MSRA Cheat Sheet 2026

The 30 highest-yield MSRA facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. A 30-year-old woman presents with butterfly rash, joint pain, fatigue, and a positive ANA. Complement levels are low. What is the most likely diagnosis? → Systemic lupus erythematosus
2. In the Professional Dilemmas paper, what are the two main question formats? → Ranking and multiple-choice (most/least appropriate)
3. According to NICE guidelines, which antihypertensive is recommended as first-line for a patient aged 55 or older with uncomplicated hypertension? → Calcium channel blocker
4. An OGTT shows fasting glucose 5.9 mmol/L and 2-hour glucose 9.5 mmol/L. How should this be classified? → Impaired glucose tolerance
5. Which of the following is a mandatory notification to the Care Quality Commission (CQC) in England? → Deaths of service users where abuse or neglect may have contributed
6. A patient presents with an acute gout attack. Which intervention should be avoided during the acute phase? → Initiating allopurinol
7. Which of the following medications routinely requires therapeutic drug level monitoring in clinical practice? → Phenytoin
8. Troponin I at 3 hours is 0.06 µg/L (reference <0.04) and at 6 hours is 0.22 µg/L. ECG shows no ST changes. How should this rise be interpreted? → Non-ST elevation myocardial infarction (NSTEMI) requiring ACS management
9. A 45-year-old woman presents with sudden-onset severe headache described as 'the worst headache of her life.' What is the most important diagnosis to exclude? → Subarachnoid hemorrhage
10. Which two main components make up the MSRA? → Clinical Problem Solving and Professional Dilemmas
11. A patient newly started on sodium valproate requires monitoring. Which investigations are most important? → Liver function tests and full blood count
12. Which best describes the mechanism of action of furosemide? → Inhibits Na-K-2Cl cotransporter in the loop of Henle
13. LFTs show: ALP 480 U/L, GGT 510 U/L, ALT 65 U/L, bilirubin 55 µmol/L, albumin 38 g/L. What pattern do these results suggest? → Cholestatic liver disease
14. A patient lacks mental capacity and has no advance directive. What framework governs treatment decisions in England and Wales? → The Mental Capacity Act 2005
15. A 30-year-old woman presents with sudden-onset severe headache described as the worst headache of her life. What investigation should be performed urgently? → CT head without contrast, followed by lumbar puncture if CT is negative
16. A 50-year-old male has: Hb 95 g/L, MCV 72 fL, serum ferritin 8 µg/L, TIBC 68 µmol/L. What is the diagnosis? → Iron deficiency anaemia
17. An ECG shows a rate of 150 bpm, regular, narrow QRS complexes, no visible P waves, and a sawtooth baseline at 300/min. What is the rhythm? → Atrial flutter with 2:1 block
18. A patient on warfarin is started on amoxicillin for a chest infection. What is the most likely effect on their INR? → Increase in INR
19. A 60-year-old woman has K⁺ 2.8 mmol/L, Na⁺ 142 mmol/L, Cl⁻ 88 mmol/L, and HCO₃⁻ 38 mmol/L. She takes furosemide. What is the diagnosis? → Metabolic alkalosis with hypokalaemia
20. A patient on simvastatin is prescribed clarithromycin. What is the most significant clinical risk of this interaction? → Increased risk of myopathy and rhabdomyolysis
21. A competent adult patient refuses a blood transfusion on religious grounds despite life-threatening haemorrhage. What should the clinician do? → Respect the refusal, document it, and provide alternative management
22. Which class of medications is used to treat male patients primarily for voiding symptoms in the first line of care? → Alpha Blocker
23. A study reports a relative risk reduction of 30% for a new drug compared to placebo. The control event rate is 6%. What is the absolute risk reduction? → 1.8%
24. A GP receives a Subject Access Request (SAR) from a patient requesting their full medical records. Under GDPR/UK GDPR, what is the maximum response time? → 30 days (one month)
25. A patient taking an SSRI for depression is prescribed tramadol for post-operative pain. What is the most serious potential drug interaction? → Serotonin syndrome
26. The MSRA is primarily used to assess applicants for which stage of UK medical training? → Specialty (ST1/CT1) training recruitment
27. A patient on warfarin presents with an INR of 8.0 and minor bleeding. What is the most appropriate management? → Stop warfarin and give oral vitamin K
28. During a ward round, a consultant makes a clinical error and asks the junior doctor not to document it. What should the junior doctor do? → Document the clinical facts accurately and escalate the error via incident reporting
29. What is the typical format of questions in the Clinical Problem Solving paper? → Best-of-five and extended matching questions
30. You notice a senior colleague making a prescribing error. What is the most appropriate response? → Raise the concern politely with the colleague directly and ensure the error is corrected