Smoking, alcohol and substance misuse questions in the AKT are about more than recalling guidance or recognising a substance-use disorder.

These 10 questions focus on

• Interpreting risk and dependence

• Applying harm-reduction and prescribing principles appropriately

• Deciding what needs to happen next

They cover common and important areas including smoking cessation, alcohol dependence and withdrawal, relapse-prevention treatment, opioid dependence, overdose prevention, benzodiazepine use, blood-borne virus risk and dependence on prescribed or over-the-counter medicines.

Test your knowledge: Work through each question and choose your answer. Once you’ve answered, the explanation will be revealed. The aim is not simply to get the answer right, but to recognise the clinical details that should influence your assessment, prescribing or management.

Keep going: Questions in this area become much easier when you move beyond simply identifying the substance or remembering a guideline.

Think: What is the immediate risk? → What does the pattern of use tell me? → What changes the management? → What do I need to do next?

These are original GP Fluency learning questions designed to support applied clinical learning and AKT preparation. They are not recalled MRCGP examination questions and are not produced or endorsed by the RCGP.