MRCOG Part 1: Pathology
Pathology covers the general mechanisms of disease — cell injury, inflammation, repair and neoplasia — as well as gynaecological pathology directly relevant to O&G practice. Approximately 100 questions, making it a medium-priority subject.
Topics Covered
Cell Injury & Death
- ›Reversible vs irreversible cell injury
- ›Apoptosis vs necrosis — mechanisms and morphology
- ›Types of necrosis: coagulative, liquefactive, caseous, fat, fibrinoid
- ›Free radical injury, ischaemia-reperfusion injury
- ›Cellular adaptations: hypertrophy, hyperplasia, metaplasia, dysplasia, atrophy
Inflammation
- ›Acute inflammation — vascular and cellular events, mediators (histamine, prostaglandins, leukotrienes)
- ›Chronic inflammation — macrophages, granulomas, types of granulomatous disease
- ›Systemic inflammatory response — cytokines (TNF, IL-1, IL-6)
- ›Wound healing — primary vs secondary intention, growth factors
- ›Complement system — classical, lectin and alternative pathways
Neoplasia
- ›Benign vs malignant — features, differentiation, grading
- ›Carcinogenesis — oncogenes (RAS, HER2), tumour suppressor genes (p53, BRCA)
- ›Cancer staging — TNM system, relevance to gynaecological cancers
- ›Invasion and metastasis — routes (lymphatic, haematogenous)
- ›Paraneoplastic syndromes
Gynaecological Pathology
- ›Cervical dysplasia (CIN) — grading, HPV role, colposcopy findings
- ›Endometrial pathology — hyperplasia, carcinoma, risk factors
- ›Ovarian tumours — surface epithelial, germ cell, sex cord-stromal classification
- ›Gestational trophoblastic disease — molar pregnancy, choriocarcinoma, HCG monitoring
- ›Ectopic pregnancy — sites, histological features, risk factors
Exam Tips for Pathology
Apoptosis vs necrosis differences are tested frequently — know the key distinguishing features (inflammation, cell membrane integrity, caspases).
Granuloma formation: know the cell types (activated macrophages = epithelioid cells, Langhans giant cells) and common causes (TB, sarcoidosis, Crohn's).
Oncogene vs tumour suppressor gene distinction — gain of function vs loss of function; one vs two alleles needed.
CIN grading must be precise: CIN1 = lower third of epithelium involved; CIN3 = full thickness (not yet invasive).
GTD: know the HCG monitoring schedule after molar pregnancy and when choriocarcinoma should be suspected.
Recommended Book
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