MRCS Part B Revision · Surgical pathology
PR Bleeding — MRCS Part B Surgical pathology
By Dr Richard Miller, MBChB FRCS · Reviewed
PR Bleeding 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 PR Bleeding station
PR Bleeding
Diverticular Disease
Diverticulitis is a common digestive disease which involves the formation of pouches (diverticula) within the bowel wall. This process is known as diverticulosis, and typically occurs within the large intestine, or colon, although it can occasionally occur in the small intestine as well. Diverticulitis results when one of these diverticula becomes inflamed.
People often have left lower quadrant abdominal pain and tenderness, fever, and an increased white blood cell count. They may also complain of nausea or diarrhoea; others may be constipated. The severity of symptoms depends on the extent of the infection and complications. Less commonly, an individual with diverticulitis may have right-sided abdominal pain. This may be due to the less common right-sided diverticula or a highly redundant sigmoid colon.
Haemorrhoids
Haemorrhoids are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. They become pathological or piles when swollen or inflamed. At this point the condition is technically known as hemorrhoidal disease.
The signs and symptoms of haemorrhoids depend on the type present. Internal haemorrhoids usually present with painless rectal bleeding, while external haemorrhoids may produce few symptoms or if thrombosed significant pain and swelling in the area of the anus. While the exact cause of haemorrhoids remains unknown, a number of factors which increase intra-abdominal pressure, in particular constipation, is believed to play a role in their development.
Initial treatment for mild to moderate disease consists of increasing fiber intake, oral fluids to maintain hydration, NSAIDs to help with pain, and rest. A number of minor procedures may be performed if symptoms are severe or do not improve with conservative management. Surgery is reserved for those who fail to improve following these measures. Up to half of people may experience problems with haemorrhoids at some point in their lives. Outcomes are usually good.
What are you asked at the PR Bleeding station?
The station runs to 15 questions over nine minutes. These are the questions as they are put to you; the model answers are in the question bank.
- How would you assess this patient?
- What is your differential diagnosis?
- What is a diverticulum?
- What are the semantic differences between diverticular disease, diverticulosis and diverticulitis as they relate to the bowel?
- What is Meckel's diverticulum?
- How might a patient with Meckel’s Diverticulum present?
- What is a Zenker's diverticulum?
- How would you manage a Zenker's diverticulum?
- The patient is diagnosed with diverticular disease following a CT abdomen and pelvis. On PR she is also noted to have several large haemorrhoids. What is a haemorrhoid?
- What are the causes of haemorrhoids?
- How are haemorrhoids classified?
- What are the treatment options for haemorrhoids?
And 3 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 PR Bleeding station ask?
It opens with "How would you assess this patient?" and runs to 15 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