MRCPath example questions
- Sudden cardiac death. Young
woman with normal hearing. No gross/microscopic cardiac pathology during
autopsy. Several family members also have sudden cardiac death.
Choices: Catecholamine mediated something something
syndrome, atherosclerosis, HCM etc. Answer I think is long qt.
long qt. two types –Romano Ward(autosm dominant, no deafness) the other I think is
something something Nielsen- with deafness, autosomal recessive
- description of some sort of intraendometrial
polypoid growth, postmenopausal woman.
Prominent stroma, with glands showing ‘various metaplasias’(don’t ask me) , with stromal
condensation.Then asks what is the likely eitiologic agent
I chose tamoxifen
3. Most common location for ectopic parathyroids. Dunno this one… I
- Crusty, brown, itchy skin
lesions in a teenage boy. Nail abnormalities(vertical
alternating red, white stripes, V-shaped nick in the free edge) . Answer-Dariers /Keratosis Follicularis
- Description of renal biopsy. Thickened
BM with breaks, spikes, holes . Complement and IgG deposition. I think ans
is Membranous GN
- A NHS specific question(groan)A pathologist discovers that the
departmental breast tumour reporting is not
conforming with the generally accepted guidelines. He attempts to rectify
this in a departmental meeting. Who is the person ULTIMATELY responsible for the quality
of the reporting . Choices are nhs chairman, director of histopathology for that NHS
trust, Clinical director for Pathology… etc… hated this question.
- Most important prognostic
factor for Gastric Ca. Choices include depth of invasion, subtype of
gastric ca, presence of IM.
- Most important prognostic
factor for a buccal poorly diff SCC , perineural invasion
with 3 positive level 2 cervical lymph nodes(supraomohyoid
neck disscn) with extranodal
extension. I chose EN extension. Other choices are lymph node mets, perineural invasion,
poorly differentiated subtype)
- HPV –which of the
following is low-risk subtype(found in a cervical
acetowhite area, microscopically only koilocytosis). What can I say, just have to memorise the low and high risk subtypes.
- Gene involved in clear cell rCC.
- Gene involved in non polyposis coli.
- jejunal biopsy with villous
atrophy, intraepithelial lymphocytosis,
increased lamina propria chronic inflamm cells.. question is
which serological marker is most useful. FYI, there are two.
- Lip lesion with bilayered bland epithelium, reddish chondromyxoid stroma ,
cystic spaces, channels etc I THINK ans is canalicular adenoma
- Upper size limit for pN1mi (micromets) in breast carcinoma. Answer is 2mm
- 25 yr old man with AIDS, 5
months diarrhea. Small bowel bx , 2 micron , round specks coating the villous surface.
What is this? Ans=cryptosporidium. A sidenote, microsporidium is
- You want to demonstrate BOTH
gram negs and gram positives using one stain.
Which of the following do you use. Ans: Brown-Hopps by process
of elimination, since the other choices were so ridiculous eg PAS, Warthin Starry, ZN, Gomori meth silver (sidenote,
after googling, I found that this stain stains
gram negs red and gram pos blue)
- Examination of the ovarian hilus shows aggregates of glandlike
structures lined by bland nonciliated
epithelium. What is this? Ans=rete ovarii.
- Patient is s/p Hartmanns for perforated sigmoid diverticulum. Has bleeding and mucus from rectal
Histo, fissuring, crypt abscesses,
diffuse inflammation, crypt architecture distortion. What is the cause
of this ? Answer= lack of short chain fatty acids
- Sudden death patient. Young woman.facial rash,
joint pain, haematuria and some other
stuff. Skin biopsy done. Sudden death in
hospital. Asked me what
is likely to be seen in the arterioles of the skin bx. My answer is fibrinoid necrosis, since I think that the sudden
death in hospital is due to malignant hypertensive episode.,
secondary to lupus. Point:
must know features of lupus skin, lupus nephritis, and histologic
difference between benign and malignant hypertension. Robbins Review
covers this in a few of their mcq I think.
- Description of a ‘decoy cell’ and
EM showing some lattice array something or other. Straightforward. Next
- Elderly woman with A.Fib, Coronary artery dis, abdo pain, died. Autopsy-infarcted,
dusky small intestine, bloody ascetic fluid. What has happened-Inf mesenteric artery embolus
- DD between oncocytoma
and renal cell carcinoma which test I narrowed this down to
using EMA immuno and EM to detect mitochondria.
I chose the EM for mitochondria.
- Which mineral exposure causes granuloma-like lesion in lungs. I think ans s beryllosis.
- sudden death. Haemorrhage
covering surface of medial temp lobe and frontal lobe. What
is likely to be seen on autopsy. I put berry
aneurysm of anterior communicating artery.
- Forensics… laceration vs incised wound
- man with hypernatremia,
excess K+ excretion, what syndrome does he have- Conns
- Man ith
6cm adrenal tumour, no metastases. Histologically, occasional atypia,
necrosis with neutrophil infiltration, Which of
the following is most predictive of malignancy. Necrosis, size…. Some
other stuff. I put down necrosis.
- fat woman. 1.2cm endometrial
stripe- bx shows well diff endometroid
Which of the following hormones is most important in the
pathogenesis. Oestradiol or oestrone….????????
- Description of a gastric erythematous patch’vascular ectasia, minimal inflammatory cells, upward growth of musc mucosae, foveolar hyperplasia’ What is the most likely aetiology… sounds like chemical gastritis/reactive gastropathy… had to choose between bile and pancreatic
- Baby with jaundice. Has bile
ductile proliferation, feathery degen
of hepatocytes, large cell change, periportal oedema. What is this. Answer I think is extrahepatic
- Various lymphomas with their cytogenetic translocations and immuno stains…. Two sets of emqs
- EMQ: Chest wall tumours- descriptions were purely immuno.
Combination of CAM, ema, vimentin,
cd99, cd31, cd34 ttf1, calret, ck5and some weird thing called D34. choices mesothelioma, scc lung,
synovial sarc, malignant sft,,
- fast growing forehead mass,
histology shows high nc ratio, nuclear molding,
finely granular chromatin, ttf1 neg, cd45 neg, ck20 pos, perinuclear dotlike CAM5.2… answer is Merkel cell ca.
- Positive p anca,
hemoptysis some other things… what is this. Ans churg strauss
- sudden death in a mentally
retarded young boy. Faecal soiling of genitals, small bruises on shins ,
torn oral frenulum, some other stuff. which of these is most likely due to Non accidental
injury . I chose torn oral frenulum
- Testicular tumour.Description of fibrovascular
cores with central vessel, papillae around it, has varied solid, cystic
pattern, areas resembling foetal liver, grossly yellowish , mostly solid with
some cystic areas too. Immuno cd30, cd117 plap neg, bhcg neg, afp
- question about borderline serous tumour of ovary. Which is most important prognostic
factor: amount of psamomma bodies, degree of
papillary architecture, invasive peritoneal implants ovarian stromal microinvasion,
degree of cellular atypia
- EMQ about various expected
autopsy findings …. Cant remember all of the choices- included severe steatosis ( put this for a 40 year old binge drinker
who suddenly died), mild steatosis, micronodular cirrhosis
Then came the descriptions, the ones I remember
are a toddler who died in his sleep, autopsy shows various small bruises over
shin, and some redness in the trachea, healed full thickness burn over shoulder
. None of the choices showed anything resembling child abuse … so I put (no
- Various dead people, provisional diagnosis asphyxiation. Then gives
the ‘crime scene’, description of the patients past medical history. Then
a whole bunch of causes like positional asphyxia, foul play(scene
made to look like suicide). I remember some of the descriptions
.a) man on floor , sky high blood
alcohol, wedged between bed and cupboard.
with depression. Hanging by neck from doorway, but no bruises, no fractured
hyoid, no C2 fracture, face pale, no petechiae.
C) Fat man, copd, heart disease, lying face down. Very congested face,
no laryngeal or hyoid fracture, but has strap muscle bruising. I chose plastic
35. Uses of various
bones to the forensic pathologist. What bone you use to determine gender,
height, age, which bone easiest to get marrow from (to look for diatoms in case
of suspected river drowning)
36. Some urine
cytology. I’m only pretty sure I got the SCC (keratinous debris, blood, oval refractile bodies with hooks at one end, and TCC for certain.Others were a bit bewildering.
37. Autopsy appearance
of brain (gross )appearance and a description of the traumatic incident leading up to it.
There was a MVA victim with multiple fractures,
autopsy showed diffuse petecial h’ge
in white matter. One other collapsed in street, had tonsillar
herniation and pontine h’ge on autopsy.
One was a man with
worsening headaches and onset of mild dementia, sudden death. Autopsy =various
superficial cortical haemorrhages of various ages.
Also had young girl,
unrestrained back seat, in MVA. Had no skull fractures, but autopsy showed uncal herniation and upper
brainstem petechial haemorrhages.
(pretty sure this was cerebral oedema,but
I chose EDH since there was no cerebral oedema. I
suppose edh will also
Need to know features of DAI, SAH, EDH, SDH,
hypertensive h’ge, Duret haemorrhages,
38. Various skin lesions, clinical, histo and sometimes IMF given. Must know the clinical, light
micro and imf(IF APPLICABLE) all these-Lichen planus, Derm
Herpetiformis, polymorphous light eruption, Epidermolyis bullosa congenita and acquisita, lichen aureus and other pigmented purpuric
dermatoses, Bullous pemphigoid,
Pemphigus vulgaris, foileaceous.
39. oligodendroma-which of the
following features most predictive of aggressive behaviour
40.more nhs BS- various buzzwords like clinical
governance, revalidation, clinical audit… match them up with the official
bureaucratese translation. I had
fun with this EMQ…. Not.
41. Various nonneoplastic
lung lesions-given age, gender, occupation, radiogic
and microscopic description…. Some weird stuff like serum angiotensin
converting enzyme , something with ‘eosinophilic macrophages’
As far as I know, the choices included the
usual fodder like nsip, uip,
lymhocytic interstitial lung dis,
EAA, DIP, sarcoid, boop.
Some other stuff I never heard of like pseudolymphoma
also came up.
42. description of
various dead people’s hearts with congenital defect- what can I say… must know
the congenital heart defects well. Includes ebsteins
, TOF, truncus, total anomalous pulmonary return, hypoplastic left heart, disruption of aorta, transposition
of great vessels, coarctation of aorta(this one was
easy- a lot of good clinical info also was given-rib notching, weak pedal
pulses, Turner syndrome)
43. Stillborn infant with brain/liver weight
ratio of 6(increased), small for dates, normal brain mass, enlarged liver.
Cause? I put down cmv
infection, but in retrospect I think answer is preeclampsia. Must know TORCH
infections and their clinical features well. Forgot that cmv
has microcephly, ventricular calcification etc. still
44. Sudden death in young woman 1 wk post
partum, Normal vag delivery-healthy baby girl. I put
down amniontic fluid embolus
description of various brain degenerative
diseases –clinical and pathological. Then have to match up with the
correct protein that is altered.
Caudate nucleus atrophy in young man, history
of chorea, father also had chorea and died at age 50.-Huntingtin
Parkinson symptoms- alpha synuclein
Frontal lobe atrophy, inappropriate behaviour- tau protein I think?
Woman with myoclonus,
triphasic EEG- donno what
the answer to this is, I put prion protein. Vaguely
remember that CJD
causes a distinctive EEG pattern.