Pathology questions from past FMGE papers

1. Q1. A patient with marked leucocytosis, basophilia and massive splenomegaly is suspected of chronic myeloid leukaemia. Which finding confirms the diagnosis?

   • A. Detection of the BCR-ABL1 fusion gene
   • B. A low leucocyte alkaline phosphatase score
   • C. Basophilia on the peripheral smear
   • D. A hypercellular marrow on biopsy

   Answer: A. Detection of the BCR-ABL1 fusion gene

2. Q2. Neutrophil extracellular traps are webs of chromatin and granule proteins released by activated neutrophils. Which statement about them is correct?

   • A. They are formed by drawing the organism into a phagocytic vacuole
   • B. They require intact mitochondrial oxidative phosphorylation to form
   • C. They are released only by eosinophils
   • D. They trap extracellular microbes and can expose nuclear autoantigens implicated in SLE

   Answer: D. They trap extracellular microbes and can expose nuclear autoantigens implicated in SLE

1. Q1. Which organ is a primary lymphoid organ, and what makes it primary rather than secondary?

   • A. Thymus, because lymphocytes develop and undergo selection there before encountering antigen
   • B. Spleen, because it filters blood-borne antigen
   • C. Lymph node, because germinal centre reactions occur there
   • D. Peyer's patches, because they sample gut antigen

   Answer: A. Thymus, because lymphocytes develop and undergo selection there before encountering antigen

2. Q2. Which biomarker rises earliest after myocardial injury, and why is troponin still the diagnostic test of choice?

   • A. CK-MB rises first, but troponin remains elevated for longer
   • B. LDH rises first, but troponin costs less
   • C. Myoglobin rises first and is more cardiac-specific than troponin
   • D. Heart-type fatty acid binding protein rises first, but troponin is far more cardiac-specific

   Answer: D. Heart-type fatty acid binding protein rises first, but troponin is far more cardiac-specific

1. Q1. Anaphylaxis after eating shellfish is a type I hypersensitivity reaction. Which mediator accounts for the immediate phase within minutes, and which for the late phase hours afterwards?

   • A. Complement C3a immediately, and antibody later
   • B. Preformed histamine immediately, and newly synthesised leukotrienes and cytokines later
   • C. Interferon gamma immediately, and histamine later
   • D. Immune complexes immediately, and neutrophils later

   Answer: B. Preformed histamine immediately, and newly synthesised leukotrienes and cytokines later

2. Q2. Which neurodegenerative disease is characterised by intraneuronal neurofibrillary tangles of hyperphosphorylated tau together with extracellular amyloid beta plaques?

   • A. Huntington disease
   • B. Amyotrophic lateral sclerosis
   • C. Alzheimer disease
   • D. Parkinson disease

   Answer: C. Alzheimer disease

1. Q1. Which enzyme allows cancer cells to divide indefinitely, and how?

   • A. Telomerase, by rebuilding the telomeric repeats lost at each division
   • B. Topoisomerase, by relieving supercoiling
   • C. Helicase, by unwinding the double helix
   • D. RNA polymerase, by increasing transcription

   Answer: A. Telomerase, by rebuilding the telomeric repeats lost at each division

2. Q2. A thyroid biopsy shows overlapping cells with optically clear nuclei, nuclear grooves and intranuclear inclusions, with psammoma bodies. What is the diagnosis, and how does it usually spread?

   • A. Follicular carcinoma, spreading haematogenously
   • B. Papillary carcinoma, spreading by lymphatics to cervical nodes
   • C. Medullary carcinoma, arising from parafollicular C cells
   • D. Anaplastic carcinoma, spreading by direct invasion

   Answer: B. Papillary carcinoma, spreading by lymphatics to cervical nodes

1. Q1. Which ion is the final common mediator of irreversible cell injury, and what does its rise activate?

   • A. Calcium, activating phospholipases, proteases and endonucleases
   • B. Copper, activating oxidative enzymes
   • C. Selenium, activating glutathione peroxidase
   • D. Magnesium, activating kinases

   Answer: A. Calcium, activating phospholipases, proteases and endonucleases

2. Q2. Ischaemic infarction of the brain produces which pattern of necrosis, and why does it differ from the heart?

   • A. Coagulative necrosis, because protein denaturation dominates
   • B. Liquefactive necrosis, because the brain is lipid-rich, low in supporting stroma, and microglial hydrolases dominate
   • C. Caseous necrosis, because of granuloma formation
   • D. Fat necrosis, because of lipase release

   Answer: B. Liquefactive necrosis, because the brain is lipid-rich, low in supporting stroma, and microglial hydrolases dominate

1. Q1. Berry aneurysms form at branch points of the circle of Willis. Which structural defect underlies them?

   • A. Loss of the endothelium from hypertension
   • B. A congenital deficiency of the tunica media and internal elastic lamina at arterial bifurcations
   • C. Adventitial inflammation
   • D. Intimal lipid deposition

   Answer: B. A congenital deficiency of the tunica media and internal elastic lamina at arterial bifurcations

2. Q2. A man who worked 20 years in a shipyard has breathlessness, and HRCT shows bilateral pleural plaques with basal fibrosis. Which pneumoconiosis is this, and which malignancy is associated?

   • A. Silicosis, associated with tuberculosis
   • B. Coal worker's pneumoconiosis, associated with emphysema
   • C. Berylliosis, associated with granulomas
   • D. Asbestosis, associated with mesothelioma and bronchogenic carcinoma

   Answer: D. Asbestosis, associated with mesothelioma and bronchogenic carcinoma

1. Q1. Stellate suppurative granulomas with necrotic centres in a lymph node draining a scratch suggest which infection?

   • A. Cat scratch disease caused by Bartonella henselae
   • B. Tuberculous lymphadenitis
   • C. Sarcoidosis
   • D. Histoplasmosis

   Answer: A. Cat scratch disease caused by Bartonella henselae

2. Q2. A graft taken from a different species is termed what, and what is the main barrier to its use?

   • A. An autograft, limited by donor site morbidity
   • B. An isograft, limited by donor availability
   • C. A xenograft, limited by hyperacute rejection against preformed antibodies
   • D. An allograft, limited by HLA mismatch

   Answer: C. A xenograft, limited by hyperacute rejection against preformed antibodies

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.