100+ Free MSRA Practice Questions

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2026 Statistics

Key Facts: MSRA Exam

2 papers

Professional Dilemmas (SJT) and Clinical Problem Solving make up the MSRA

NHS England Medical Hub - Structure of the MSRA

170 minutes

Total MSRA test time: PD 95 minutes plus CPS 75 minutes

NHS England Medical Hub - Structure of the MSRA

50 questions

Professional Dilemmas paper, mixing ranking and multiple-best-action items

NHS England Medical Hub - What's in the MSRA

86 scored

CPS paper has 97 questions, of which 86 count toward the score

NHS England Medical Hub - Clinical Problem Solving paper

12 topic areas

Clinical Problem Solving covers 12 general-medicine topic areas at FY2 level

NHS England Medical Hub - Clinical Problem Solving paper

No fee

There is no charge to sit the MSRA

NHS England Medical Hub - Multi-Specialty Recruitment Assessment

No negative marking

Candidates are advised to answer every question on both papers

NHS England Medical Hub - Structure of the MSRA

100

Free original practice questions here across both MSRA papers

OpenExamPrep

The MSRA is a computer-based assessment for UK specialty training applicants, run by NHS England and delivered via Pearson VUE. It has two independently timed papers: Professional Dilemmas (50 situational-judgement questions in 95 minutes) and Clinical Problem Solving (97 questions, 86 scored, in 75 minutes), for 170 minutes of total test time plus an optional 5-minute break. The CPS paper covers 12 general-medicine topic areas at Foundation (FY2) level; the PD paper tests professional integrity, coping with pressure, and empathy and sensitivity. There is no fee and no negative marking; each paper is reported as a standardised score that specialties combine differently for shortlisting. This 100-question bank gives original single-best-answer practice across both papers with explanations for every option.

Sample MSRA Practice Questions

Try these sample questions to test your MSRA exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 64-year-old man presents with central crushing chest pain for 40 minutes and diaphoresis. His ECG shows 2 mm ST elevation in leads II, III and aVF. What is the single most appropriate immediate management priority?

A.Arrange urgent primary percutaneous coronary intervention (PCI)

B.Start oral beta-blocker and review in 24 hours

C.Request an outpatient exercise tolerance test

D.Reassure and discharge with a GTN spray

Explanation: The ECG shows an inferior ST-elevation myocardial infarction (STEMI). UK guidance is immediate reperfusion, with primary PCI the preferred strategy when it can be delivered promptly. Loading antiplatelets and analgesia accompany activation of the PCI pathway.

2A 72-year-old woman has an irregularly irregular pulse and ECG confirms atrial fibrillation. She has hypertension and diabetes (CHA2DS2-VASc score 4) and no bleeding risk factors. What is the single most appropriate long-term stroke-prevention treatment?

A.Aspirin 75 mg daily

B.A direct oral anticoagulant (DOAC)

C.No antithrombotic therapy

D.Clopidogrel 75 mg daily

Explanation: With a CHA2DS2-VASc score of 4, anticoagulation is indicated for stroke prevention in non-valvular AF. NICE recommends a DOAC as first line in most patients, with warfarin as an alternative. Antiplatelets are not recommended for stroke prevention in AF.

3A 55-year-old man with type 2 diabetes has a clinic blood pressure of 158/96 mmHg confirmed by ambulatory monitoring. He has no contraindications. According to NICE, what is the single most appropriate first-line antihypertensive?

A.An ACE inhibitor (e.g. ramipril)

B.A thiazide-like diuretic

C.A beta-blocker

D.An alpha-blocker

Explanation: For people with type 2 diabetes of any age or origin, NICE recommends an ACE inhibitor (or ARB) as first-line antihypertensive because of additional renoprotective benefit. Calcium-channel blockers or thiazide-like diuretics are added at later steps.

4A 78-year-old man presents with progressive exertional breathlessness, bilateral basal crackles, raised JVP and pitting ankle oedema. Which single blood test is most useful to support a diagnosis of heart failure before echocardiography?

A.N-terminal pro-B-type natriuretic peptide (NT-proBNP)

B.Serum troponin

C.C-reactive protein

D.D-dimer

Explanation: NICE recommends measuring NT-proBNP in suspected chronic heart failure; a raised level prompts referral for echocardiography. It has a high negative predictive value, helping rule out heart failure when normal.

5A 30-year-old woman presents with sudden pleuritic chest pain and breathlessness three weeks after a long-haul flight. She is tachycardic with a normal chest X-ray. Wells score for PE is 6 (likely). What is the single most appropriate next step?

A.Arrange a CT pulmonary angiogram (CTPA)

B.Request a D-dimer and discharge if negative

C.Start oral antibiotics for pneumonia

D.Reassure and arrange routine GP follow-up

Explanation: With a Wells score indicating PE is likely (>4), NICE advises immediate CTPA rather than D-dimer. Interim anticoagulation should be given if imaging is delayed. D-dimer is reserved for the PE-unlikely pathway.

6A 68-year-old man with a 40 pack-year smoking history has progressive breathlessness and a productive cough. Spirometry shows a post-bronchodilator FEV1/FVC ratio of 0.62. What does this finding most strongly indicate?

A.Chronic obstructive pulmonary disease (obstructive pattern)

B.Pulmonary fibrosis (restrictive pattern)

C.Normal lung function

D.Acute asthma exacerbation only

Explanation: A post-bronchodilator FEV1/FVC ratio below 0.7 that is not fully reversible confirms airflow obstruction, consistent with COPD in a heavy smoker. The persistent ratio reduction distinguishes COPD from reversible asthma.

7A 24-year-old woman with known asthma presents acutely. She cannot complete sentences, her peak flow is 40% of best, respiratory rate is 28 and oxygen saturation is 93% on air. What is the single most appropriate immediate treatment?

A.High-flow oxygen and nebulised salbutamol

B.Oral prednisolone alone and discharge

C.A trial of inhaled corticosteroid increase only

D.Reassurance and breathing exercises

Explanation: This is an acute severe asthma attack. Immediate management is controlled high-flow oxygen to maintain saturations of 94-98% plus nebulised salbutamol, with steroids and ipratropium added. Rapid bronchodilation is the priority.

8A 55-year-old man presents with a 3-week history of cough, breathlessness and fever. Chest X-ray shows right lower lobe consolidation. His CRB-65 score is 1. What is the single most appropriate management setting?

A.Consider treatment in the community with oral antibiotics

B.Immediate intensive care admission

C.Discharge with no treatment

D.Urgent CT thorax before any treatment

Explanation: A CRB-65 score of 0-1 indicates low-severity community-acquired pneumonia that can often be managed at home with oral antibiotics and safety-netting. Higher scores prompt hospital assessment or admission.

9A 19-year-old man with type 1 diabetes presents with vomiting, abdominal pain and deep sighing breathing. Capillary glucose is 28 mmol/L, blood ketones 5.2 mmol/L and venous pH 7.18. What is the single most appropriate first treatment?

A.Intravenous 0.9% sodium chloride infusion

B.Subcutaneous long-acting insulin only

C.Oral rehydration and review in the morning

D.Intravenous sodium bicarbonate

Explanation: This is diabetic ketoacidosis. Management begins with intravenous fluid resuscitation using 0.9% sodium chloride to correct dehydration, followed by a fixed-rate intravenous insulin infusion and potassium monitoring. Fluids are the immediate first step.

10A 48-year-old woman reports weight gain, cold intolerance, fatigue and constipation. Thyroid function shows TSH 12 mU/L (raised) and free T4 below the reference range. What is the single most appropriate treatment?

A.Levothyroxine replacement

B.Carbimazole

C.Radioactive iodine

D.Propranolol alone

Explanation: A high TSH with low free T4 confirms primary hypothyroidism. Treatment is levothyroxine, titrated to symptoms and TSH. The other agents treat hyperthyroidism, not the opposite condition.

About the MSRA Exam

The Multi-Specialty Recruitment Assessment (MSRA) is a computer-based assessment used in UK postgraduate specialty recruitment for general practice and around 20 other specialties, including psychiatry, ophthalmology, obstetrics and gynaecology, radiology and neurosurgery. Delivered through Pearson VUE on behalf of NHS England, it comprises two independently timed papers. The Professional Dilemmas (PD) paper is a Situational Judgement Test of 50 scenarios assessing professional integrity, coping with pressure, and empathy and sensitivity. The Clinical Problem Solving (CPS) paper presents clinical scenarios as extended-matching and single-best-answer questions across 12 general-medicine topic areas, testing applied clinical reasoning at Foundation (FY2) level. There is no negative marking, and each paper produces a standardised score that specialties weight differently for shortlisting.

Assessment

Two computer-based papers: Professional Dilemmas (50 SJT questions, ~50% ranking and ~50% multiple-best-action) and Clinical Problem Solving (97 questions, 86 scored, mixing extended-matching and single-best-answer). No negative marking.

Time Limit

170 minutes of test time: Professional Dilemmas 95 minutes and Clinical Problem Solving 75 minutes, with an optional 5-minute break between the two papers. Candidates may be granted 25% or 50% extra time as a reasonable adjustment.

Passing Score

No fixed pass mark. Each paper yields a standardised score, and individual specialties weight and combine the CPS and PD scores differently for shortlisting; some set minimum thresholds.

Exam Fee

There is no charge to sit the MSRA. Candidates meet their own travel and accommodation costs, which are not reimbursed. (NHS England (assessment by the Work Psychology Group), delivered via Pearson VUE)

MSRA Exam Content Outline

60%

Clinical Problem Solving (CPS)

Official paper: 97 questions (86 scored) in 75 minutes, roughly half extended-matching and half single-best-answer, at Foundation (FY2) level. The 12 topic areas are cardiovascular; dermatology/ENT/eyes; endocrinology/metabolic; gastroenterology/nutrition; infectious disease/haematology/immunology/allergies/genetics; musculoskeletal; paediatrics; pharmacology and therapeutics; psychiatry/neurology; renal/urology; reproductive; and respiratory. Practice here covers diagnosis, investigation, first-line management, prescribing and red flags grounded in NICE CKS and UK guidelines.

40%

Professional Dilemmas (PD)

Official paper: 50 situational-judgement questions in 95 minutes, about half ranking and half multiple-best-action items, assuming the role of an FY2 doctor. It assesses professional integrity, coping with pressure, and empathy and sensitivity against GMC Good Medical Practice. Practice here covers patient safety, probity, raising concerns, consent, confidentiality, escalation and working in teams using single-best-action items.

How to Pass the MSRA Exam

What You Need to Know

Passing score: No fixed pass mark. Each paper yields a standardised score, and individual specialties weight and combine the CPS and PD scores differently for shortlisting; some set minimum thresholds.
Assessment: Two computer-based papers: Professional Dilemmas (50 SJT questions, ~50% ranking and ~50% multiple-best-action) and Clinical Problem Solving (97 questions, 86 scored, mixing extended-matching and single-best-answer). No negative marking.
Time limit: 170 minutes of test time: Professional Dilemmas 95 minutes and Clinical Problem Solving 75 minutes, with an optional 5-minute break between the two papers. Candidates may be granted 25% or 50% extra time as a reasonable adjustment.
Exam fee: There is no charge to sit the MSRA. Candidates meet their own travel and accommodation costs, which are not reimbursed.

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

MSRA Study Tips from Top Performers

1Use NICE Clinical Knowledge Summaries (CKS) as your core CPS resource; they map closely to the foundation-level diagnosis, investigation and first-line management decisions the exam tests.

2Read GMC Good Medical Practice before the Professional Dilemmas paper; most SJT answers turn on patient safety first, then probity, consent, confidentiality and escalating concerns.

3Practise to the clock: with about 86 scored CPS items in 75 minutes you have under a minute each, so train yourself to flag and move on rather than stall.

4For ranking PD questions, identify the single most and least appropriate actions first; the middle ranks are easier once the extremes are fixed.

5For multiple-best-action PD questions, choose the three actions that are complementary and could all be done together, prioritising immediate patient safety and senior escalation.

6Cover the whole CPS blueprint, not just your own specialty; the paper deliberately samples all 12 general-medicine topic areas, so broad revision beats deep niche knowledge.

Frequently Asked Questions

How many papers are in the MSRA and how long is it?

Two computer-based papers totalling 170 minutes of test time: Professional Dilemmas (95 minutes) and Clinical Problem Solving (75 minutes), with an optional 5-minute break between them. The papers are independently timed.

How many questions are on the MSRA?

The Professional Dilemmas paper has 50 questions and the Clinical Problem Solving paper has 97 questions, of which 86 are scored (the remainder are unlabelled pilot questions). There is no negative marking.

What does the Clinical Problem Solving paper cover?

It tests applied clinical reasoning at Foundation (FY2) level across 12 general-medicine topic areas, from cardiovascular and respiratory to paediatrics, psychiatry/neurology and pharmacology, using extended-matching and single-best-answer questions on diagnosis, investigation and management.

What does the Professional Dilemmas paper assess?

It is a Situational Judgement Test assessing professional integrity, coping with pressure, and empathy and sensitivity. Scenarios are based on GMC Good Medical Practice and the FY2 role, using ranking and multiple-best-action question formats.

Is there a pass mark for the MSRA?

No. Each paper is reported as a standardised score, and individual specialties combine and weight the CPS and PD results differently for shortlisting; some apply minimum thresholds. There is no single national pass mark.

Are these official MSRA questions?

No. These are original OpenExamPrep practice questions modelled on the MSRA's published structure and topic areas. NHS England and Pearson VUE provide official practice papers and a demo separately.