How systemic pathology 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 |
|---|---|
| Atherosclerosis | Endothelial injury, fatty streak, fibrous plaque, rupture |
| MI timeline | Neutrophils at 1 to 3 days, macrophages at 3 to 7, granulation tissue, scar |
| Lung | Emphysema patterns, pneumonia stages |
| Liver | Cirrhosis, hepatitis, steatosis |
| Kidney | Nephritic versus nephrotic syndromes |
| GI | Coeliac, IBD, adenoma-carcinoma sequence |
Worked questions
Worked question · MI
When does granulation tissue typically appear after myocardial infarction?
- A 1 to 2 weeks
- B Within 4 hours
- C At 24 hours
- D After 3 months
- E After 1 year
Show the reasoning
Answer A. Granulation tissue forms at about 1 to 2 weeks, followed by scar over weeks to months. Neutrophils peak at 1 to 3 days.
Worked question · Renal
Which feature is typical of nephrotic syndrome?
- A Heavy proteinuria
- B Red cell casts
- C Hypertension and haematuria
- D Oliguria
- E Hypercalcaemia
Show the reasoning
Answer A. Nephrotic syndrome: proteinuria above 3.5 g/day, hypoalbuminaemia, oedema and hyperlipidaemia. Red cell casts suggest nephritic syndrome.
High-yield facts to memorise
| Term | Key fact |
|---|---|
| Centriacinar emphysema | Smoking, upper lobes |
| Panacinar emphysema | Alpha-1 antitrypsin deficiency, lower lobes |
| Nephritic syndrome | Haematuria, hypertension, red cell casts |
| Micronodular cirrhosis | Alcohol |
| Coeliac disease | Villous atrophy, crypt hyperplasia, intraepithelial lymphocytes |
| Hashimoto thyroiditis | Lymphocytic infiltrate with germinal centres |
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 | Cardiovascular and lung |
| 2 | Liver, GI and kidney |
| 3 | Endocrine and mixed |
Answer timed questions daily and write a one-line mechanism for every question you get wrong.
Common traps
- Wrong MI timeline.
- Mixing nephritic and nephrotic.
- Forgetting adenoma-carcinoma steps.
Free sample systemic pathology questions
Questions from our Pathology (RCPA) bank. Choose your answer, then open the explanation.
Psammoma bodies are typical of:
- AAnaplastic carcinoma
- BFollicular carcinoma with capsular invasion
- CPapillary thyroid carcinoma
- DMedullary carcinoma
- EHashimoto thyroiditis
Show answer and explanation
Answer C. Papillary carcinoma: Orphan Annie nuclei, grooves, psammoma bodies.
Learning point: Psammoma: papillary thyroid.
The earliest light microscopy change in myocardial infarction (4 to 12 hours) is:
- ADense collagen scar
- BNeutrophil-free macrophage infiltrate
- CCalcified necrotic myocardium
- DGranulation tissue at the infarct border
- EWavy fibres, early necrosis
Show answer and explanation
Answer E. Early changes: wavy fibres, contraction bands and beginning coagulative necrosis; neutrophils follow at 1 to 3 days.
Learning point: Early MI: wavy fibres.
Earliest visible lesion of atherosclerosis:
- AFibrous cap with necrotic core
- BComplicated plaque
- CThrombosed plaque
- DFatty streak
- ECalcified plaque
Show answer and explanation
Answer D. Fatty streaks of foam cells appear in childhood; later fibroatheromas with caps.
Learning point: Earliest: fatty streak.
Practise more systemic pathology questions free
Every systemic pathology subtopic in our bank
The bank holds 22 systemic pathology questions across 21 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Alcoholic liver disease1
- Alzheimer1
- Atherosclerosis1
- Atherosclerotic plaque rupture1
- Breast cancer receptors1
- Cirrhosis1
- Coeliac disease histology1
- Coeliac histology1
- Glomerulonephritis1
- Hashimoto1
- Helicobacter1
- Hodgkin1
- IgA nephropathy2
- Ischaemic heart disease1
- Lung cancer type1
- Melanoma prognosis1
- Myeloma1
- Papillary thyroid carcinoma1
- Prostate cancer grading1
- Thyroid pathology1
- Vulnerable plaque1
Common questions
Is systemic pathology a large part of BPS?
It applies general principles to organs and is commonly tested.
What defines nephrotic syndrome?
Heavy proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia.
What is the adenoma-carcinoma sequence?
Stepwise mutations (APC, KRAS, TP53) from adenoma to carcinoma.
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)