MSRA (Multi-Specialty Recruitment Assessment) — Questions and Answers

Question 1: 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?

MRI brain with contrast
Blood tests only
CT head without contrast, followed by lumbar puncture if CT is negative (Correct answer)
Skull X-ray

Correct answer: CT head without contrast, followed by lumbar puncture if CT is negative

Thunderclap headache requires urgent CT head to rule out subarachnoid hemorrhage. If CT is negative but clinical suspicion remains, lumbar puncture should be performed to look for xanthochromia.

Question 2: A 68-year-old woman with known atrial fibrillation presents with sudden left-sided weakness and facial droop lasting 45 minutes before fully resolving. What is the most appropriate next step?

Order an MRI in outpatient clinic
Admit urgently using the ABCD2 score and fast-track TIA pathway (Correct answer)
Start aspirin and review in 2 weeks
Reassure and discharge

Correct answer: Admit urgently using the ABCD2 score and fast-track TIA pathway

A TIA in a patient with AF carries high early stroke risk; same-day neurovascular assessment and urgent investigation are mandatory under the fast-track TIA pathway.

Question 3: You notice a senior colleague making a prescribing error. What is the most appropriate response?

Correct the prescription yourself without telling anyone
Ignore it because they are more senior
File an anonymous complaint to the hospital board
Raise the concern politely with the colleague directly and ensure the error is corrected (Correct answer)

Correct answer: Raise the concern politely with the colleague directly and ensure the error is corrected

Patient safety requires addressing the error. Speaking directly to the colleague is appropriate first, allowing them to correct it. If the error isn't corrected or there's a pattern, escalation to a supervisor is necessary.

Question 4: A 25-year-old male presents with acute onset monoarthritis of the right knee, urethral discharge, and conjunctivitis following a gastrointestinal infection. What is the likely diagnosis?

Septic arthritis
Gout
Gonococcal arthritis
Reactive arthritis (Correct answer)

Correct answer: Reactive arthritis

The triad of arthritis, urethritis, and conjunctivitis following an enteric or urogenital infection is diagnostic of reactive arthritis (formerly Reiter's syndrome).

Question 5: A patient with schizophrenia refuses antipsychotic medication. He is currently detained under Section 3 of the Mental Health Act. Can treatment be given without consent?

Only with a second opinion from an independent doctor from admission
Yes — immediately on detention with no restrictions
Yes — Section 3 allows treatment for mental disorder without consent after 3 months under Part IV MHA (Correct answer)
No — detention does not authorise treatment without consent

Correct answer: Yes — Section 3 allows treatment for mental disorder without consent after 3 months under Part IV MHA

Under Part IV of the Mental Health Act, a patient detained under Section 3 can be treated for mental disorder without consent after 3 months, subject to second opinion (SOAD) safeguards.

Question 6: A pharmaceutical company offers a doctor a paid speaking engagement with flights and accommodation to promote their new drug. What should the doctor do?

Accept provided the drug is on formulary
Accept and declare the interest only if asked
Decline if the arrangement could reasonably be seen as influencing prescribing behaviour (Correct answer)
Accept as it is a legitimate educational opportunity

Correct answer: Decline if the arrangement could reasonably be seen as influencing prescribing behaviour

GMC guidance prohibits accepting gifts or hospitality that could influence, or appear to influence, clinical decisions; sponsored engagements tied to product promotion fall into this category.

Question 7: Which ethical principle underpins the obligation to obtain informed consent before any medical procedure?

Autonomy (Correct answer)
Non-maleficence
Beneficence
Justice

Correct answer: Autonomy

Informed consent is rooted in the principle of autonomy — the patient's right to make informed decisions about their own body and treatment.

Question 8: Which statement best describes first-order pharmacokinetics?

Drug half-life increases as plasma concentration rises
A fixed amount of drug is eliminated per unit time
The rate of elimination is proportional to the drug concentration (Correct answer)
Elimination rate is independent of drug concentration

Correct answer: The rate of elimination is proportional to the drug concentration

In first-order kinetics, the rate of drug elimination is proportional to the plasma concentration, resulting in a constant half-life — the majority of drugs at therapeutic doses follow this pattern.

Question 9: Which class of medications is used to treat male patients primarily for voiding symptoms in the first line of care?

SNRI
5-alpha reductase inhibitor
Antimuscarinics
Alpha Blocker (Correct answer)

Correct answer: Alpha Blocker

Voiding symptoms in male patients, often associated with benign prostatic hyperplasia (BPH), are caused by the enlargement of the prostate gland obstructing the urethra. Alpha-blockers work by relaxing the smooth muscles in the prostate and bladder neck, which reduces the resistance to urine flow. This action improves urinary symptoms like hesitancy, weak stream, and incomplete emptying, making them a first-line treatment.

Question 10: 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 (Correct answer)
Stable angina — discharge with outpatient follow-up
Laboratory error — repeat in 24 hours
Likely type 2 MI from demand ischaemia only

Correct answer: Non-ST elevation myocardial infarction (NSTEMI) requiring ACS management

A rising troponin pattern (delta change >20% over 3–6 hours) with symptoms consistent with ACS confirms NSTEMI requiring antiplatelet therapy and cardiology input.

Question 11: A patient presents 4 hours after a suspected paracetamol overdose. What is the most important initial investigation?

Serum paracetamol level (Correct answer)
Liver function tests
Urine toxicology screen
Prothrombin time

Correct answer: Serum paracetamol level

The serum paracetamol level at 4 hours post-ingestion is plotted on the treatment nomogram to determine whether N-acetylcysteine (NAC) therapy is indicated.

Question 12: A patient's family member asks you not to tell the patient about their terminal diagnosis. What should you do?

Explore the family's concerns but explain that the patient has the right to know their diagnosis if they wish (Correct answer)
Agree to withhold the diagnosis as the family requested
Tell the patient immediately without further discussion
Refer the decision to the hospital ethics committee

Correct answer: Explore the family's concerns but explain that the patient has the right to know their diagnosis if they wish

While understanding family concerns is important, patients have the right to know their diagnosis (GMC guidance on consent). Explore what the patient wants to know and share information at an appropriate pace, respecting patient autonomy.

Question 13: An 80-year-old overweight man complains of leg cramps that get worse when he exercises. He smokes fifteen cigarettes a day and consumes thirty units of alcohol daily. Which of the following suggestions would be the best place to start?

Increase Exercise
Reduce Alcohol Intake
Lose Weight
Stop Smoking (Correct answer)

Correct answer: Stop Smoking

The patient's leg cramps worsening with exercise (intermittent claudication) are highly indicative of peripheral arterial disease (PAD). Smoking is the single most significant modifiable risk factor for the development and progression of PAD, as it directly contributes to atherosclerosis. While other lifestyle changes like reducing alcohol intake, losing weight, and increasing exercise are beneficial, stopping smoking offers the most immediate and impactful benefit in slowing disease progression and improving symptoms.

Question 14: 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 fibrillation
SVT
Atrial flutter with 2:1 block (Correct answer)
Sinus tachycardia

Correct answer: Atrial flutter with 2:1 block

Atrial flutter typically produces a sawtooth atrial rate of ~300/min; with 2:1 AV block, the ventricular rate is ~150 bpm with regular narrow complexes.

Question 15: You are asked to see more patients than you feel is safe during an on-call shift. What should you do?

Leave the shift early to maintain your own safety
See only the patients you feel comfortable with and ignore the rest
Raise your concerns with the on-call senior and document your concerns about patient safety (Correct answer)
Work through it without complaining

Correct answer: Raise your concerns with the on-call senior and document your concerns about patient safety

You have a duty to raise concerns about patient safety. Escalate to the on-call senior, clinical supervisor, or site manager, documenting your concerns. Never simply abandon patients or stay silent about unsafe conditions.

Question 16: As a Foundation (F2) physician, you are employed in a crowded medical ward. Mr. Davies, a patient, has complained to you about two occasions when the registrar* spoke to him in an abrupt and icy manner. It is well known that the registrar treats patients with extreme kindness and gentleness. Choose the 3 most appropriate actions to take in this situation.

Option H: Assure Mr. Davies that the registrar did not mean to come across as condescending.
Option E: Describe to Mr. Davies the steps involved in filing a formal complaint.
Option D: Express your regret for Mr. Davies's feelings. (Correct answer)
Option F: Explain to Mr. Davies how busy the job is for all of the staff.
Option A: Tell Mr. Davies to talk to the consultant about this.
Option B: Tell Mr. Davies that you think the registrar is a competent physician.
Option C: Request more explanation from Mr. Davies. (Correct answer)
Option G: Find out what Mr. Davies wants you to do. (Correct answer)

Correct answer: Option D: Express your regret for Mr. Davies's feelings.

Requesting more explanation from Mr. Davies is the most appropriate initial step as it allows you to gather specific details about his concerns. Understanding the exact nature of the interactions will help you assess the situation accurately and determine the best course of action. This demonstrates active listening and ensures that you are fully informed before making any judgments or taking further steps regarding the registrar's conduct.

Question 17: While on a medical ward round, the consultant instructs Emily, one of your Foundation (F2) medical colleagues, to tap Mr. Lucas's pleura. Emily informs the consultant that she is capable of performing the surgery. But Emily informed you a few days ago that she had never done this procedure before. You've carried out this process multiple times. Choose the 3 most appropriate actions to take in this situation.

Option G: Discuss the matter during your upcoming Foundation class.
Option B: Tell Emily about your worries. (Correct answer)
Option A: Demand that you carry out the process yourself.
Option H: Encourage Emily to speak with her consultant. (Correct answer)
Option E: You should let Mr. Lucas know about your worries.
Option F: Consult your medical defense organization* for advice.
Option D: Address the consultant's concerns.
Option C: Offer Emily assistance with the process. (Correct answer)

Correct answer: Option B: Tell Emily about your worries.

Directly telling Emily about your worries is a professional and ethical action, as it addresses a potential patient safety concern. It gives her an opportunity to reconsider her statement to the consultant and ensures that a procedure is not performed by someone lacking the necessary experience. This approach prioritizes patient safety while also supporting a colleague by giving her a chance to correct the situation discreetly.

Question 18: A terminally ill patient with capacity asks the doctor to administer a lethal dose of medication. What is the legal position in England and Wales?

Illegal — active euthanasia is not lawful (Correct answer)
Legal if two doctors agree the patient is terminally ill
Legal if the patient has a valid advance directive
Permitted under the doctrine of double effect

Correct answer: Illegal — active euthanasia is not lawful

Active euthanasia — intentionally administering a lethal agent — remains illegal in England and Wales regardless of patient consent or terminal prognosis.

Question 19: A 4-year-old child presents with fever, stridor, and a 'barking cough' that is worse at night. What is the most likely diagnosis?

Foreign body aspiration
Epiglottitis
Bacterial tracheitis
Croup (laryngotracheobronchitis) (Correct answer)

Correct answer: Croup (laryngotracheobronchitis)

A barking cough with stridor that worsens at night in a young child is the hallmark presentation of croup, typically caused by parainfluenza virus.

Question 20: A 22-year-old university student presents with high fever, severe headache, neck stiffness, photophobia, and a rapidly spreading non-blanching purpuric rash. What is the single most important immediate action?

Obtain blood cultures and await sensitivity results before treating
Administer intravenous benzylpenicillin immediately (Correct answer)
Request an urgent CT head before any treatment
Perform a lumbar puncture to confirm diagnosis

Correct answer: Administer intravenous benzylpenicillin immediately

A non-blanching purpuric rash with signs of meningism indicates probable meningococcal septicaemia — a life-threatening emergency. IV benzylpenicillin must be given immediately without waiting for investigations, as delay significantly increases mortality. Lumbar puncture and CT can follow once the patient is stabilised.

Question 21: A patient lacks mental capacity and has no advance directive. What framework governs treatment decisions in England and Wales?

The Mental Health Act 1983
The Human Rights Act 1998
Common law best interests standard only
The Mental Capacity Act 2005 (Correct answer)

Correct answer: The Mental Capacity Act 2005

The Mental Capacity Act 2005 governs decision-making for incapacitated adults, requiring clinicians to act in the patient's best interests after consulting those close to them.

Question 22: A patient with end-stage renal failure requires analgesia for severe pain. Which opioid is most appropriate?

Codeine
Morphine
Tramadol
Fentanyl (Correct answer)

Correct answer: Fentanyl

Fentanyl is the preferred opioid in renal failure as it has no active metabolites; morphine and codeine accumulate toxic metabolites (morphine-6-glucuronide and norcodeine) that cause prolonged sedation and respiratory depression.

Question 23: Due to some of your coworkers' recent leaves of absence, you have been extremely busy at work. You are having a lot of personal problems right now. You haven't been getting enough sleep. You know you're not working as well as you usually do, and you frequently don't finish your tasks by the end of the shift. You've exhibited irritability toward coworkers. Choose the 3 most appropriate actions to take in this situation.

Option F: Put your personal problems on hold and concentrate on your work.
Option G: Bring up your workload with the hospital administration.
Option A: Every day, arrive at work one hour early so that you can finish any incomplete tasks.
"Option H: Go to your neighborhood drugstore to get a sleeping pill. "
Option E: Talk about the problems with a more experienced team member. (Correct answer)
Option D: Give taking a break from work some thought. (Correct answer)
Option B: Make an appointment with your occupational health physician or GP. (Correct answer)
Option C: Enroll in a time management course.

Correct answer: Option E: Talk about the problems with a more experienced team member.

Making an appointment with an occupational health physician or GP is a crucial step for addressing your personal problems and their impact on your well-being and work performance. These professionals can provide confidential support, assess your health, and offer appropriate advice or interventions, including sick leave if necessary. This proactive approach prioritizes your health and ensures you receive the necessary support to prevent burnout and maintain patient safety.

Question 24: 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?

4.2%
30%
1.8% (Correct answer)
6%

Correct answer: 1.8%

Absolute risk reduction = relative risk reduction × control event rate = 0.30 × 6% = 1.8%; the NNT would be 1/0.018 ≈ 56 patients.

Question 25: A hospital audit reveals a systematic issue where a specific consent form omits a significant risk of paralysis for spinal surgery. What is the most appropriate response?

Report individual surgeons to the GMC
Update only future consent forms
Perform a root cause analysis, update the consent form, and implement a system-wide change with staff education (Correct answer)
Inform only the patients who suffered the complication

Correct answer: Perform a root cause analysis, update the consent form, and implement a system-wide change with staff education

Systemic consent failures require a systems-level response: root cause analysis, process redesign, and education to prevent recurrence and uphold the duty of candour.

Question 26: A colleague asks you to see their private patients during NHS working hours for a small financial arrangement. What should you do?

Decline, as seeing private patients during NHS time is a conflict of interest and breach of employment contract (Correct answer)
Refer the private patients to the NHS waiting list
Agree but only if the NHS patients have no urgent needs
Agree as it is a favour to a colleague

Correct answer: Decline, as seeing private patients during NHS time is a conflict of interest and breach of employment contract

Using NHS time to provide private clinical care constitutes a breach of employment contract, a conflict of interest, and a failure of professional duties to NHS patients.

Question 27: A patient newly started on sodium valproate requires monitoring. Which investigations are most important?

Liver function tests and full blood count (Correct answer)
Thyroid function tests
Renal function every 6 months
Serum calcium and phosphate

Correct answer: Liver function tests and full blood count

Sodium valproate can cause hepatotoxicity (especially in young children) and thrombocytopenia, so liver function tests and full blood count must be monitored regularly.

Question 28: A 52-year-old man presents with severe epigastric pain radiating to the back, nausea, and vomiting following a heavy alcohol binge. Serum amylase is five times the upper limit of normal. Which scoring system is used to stratify the severity of this condition?

CURB-65 score
Glasgow-Blatchford score
Glasgow (Imrie) score (Correct answer)
Wells score

Correct answer: Glasgow (Imrie) score

The Glasgow (Imrie) score uses eight clinical and laboratory parameters to predict severe acute pancreatitis within 48 hours of admission. CURB-65 stratifies pneumonia severity; the Glasgow-Blatchford score risk-stratifies upper GI bleeds; the Wells score estimates pre-test probability of PE or DVT.

Question 29: A pharmaceutical representative offers you an expensive gift in exchange for promoting their medication. What should you do?

Decline the gift as it represents a conflict of interest that could influence prescribing decisions (Correct answer)
Accept it but declare it to your department
Accept it and prescribe whatever you think is best anyway
Accept it as it's a common industry practice

Correct answer: Decline the gift as it represents a conflict of interest that could influence prescribing decisions

Accepting gifts from pharmaceutical companies creates conflicts of interest and may bias prescribing. GMC guidance requires doctors to be honest about financial interests and avoid conflicts that could affect patient care.

Question 30: What approach is recommended for ranking Professional Dilemma responses?

Consider only the legal implications
Rank based on what seems easiest to do
Always rank the most extreme action first
Consider patient safety first, then professional obligations, then personal preferences when ranking actions (Correct answer)

Correct answer: Consider patient safety first, then professional obligations, then personal preferences when ranking actions

The recommended hierarchy for ranking is: patient safety (most important), professional obligations and GMC guidance, maintaining trust in the profession, and then practical/personal considerations.

MSRA (Multi-Specialty Recruitment Assessment)

The MSRA is a computer-based exam used by NHS England to assess doctors applying for specialty training. It evaluates Clinical Problem Solving across 12 medical topic areas and Professional Dilemmas covering professional judgment, ethics, and communication.

147

Questions

170 min

Time Limit

70%

To Pass

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Exam Rules

You can skip questions and return to them later
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No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

medical.hee.nhs.uk — Registration deadline, score release, test dates, eligibility, passing score, retake policy, exam format, time limit, test delivery · verified Oct 2026