FRCPath Part1 Course
Cytopathology Gynae MCQ 1 You are delivering a course for nurses who are undertaking smear taker training for liquid based preparations. Following your presentation one of the nurses asks the age at which frequency of call for a routine smear changes from 3 yearly to 5 yearly. Select the most appropriate answer. A. B. C. D. E.
30 45 40 45 50
MCQ 2 A cytoscreener brings a cervical screening sample to you for your opinion. The patient is a 37 year old woman who has had a previous cone biopsy for CIN3 6 months ago. There are crowded groups of hyperchromatic cells which you believe represent lower uterine segment sampling. The screener asks if testing for Human Papilloma Virus (HPV) may help to ascertain if residual CIN is present. What HPV type would you recommend testing for? A. B. C. D. E.
1. 3. 6. 8. 16.
MCQ 3 You are auditing a case of invasive carcinoma of the cervix. A cervical smear 3 years before she presented with cervical carcinoma was reported as borderline nuclear changes with a repeat smear requested in 6 months. Who is responsible for operating failsafe for this abnormal result? A. B. C. D. E.
The general practitioner. The laboratory. The colposcopy clinic. The hospital based programme co-ordinator. Central operations (call/recall) office.
MCQ 4 A trainee cytoscreener who is screening the days work notices simple, unbranched fungal hyphae and spores in a liquid based cervical screening sample. He asks you what the significance of this is. Select the most appropriate answer. A. B. C. D. E.
Artefactual overgrowth which should be discounted. A harmless commensal which is of no clinical significance. An invasive infection which is likely to lead to tubo-ovarian abscesses. An unusual infection suggesting immunosuppression. A notifiable disease which should be reported to the director of public health.
FRCPath Part1 Course Non-Gynae MCQ 5 A medical student undertaking a pathology study module is assigned to cytology. He notices that alcohol is put on the slide before a Papanicolaou stain is applied. He asks you to explain the purpose of this alcohol. Choose the most appropriate response… A. B. C. D. E.
To ‘glue’ the cells onto the slide so that the cells are not lost during staining. To fix the cells so that cellular detail is preserved. To ensure the cells take up orange G allowing easy recognition of squamous cells. To remove water from the cells so that the mountant remains transparent. To lyse red blood cells.
Breast MCQ 6 A 48 year old female is discussed at the breast MDT meeting. She presented with a firm, mobile mass in the left breast which had been present for 8 weeks. Mammography revealed a well defined, ovoid mass considered to be benign (M2) and ultrasound revealed a slightly lobulated, well defined hypoechoic mass again considered to be benign (U2). A fine needle aspirate was reported as carcinoma (C5). A core biopsy was performed due to the discrepancy. A single palpable core was taken. This revealed fat necrosis and scattered breast lobules with no evidence of malignancy (B2). The most appropriate conclusion is: A. B. C. D. E.
The correct diagnosis is fat necrosis. The correct diagnosis is a fibroadenoma. The correct diagnosis has not been established. The correct diagnosis is carcinoma. The correct diagnosis is an abscess.
Urine MCQ 7 A 79 year old male is referred to the urology department with microscopic haematuria. He has a past history of ischaemic heart disease and diabetes mellitus. Investigations performed in the clinic confirm haematuria on dipstick testing, and ultrasound reveals a mass measuring 5x3cm in the left kidney. A sample of urine is submitted for cytological evaluation. This contains mature and anucleate squamous cells, variably degenerate urothelial cells, macrophages, neutrophils and corpora amylacea. The most likely diagnosis… A. B. C. D. E.
Renal calculus. Prostatic adenocarcinoma. Renal cell carcinoma. Transitional cell carcinoma. Malakoplakia.
FRCPath Part1 Course Thyroid MCQ 8 A 24 year old male presents with a mass in the right side of the neck, which has been growing for the previous 3 months. Ultrasound scan of the neck reveals a solitary mass in the right thyroid which is of high vascularity. Enlarged lymph nodes are also present in the right carotid chain. Fine needle aspiration of the thyroid mass includes numerous cells with moderate amounts of slightly granular cytoplasm and eccentric nuclei. The nuclei are round and oval with finely granular chromatin and inconspicuous nucleoli. Immunocytochemistry reveals strong expression of cytokeratins and calcitonin. The most appropriate classification for this aspirate is: A. B. C. D. E.
Thy1. Thy2. Thy3f. Thy4. Thy5.
Salivary gland cytology MCQ 9 You are assessing a fine needle aspirate from a parotid mass in a 68 year old female. The aspirate contains mucoid material, plentiful lymphoid cells of mixed type and papillary groups of epithelial cells with copious, granular cytoplasm and round nuclei with prominent nucleoli. Select the most likely diagnosis. A. B. C. D. E.
Pleomorphic adenoma. Muco-epidermoid carcinoma. Warthin’s tumour. Non-Hodgkin’s lymphoma. Low grade polymorphous carcinoma.
Serous Fluid Cytology MCQ 10 A 56 year old female with a history of cirrhosis of unknown aetiology presents with increasing lethargy and abdominal distension. Clinical examination reveals tense ascites which is drained and a sample submitted for cytological examination. The consultant asks for a cell count on the specimen. The count of which type of cell provides the most diagnostic information? A. B. C. D. E.
(a). Eosinophil. (b). Macrophage. (c). Lymphocyte. (d). Neutrophil. (e). Basophil.
FRCPath Part1 Course
A. CD45 B. CD9 C. CD38 D. CD29 E. CD3
F. CD30 G. CD56 H. CD82 I. CD20 J. CD99
1. A 73 year old male presents with increasing shortness of breath. He has smoked cigarettes for many years and has a history of chronic obstructive pulmonary disease. Investigations reveal a left sided pleural effusion. A sample of this is submitted for cytological examination which reveals large numbers of mature, small lymphocytes with scattered macrophages and reactive mesothelial cells. There are also medium sized cells with scanty cytoplasm, hyperchromatic nuclei and stippled chromatin. Nuclear moulding is present. Which antibody, from the list given above, would you expect to be expressed by the medium sized cells? 2. A 68 year old male presents with increasing shortness of breath and cervical lymphadenopathy. He has smoked cigarettes for many years and has a history of chronic obstructive pulmonary disease. Investigations reveal a left sided pleural effusion. A fine needle aspiration of the palpable neck lymph nodes is performed. This contains abundant material composed of cells with scanty cytoplasm with many of the cells being disrupted with streaking of the DNA. Small nucleoli are present. A colleague suggests these are from a poorly differentiated carcinoma, but you believe them to be lymphoid cells. Which antibody, from the list given above, is most likely to be expressed in this case if you are correct?
3. A 17 year old male presents with night sweats and weight loss. Enlarged cervical lymph nodes are noted on clinical examination. Fine needle aspiration of the lymph nodes is performed. The aspirate includes abundant material composed of a dispersed mixture of cells of varying type including eosinophils. There are several large cells with pale staining cytoplasm, large nuclei and prominent nucleoli. Some of the large cells are binucleate. Which antigen, from the list given above, is most likely to be expressed by the large cells? 4. A 63 year old female presents with a rapidly enlarging mass in the left side of the neck. An ultrasound scan of the neck reveals the mass to be formed of several large, rounded lymph nodes which lack a fatty hilum. Fine needle aspiration of this is performed. The aspirate includes numerous large cells with plentiful cytoplasm, irregular nuclei, irregular chromatin and multiple nucleoli. Several mitotic figures are noted many of which are morphologically abnormal. Plentiful tingible body macrophages are present giving a ‘starry sky’ appearance. Which antibody, from the list given above, is most likely to be of diagnostic value in this case? 5. A 17 year old male presents with a mass on the left chest wall. A chest X-ray reveals a mass expanding the 7th rib with an ‘onion skin’ appearance. Fine needle aspiration of the mass is performed. Numerous cells with scanty cytoplasm and round, hyperchromatic nuclei are present. Frequent mitotic figures are noted. Which antigen, from the list given above, is most likely to be expressed by the cells?