How pathology is examined
According to the FACEM Training Handbook, the Primary Written Examination is two three-hour papers, each of 180 select-choice questions, across anatomy, pathology, physiology and pharmacology. It can be attempted at any time in Training Stage 1, and the pass standard is a pre-defined level of performance. Once it is passed, the Primary Integrated Viva is four 10-minute stations, each scored across anatomy, pathology, physiology, pharmacology and clinical building blocks. Check the ACEM website for the current format and dates.
Pathology questions ask about mechanisms (why a patient develops DIC), morphology (what a tissue shows after infarction) and laboratory findings (what a coagulation profile means).
General pathology
| Topic | Key concepts |
|---|---|
| Cell injury | Reversible versus irreversible injury, necrosis types, apoptosis |
| Inflammation | Acute versus chronic, mediators, outcomes |
| Healing | Regeneration and repair, wound healing phases, factors that delay healing |
| Haemostasis | Platelets, coagulation cascade, fibrinolysis |
| Thrombosis and embolism | Virchow triad, fat and amniotic emboli |
| Shock | Hypovolaemic, cardiogenic, distributive, obstructive; cellular effects |
| Neoplasia | Benign versus malignant, spread, paraneoplastic syndromes, oncological emergencies |
| Immunology | Hypersensitivity types I to IV, anaphylaxis |
Coagulation in the emergency department
| Test pattern | Likely cause |
|---|---|
| Raised INR only | Warfarin, liver disease, early vitamin K deficiency |
| Raised APTT only | Heparin, haemophilia, lupus anticoagulant |
| Raised INR and APTT, low fibrinogen and platelets | Disseminated intravascular coagulation |
| Low platelets, normal coagulation | ITP, TTP, HIT, marrow failure |
Infection and sepsis
- Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Gram-positive toxins (such as staphylococcal and streptococcal superantigens) cause toxic shock syndrome.
- Necrotising fasciitis spreads along fascial planes; pain is out of proportion to signs.
- Tetanus toxin blocks inhibitory neurotransmitter release.
Worked questions
Worked SCQ 1 · Coagulation
A septic patient has bleeding from cannula sites, low platelets, prolonged INR and APTT, low fibrinogen and raised D-dimer. What is the most likely cause?
- A Vitamin K deficiency
- B Disseminated intravascular coagulation
- C Immune thrombocytopenia
- D Haemophilia A
- E Heparin-induced thrombocytopenia with thrombosis
Show the reasoning
Answer B. DIC consumes platelets and clotting factors while activating fibrinolysis, producing this pattern. Treatment is directed at the underlying sepsis with blood product support for bleeding.
Worked SCQ 2 · Hypersensitivity
Which hypersensitivity type causes anaphylaxis?
- A Type I, IgE-mediated
- B Type II, antibody against cell surface
- C Type III, immune complex
- D Type IV, T cell-mediated
- E Complement deficiency
Show the reasoning
Answer A. Anaphylaxis is a type I reaction: allergen cross-links IgE on mast cells and basophils, releasing histamine and other mediators.
A 6-week pathology plan alongside clinical work
| Week | Focus |
|---|---|
| 1 | Cell injury, inflammation and healing |
| 2 | Haemostasis, thrombosis and shock |
| 3 | Immunology and infection |
| 4 | Neoplasia and oncological emergencies |
| 5 | Systemic pathology: cardiac, respiratory, renal, liver |
| 6 | Mixed timed sets and error log review |
Do 20 to 30 timed questions on most days and keep an error log: write the concept you missed in one line, then revisit it at the end of the week.
Common pathology traps
- Neglecting general pathology for systemic.
- Mixing up hypersensitivity types.
- Misreading coagulation profiles.
- Forgetting time course of infarction changes.
- Not linking pathology to emergency presentations.
Free sample pathology questions
Questions from our Emergency (ACEM) bank. Choose your answer, then open the explanation.
On day 3 to 7 after myocardial infarction, which complication is most associated with the phase of macrophage removal of necrotic tissue?
- AVentricular aneurysm at months
- BFibrinous pericarditis in the first day only
- CVentricular free wall rupture
- DDressler syndrome at 6 weeks after the infarct
- EImmediate VF in the first hour
Show answer and explanation
Answer C. Between days 3 and 7, macrophages remove necrotic myocardium, leaving the wall weakest; free wall rupture, septal rupture and papillary muscle rupture peak then. VF is earliest; aneurysm forms later with scar.
Learning point: MI rupture risk peaks days 3 to 7 (macrophage phase).
What is the earliest reliable clinical feature of acute compartment syndrome?
- AComplete paralysis
- BSkin necrosis
- CPain out of proportion, worse on stretch
- DAbsent distal pulses and a cold, pale foot
- EPallor of the limb
Show answer and explanation
Answer C. Pain disproportionate to the injury and pain on passive stretch of muscles in the compartment are early signs. Loss of pulses is late. Compartment pressure measurement helps when the patient cannot report pain.
Learning point: Compartment syndrome: pain out of proportion and on passive stretch; pulses lost late.
Ethylene glycol poisoning causes kidney injury through which crystals?
- AStruvite
- BCalcium oxalate
- CCystine
- DUric acid (urate)
- ECholesterol
Show answer and explanation
Answer B. Ethylene glycol is metabolised by alcohol dehydrogenase to glycolate and oxalate, causing high anion gap acidosis and calcium oxalate crystals in urine and kidneys. Treatment: fomepizole or ethanol, and dialysis.
Learning point: Ethylene glycol: oxalate crystals, high AG acidosis; fomepizole and dialysis.
Practise more pathology questions free
Every pathology subtopic in our bank
The bank holds 35 pathology questions across 35 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Anaphylaxis mediators1
- Aortic dissection pathology1
- Aortic dissection risk1
- ARDS1
- Bacterial meningitis CSF1
- Burns depth1
- Carcinoid and paraneoplastic1
- Coagulative necrosis1
- Compartment syndrome1
- Diabetic ketoacidosis1
- DIC1
- Fat embolism1
- Gas gangrene1
- Heparin-induced thrombocytopenia1
- Hypertensive emergency1
- Hypoglycaemia causes1
- Hyponatraemia and cerebral oedema1
- Meningococcal disease1
- Myocardial infarction timeline1
- Necrotising fasciitis1
- Pancreatitis causes1
- Pneumonia organisms1
- Pulmonary embolism pathology1
- Pulmonary oedema1
- Rhabdomyolysis1
- Rhabdomyolysis and kidney injury1
- Sepsis pathophysiology1
- Shock pathology1
- Subarachnoid haemorrhage1
- Testicular torsion pathology1
- Thyroid storm triggers1
- Toxic alcohols1
- Tumour lysis syndrome1
- Type IV hypersensitivity1
- Wound healing phases1
Common questions
Is pathology tested in the Primary viva?
Yes. Pathology is one of the five areas scored at each Integrated Viva station.
Should I focus on general or systemic pathology?
Both. General pathology concepts underpin many systemic questions.
How do I learn coagulation tests?
Learn patterns and link each to a clinical cause seen in the ED.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.