How cell injury and inflammation is examined
The RCPA Basic Pathological Sciences (BPS) examination is an online invigilated exam open to medical, science and dental students and graduates, as well as RCPA trainees, international medical graduates, registrars and junior doctors. It tests the general principles of pathology that underpin every discipline. Check the RCPA website for the current format, dates, fees and exemptions.
Core concepts
| Concept | What to know |
|---|---|
| Adaptation | Hypertrophy, hyperplasia, atrophy, metaplasia |
| Reversible injury | Cell swelling, fatty change |
| Necrosis types | Coagulative, liquefactive, caseous, fat, fibrinoid, gangrenous |
| Apoptosis | Intrinsic (mitochondrial) and extrinsic (death receptor) pathways; caspases |
| Acute inflammation | Vascular changes, neutrophil recruitment, mediators |
| Chronic inflammation | Macrophages, lymphocytes, granulomas |
| Repair | Regeneration, granulation tissue, scar |
Worked questions
Worked question · Metaplasia
Barrett oesophagus is an example of which adaptation?
- A Metaplasia
- B Hyperplasia
- C Dysplasia
- D Atrophy
- E Hypertrophy
Show the reasoning
Answer A. Squamous epithelium is replaced by intestinal-type columnar epithelium in response to acid reflux: metaplasia, which can progress to dysplasia.
Worked question · Granuloma
Which cell is the key component of a granuloma?
- A Epithelioid macrophage
- B Segmented neutrophil
- C Activated tissue eosinophil
- D Tissue mast cell
- E Mature plasma cell
Show the reasoning
Answer A. Granulomas are collections of activated (epithelioid) macrophages, often with giant cells, surrounded by lymphocytes.
High-yield facts to memorise
| Term | Key fact |
|---|---|
| Neutrophils | First responders in acute inflammation (6 to 24 hours) |
| Macrophages | Dominant from 24 to 48 hours; chronic inflammation |
| Histamine | Immediate vasodilation and increased permeability |
| Prostaglandins | Vasodilation, pain, fever |
| Leukotriene B4 | Neutrophil chemotaxis |
| IL-1 and TNF | Fever, acute phase response |
Turn each row into a flashcard and test yourself until you can explain the mechanism, not just the label.
A 3-week revision block
| Week | Focus |
|---|---|
| 1 | Adaptation, injury and cell death |
| 2 | Acute and chronic inflammation |
| 3 | Repair and mixed questions |
Answer timed questions daily and write a one-line mechanism for every question you get wrong.
Common traps
- Confusing metaplasia and dysplasia.
- Mixing necrosis types.
- Forgetting mediator functions.
Free sample cell injury and inflammation questions
Questions from our Pathology (RCPA) bank. Choose your answer, then open the explanation.
Which is a feature of reversible cell injury?
- ALarge flocculent mitochondrial densities
- BPlasma membrane disruption with leakage
- CNuclear fragmentation (karyorrhexis)
- DRupture of lysosomal membranes
- ECellular swelling
Show answer and explanation
Answer E. Reversible injury: cell swelling (hydropic change), fatty change, membrane blebbing, ER dilation, small mitochondrial densities. Nuclear changes and membrane rupture signal irreversibility.
Learning point: Reversible: swelling, fatty change.
Hyaline arteriolosclerosis is typical of:
- AGiant cell arteritis
- BMalignant hypertension with onion-skinning
- CKawasaki disease
- DAtheroma of the aorta
- EDiabetes and benign hypertension
Show answer and explanation
Answer E. Hyaline thickening of arterioles occurs with ageing, benign hypertension and diabetes. Malignant hypertension causes hyperplastic arteriolosclerosis.
Learning point: Hyaline: diabetes, benign hypertension.
Which tissue typically undergoes liquefactive necrosis after ischaemia?
- ALiver
- BHeart transplant
- CKidney transplant
- DSpleen
- EBrain
Show answer and explanation
Answer E. Ischaemic brain tissue undergoes liquefactive necrosis because of high lipid content and lysosomal enzymes; most solid organs show coagulative necrosis.
Learning point: Brain infarcts liquefy.
Practise more cell injury and inflammation questions free
Every cell injury and inflammation subtopic in our bank
The bank holds 22 cell injury and inflammation questions across 22 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Amyloid1
- Apoptosis1
- Apoptosis features1
- Atrophy1
- Autophagy1
- Caseous necrosis1
- Caspases1
- Dystrophic calcification1
- Fatty liver1
- Free radical injury1
- Free radicals1
- Hyaline arteriolosclerosis1
- Hypertrophy1
- Ischaemia-reperfusion1
- Keloid1
- Leukocyte adhesion1
- Lipofuscin1
- Liquefactive necrosis1
- Metaplasia1
- Necrosis types1
- Pigment1
- Reversible injury1
Common questions
Who can sit the BPS exam?
The RCPA registration form lists students and graduates of medicine, science or dentistry, RCPA trainees and other doctors.
Is the BPS exam online?
The RCPA describes it as an online invigilated (proctored) exam.
What is the difference between necrosis and apoptosis?
Necrosis is uncontrolled death with inflammation; apoptosis is programmed death without inflammation.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.
- RCPA Basic Pathological Sciences examination
- Robbins and Kumar Basic Pathology (standard text)