100+ Free FRCPath Part 1 Practice Questions

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A patient has profuse watery diarrhoea after a course of co-amoxiclav. Stool testing detects Clostridioides difficile toxin. Which laboratory approach is recommended for diagnosis in UK practice?

Stool culture for the organism alone

Blood culture for C. difficile

Toxin EIA alone as a single test

A two-stage algorithm: GDH/PCR screen followed by a toxin (EIA) test

to track

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Sample FRCPath Part 1 Practice Questions

Try these sample questions to test your FRCPath Part 1 exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 62-year-old man with a 40 pack-year smoking history has a hilar lung mass biopsied. Histology shows nests of cells with keratin pearls and intercellular bridges. Which is the most likely diagnosis?

A.Small cell carcinoma

B.Squamous cell carcinoma

C.Adenocarcinoma

D.Large cell neuroendocrine carcinoma

Explanation: Keratin pearls and intercellular bridges are the defining morphological features of squamous differentiation, diagnostic of squamous cell carcinoma. It is strongly associated with smoking and classically arises in a central/hilar location.

2A colonic adenocarcinoma resection is being reported using the RCPath dataset. Which feature is the single most important determinant of the pT stage?

A.Depth of invasion through the bowel wall

B.Tumour grade (differentiation)

C.Number of involved lymph nodes

D.Presence of lymphovascular invasion

Explanation: In the TNM system the pT category for colorectal cancer is defined by the depth of local invasion (mucosa, submucosa, muscularis propria, subserosa/pericolic tissue, serosal surface/adjacent organs). Nodal status is pN and metastasis is pM, which are reported separately.

3Immunohistochemistry on a poorly differentiated metastatic carcinoma of unknown primary shows CK7-positive, CK20-negative, TTF-1-positive staining. Which primary site is most likely?

A.Colon

B.Bladder (urothelial)

C.Prostate

D.Lung

Explanation: TTF-1 positivity with a CK7+/CK20- profile is highly characteristic of pulmonary adenocarcinoma (TTF-1 also marks thyroid follicular carcinoma). This panel is a standard first-line approach to a carcinoma of unknown primary.

4Which immunohistochemical marker is most useful for confirming a diagnosis of gastrointestinal stromal tumour (GIST)?

A.Desmin

B.S100

C.DOG1 (and CD117/KIT)

D.Cytokeratin AE1/AE3

Explanation: GISTs characteristically express DOG1 and CD117 (KIT), reflecting their origin from the interstitial cells of Cajal and frequent KIT or PDGFRA mutations. DOG1 is positive even in many KIT-negative GISTs.

5A breast core biopsy shows invasive carcinoma. Which combination of biomarkers determines whether the patient is offered anti-HER2 therapy and endocrine therapy?

A.CK5/6 and EGFR

B.ER, PR and HER2

C.Ki-67 and p53

D.E-cadherin and CK7

Explanation: Oestrogen receptor (ER) and progesterone receptor (PR) status guide endocrine therapy, while HER2 status (by IHC and, if equivocal, ISH) determines eligibility for anti-HER2 agents such as trastuzumab. This triad is the core predictive panel in breast cancer reporting.

6A renal tumour shows nests of cells with clear cytoplasm and a delicate vascular network. Loss of which tumour suppressor gene is most characteristic of this entity?

A.VHL

B.RB1

C.APC

D.NF2

Explanation: Clear cell renal cell carcinoma is strongly associated with inactivation of the VHL gene on chromosome 3p, leading to HIF accumulation and the characteristic richly vascular clear-cell histology. VHL loss occurs in both sporadic and hereditary (von Hippel-Lindau) forms.

7A skin lesion shows atypical melanocytes with a Breslow thickness of 1.8 mm and no ulceration. According to standard melanoma reporting, what is the single most important prognostic parameter for this primary cutaneous melanoma?

A.Clark level

B.Pigmentation

C.Number of dermal mitoses per high-power field alone

D.Breslow thickness

Explanation: Breslow thickness (the depth in millimetres from the granular layer to the deepest tumour cell) is the strongest histological predictor of outcome and the basis of the T category in melanoma staging. Ulceration is the next most important modifier.

8During a hospital autopsy, the pathologist finds a saddle embolus occluding the bifurcation of the main pulmonary artery. What is the most likely source of this thromboembolus?

A.Left atrial appendage

B.Aortic atheromatous plaque

C.Deep veins of the lower limb

D.Hepatic portal vein

Explanation: The overwhelming majority of pulmonary thromboemboli arise from deep vein thrombosis of the lower limb and pelvic veins, embolising via the right heart into the pulmonary arteries. A large saddle embolus across the bifurcation can cause sudden death.

9Under the Coroners and Justice Act 2009 (England and Wales), which of the following deaths must be reported to the coroner?

A.An expected death from advanced metastatic cancer certified by the treating GP

B.A death where the cause is unknown

C.A death from natural pneumonia in a patient seen by their doctor within 28 days

D.A death from documented chronic ischaemic heart disease attended by the consultant

Explanation: Deaths of unknown cause must be referred to the coroner. Other reportable categories include violent/unnatural deaths, deaths in custody, deaths possibly due to industrial disease, and deaths where no doctor can certify a natural cause.

10A liver biopsy in a patient with chronic hepatitis C shows bridging fibrosis with regenerative nodules. Which special stain is most useful for highlighting the architecture of fibrous septa and reticulin framework?

A.Reticulin (silver impregnation)

B.Periodic acid-Schiff (PAS)

C.Congo red

D.Ziehl-Neelsen

Explanation: Reticulin (silver) stains highlight the type III collagen framework and are invaluable for assessing collapse, regenerative nodularity and fibrous septa in chronic liver disease and cirrhosis. A Masson trichrome or Sirius red is also commonly used to demonstrate collagen.

About the FRCPath Part 1 Exam

The FRCPath Part 1 examination is the first-stage knowledge assessment for UK pathology specialty training, tested separately in each pathology specialty such as histopathology, haematology, microbiology/infection, chemical pathology (clinical biochemistry) and immunology. It uses single-best-answer and extended-matching questions, plus essays in some specialties, to test core diagnostic and disease-mechanism knowledge.

Assessment

Two same-day written papers in most specialties: an essay/short-answer paper and/or a 125-question SBA/EMQ paper, content varying by chosen pathology specialty.

Time Limit

3 hours per paper (some specialties sit two 3-hour papers).

Passing Score

Standard set per paper; written long-answer papers use a 50% minimum standard, and SBA/EMQ papers are standard-set by the modified Angoff method. All required papers must be passed at one sitting.

Exam Fee

Approximately £670-£710 per specialty in 2026 (e.g. histopathology around £707); confirm the current fee on the RCPath website. (Royal College of Pathologists (RCPath))

FRCPath Part 1 Exam Content Outline

21%

Histopathology and cellular pathology

Diagnostic surgical pathology, tumour classification and staging, immunohistochemistry, cytopathology, autopsy practice and basic sciences underpinning histopathology.

22%

Haematology

General haematology, blood transfusion, haematological oncology and haemostasis & thrombosis, each contributing roughly equal weight in the haematology MCQ/EMQ paper.

17%

Chemical pathology / clinical biochemistry

Endocrine and metabolic biochemistry, fluid/electrolyte and acid-base disorders, therapeutic drug monitoring, toxicology, screening and laboratory statistics.

16%

Microbiology and infection

Bacteriology, virology, mycology, parasitology, antimicrobial resistance, diagnostic methods and infection control relevant to UK practice.

15%

General pathology and basic sciences

Inflammation and repair, cell injury and death, neoplasia and carcinogenesis, molecular pathology methods, laboratory management, quality assurance and medicolegal/HTA frameworks.

Immunology

Innate and adaptive immunity, hypersensitivity, autoimmunity and autoantibodies, complement, immunodeficiency and transplantation immunology.

How to Pass the FRCPath Part 1 Exam

What You Need to Know

Passing score: Standard set per paper; written long-answer papers use a 50% minimum standard, and SBA/EMQ papers are standard-set by the modified Angoff method. All required papers must be passed at one sitting.
Assessment: Two same-day written papers in most specialties: an essay/short-answer paper and/or a 125-question SBA/EMQ paper, content varying by chosen pathology specialty.
Time limit: 3 hours per paper (some specialties sit two 3-hour papers).
Exam fee: Approximately £670-£710 per specialty in 2026 (e.g. histopathology around £707); confirm the current fee on the RCPath website.

Keys to Passing

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

FRCPath Part 1 Study Tips from Top Performers

1Map your revision to your specialty's RCPath curriculum and relevant national guidelines (e.g. BSH and NHSBT for haematology/transfusion, NHSCSP terminology for cervical cytology, RCPath datasets for histopathology reporting).

2Practise large volumes of timed SBA and EMQ questions, since EMQs are difficult to guess and reward thorough, discriminating knowledge.

3Cover the shared basic sciences (general pathology, molecular methods, immunology, laboratory management and quality assurance) that recur across specialties as well as your specialty-specific diagnostic content.

Frequently Asked Questions

How is the FRCPath Part 1 examination structured?

It is specialty-specific and sat as two same-day written papers in most specialties. Many specialties (e.g. histopathology) use a single 125-question SBA/EMQ paper of 3 hours, while others (e.g. haematology, chemical pathology) add a separate essay/short-answer paper.

How many questions are in the FRCPath Part 1 SBA/EMQ paper?

The SBA/EMQ paper contains 125 questions in a mixture of single-best-answer and extended-matching formats, to be completed in 3 hours. The exact balance of essay versus MCQ content depends on the chosen pathology specialty.

What is the pass mark for FRCPath Part 1?

Pass standards are set per paper. Long-answer/essay papers use a minimum 50% standard, while SBA/EMQ papers are standard-set using the modified Angoff method, so the exact pass mark varies by sitting and difficulty. Candidates must pass all required papers at a single sitting.

How much does the FRCPath Part 1 exam cost in 2026?

The fee is approximately £670-£710 per specialty in 2026 (for example, around £707 for histopathology). Always confirm the current fee on the RCPath examinations fees page before applying.