What happens when two AKT answers look good?

Firstly – don’t panic!

The AKTs are designed by intention to do this – they give two or more answers which are correct, but one answer is more correct than the other.

Consider this example:

James Bashford, aged 52 years old, presents with as six-week history of new onset lower back pain and left lower leg weakness. On examination you note the presence of numbness over his left big toe and an inability to flex it. What is the most appropriate investigation?

• Full blood count
• Magnetic resonance imaging scan of lumbar spine (1 mark)
• X-ray of lumbar spine
• Computed tomography scan of lumbar spine
• Erythrocyte sedimentation rate

Look how similar the answers are!

So why is MRI of the lumbar spine more correct?

 Well let’s go back to our clues:

• >50 years
• New onset back pain
• No mention of trauma
• Signs and symptoms of L5 radiculopathy

The guidelines are clear and in this instance, MRI is the preferred imaging modality.

Note of course that this might not occur in real life – because CT scans can be bulk billed, whereas MRI scans can’t usually be. But the exams test evidence-based medicine – it goes back to our PassGP Academy class on the importance of references.

Once again, don’t worry – our PassGP examiners will take you through exactly how to approach these scenarios.