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100+ Free FRCPath Part 2 Practice Questions
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A long case kidney tumour shows nests of cells with clear cytoplasm and a delicate branching ('chicken-wire') vascular network, low nuclear grade. CAIX shows diffuse membranous box-like positivity. What is the diagnosis?
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Sample FRCPath Part 2 Practice Questions
Try these sample questions to test your FRCPath Part 2 exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A surgical short-case slide shows a breast core biopsy with a proliferation of small, regular epithelial cells in a cribriform and solid pattern filling and distending ducts, with no myoepithelial layer demonstrable on p63 immunostaining around the involved spaces but preserved myoepithelium peripherally. There is no stromal invasion. What is the correct FRCPath-level diagnosis?
A.Invasive ductal carcinoma of no special type
B.Ductal carcinoma in situ
C.Usual ductal hyperplasia
D.Sclerosing adenosis
Explanation: Distension of ducts by a monotonous cribriform/solid epithelial proliferation with loss of the intraluminal/architectural myoepithelium but an intact peripheral myoepithelial layer defines ductal carcinoma in situ. The retained outer p63-positive myoepithelial layer excludes invasion.
2In an FRCPath Part 2 surgical histology short case, a colonic polyp shows serrated crypt architecture with dilatation and lateral (boot-shaped) growth at the crypt base, crypt branching, and no overt cytological dysplasia. Which lesion best fits these features?
A.Hyperplastic polyp
B.Sessile serrated lesion
C.Traditional serrated adenoma
D.Tubular adenoma
Explanation: Basal crypt dilatation, lateral growth along the muscularis mucosae (boot/anchor or inverted-T shapes) and crypt branching without overt dysplasia are the diagnostic architectural features of a sessile serrated lesion. These are typically right-sided and BRAF-mutated.
3A renal core biopsy long case shows diffuse global thickening of glomerular basement membranes with subepithelial 'spikes' on silver stain and granular capillary-loop IgG and C3 on immunofluorescence. PLA2R immunostaining is positive. What is the diagnosis?
A.Minimal change disease
B.Membranous nephropathy
C.Post-infectious glomerulonephritis
D.Diabetic nephropathy
Explanation: Subepithelial immune-complex deposition producing silver-positive spikes with granular capillary-wall IgG/C3 and positive PLA2R staining is diagnostic of (primary) membranous nephropathy. PLA2R positivity supports a primary autoimmune aetiology.
4A soft tissue long case shows a deep thigh tumour with sheets of uniform small round blue cells, a delicate fibrous septal network and strong membranous CD99. FISH demonstrates an EWSR1 gene rearrangement. Which diagnosis is most appropriate?
A.Synovial sarcoma
B.Ewing sarcoma
C.Rhabdomyosarcoma
D.Lymphoblastic lymphoma
Explanation: A small round blue cell tumour with diffuse membranous CD99 and an EWSR1 rearrangement (typically EWSR1-FLI1) is Ewing sarcoma. The EWSR1 FISH break-apart result confirms the diagnosis in the appropriate morphological context.
5On a surgical short case, a thyroid lobectomy slide shows a well-circumscribed encapsulated follicular-patterned tumour. The nuclei are enlarged, overlapping, with nuclear grooves and occasional pseudoinclusions, but there is no capsular or vascular invasion. What is the most accurate diagnosis to give?
A.Papillary thyroid carcinoma, classical type
B.Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)
C.Follicular carcinoma, widely invasive
D.Nodular hyperplasia
Explanation: An encapsulated/well-demarcated follicular-patterned tumour with papillary-type nuclear features but no invasion and no true papillae or psammoma bodies is classified as NIFTP. Recognising this avoids over-diagnosis of carcinoma and unnecessary completion thyroidectomy.
6A lymph node long case shows effacement by a nodular proliferation with large cells having multilobated 'popcorn' nuclei (LP cells) in a background of small B cells and follicular dendritic meshworks. The large cells are CD20-positive, CD15-negative and CD30-negative. What is the diagnosis?
A.Classic Hodgkin lymphoma, nodular sclerosis
B.Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)
C.Follicular lymphoma
D.T-cell/histiocyte-rich large B-cell lymphoma
Explanation: Popcorn (LP) cells that are CD20-positive but CD15/CD30-negative within nodular meshworks of follicular dendritic cells define nodular lymphocyte-predominant Hodgkin lymphoma. Retained B-cell programme (CD20+) distinguishes it from classic Hodgkin lymphoma.
7A gastric biopsy short case shows full-thickness mucosal architectural distortion, dense lamina propria plasma cells, basal lymphoplasmacytosis and Paneth cell metaplasia in the antrum, with no Helicobacter on special stains. Which diagnosis is best supported?
A.Acute gastritis
B.Chronic active gastritis with features of autoimmune/atrophic process
C.Reactive (chemical) gastropathy
D.Lymphocytic gastritis
Explanation: Architectural distortion, basal plasmacytosis and metaplastic change (Paneth cell metaplasia) indicate chronicity and atrophy. Antral Paneth cell metaplasia and a Helicobacter-negative dense plasma cell infiltrate should prompt consideration of an atrophic/autoimmune-pattern chronic gastritis.
8A skin excision short case shows an asymmetric melanocytic proliferation with poor maturation, deep mitoses, pagetoid upward spread and confluent junctional nests of variably sized atypical melanocytes. What is the most appropriate diagnosis?
A.Dysplastic naevus
B.Malignant melanoma
C.Spitz naevus
D.Blue naevus
Explanation: Asymmetry, lack of maturation with depth, deep dermal mitoses, confluent atypical nests and pagetoid spread are architectural and cytological hallmarks of malignant melanoma. These criteria distinguish melanoma from benign naevi at FRCPath level.
9In a long case, a liver biopsy from a patient with deranged liver function shows a portal-based lymphocytic infiltrate with florid duct lesions (granulomatous bile duct destruction) and ductopenia. AMA serology is positive. Which is the correct diagnosis?
A.Primary sclerosing cholangitis
B.Autoimmune hepatitis
C.Primary biliary cholangitis
D.Large duct obstruction
Explanation: Granulomatous destruction of interlobular bile ducts (florid duct lesion) with portal lymphoplasmacytic inflammation, progressive ductopenia and positive AMA is diagnostic of primary biliary cholangitis. The florid duct lesion is the histological hallmark.
10A surgical short case of a uterine curettage shows back-to-back endometrial glands with cribriforming, loss of intervening stroma over an area greater than 2.1 mm, and cytological atypia. What is the diagnosis according to current WHO terminology?
A.Endometrial hyperplasia without atypia
B.Atypical hyperplasia / endometrioid intraepithelial neoplasia (EIN)
C.Endometrioid adenocarcinoma, FIGO grade 1
D.Disordered proliferative endometrium
Explanation: Glandular crowding with cytological atypia in a focus exceeding 1 mm but without unequivocal stromal invasion corresponds to atypical hyperplasia / endometrioid intraepithelial neoplasia (EIN). It carries a high risk of progression to or coexistence with carcinoma.
About the FRCPath Part 2 Practice Questions
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