MRCPath example questions

1. 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

,Long QT syndrome, atherosclerosis, HCM etc. Answer I think is long qt.

Explanation: long qt. two types –Romano Ward(autosm dominant, no deafness) the other I think is something something Nielsen- with deafness, autosomal recessive

2. 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 put thymus.

3. 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
4. Description of renal biopsy. Thickened BM with breaks, spikes, holes . Complement and IgG deposition. I think ans is Membranous GN
5. 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.
6. Most important prognostic factor for Gastric Ca. Choices include depth of invasion, subtype of gastric ca, presence of IM.
7. 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)
8. 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.
9. Gene involved in clear cell rCC.
10. Gene involved in non polyposis coli.
11. 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.
12. Lip lesion with bilayered bland epithelium, reddish chondromyxoid stroma , cystic spaces, channels etc I THINK ans is canalicular adenoma
13. Upper size limit for pN1mi (micromets) in breast carcinoma. Answer is 2mm
14. 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 intracellular.
15. 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)
16. Examination of the ovarian hilus shows aggregates of glandlike structures lined by bland nonciliated epithelium. What is this? Ans=rete ovarii.
17. Patient is s/p Hartmanns for perforated sigmoid diverticulum. Has bleeding and mucus from rectal stump . Histo, fissuring, crypt abscesses, diffuse inflammation, crypt architecture distortion. What is the cause of this ? Answer= lack of short chain fatty acids
18. 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.
19. Description of a ‘decoy cell’ and EM showing some lattice array something or other. Straightforward. Next
20. 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
21. 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.
22. Which mineral exposure causes granuloma-like lesion in lungs. I think ans s beryllosis.
23. 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.
24. Forensics… laceration vs incised wound
25. man with hypernatremia, excess K+ excretion, what syndrome does he have- Conns
26. 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.
27. fat woman. 1.2cm endometrial stripe- bx shows well diff endometroid adenoca. Which of the following hormones is most important in the pathogenesis. Oestradiol or oestrone….????????
28. 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 enzymes..???????
29. Baby with jaundice. Has bile ductile proliferation, feathery degen of hepatocytes, large cell change, periportal oedema. What is this. Answer I think is extrahepatic biliary obstruction.

30. Various lymphomas with their cytogenetic translocations and immuno stains…. Two sets of emqs for this!!
31. 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,, epithelioid angiosarc
32. 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.
33. Positive p anca, hemoptysis some other things… what is this. Ans churg strauss
34. 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
35. 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 pos.
36. 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
37. 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 other findings)

38. 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.

B) woman 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 bag asphyixiation.

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 not sure….

44. Sudden death in young woman 1 wk post partum, Normal vag delivery-healthy baby girl. I put down amniontic fluid embolus

45. 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.