Introduction to FRCPath
examination
Pathology ‘E’ Learning platform for FRCPath
Dr. Maitrayee Roy MD FRCPath
Dr. Akshay Bali MD DipRCPath
Pathology 'E' learning for FRCPath
FRCPath examination: Introduction
• FRCPath (histopathology) is a two-part exam; part 1
is a theory paper conducted online and part 2 is a
practical examination.
• The examination is designed to assess knowledge of
common and uncommon lesions (including detailed
knowledge of immunohistochemistry, basic
understanding of genetics, direct
immunofluorescence and electron microscopy for
kidney biopsies) and test independent
histopathology reporting ability of a candidate at a
district level hospital.
Pathology 'E' learning for FRCPath
Part 1 - theory
• 125 questions in 3 hours
➢ Picture based MCQs
➢ Single best option descriptive written MCQs
➢ Extended matching questions: Multiple options
are provided in the beginning followed by 5
questions
❖Pre-Covid: Center in India was ILBS, New Delhi
❖Since autumn 2020, the exam is conducted online
Pathology 'E' learning for FRCPath
What is included in FRCPath part 1?
• Part 1 is common for 4 specialties →
histopathology, neuropathology, pediatric
pathology, and forensic pathology
• Autopsy, neuropathology and cervical cytology
are not included in part 2 practical
examination
Pathology 'E' learning for FRCPath
What is assessed in the part 1 exam?
• Questions are analytical and long
• Requires a candidate to be well acquainted with
morphology, diagnostic IHC as well as common
genetic mutations and syndrome
• Equal emphasis to neoplastic and non-neoplastic
diseases
• Very focused on prognosis and treatment
implications
Pathology 'E' learning for FRCPath
• Candidate should also be well versed with
1. AJCC 8th edition TNM classification of tumors
2. Updated WHO classifications and grading (e.g.
updated Gleason grade)
3. Newer reporting systems like the Paris system, the
Milan system, the Thy system for thyroid reporting,
the updated NHS cervical screening guidelines
Pathology 'E' learning for FRCPath
Examples
Pathology 'E' learning for FRCPath
1. Gastric polyp biopsy. This gastric polyp can be seen in which of the
following syndromes ?
A. Lynch syndrome
B. Peutz-Jegher syndrome
C. Familial adenomatosis polyposis (FAP) syndrome
D. Juvenile polyposis syndrome
E. Cowden syndrome
Pathology 'E' learning for FRCPath
13. 55 years/ diabetic female. Nephrotic range proteinuria. Kidney biopsy; HE
and silver stain. The histological picture corresponds to which probable
diagnosis
A. Amyloidosis
B. Diabetic nodular glomerulosclerosis
C. Membranous glomerulonephritis
D. Focal segmental glomerulosclerosis
E. Crescentic glomerulonephritis
Pathology 'E' learning for FRCPath
16. 35 years female; right lobe of thyroid mass FNAC. Most likely Thy
category
A. Thy2
B. Thy 3a
C. Thy 3f
D. Thy 4
E. Thy 5 Pathology 'E' learning for FRCPath
Luminal type B breast cancers are characterized by
following immunophenotype
A. ER +, PR+, Her2 neu-, AE1/AE3 +, Ki 67 low
B. ER+, PR+, Her2neu +, AE1/AE3 +, Ki67 high
C. ER+, PR-, Her2neu -, AE1/AE3 -, Ki67 low
D. ER-, PR-, Her2neu-, CK5/6+, Ki67 high
E. ER-, PR-, Her2neu+, Ki67 high
Pathology 'E' learning for FRCPath
60 years/ male. Diagnosed with nodular melanoma of
forearm. The depth of invasion is 1.0 mm with
presence of ulceration of epidermis. What is the pT
stage ?
A. pT1a
B. pT1b
C. pT2a
D. pT2b
E. pT3a
Pathology 'E' learning for FRCPath
Round cell tumor 1. 60 years/male. Growth in forehead.
Tumor cells have salt and pepper
A. Monophasic synovial chromatin. Synaptophysin +,
sarcoma chromogranin +, CK 20 dot +, Ki67
B. Ewing sarcoma/PNET labeling index high
C. Alveolar rhabdomyosarcoma
D. Desmoplastic small round 2. 15 years/female. Mass in abdomen. CK+,
Desmin +, CD 56 +, t(11;22)EWSR1-WT1
cell tumor
E. Round cell liposarcoma 3. 25 years/male. Mass in left lower
F. Nephroblastoma extremity. EMA +, CD 99 +, BCL2 +, CD
G. Neuroblastoma 34-, Myogenin -, Synaptophysin-
H. Hepatoblastoma
I. Small cell neuroendocrine
carcinoma 4. 5 years/female, tumor arising from
adrenal medulla. Synaptophysin +,
J. Merkel cell carcinoma chromogranin+, N-MYC amplification
K. Mesenchymal
chondrosarcoma 5. Tumor associated with Denys Drash
syndrome
Pathology 'E' learning for FRCPath
Strategy for FRCP part 1 examination
• Questions are lengthy, layered and analytical
• Three hours time may seem inadequate
• Practice to read and comprehend quickly
• It is not a competitive exam, but a screening test
• Consensus marking is done and the cut off is
different every time (generally varies between 65
and 80)
Pathology 'E' learning for FRCPath
Strategy for FRCP part 1 examination
• Don’t worry if you cannot answer some questions !
• An useful strategy would be to aim for at least 80
correct answers out of 125
• No negative marking → so do not leave any question
unattended
Pathology 'E' learning for FRCPath
Part 2 (practical) exam: Brief introduction
7 sections
1. Non-gynaec cytology – 8 cases --- each 5 marks ( 2
to 3 FNAC and 5 to 6 Fluid cytology)
2. Short cases (20 cases --- each 5 marks)
3. Long cases (4 cases ---- each 20 marks)
4. Frozen sections (6 cases ----each 5 marks)
5. Gross (4 cases ---- each 5 marks)
6. OSPE 1 (viva – 20 marks)
7. OSPE 2 (written – 20 marks)
Pathology 'E' learning for FRCPath
Part 2 - practical
• 2 days examination in UK and some middle east
nations (if adequate candidate)
• A year of preparation is recommended after part 1
by royal college but not mandatory
• Part 2 does not include neuropath, pediatric path,
forensic pathology and cervical cytology.
Pathology 'E' learning for FRCPath
Part 2 - practical
• Again it is a screening examination
• Needs to pass each section independently
• Pass percentage is between 30 to 55%
• Cytology, Histology long and short cases, OSPE 2
→ Centralized marking
• Frozen, gross and OSPE 1 → Local marking
Pathology 'E' learning for FRCPath
Thank you
Pathology 'E' learning for FRCPath