MRCPath part 1 Autumn 2009



1)  A known alcoholic 45 year-old male was found dead outside a pub. Which of the following suggest foul play?


2)  A friend of yours is interested in applying for a medical examiner job. He asked you for advice. Who hires the medical examiner?


3)  A woman died in the hospital after started on a course of penicillin. Anaphylaxis is suspected. Which of the followings indicate anaphylaxis ?


4)  A child with a lesion composed of cells positive for CD1a and S100.


5)  27 yo man from Hong Kong has a neck lump. The cells show large nuclei with prominent nucleoli with a syncytial growth pattern. Which of the following IHC would you perform?


6)  A man was found dead lying face down on the kitchen floor in his own home with a chair toppled. A pool of blood on the floor.


7)  A 32 yo female whose cervical smear was reported as moderate dyskaryosis and referred for colposcopy. However, 6 months later, your department has not received any specimen. You received a letter from the GP saying that this patient has moved. Who is responsible for the cervical cytology result?


8)  A mechanic who is a part-time bodybuilder admitted with acute renal failure. He admitted to drinking liquid from unlabelled bottle in the Gym. There are birefringent crystals in the urine. Which of the following is the most likely cause?


9) An elderly farmer had a dispute with his neighbours. He was found dead at home. PM - his  lungs are solid with hemorrhage and consolidation. What is likely to be the cause?


10) Lesion from the thigh of a man showing biphasic lesion composed of spindle cells and epithelial cells forming glands.


11) A tumour in the small bowel with tumour cells positive for CD34 and CD117, what is it?


12) A female patient with breast carcinoma. What is the most important prognostic feature?


13) Suspicious of GIST, CD117 not working, which other immuno would you use?


14) A bladder TCC invades deep into the muscularis mucosae, what is the stage?


15) Post mortem MRI is most useful in which of the following situation?

16)  Post-mortem of a patient with suspected MI 1 day prior to death, which is the most useful test?


17) Prostate needle biopsy show areas of small regular glands and areas of gland fusion giving rise to cribriform appearance. Which is the most likely grade?


18) A young pregnant lady who was febrile and had a stillbirth. Which of the following is the most likely sequence of event?


19) Axillary sentinel lymph node biopsy for breast carcinoma. What is the best practice to process the lymph nodes?


20) Young man with enlarge neck node. LN shows high endothelial venules proliferation and plasma cells. Patient has polyclonal hypergammaglobulinemia. Which is the likely cause?


21) Young man with phaechromocytoma and a mass in the ?thyroid. which of the following gene mutation is most likely?


22) A man with hypertension, hypokalemia and hypernatremia. (Conn’s syndrome) which is the most likely finding?


23) A mother with type 1 diabetes. The baby was born with hypoglycaemia immediately, why?


24) An afro-caribbean female with skin rash. Chest X-ray was done and a diagnosis was made. What is the most likely diagnosis?


25)  A 63yo female has a negative cervical smear. She had a borderline smear 5 years ago but since had 3 subsequent negative smear. What action should you take?


26) Renal transplant patient with renal failure. The biopsy showed ‘Decoy cells’. What is the likely cause?


27) Child with recurrent chest infection, failure to thrive and died. What is the underlying disease?


28)Young man with ? accident, right arm/leg weakness, 6th nerve palsy. What is the cause?


29) A miner’s lung with calcified fibrous nodules. Which minerals he was exposed to?


30) Elderly man from England travel to visit his son in Scotland. He had COPD. Prior to returning to England, his health deteriorated and he died in the hospital. His body was returned  to England. The coroner asked you to perform a second autopsy. However, you discovered that no autopsy had been done in Scotland. What is the most likely explanation?


31) Frozen section of parathyroid gland, surgeon wants to know whether it is an adenoma. What would you tell the surgeon?


32)  Frozen section of a lymph node from neck. The patient was exposed to TB recently. Surgeon wants to rule out TB with frozen section. What would you do?


33)  What is the normal size of parathyroid gland?


34)  FNA from neck lump showed 2 small clusters of follicles and debris. Which of the following result is appropriate?


35)  A male patient , post aortic aneurysm repair. Developed left sided abdominal pain and died. Which of the following branch is most likely to have been blocked?


36)  A young man with stomach GIST has a family history of tumours and multiple subcutaneous nodules. Which of the following is the syndrome?

      A) ?? 

37)  In the case of diaphragmatic hernia, what is the most important prognostic factor?

      A) Lung hypoplasia


38)  Breast cancer axillary node clearance. There is a group of cells in the subcapsular space. Which of the following immunostaining means that this group of cells is likely to be benign.


39)  When you find that a specimen you are trimming is different from the description on the request form, what would you do?


40)  In a liver biopsy, there are PAS positive globules in the hepatocytes, what is the likely diagnosis?


41)  A vulval lesion with large epithelial cells infiltrating the epidermis. These cells are CK7 –ve, CK20+ve, CEA+ve and CDX2-ve. Diagnosis?


42)  What does “p” in pT1N2Mx mean?


43)  HOCM morphology, which gene is mutated? 

44)  Female with mastectomy for breast cancer. She also had chemo-radiotherapy.  Presented with a vascular breast lump. What is the likely diagnosis?


45)  20 yo male with multiple skin lesions ? site. Histology shows cup-shaped lesion, intracellular inclusion, extends to surface. What is the likely diagnosis?


46)  IVDU, pleural effusion. “Maltese cross” seen in the effusion. What is the likely substance?


47)  A patient with 47 XXY chromosome, what is the commonest ovarian tumour 



1)  What is the likely precursor protein for amyloid  deposition in the following conditions?


2)  Liver biopsy from following patients, what is the likely diagnosis?


3)  Neurodegenerative disease, what is the likely diagnosis?


4)  FNA cytology of neck lump?


5)  Infectious diseases.


6)  Diarrhoea, what is the likely cause?


7)  Polyps from intestine.


8)  Bone tumours.


9)  Skin IF.


10)  Cardiar anomalies- morphology descriptions, can’t remember, but answers below should be correct, just read the chapter!

      A)  Ebstein anomaly


11)  Cervical cytology – Infections:


12)  Insignificant Gynae lesions seen on histology- Please read the books about their morphology.


13)  Prostate needle biopsy.


14)  Breast pathology- Please read textbook for morphology descriptions:


15)  Auto-antibodies.