MRCS Part B Revision · Surgical pathology
Haematology — MRCS Part B Surgical pathology
By Dr Richard Miller, MBChB FRCS · Reviewed
Haematology is a surgical pathology station. Two of the seventeen examined stations in the MRCS Part B OSCE are surgical pathology. The surgical pathology stations ask you to reason from a specimen, a slide, a report or a vignette to a diagnosis, and then to say what it means for the patient in front of you.
What you need to know for the Haematology station
Haemolytic Disorders
Myeloma
Multiple myeloma is a cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies. In multiple myeloma, collections of abnormal plasma cells accumulate in the bone marrow, where they interfere with the production of normal blood cells. Most cases of multiple myeloma also feature the production of a paraprotein—an abnormal antibody which can cause kidney problems. Bone lesions and hypercalcemia (high blood calcium levels) are also often encountered.
Multiple myeloma is diagnosed with blood tests (serum protein electrophoresis, serum free kappa/lambda light chain assay), bone marrow examination, urine protein electrophoresis, and X-rays of commonly involved bones.
Multiple myeloma is considered to be incurable but treatable. Remissions may be induced with steroids, chemotherapy, proteasome inhibitors, immunomodulatory drugs such as thalidomide or lenalidomide, and stem cell transplants. Radiation therapy is sometimes used to reduce pain from bone lesions
Hodgkin Lymphoma
Hodgkin lymphoma is a type of lymphoma, in which cancer originates from white blood cells called lymphocytes.
A history of infectious mononucleosis due to infection by Epstein–Barr virus (EBV) may increase risk of HL, but the precise contribution of Epstein–Barr virus remains largely unknown. Hodgkin lymphoma is characterized by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease. When Hodgkins cells are examined microscopically, multinucleated Reed–Sternberg cells (RS cells) are the characteristic histopathologic finding.
Hodgkin lymphoma may be treated with radiation therapy, chemotherapy, or hematopoietic stem cell transplantation, with the choice of treatment depending on the age and sex of the patient and the stage, bulk, and histological subtype of the disease
Images from this station
What are you asked at the Haematology station?
The station runs to 19 questions over nine minutes. A prompt the station repeats — against each marker on a specimen, for instance — is listed once here; the model answers are in the question bank.
- The admitting emergency doctor has requested an MRI lumbar spine as she is concerned about cauda equina syndrome Pathology: Haematological Disorders
- What does the MRI demonstrate?
- What is cauda equina syndrome?
- What the potential causes of cauda equine syndrome?
- Why is an urgent MRI scan required in anyone you suspect may have CES?
- A blood film from the same patient is shown. What does it demonstrate?
- Taking into account the history, MRI findings and blood film what is the likely diagnosis?
- What other tests would help to confirm the diagnosis?
- What clinical features might you expect in a patient with myeloma?
- A 23 year old lady is referred into your clinic by the haematologists with hepatosplenomegally and rubbery cervical and groin lymph nodes for lymph node biopsy. You decide to biopsy one of the lymph nodes. What does the biopsy film show?
- What disease is this finding associated with?
- What virus is associated with Hodgkin’s lymphoma?
And 6 more at this station.
How is the surgical pathology station marked in MRCS Part B?
Like the anatomy stations, a surgical pathology station is marked out of 20 with all 20 marks going to clinical knowledge and its application. The second of the two may be a microbiology station.
FAQ
What does the Haematology station ask?
It opens with "The admitting emergency doctor has requested an MRI lumbar spine as she is concerned about cauda equina syndrome Pathology: Haematological Disorders" and runs to 19 questions over nine minutes. Like the anatomy stations, a surgical pathology station is marked out of 20 with all 20 marks going to clinical knowledge and its application. The second of the two may be a microbiology station.
How many pathology stations are in MRCS Part B?
Two of the seventeen examined stations. The intercollegiate blueprint titles the second one surgical pathology and/or microbiology, so infection and antimicrobial topics appear here rather than in a station of their own.
How is the pathology station marked?
Out of 20, with every mark awarded for clinical knowledge and its application. There are no communication or professionalism marks available in it.
What should I revise for surgical pathology?
The general processes the syllabus names, inflammation, healing, neoplasia and infection, applied to the specimens and reports a surgical trainee meets. Candidates most often report malignancies and their mutations, inherited cancer syndromes, and obstructive jaundice.
How many stations are in the MRCS Part B OSCE?
Seventeen examined stations of nine minutes each, with a minute to read the task before each one. Two preparation stations and at least one rest station bring the circuit to about twenty, and the exam takes about three and a half hours.
What is the pass mark for MRCS Part B?
There is no published pass mark. The cut score is set separately for Applied Knowledge and Applied Skills, for each circuit, by borderline regression. Published pass rates across the 2024/25 diets ranged from 51% to 66%.
Can I fail a station and still pass?
Yes. There is no rule about how many stations you may fail: the cut score applies to your total mark in each component, so a weak station costs the marks you lost on it and strong stations elsewhere can make them back. Applied Knowledge and Applied Skills are passed separately and must both be passed at the same sitting, so a strong anatomy performance cannot rescue a weak communication one.
Dr Richard Miller, MBChB FRCS
Station summaries are reviewed against the current intercollegiate MRCS syllabus and the published marking blueprint. Guidance changes between diets: check the royal colleges' own pages before relying on a date, a fee or a threshold.
Practise this station
The question bank carries the model answer to every question above, with the rest of the surgical pathology stations.
More surgical pathology stations