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FCPS Part 1 Pathology MCQs
Pathology questions cover cell injury, inflammation and repair, neoplasia and tumour markers, haemodynamic disorders and the systemic pathology of the heart, lung, liver, kidney and bone.
Below are 5 free single-best-answer questions drawn from the most frequently examined pathology concepts, each with the answer and a rationale for every option. The full bank has 352 pathology concepts, each asked several different ways.
Free pathology questions
Question 1
Dry cough, dyspnoea, bilateral hilar nodes and compact granulomas without necrosis or acid-fast bacilli indicate:
- A. Cat scratch disease
- B. Silicosis
- C. Sarcoidosis
- D. Tuberculosis
- E. Histoplasmosis
Show answer
Answer: C. Sarcoidosis
Sarcoidosis is a T-cell driven granulomatous disease with compact non-necrotising granulomas, mainly in hilar nodes and lung. Granuloma macrophages make ACE and activate vitamin D, raising calcium.
Why not the others: Tuberculosis: caseating granulomas and AFB positive. Histoplasmosis: fungal stains positive. Silicosis: occupational dust exposure with eggshell calcification. Syphilis: gummas with necrosis. Cat scratch disease: stellate necrotising granulomas.
High-yield: Non-caseating granulomas with negative AFB and fungal stains = sarcoidosis.
Question 2
Typical necrosis pattern found in the myocardium after infarction:
- A. Liquefactive necrosis
- B. Coagulative necrosis
- C. Fibrinoid necrosis
- D. Fat necrosis
- E. Caseous necrosis
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Answer: B. Coagulative necrosis
Ischaemia denatures structural proteins and enzymes alike, so proteolysis is delayed. Tissue architecture is preserved for days while nuclei disappear.
Why not the others: Liquefactive necrosis: brain infarcts and abscesses. Caseous necrosis: tuberculosis. Fat necrosis: pancreatitis, breast trauma. Fibrinoid necrosis: vasculitis and malignant hypertension.
High-yield: Infarct in any solid organ except brain = coagulative necrosis.
Question 3
Histology of the wall in classic acute appendicitis shows which inflammation?
- A. Suppurative (purulent) inflammation
- B. Granulomatous inflammation
- C. Caseating necrosis
- D. Chronic non-specific inflammation
- E. Fibrous scarring
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Answer: A. Suppurative (purulent) inflammation
Acute appendicitis is a severe acute inflammation with a purulent exudate rich in neutrophils, plus oedema and congestion of the wall. Granulomatous and caseating patterns belong to chronic specific disease.
Why not the others: Granulomatous inflammation: epithelioid granulomas. Caseating necrosis: tuberculosis. Chronic non-specific inflammation: prolonged low-grade process. Fibrous scarring: healed stage. Eosinophilic inflammation: parasitic or allergic. Plasma-cell infiltrate: chronic inflammation.
High-yield: Acute appendicitis = suppurative inflammation, not granulomatous.
Question 4
Type of necrosis in an ischaemic stroke:
- A. Fibrinoid necrosis
- B. Fat necrosis
- C. Coagulative necrosis
- D. Caseous necrosis
- E. Liquefactive necrosis
Show answer
Answer: E. Liquefactive necrosis
Brain has little supporting stroma and is rich in lipid; enzymes liquefy the dead tissue (autolysis), which is then cleared, leaving a cyst.
Why not the others: Coagulative: ischaemic infarcts of every solid organ except brain. Caseous: tuberculosis. Fat: pancreatitis, breast trauma. Fibrinoid: vasculitis, malignant hypertension.
High-yield: Brain infarct = liquefactive; heart, kidney, spleen = coagulative.
Question 5
Underlying plasma abnormality causing oedema and pot belly in kwashiorkor:
- A. Hyperbilirubinaemia
- B. Hypernatraemia
- C. Lymphatic obstruction
- D. Portal hypertension
- E. Hypoalbuminaemia
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Answer: E. Hypoalbuminaemia
Plasma albumin generates most of the oncotic pressure. Protein deficiency (kwashiorkor) or urinary loss (nephrotic syndrome) lowers it, so fluid leaves capillaries into the interstitium.
Why not the others: Portal hypertension: ascites in cirrhosis. Hypernatraemia: dehydration. Hyperbilirubinaemia: jaundice. Lymphatic obstruction: non-pitting oedema.
High-yield: Generalised oedema + protein loss or deficiency = hypoalbuminaemia.
Keep going with pathology
Anaesgen brings every concept back on a spaced-repetition schedule timed to your exam date, as a different question each time, with full mock papers for Paper 1 and 2.
Get full access Try the 5 sample questionsHigh-yield pathology one-liners
The most-tested pathology concepts, as a clue and the answer it points to:
- Bilateral hilar nodes, non-caseating granulomas, ↑ACE, ↑Ca, AFB negative → sarcoidosis.
- MI, renal infarct, preserved ghost outlines, no nuclei → coagulative necrosis.
- Acute appendicitis, neutrophils, pus → suppurative inflammation.
- Brain infarct or abscess → liquefactive.
- Kwashiorkor, nephrotic syndrome, low oncotic pressure → hypoalbuminaemia.
- Amorphous mitochondrial densities, myelin figures, membrane damage → irreversible injury.
- Councilman (acidophil) bodies → apoptosis; viral hepatitis, yellow fever.
- Starry sky, jaw mass, t(8;14), c-myc, EBV → Burkitt lymphoma.
- Pus, first 24 hours of inflammation, drumstick Barr body → neutrophils.
- Flank mass, haematuria, polycythaemia or hypercalcaemia → renal cell carcinoma.
- Diapedesis, CD31, endothelial junction → PECAM-1.
- Burkitt, starry sky, MYC → t(8;14).
- Ovarian epithelial cancer → CA-125.
- Chicken fat over currant jelly, unattached → postmortem clot.
- Months after transplant, T-cell infiltrate, reverses with steroids → acute cellular rejection.
- Cardinal signs, neutrophils, pus, vasodilatation within hours → acute inflammation.
- Hypoperfusion, muddy-brown casts, FENa >2%, oliguria not fluid-responsive → ATN.
- Heavy drinker, Mallory-Denk bodies, AST above ALT → alcoholic hepatitis.
- Concentric LVH, syncope-angina-dyspnoea, carotid radiation → aortic stenosis.
- Shipyard, demolition, lower-lobe fibrosis, pleural plaques, ferruginous bodies → asbestosis.
Other FCPS Part 1 subjects
AnatomyPharmacologyBiochemistry & GeneticsCardiovascularNeurophysiologyMicrobiologyHaematologyGeneral PhysiologyImmunologyEndocrineRespiratoryEmbryologyObstetrics & GynaeRenal & Acid-BaseHistologyGI & LiverPhysicsBiostatistics
New to the exam? Read the FCPS Part 1 exam guide: dates, format and a 12-week study plan.