MSRA · UKMLA AKT · Finals · PLAB 1

MSRA, UKMLA and PLAB revision from first principles

Build clinical understanding for the MSRA, UKMLA AKT, medical school finals and PLAB 1 with first-principles explanations, single-best-answer questions and spaced revision. MSRA candidates also get separate situational-judgement practice.

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See exactly what's covered · Explore MSRA revision · Sitting PLAB 1? It's set against the same map

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Understand the mechanism, then prove it in the exam format

Every condition is taught from first principles, so the clinical picture, investigations and management follow from the biology instead of a list to memorise. Here is a real page, and a question that tests it.

From first principlesFree sample page

Acute coronary syndrome

Rupture of an unstable atherosclerotic plaque triggers thrombus formation that partially or completely occludes a coronary artery, and the resulting ECG and troponin pattern (STEMI, NSTEMI, or unstable angina) dictates exactly how urgently the vessel must be reopened.

One process, a spectrum of severity

Acute coronary syndrome begins when an atherosclerotic plaque's fibrous cap ruptures, exposing thrombogenic material to flowing blood. If the thrombus is non-occlusive, ischaemia occurs without myocyte death (unstable angina). If it partially occludes the vessel, the oxygen-hungry subendocardium infarcts (NSTEMI). If it completely occludes the vessel, the full thickness of the wall infarcts (STEMI). One mechanism produces a graded spectrum of severity.

Why the complications follow from the damage

Complications map directly onto what infarcted: electrically irritable tissue causes arrhythmia, extensive loss of contractile mass causes cardiogenic shock, and damage to a specific structure causes a specific mechanical failure. The posteromedial papillary muscle has a single blood supply, so an inferior infarct can rupture it and cause acute mitral regurgitation, which is exactly what the question on the right is testing.

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Sample question

HarderSingle best answer

A 72-year-old woman is on the coronary care unit 4 days after an inferior ST-elevation myocardial infarction treated with primary PCI. She suddenly becomes acutely breathless. On examination there are coarse crackles to both mid-zones and a new loud pansystolic murmur heard best at the apex and radiating to the axilla. Her observations are shown. What is the most likely complication?

Observations

Heart rate	118beats/min	↑	(60–100)
Blood pressure	84/52mmHg	↓
Oxygen saturation	88%	↓	(94–98)

Use the cross-out button on the right to eliminate options. Click it again to restore them.

Select an answer, then submit.

Four things, done properly

First-principles knowledge base

Each condition starts from mechanism, not memorisation - why the biology produces the clinical picture, then presentation, investigations and management.

Clinical questions and MSRA SJT

Five-option clinical single-best-answer questions with explanations for every option, plus separate ranking and choose-three situational-judgement practice for MSRA Professional Dilemmas.

A clear framework for clinical coverage

400+ condition pages organised around the GMC's MLA content map, including clinical topics relevant to the MSRA. Explore the map to see the textbook's coverage and gaps.

See exactly what's covered

Forgetting-curve scheduling

An SM-2 spaced-repetition scheduler brings items back right before you're likely to forget them, mixing due reviews with new material each session.

For MSRA, clinical practice here uses single-best-answer questions; the exam also includes extended-matching questions. Situational-judgement practice is separate.

Simple pricing

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The high-yield textbook and free practice samples.

The full high-yield textbook
Selected extended chapters in full, with previews of the others
A free sample of the question bank, no account required

Full access

Founding member deal

Everything in Free, plus the full textbook and practice bank.

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Founding price, locked in for life. Offer ends 20 November 2026 at 23:59 (UK time). New members then pay £24.99/year.

Every condition page in full, high-yield and extended
The complete SBA question bank, with per-option explanations
SJT rank-5 and choose-3 practice (MSRA users only)
Forgetting-curve scheduling and a weak-topic dashboard