MSRA · CPS question techniques
CPS asks you to apply Foundation-level knowledge to a precise clinical decision. Identify the task before comparing options: diagnosis, investigation, emergency, prescribing or non-prescribing management.
Single Best Answer items use one clinical presentation and typically five to eight plausible options.
Extended Matching Questions have a common set of seven to ten responses and multiple independent cases.
The official CPS blueprint covers investigation, diagnosis, emergency, prescribing and non-prescribing management.
In depth
Section 01
First read the lead-in, then identify the few findings distinguishing the most plausible answers. Form a provisional response and challenge it against the nearest distractor.
A candidate who correctly recognises a disease but chooses treatment when asked for the next investigation still answers the wrong task. A technically reasonable alternative is not always the single best answer in the presented context.
Do not invent missing examinations or assume specialist resources unless the vignette states them. Foundation-level practice, not an exhaustive subspecialty work-up, frames the official paper.
Section 02
Scan the shared answers to recognise whether the task concerns diagnoses, tests or treatments. Keep the common lead-in in mind for every vignette.
Treat each case independently. The official format explicitly allows responses to repeat, so previously chosen letters are still available.
Look for discriminating clues: a common symptom such as dyspnoea may have different causes depending on the onset, observations, relevant risk factors and imaging findings.
Section 03
Classify errors as missing knowledge, the wrong task, a missed clue, a close distractor or time pressure. Each has a different remedy.
For a near-miss distractor, write one short sentence explaining why its supporting features are absent. For an emergency-recognition miss, revise acuity and red flags; for a misunderstood lead-in, practise naming the requested action.
A copied explanation does not prove transfer. Recheck your understanding using a different clinical vignette a few days later.
Section 04
The 75-minute CPS section has 86 items, approximately 52 seconds each on average. This is a calculation, not a separate timer imposed on every item.
An EMQ set takes time to read at the start; some follow-up cases then answer quickly. Avoid spending so long on one difficult item that easy later marks become unreachable.
NHS England confirms no negative marking; make your best supported selection even where uncertainty remains.
Original teaching exercise
Select the most likely diagnosis for each patient from the same list: A asthma, B community-acquired pneumonia, C pulmonary embolism, D pneumothorax, E COPD, F heart failure, G pleural effusion. Case 1: a 41-year-old develops sudden pleuritic chest pain and breathlessness after prolonged immobility; tachycardic and afebrile. Case 2: a 64-year-old has fever, productive cough and focal crackles with lobar air-space opacity.
Start with the task, then the differentiating clue, then the closest alternative.
Original teaching exercise only, not an official MSRA item or a clinical protocol.
Preparation
Common mistakes
Free Mini MSRA Bank
240 CPS questions and 50 PD scenarios with explanations. A free account is required.
Full MSRA Bank — £29 once for four calendar months from purchase; no automatic renewal.
Official source
Last checked 12 October 2026. Official NHS England guidance remains the source of truth.
Check primary sources for changes to exam arrangements, recruitment and professional standards.
Explore the MSRA guides
MSRA Clinical Problem Solving Guide
The CPS paper tests whether you can apply Foundation-level clinical knowledge to realistic decisions. It is not simply a recall paper: the official blueprint emphasises synthesis, investigation, diagnosis, emergency care, prescribing and management.
Read The MSRA Bank guide →
MSRA Mock Exam Strategy and Timing
A mock is valuable when it changes what you do next. Simulate the separately timed papers, distinguish incorrect from unattempted items, and verify that revisions transfer to fresh questions.
Read The MSRA Bank guide →
MSRA Revision Plan: 4, 8 and 12 Weeks
Build a timetable around your current knowledge, rota and reliable study hours. These routes develop both papers with spaced review and time-limited practice, rather than prescribing an unrealistic number of questions.
Read The MSRA Bank guide →