek a source of GI loss in older patients), normocytic (chronic disease), macrocytic (B12/folate, alcohol, hypothyroidism). Know DOAC versus warfarin monitoring and the management of a high INR.

Recognise sepsis early (NEWS2, the red-flag features) and know when antibiotics are and are not indicated. The immunisation schedule is examined every sitting — live vaccines and contraindications especially. For travel, malaria prophylaxis and the notifiable diseases list recur. Antimicrobial stewardship underlies many stems: shortest effective course, right drug.

A newer curriculum area with a strong ethical and reasonable-adjustments theme. Know the annual health check for people on the LD register, diagnostic overshadowing (attributing physical symptoms to the disability and missing disease), and the Mental Capacity Act framework — capacity is decision-specific and presumed until shown otherwise.

Contraception questions turn on UKMEC categories — matching a medical condition to whether a method is safe. Know the absolute contraindications to combined hormonal contraception (migraine with aura, high VTE risk, breast cancer), emergency contraception options and timings, and the basics of safe prescribing in pregnancy and breastfeeding.

Common mental health presentations dominate here. Know the stepped-care model for depression and anxiety, first-line SSRI choice and the safety issues (young people and suicidality, SSRI discontinuation, serotonin syndrome, hyponatraemia in the elderly). Recognise red flags for psychosis and risk that require urgent referral, and the safeguarding overlap.

Diabetes is examined every sitting — know the diagnostic thresholds (HbA1c 48 mmol/mol), the NG28 treatment ladder with early SGLT2 inhibitors where there is cardiovascular/renal risk, and sick-day rules. For thyroid, interpret TFT patterns and the treatment of hypo/hyperthyroidism. Obesity now includes the newer pharmacotherapies.

MSK marks come from separating inflammatory from mechanical disease and knowing urgent referrals. Early inflammatory arthritis (persistent early-morning stiffness, small-joint swelling) needs prompt rheumatology referral. Know gout management (acute versus urate-lowering, NG219), the FRAX/DEXA pathway for osteoporosis, and cauda equina/red-flag back pain.

This area focuses on recognition, referral and shared-care rather than initiating specialist drugs. Know the core features of ADHD and autism spectrum disorder, that diagnosis is specialist-led, and the primary-care role in monitoring (e.g. growth and cardiovascular checks for ADHD stimulants). Watch for the safeguarding and educational dimensions.

Neurology — and gait in particular — has been flagged by examiners across consecutive AKTs, so it is worth disproportionate revision. Master the headache red flags (thunderclap, new headache with focal signs, features of raised intracranial pressure or GCA), the driving rules after a seizure (DVLA), and localising gait: UMN vs LMN, cerebellar vs parkinsonian.

Know the CKD staging by eGFR and ACR, the drugs to review or stop in declining renal function, and when to refer. UTI management follows NG109 (nitrofurantoin first-line, methenamine for prevention). For prostate, interpret LUTS, PSA counselling and 2-week-wait referral for suspected prostate cancer.

The asthma guidance changed substantially (NG245): AIR — anti-inflammatory reliever therapy with ICS/formoterol — is now central, and SABA-only treatment is no longer recommended. Know COPD inhaled therapy escalation, the smoking-cessation offer, and the lung-cancer 2-week-wait/CXR criteria for persistent or red-flag respiratory symptoms.

Focus on first-line STI management and partner notification, testing windows, and safeguarding (under-16s, Fraser competence, and non-consensual concerns). Know the HIV testing offer and PrEP, and the cardiovascular workup and treatment ladder for erectile dysfunction (ED can be an early cardiovascular warning).

Screening and brief intervention thread through this area. Use AUDIT-C to identify hazardous drinking, know the CAGE and the features of dependence and withdrawal (and the risk of delirium tremens/Wernicke's — give thiamine). For smoking, know the pharmacological aids and combining behavioural support for best quit rates.

This pulls together time-critical recognition across the curriculum. NEWS2 drives escalation; know the sepsis red flags and the anaphylaxis algorithm (repeated from Allergy for a reason). Include the acute chest pain, stroke (FAST) and acute asthma pathways, and safe handover/safety-netting when managing undifferentiated acute presentations.