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100+ Free RANZCR Pathology Practice Questions

Pass your RANZCR Clinical Radiology Phase 2 - Pathology exam on the first try — instant access, no signup required.

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RANZCR's Phase 2 Written Examination Report for 2025 Sitting 2 recorded a Pathology first-attempt pass rate of 79.8% (99 of 124 candidates); overall Pathology results that sitting were 36% straight pass, 37% conceded pass, and 27% fail. Pass Rate
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Sample RANZCR Pathology Practice Questions

Try these sample questions to test your RANZCR Pathology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 12-year-old with multiple café-au-lait macules and axillary freckling undergoes MRI showing optic pathway glioma. Which inherited disorder is most likely?
A.Tuberous sclerosis
B.Neurofibromatosis type 1
C.Von Hippel-Lindau disease
D.Li-Fraumeni syndrome
Explanation: Optic pathway glioma with café-au-lait spots and axillary freckling is characteristic of neurofibromatosis type 1 (NF1).
2Renal angiomyolipomas and cortical tubers on MRI in a young adult most strongly suggest which diagnosis?
A.Neurofibromatosis type 2
B.Tuberous sclerosis complex
C.Sturge-Weber syndrome
D.Cowden syndrome
Explanation: Tuberous sclerosis complex (TSC) causes cortical/subcortical tubers, subependymal nodules, and renal angiomyolipomas.
3Bilateral cerebellar haemangioblastomas and a pancreatic neuroendocrine tumour in a 35-year-old suggest mutation of which gene?
A.NF1
B.VHL
C.RET
D.PTEN
Explanation: Von Hippel-Lindau (VHL) disease results from VHL tumour suppressor gene mutation, causing haemangioblastomas and visceral tumours.
4Medullary thyroid carcinoma, phaeochromocytoma, and parathyroid hyperplasia in one patient indicate which syndrome?
A.MEN type 1
B.MEN type 2A
C.MEN type 2B
D.Carney complex
Explanation: MEN 2A (Sipple syndrome) comprises medullary thyroid carcinoma, phaeochromocytoma, and primary hyperparathyroidism.
5Osteogenesis imperfecta is primarily caused by defective synthesis of which structural protein?
A.Elastin
B.Type I collagen
C.Fibrillin-1
D.Laminin
Explanation: Osteogenesis imperfecta results from mutations affecting type I collagen synthesis, causing brittle bones and blue sclerae.
6In an IDH-wildtype diffuse astrocytic glioma, which histological finding is sufficient to support a diagnosis of glioblastoma, CNS WHO grade 4?
A.Oligodendroglial component
B.Microvascular proliferation or necrosis
C.Rosenthal fibres
D.Psammoma bodies
Explanation: Glioblastoma is an IDH-wildtype diffuse astrocytic glioma assigned CNS WHO grade 4. Either microvascular proliferation or necrosis supports that diagnosis; certain molecular alterations (TERT promoter mutation, EGFR amplification, +7/-10) can also establish the diagnosis when those histological features are absent.
7A diffuse glioma is IDH-mutant and has whole-arm 1p/19q codeletion. Which integrated diagnosis is supported?
A.Oligodendroglioma
B.Astrocytoma, IDH-mutant
C.Glioblastoma, IDH-wildtype
D.Ependymoma
Explanation: An oligodendroglioma is defined by both an IDH mutation and whole-arm 1p/19q codeletion in the current integrated classification. Treatment decisions depend on grade, clinical context, and local multidisciplinary management rather than on this marker alone.
8Ring-enhancing lesions with central necrosis in an immunocompromised patient most commonly represent which pathology?
A.Toxoplasmosis
B.Progressive multifocal leukoencephalopathy
C.Subacute sclerosing panencephalitis
D.Creutzfeldt-Jakob disease
Explanation: Cerebral toxoplasmosis classically produces multiple ring-enhancing lesions with surrounding oedema in AIDS patients.
9Demyelinating plaques in multiple sclerosis show perivenular inflammation and loss of which stained structure?
A.Myelin (Luxol fast blue)
B.Neurofibrillary tangles
C.Corpora amylacea
D.Bergmann glia
Explanation: MS plaques demonstrate perivenular lymphocytic inflammation with demyelination, highlighted by loss of myelin on Luxol fast blue stain.
10A cystic cerebellar tumour with an enhancing mural nodule in a child is most consistent with which diagnosis?
A.Medulloblastoma
B.Pilocytic astrocytoma
C.Ependymoma
D.Atypical teratoid/rhabdoid tumour
Explanation: Pilocytic astrocytoma (WHO grade 1) commonly presents in the posterior fossa as a cystic mass with an enhancing mural nodule.

About the RANZCR Pathology Exam

The RANZCR Clinical Radiology Phase 2 Pathology examination is one of three Phase 2 written papers (with Clinical Radiology MCQ and Case Reporting) that clinical radiology trainees in Australia and New Zealand must pass before sitting the OSCER. The 3-hour paper tests applied general pathology as it relates to imaging interpretation across nine topic areas, through 100 multiple choice questions and 10 short answer questions. Questions assess recognition of pathological consequences of disease, morphological changes associated with therapies, and occupational exposures. It is offered twice yearly, typically in January and July.

Assessment

One 3-hour written paper: 100 MCQs (single best answer, 1 mark each, 100 marks) and 10 short answer questions (6 marks each, 60 marks), for 160 marks total. From sitting 1, 2026, MCQs have four answer options instead of five. Delivered twice a year at invigilated Clifton venues. The MCQ section may include pictorial multiple-choice questions (PMQs) with images.

Time Limit

3 hours.

Passing Score

Standard-set for each sitting; RANZCR does not publish a fixed numerical pass mark. Trainees must pass all three Phase 2 written components (Pathology, Radiology MCQ, and Case Reporting) before sitting the OSCER.

Exam Fee

Phase 2 written component fees are published annually on the RANZCR Fees page; each of the three Phase 2 written papers is charged separately. Fees are reviewed annually by RANZCR. (Royal Australian and New Zealand College of Radiologists (RANZCR))

RANZCR Pathology Exam Content Outline

5%

Genetic Syndromes / Multi-system Conditions

Inherited tumour syndromes, connective tissue disorders, and multi-system conditions with characteristic imaging-pathological correlates.

15%

Brain

CNS neoplasms, demyelination, infection, vascular pathology, neurodegeneration, and congenital malformations.

15%

Head and Neck

Salivary gland, thyroid, sinonasal pathology, squamous cell carcinoma, and skull base lesions.

5%

Spine

Disc degeneration, infection, neoplasms, metabolic bone disease, and cord compression.

15%

Cardiothoracic

Lung neoplasms, interstitial lung disease, pleural pathology, mediastinal masses, and cardiac pathology.

20%

Abdomen and Pelvis

Hepatobiliary, pancreatic, gastrointestinal, renal, and adrenal pathology.

5%

Musculoskeletal

Bone tumours, arthritis, metabolic bone disease, soft tissue tumours, and fracture healing.

5%

Breast

Benign and malignant breast lesions, calcification patterns, and post-treatment changes.

15%

Obstetrics and Gynecology

Placental pathology, gestational trophoblastic disease, and ovarian and uterine neoplasms.

How to Pass the RANZCR Pathology Exam

What You Need to Know

  • Passing score: Standard-set for each sitting; RANZCR does not publish a fixed numerical pass mark. Trainees must pass all three Phase 2 written components (Pathology, Radiology MCQ, and Case Reporting) before sitting the OSCER.
  • Assessment: One 3-hour written paper: 100 MCQs (single best answer, 1 mark each, 100 marks) and 10 short answer questions (6 marks each, 60 marks), for 160 marks total. From sitting 1, 2026, MCQs have four answer options instead of five. Delivered twice a year at invigilated Clifton venues. The MCQ section may include pictorial multiple-choice questions (PMQs) with images.
  • Time limit: 3 hours.
  • Exam fee: Phase 2 written component fees are published annually on the RANZCR Fees page; each of the three Phase 2 written papers is charged separately. Fees are reviewed annually by RANZCR.

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

RANZCR Pathology Study Tips from Top Performers

1Weight your revision toward Abdomen and Pelvis and Brain, which together make up 35% of the approximate topic weighting — hepatocellular carcinoma grading, pancreatic ductal adenocarcinoma features, and glioma classification recur heavily in examiner reports.
2Study pathology through its radiological correlate, not as isolated histology — RANZCR examiner reports consistently note that candidates who memorise microscopic descriptions without linking them to imaging findings underperform on both MCQs and SAQs.
3Practise concise SAQ answers (3–4 sentences maximum) listing specific anatomical zones, histological subtypes, and staging features — the real exam awards partial marks for structured short answers, and vague terminology loses marks even when the underlying knowledge is correct.

Frequently Asked Questions

What is the RANZCR Pathology exam?

The Pathology exam is one of the three RANZCR Clinical Radiology Phase 2 written papers (alongside Clinical Radiology MCQ and Case Reporting). It is a 3-hour paper testing applied general pathology as it relates to imaging interpretation, through 100 multiple choice questions and 10 short answer questions.

What is the pass mark for the RANZCR Pathology exam?

RANZCR does not publish a fixed numerical pass mark. The standard is set individually for each sitting using formal standard-setting procedures. All three Phase 2 written papers must be passed before a trainee is eligible to sit the OSCER.

How often is the RANZCR Pathology exam held?

The Pathology paper is offered twice a year, typically in January and July, at invigilated Clifton venues in Australia, New Zealand, and Singapore, delivered via the risr/assess platform.

What topics does the Pathology exam cover?

The Pathology curriculum covers nine topic areas with approximate weightings: Genetic Syndromes (5%), Brain (15%), Head and Neck (15%), Spine (5%), Cardiothoracic (15%), Abdomen and Pelvis (20%), Musculoskeletal (5%), Breast (5%), and Obstetrics and Gynecology (15%). RANZCR notes these percentages are approximate and may vary slightly between sittings.

Are there images in the RANZCR Pathology exam?

Yes. The MCQ section can include pictorial multiple-choice questions (PMQs) with images; RANZCR's 2026 Sitting 1 report describes a mix of text-based SBAs and PMQs. This free practice bank uses text-based stems.