Back pain and sciatica
Revise when not to image, when to keep active, when sciatica changes management, and the red flags for cauda equina, fracture, malignancy or infection.
MRCGP AKT musculoskeletal revision
Musculoskeletal AKT questions are usually about safe sorting: which pain can be managed conservatively, which joint needs urgent referral, when imaging is unnecessary, and when red flags override a familiar presentation.
Quick answer
For AKT musculoskeletal revision, prioritise back pain and sciatica red flags, cauda equina, osteoarthritis, rheumatoid arthritis referral, osteoporosis risk assessment, gout, septic arthritis, fracture suspicion, analgesic safety and when imaging is not indicated.
What to revise first
Osteoarthritis
Know the clinical diagnosis, short morning stiffness, exercise and weight management, topical NSAIDs, oral NSAID risk, injections and when joint replacement referral is appropriate.
Rheumatoid arthritis
Focus on persistent synovitis, small-joint symptoms, morning stiffness, squeeze-test clues, urgent rheumatology referral and DMARD monitoring principles.
Osteoporosis and fragility fracture
Revise FRAX or QFracture, DEXA, bisphosphonate counselling, steroid risk, calcium and vitamin D, falls risk and secondary fracture prevention.
Gout and inflammatory joints
Separate gout, septic arthritis and inflammatory arthritis. Know acute treatment, urate-lowering therapy, allopurinol timing and why serum urate may mislead during a flare.
Soft tissue and trauma
Know sprains, tendon problems, shoulder pain, carpal tunnel, fracture suspicion, safeguarding concerns and when same-day orthopaedic assessment is needed.
Red flags to recognise quickly
- Cauda equina symptoms: urinary retention, saddle anaesthesia, bilateral neurology or severe progressive weakness
- Back pain with fever, immunosuppression, IV drug use, cancer history, trauma or unexplained weight loss
- Hot swollen joint where septic arthritis is possible
- Suspected fracture, non-accidental injury, open injury or neurovascular compromise
- Persistent synovitis suggesting inflammatory arthritis
- Acute limb ischaemia, compartment syndrome symptoms or severe pain out of proportion
Why musculoskeletal questions catch candidates out
The AKT often gives a common symptom and tests whether you spot the unsafe exception. Most stems are not about memorising every joint examination; they are about recognising urgent referral, avoiding unnecessary imaging and choosing safe first-line care.
AKT musculoskeletal FAQ
Is musculoskeletal health high yield for the MRCGP AKT?
Yes. Musculoskeletal health is a major RCGP clinical topic and AKT questions commonly test back pain red flags, osteoarthritis, rheumatoid arthritis, osteoporosis, gout, soft tissue injuries, fracture suspicion and urgent referral.
What musculoskeletal topics should I revise for the AKT?
Prioritise low back pain and sciatica, cauda equina and fracture red flags, osteoarthritis, rheumatoid arthritis referral, osteoporosis risk assessment, gout, septic arthritis, analgesic safety and when imaging is not needed.
How does back pain come up in AKT questions?
Back pain questions often test whether the presentation is non-specific and safe for conservative management, or whether red flags such as cauda equina, infection, malignancy or fracture mean urgent imaging or referral.
What arthritis facts are high yield for the AKT?
Know how osteoarthritis differs from inflammatory arthritis, why persistent synovitis needs urgent referral, how rheumatoid arthritis presents, and when gout or septic arthritis changes the safest next step.
Official sources
This is revision guidance, not official RCGP advice. Check current RCGP, NICE CKS and BNF guidance for clinical decisions. Last reviewed June 2026.
October sitting
Oct 26
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days
Keep moving, even on tired days.
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