FRCPath Sample Papers — Thematic Question Bank

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FRCPath Sample Papers — Thematic Question Bank

FRCPath Sample Papers — Thematic Question Bank

All questions from the 8 uploaded RCPath sample papers (Part 1, Part 2, CICE and OSPE formats), reorganised by theme with answers and explanations. Where the source PDF included an official College mark scheme, this is labelled “Official mark scheme”. Where it did not, the answer is Claude’s own clinical/microbiological reasoning and is explicitly flagged with a confidence band — see the Thematic Analysis tab for the full breakdown and for one flagged single-best-answer ambiguity and one self-corrected item.

71 items catalogued · 12 tabs · generated for personal FRCPath revision use
19 item(s)
SAQ1 Q1 Sample SAQ/OSPE questions, March 2024 2 marks Official mark scheme
Question53F, T2DM, chronic foot ulcer with suspected osteomyelitis. Bone biopsy grows E. coli, resistant to gentamicin, tobramycin, ampicillin, cefepime, cefotaxime, ceftazidime, piperacillin-tazobactam and ciprofloxacin, but susceptible to carbapenems, temocillin (I), amikacin and colistin. What is the most likely primary mechanism of β-lactam resistance?
AnswerESBL, most likely CTX-M type.
ExplanationResistance to penicillins and all three oxyimino-cephalosporins with preserved carbapenem susceptibility is the classic ESBL signature; CTX-M is now the dominant ESBL family in E. coli in the UK.
SAQ1 Q2 Sample SAQ/OSPE questions, March 2024 5 marks Official mark scheme
QuestionDescribe the antibiogram features that support an ESBL mechanism in the case above.
AnswerPotentiation of cefotaxime, cefepime and ceftazidime by clavulanate (greatest for cefotaxime); no potentiation with cloxacillin (excludes AmpC) or imipenem/EDTA (excludes MBL); retained temocillin activity and cefoxitin susceptibility (both against AmpC/carbapenemase).
ExplanationClavulanate potentiation of oxyimino-cephalosporins is the phenotypic hallmark of ESBL production; the negative cloxacillin and EDTA potentiation tests exclude AmpC and metallo-carbapenemase as co-existing mechanisms.
SAQ2 Q1 (C. difficile) Sample SAQ/OSPE questions, March 2024 2 marks Official mark scheme
Question74M, diarrhoea 6 weeks post-stroke admission after multiple antibiotic courses. Distended, tender abdomen, WCC 17.2, neutrophils 14.1, platelets 113. Faeces: C. difficile PCR positive, toxin negative, norovirus PCR negative, routine culture negative. What is the most likely diagnosis?
AnswerSevere C. difficile infection; the toxin EIA result is likely a false negative.
ExplanationToxin EIA has lower sensitivity than NAAT/PCR (which detects the toxin gene, not toxin production). A PCR-positive/toxin-negative result with a compatible clinical/biochemical picture (raised WCC, abdominal distension) should be treated as probable CDI, not disregarded.
Complex scenario Q3 Sample SAQ/OSPE questions, March 2024 2 marks Official mark scheme
Question26M with severe (Shigella-associated) colitis: blood cultures grow Gram-negative bacilli identified by MALDI-ToF as E. coli, while stool culture grows Shigella sonnei. What is your interpretation of the blood culture result in light of the stool report?
AnswerConcern for blood-culture isolate misidentification: MALDI-ToF currently cannot reliably discriminate E. coli from Shigella spp. Alternative hypothesis: true gut translocation/transient E. coli bacteraemia secondary to severe shigellosis (note the low albumin, in keeping with a ‘leaky gut’).
ExplanationE. coli and Shigella are essentially the same species biochemically and by mass-spectrometry protein profile (differing mainly by virulence plasmid and clinical/serological criteria), so MALDI-ToF misidentification is a recognised pitfall that must be actively considered here.
Complex scenario Q4 Sample SAQ/OSPE questions, March 2024 3 marks Official mark scheme
QuestionWhat further routine (culture-based / non-molecular) testing would you request on the blood culture isolate above, and why?
AnswerSerotyping/agglutination with diagnostic antisera and/or Vitek 2 GN ID or API 20E to resolve identification, plus phenotypic ESBL screening (isolate is ceftazidime-resistant, an indicator cephalosporin) and additional susceptibility testing (e.g. meropenem, temocillin, colistin).
ExplanationPhenotypic/biochemical panels and serotyping can separate E. coli from Shigella where MALDI-ToF cannot; ESBL confirmation is needed because ceftazidime resistance flags a resistance mechanism that changes empirical therapy.
Complex scenario Q5 Sample SAQ/OSPE questions, March 2024 1 mark Official mark scheme
QuestionDescribe the characteristic colonial appearance of Shigella sonnei on primary selective culture media, including the media used.
AnswerXLD agar: red colonies with no black centre (H2S negative). DCA: colourless colonies (S. sonnei may appear pale pink due to late lactose fermentation). MacConkey: colourless/transparent colonies. HE agar: blue-green colonies. SS agar: colourless colonies.
ExplanationShigella is a non-H2S-producing, (late/non-)lactose-fermenting Gram-negative bacillus, giving the characteristic colourless appearance on most enteric selective/differential media.
Section B4a Part 2 First Written Paper, Spring 2017 (docs 1 & 8, identical) Claude analysis — verify
QuestionWrite short notes on the complications of Chlamydia trachomatis infection.
AnswerPelvic inflammatory disease, tubal factor infertility, ectopic pregnancy, chronic pelvic pain, epididymo-orchitis, sexually-acquired reactive arthritis, Fitz-Hugh-Curtis perihepatitis, neonatal conjunctivitis and pneumonitis (vertical transmission), and lymphogranuloma venereum (serovars L1-L3: proctitis, inguinal lymphadenopathy/buboes) in MSM populations.
ExplanationStandard genitourinary-medicine/microbiology teaching; complications reflect ascending genital tract infection, immune-mediated joint/liver disease, and the distinct invasive LGV serovars.
Section B4b Part 2 First Written Paper, Spring 2017 (docs 1 & 8, identical) Claude analysis — verify
QuestionWrite short notes on ocular syphilis.
AnswerCan occur at any stage of syphilis (most often secondary/early latent); typically presents as uveitis (anterior, posterior or panuveitis), often bilateral. Strongly associated with HIV co-infection. Managed as neurosyphilis (CNS involvement should be assumed/excluded by CSF examination) with IV benzylpenicillin.
ExplanationOcular involvement is treated as a form of neurosyphilis in UK/BASHH guidance because of shared pathogenesis and treatment implications (standard IM benzathine penicillin is inadequate CNS penetration).
Section B4c Part 2 First Written Paper, Spring 2017 (docs 1 & 8, identical) Claude analysis — verify
QuestionWrite short notes on Klebsiella granulomatis.
AnswerCause of donovanosis (granuloma inguinale): chronic, progressive, painless genital ulceration. Diagnosis is by demonstrating intracellular Donovan bodies on tissue smear/biopsy (Giemsa/Wright stain); the organism does not grow on routine culture. Treatment: azithromycin (or doxycycline) for a minimum of 3 weeks and until lesions have healed. Endemic foci include parts of India, Papua New Guinea, southern Africa, the Caribbean and Aboriginal Australia.
ExplanationStandard STI microbiology teaching; the organism was reclassified from Calymmatobacterium to Klebsiella granulomatis on molecular grounds.
Q2 (a,b,c,e) Paper 1 Clinical Scenario (Lemierre’s disease) Official mark scheme
Question18F with ulcerative tonsillitis progressing over ~12 days to neck pain, abdominal pain, sepsis, and blood cultures positive for a Gram-negative bacillus in the anaerobic bottle. Later imaging confirms left internal jugular vein thrombosis, bilateral lung abscesses and septic arthritis of the hip. (a) Identify the organism. (b) Give the diagnosis. (c) Name three supporting clinical features. (e) Summarise the pathophysiological sequence.
Answer(a) Fusobacterium necrophorum. (b) Lemierre’s disease (syndrome). (c) Ulcerative tonsillitis, internal jugular vein thrombosis, metastatic (septic) abscesses. (e) F. necrophorum in ulcerative tonsillitis causes septic thrombophlebitis of the tonsillar veins, which extends into and thromboses the internal jugular vein; resulting septicaemia seeds metastatic abscesses (lung, joints, muscle).
ExplanationThis is the classic Lemierre’s disease vignette: post-anginal sepsis, an anaerobic Gram-negative bacillus in blood culture, and jugular vein thrombosis with septic emboli.
Q2d (prodromal illness) Paper 1 Clinical Scenario (Lemierre’s disease) Official mark scheme
QuestionWhat is a common prodromal illness that precedes Lemierre’s disease?
AnswerEpstein-Barr virus (or non-specific viral) upper respiratory tract infection.
ExplanationA preceding viral pharyngitis (classically EBV) is thought to disrupt the tonsillar mucosa, facilitating invasion by F. necrophorum.
Note: this sub-part is virology-adjacent (EBV) though grouped here with the parent bacteriology case for continuity — see also the Virology tab.
MCQ 2 / Part1-MMV MCQ 17 Part 1 / CICE Sample MCQs High confidence (~95%)
Question12-year-old boy, appendicectomy for acute appendicitis with localised peritonitis; pus swab sent for culture. Most likely pathogen?
AnswerB — Streptococcus anginosus.
ExplanationThe S. anginosus (Streptococcus milleri) group is classically associated with abscess formation and intra-abdominal/peritoneal sepsis, distinguishing it from the other listed streptococci (S. agalactiae = neonatal sepsis, S. equi/gallolyticus/infantarius = zoonotic/endocarditis-colonic associations).
MCQ 3 / Part1-MMV MCQ 18 Part 1 / CICE Sample MCQs Medium confidence (90-94%)
Question23F, fever, malaise, night sweats, migratory arthritis 2 weeks after a sore throat; ASOT 1600, CRP 221, echo shows pericardial effusion and mitral regurgitation. Rheumatic fever is suspected. Which modified Duckett-Jones criteria are fulfilled?
AnswerC — 2 major + 2 minor.
ExplanationMajor criteria present: carditis (pericardial effusion + mitral regurgitation) and polyarthritis. Minor criteria present: fever and markedly elevated CRP/ESR (arthralgia cannot be double-counted as polyarthritis is already a major criterion). Evidence of preceding GAS infection (raised ASOT) is a separate, required supporting criterion, not itself major/minor.
No official mark scheme provided for this MCQ in the source PDF; verify against the current Jones criteria table if using for exam preparation.
MCQ 11 Part 1 / CICE Sample MCQs High confidence (~95%)
Question23F contact of husband with fully sensitive smear-positive pulmonary TB; asymptomatic, BCG scar present, normal CXR, IGRA positive. Most appropriate chemoprophylaxis advice?
AnswerE — rifampicin plus isoniazid for 3 months.
ExplanationThis is the NICE NG33-recommended short-course regimen for latent TB infection (3 months rifampicin+isoniazid, or alternatively 6 months isoniazid alone); a normal CXR with positive IGRA confirms latent rather than active disease.
MCQ 16 / Part1-MMV MCQ 27 Part 1 / CICE Sample MCQs High confidence (~95%)
Question42F, ICU with severe CAP, advanced HIV, recently returned from the mid-west USA; non-directed BAL Gram stain shows yeast (2+). Which organism poses the greatest risk to laboratory staff?
AnswerC — Histoplasma capsulatum.
ExplanationH. capsulatum is a dimorphic fungus endemic to the Ohio/Mississippi River valleys (‘mid-west USA’); its mould-phase cultures are highly infectious by inhalation and must be handled in a Containment Level 3 laboratory — a key laboratory biosafety teaching point.
Classified here as Bacteriology because the question tests laboratory risk-assessment reasoning around a Gram-stain report; the organism itself is a fungus — see also Mycology tab.
MCQ 17 / Part1-MMV MCQ 28 Part 1 / CICE Sample MCQs High confidence (~95%)
Question5-year-old with diarrhoea; two classmates affected in the same week. Faeces culture: Shigella sonnei. Most likely cause of the outbreak?
AnswerD — poor hand hygiene.
ExplanationShigella has a very low infectious dose (as few as 10-100 organisms), making direct person-to-person faeco-oral spread via poor hand hygiene the dominant transmission route in childcare/school settings, rather than food- or animal-contact-associated exposure.
Part1-MMV MCQ 1 Part 1 Medical Microbiology & Virology Sample MCQs Medium confidence (90-94%)
QuestionWhich component of the Gram-positive cell wall is most associated with induction of septic shock?
AnswerC — Peptidoglycan.
ExplanationPeptidoglycan (with teichoic acid as a secondary contributor) is the Gram-positive structural analogue of Gram-negative LPS/endotoxin in triggering the innate immune/cytokine cascade of septic shock.
Teichoic acid (E) is a defensible alternative single-best-answer in some sources; flagged for verification against the intended College answer.
Part1-MMV MCQ 11 Part 1 Medical Microbiology & Virology Sample MCQs High confidence (~95%)
Question23-year-old with recurrent invasive meningococcal disease (prior episode aged 15), no other history of recurrent infection. Most likely immunodeficiency?
AnswerB — C7 deficiency (terminal complement component deficiency).
ExplanationDeficiencies of the terminal complement pathway (C5–C9, forming the membrane attack complex) are classically associated with recurrent invasive Neisseria (meningococcal/gonococcal) infection, with an otherwise unremarkable infection history.
Part1-MMV MCQ 15 Part 1 Medical Microbiology & Virology Sample MCQs Medium confidence (90-94%)
QuestionWhich organism is CFT (complement fixation test) still a useful diagnostic test for?
AnswerA — Coxiella burnetii.
ExplanationCFT has been superseded by immunofluorescence/ELISA for most pathogens, but is still cited in exam contexts as a historically/occasionally used serological method for Q fever (Coxiella burnetii), particularly phase I/II antibody patterns in chronic Q fever.
13 item(s)
OSPE1 1a (CMV) Sample SAQ/OSPE questions, March 2024 2 marks Official mark scheme
Question21F on infliximab/azathioprine for Crohn’s, deranged LFTs. CMV IgG negative, CMV IgM positive (S/CO 1.31). Interpretive comment and further testing?
AnswerCMV IgM positivity with negative IgG most likely represents cross-reaction (e.g. from acute EBV infection) rather than true acute CMV. Repeat CMV IgG in 1-3 weeks to clarify.
ExplanationIsolated IgM positivity without IgG seroconversion is a recognised pitfall, especially in the context of a strongly positive EBV VCA IgM in the same panel (heterophile/cross-reactive antibody).
OSPE1 1b (EBV) Sample SAQ/OSPE questions, March 2024 2 marks Official mark scheme
QuestionSame patient: EBV VCA IgG positive (5.87), VCA IgM positive (26.88), EBNA-1 IgG negative. Interpretive comment and further testing?
AnswerConsistent with recent/acute EBV infection (VCA IgM+/IgG+ with EBNA-1 still negative, as EBNA-1 seroconversion typically lags by weeks-months). No further testing (EBV PCR not required).
ExplanationThe absence of EBNA-1 IgG despite positive VCA antibodies is the classic serological marker of recent rather than past infection.
OSPE1 1c-1f (HAV, HBV, HCV, HEV) & Q2 Sample SAQ/OSPE questions, March 2024 9 marks (HBV 3, HCV 2, HEV 2, Q2 1, plus HAV covered under Bacteriology-adjacent virology grouping) Official mark scheme
QuestionSame panel: HAV IgG+/IgM−; HBV core total Ab+/core IgM−, e-Ab+, e-Ag−, surface Ab 97 mIU/mL, surface Ag−; HCV Ab+; HEV IgG−/IgM−. Interpret each and give the overall cause of the deranged LFTs.
AnswerHAV: consistent with past infection/immunisation, no further testing. HBV: consistent with past infection (anti-HBs, anti-HBe and anti-HBc all positive, HBsAg/HBeAg/IgM core negative); reactivation risk while immunosuppressed should be flagged, no further testing. HCV: consistent with infection at some time — needs HCV RNA or HCV antigen to determine current viraemic status. HEV: no serological evidence of infection; HEV RNA if clinically indicated. Overall cause of the deranged LFTs: primary/acute EBV infection.
ExplanationThe panel demonstrates several instances of ‘past exposure’ serology (HAV, HBV) that are clinical red herrings; the acute drivers are the EBV VCA IgM positivity and the need to clarify current HCV viraemia with a molecular/antigen test since anti-HCV alone cannot distinguish past clearance from chronic infection.
OSPE Sample station 1, Q2 Sample SAQ/OSPE questions, March 2024 Claude analysis — verify
QuestionBAL from a 29F ICU patient tested by influenza A(H1N1) real-time PCR with an internal positive control (IPC) spiked into every well. Worksheet: negative control H1 negative/IPC positive (correct); but the H1 positive control itself returns H1 negative (IPC positive); BAL sample H1 negative/IPC positive. (a) Key finding? (b) Explanation? (c) How to report?
Answer(a) The known H1-positive control failed to amplify H1 (while its IPC amplified normally), so the assay run is invalid for the H1 target. (b) Likely explanation: H1 primer/probe reagent failure or degradation, a pipetting/reagent-preparation error affecting the H1 channel, or a mislabelled/degraded positive-control material — extraction itself was clearly successful since IPC amplified in every well. (c) Report as invalid/indeterminate for influenza A(H1N1): ‘Result invalid — assay positive control failed; unable to exclude influenza A(H1N1) infection; repeat testing required’, rather than reporting a false negative.
ExplanationA positive control failing while its IPC succeeds localises the fault specifically to the H1 target reagents rather than extraction/inhibition, and is a core competency in molecular virology QC troubleshooting.
No official model answer was included in this source PDF for this OSPE station; this is Claude’s structured reasoning through the worksheet logic.
MCQ 1 / Part1-MMV MCQ 16 Part 1 / CICE Sample MCQs Flagged — verify (<90%)
Question20F, 2-day fever/headache/confusion, GCS 11, no rash/neck stiffness, CT brain normal. CSF: protein 0.85 (raised), glucose normal, WCC 126 (lymphocyte-predominant, 120 lymphocytes/6 neutrophils). Most likely causative organism?
AnswerC — Herpes simplex virus type 1 (best-answer favoured here), though B — enterovirus is a defensible alternative.
ExplanationReduced conscious level (GCS 11) with lymphocytic CSF pleocytosis raises encephalitis, for which HSV-1 is the single most important ‘must not miss’ treatable cause in UK exam teaching, even though early HSV encephalitis can occasionally have a normal CT. Enterovirus is the more common cause of isolated lymphocytic meningitis but less typically causes marked confusion/reduced GCS.
No official answer key was provided in either source PDF for this MCQ. Genuine single-best-answer ambiguity — verify against the College mark scheme before relying on this for exam preparation.
MCQ 13 / Part1-MMV MCQ 26 Part 1 / CICE Sample MCQs High confidence (~95%)
QuestionWhat is the most appropriate confirmation test following an initial reactive hepatitis B surface antigen (HBsAg) screening EIA?
AnswerA — neutralisation of the reactivity using hepatitis B surface antibody.
ExplanationThe neutralisation assay (pre-incubating the sample with anti-HBs before repeat testing) is the standard specific confirmatory step for a reactive screening HBsAg result, distinguishing true positives from assay false-positives, per UK blood-borne virus testing guidance.
MCQ 14 Part 1 / CICE Sample MCQs High confidence (~95%)
Question42M with HIV-1 and HBV co-infection. CD4 420, HIV-1 RNA 132,000 copies/mL, no resistance mutations, HLA-B*5701 negative, HBeAg+, HBV DNA 30,000 IU/mL, minimal fibrosis on biopsy. Most appropriate management?
AnswerB — efavirenz, tenofovir and emtricitabine.
ExplanationTenofovir (with emtricitabine as the second dual-active agent) treats both HIV and HBV simultaneously and is the standard co-formulated backbone for HIV/HBV co-infection; entecavir alone (C) would leave HIV untreated and risk selecting HIV resistance to a 3TC-class drug used as HBV monotherapy.
MCQ 15 Part 1 / CICE Sample MCQs High confidence (~95%)
Question20M, 7 months post allogeneic HSCT for AML, 5-day fever. Blood: adenovirus DNA 100,000 copies/mL and CMV DNA 100,000 IU/mL. Which antiviral is active against both viruses?
AnswerB — Cidofovir.
ExplanationCidofovir has broad activity against DNA viruses including both CMV and adenovirus; ganciclovir (the usual first-line CMV agent) is not reliably active against adenovirus.
MCQ 19 / Part1-MMV MCQ 29 Part 1 / CICE Sample MCQs High confidence (~95%)
Question7-year-old boy on high-dose prednisolone for nephrotic syndrome, no past chickenpox; sister developed confirmed chickenpox 24h ago. VZV IgG 8 mIU/mL (non-immune/equivocal). Most appropriate next step?
AnswerD — give varicella zoster immunoglobulin (VZIG).
ExplanationA low/negative VZV IgG in a significantly immunosuppressed contact (high-dose steroids) with significant exposure is a clear indication for VZIG per UK Green Book guidance, to prevent severe varicella.
Part1-MMV MCQ 2 Part 1 Medical Microbiology & Virology Sample MCQs High confidence (~95%)
QuestionSelect the principal means by which antigenic shift occurs in influenza A virus.
AnswerD — Reassortment of fragments of the RNA genome.
ExplanationAntigenic shift is defined as reassortment of the eight-segment influenza RNA genome (typically when two strains co-infect one host, e.g. an animal reservoir), producing a novel HA/NA combination; this is distinct from antigenic drift (low-fidelity RdRp point mutation).
Part1-MMV MCQ 6 Part 1 Medical Microbiology & Virology Sample MCQs High confidence (~95%)
QuestionMany antiviral drugs act by inhibiting a viral DNA polymerase. For which virus would this drug class be effective?
AnswerA — Cytomegalovirus.
ExplanationCMV is a DNA virus targeted by DNA-polymerase inhibitors (ganciclovir/valganciclovir, foscarnet, cidofovir); influenza, measles, mumps and rabies are all RNA viruses and are not treated via this mechanism.
Part1-MMV MCQ 8 / MCQ 24 (VZV in pregnancy/neonate) Part 1 Medical Microbiology & Virology Sample MCQs Medium confidence (90-94%)
Question26F, 17/40 pregnant, son has hand-foot-mouth disease; most appropriate advice? — and separately: premature neonate (30/40, 990 g) exposed to sibling’s chickenpox; maternal antenatal (13-week) VZV IgG was positive. Most appropriate intervention for the baby?
AnswerHFMD in pregnancy: B — reassure the mother there is no risk to the pregnancy (Coxsackievirus is not an established teratogen, unlike rubella/CMV/VZV/parvovirus). Neonatal VZV exposure: D — give VZIG, despite maternal immunity.
Explanation[SELF-CORRECTION APPLIED] An initial pass would answer ‘no action required’ for the neonate given documented maternal immunity. However, UK Green Book chapter 34 recommends VZIG for infants born below 28 weeks’ gestation OR with a birth weight under 1 kg following significant exposure, regardless of maternal antibody status, because of reduced transplacental antibody transfer at extreme prematurity/low birth weight. At 990 g this infant meets the <1 kg threshold, so VZIG is the correct answer despite maternal seropositivity.
Verify against the current Green Book chapter 34 before relying on this for practice, as UK immunisation guidance can be revised.
Part1-MMV MCQ 14 Part 1 Medical Microbiology & Virology Sample MCQs High confidence (~95%)
QuestionMale baby born at 39 weeks with petechial rash, low birthweight, hepatosplenomegaly and bilateral cataracts, thought to be congenital. Most likely cause?
AnswerC — Rubella virus.
ExplanationCongenital cataracts (with the classic triad of cataracts, congenital heart disease and sensorineural deafness) point most specifically to congenital rubella syndrome; CMV also causes petechiae/hepatosplenomegaly (‘blueberry muffin’ baby) but cataracts are the more discriminating clue here.
3 item(s)
OSPE Sample station 1, Q3 Sample SAQ/OSPE questions, March 2024 Claude analysis — verify
Question71M on treatment for ALL develops dry cough/fever unresponsive to 4 days of meropenem. CT chest: diffuse interstitial infiltrate, no nodules/cavities. Serum beta-D-glucan (BDG) 530 pg/mL (<80), galactomannan 0.3 (<0.5). (a) Most important diagnosis? (b) Diagnostic role of BDG? (c) How would you confirm the diagnosis?
Answer(a) Pneumocystis jirovecii pneumonia (PCP). (b) BDG is a highly sensitive but non-specific pan-fungal marker (positive in PCP, invasive candidiasis and aspergillosis, but characteristically negative in cryptococcosis since Cryptococcus lacks cell-wall BDG); a markedly elevated BDG with a negative galactomannan and diffuse interstitial (rather than nodular/cavitary) infiltrate favours PCP over invasive aspergillosis. (c) Induced sputum or BAL for Pneumocystis-specific staining (immunofluorescence or silver stain) and/or PCR; consider starting empirical high-dose co-trimoxazole while confirmatory results are awaited given the clinical trajectory.
ExplanationThis vignette (diffuse interstitial pattern, high BDG, low/negative galactomannan, meropenem-refractory, haematology patient) is a textbook PCP presentation distinguished from invasive aspergillosis by the imaging pattern and biomarker profile.
No official model answer provided in the source PDF for this OSPE station.
OSPE Sample station 1, Q4 OSPE Sample questions Flagged — verify (<90%)
Question3-year-old girl on induction chemotherapy for ALL develops persistent fever and widespread rash; skin biopsy culture grows a mould after 96 hours. Lactophenol cotton blue microscopy (x400) shows septate hyphae with clusters of small round conidia arising in dense radiating ‘brush/broom-like’ groups from short conidiophores at nodes along the hyphae. (a) Identity of the organism? (b) Most appropriate initial antimicrobial treatment?
Answer(a) Most likely a Fusarium species. (b) Voriconazole (or liposomal amphotericin B), alongside source control/reduction of immunosuppression where possible.
ExplanationDisseminated cutaneous lesions in a profoundly neutropenic leukaemia patient, with a mould growing from a skin biopsy, is the classic vignette for disseminated fusariosis (Fusarium is angioinvasive and — unlike Aspergillus — frequently blood-culture positive). The clustered, brush-like conidial arrangement on short monophialidic conidiophores is consistent with Fusarium microconidia, though this cannot be stated with full certainty from a single micrograph. IDSA guidance favours voriconazole as first-line for fusariosis, with amphotericin B as an alternative depending on isolate susceptibility.
Image-based mould identification cannot be verified to species level from a single photomicrograph with full confidence; treat this identification as presumptive and confirm with culture morphology/MALDI-ToF or sequencing before acting on it clinically.
MCQ 3 (Part1-MMV #3) Part 1 / CICE Sample MCQs High confidence (~95%)
Question34M with diabetic ketoacidosis, headache, nasal congestion, periorbital swelling and blood-stained nasal discharge, progressing over a week to drowsiness. Black necrotic nasal septal lesions with perforation; CSF normal; nasal discharge culture grows S. pneumoniae and S. aureus. Most likely diagnosis?
AnswerD — Rhinocerebral mucormycosis.
ExplanationDKA plus black necrotic nasal/palatal lesions is the classic vignette for rhinocerebral mucormycosis (Mucorales are angioinvasive moulds favoured by the acidic, hyperglycaemic, iron-rich environment of DKA); the bacterial culture growth is incidental/secondary colonisation, not the primary pathology — a normal CSF does not exclude early invasive sino-orbital disease.
4 item(s)
SAQ2 Paper 1 SAQ sample questions 10 marks Official mark scheme
QuestionEgyptian man, farm background (livestock/dogs/cats/chickens), abdominal pain; raised ALP/ESR/eosinophils; USS shows an enlarged liver with a single multi-loculated cystic lesion. (1) Diagnosis? (2) Pathogen? (3) How acquired? (4) Confirmatory test? (5) Drug of choice? (6) Other treatment options? (7) Two complications?
Answer(1) Hydatid cyst. (2) Echinococcus granulosus. (3) From dogs (definitive host; sheep/livestock are intermediate hosts). (4) Serology. (5) Albendazole. (6) PAIR (puncture-aspiration-injection-reaspiration) technique, or surgical excision. (7) Cyst rupture, anaphylactic shock, disseminated (secondary) disease, recurrence after surgery.
ExplanationClassic hydatid disease vignette: farming background with dog contact, eosinophilia, and a multi-loculated hepatic cyst on imaging.
Section B4d Part 2 First Written Paper, Spring 2017 (docs 1 & 8, identical) Claude analysis — verify
QuestionWrite short notes on Phthirus pubis.
AnswerEctoparasite (‘pubic/crab louse’) transmitted by close bodily/sexual contact, causing pruritus in pubic and perianal hair-bearing areas; can rarely affect eyelashes (phthiriasis palpebrarum) — found in a child’s eyelashes this should prompt consideration of sexual abuse. Treatment: topical permethrin or malathion; treat sexual contacts and screen for other STIs.
ExplanationStandard STI/parasitology teaching; the eyelash-involvement/safeguarding link is a recognised exam point.
MCQ 12 Part 1 / CICE Sample MCQs Medium confidence (90-94%)
Question35F planning a 1-week beach holiday in the Gambia, currently taking fluoxetine. Most appropriate malarial chemoprophylaxis?
AnswerA — atovaquone/proguanil.
ExplanationMefloquine is best avoided in patients on psychotropic medication/with psychiatric history because of its neuropsychiatric side-effect profile; atovaquone-proguanil is well tolerated, requires only 1 week of post-travel dosing (convenient for a short trip) and has no significant SSRI interaction, making it the most appropriate of the listed options.
No official mark scheme provided for this MCQ.
Part1-MMV MCQ 5 Part 1 Medical Microbiology & Virology Sample MCQs High confidence (~95%)
Question22F medical student, recently returned from Tanzania, haematuria; schistosomal serology positive. Treatment of choice?
AnswerD — Praziquantel.
ExplanationPraziquantel is first-line for all Schistosoma species; note it is most effective against the adult fluke, so treatment is sometimes delayed/repeated to cover the pre-patent period after recent exposure.
14 item(s)
SAQ1 Q3-Q4 Sample SAQ/OSPE questions, March 2024 3 marks total Official mark scheme
QuestionContinuing the ESBL E. coli osteomyelitis case: suggest two appropriate treatment regimens, plus two further antimicrobials that could be tested if required.
AnswerRegimens: any carbapenem (± amikacin), or tigecycline (± amikacin); colistin/colistin combinations and newer β-lactam/inhibitor combinations are acceptable if justified. Further agents to consider testing: fosfomycin, aztreonam, co-trimoxazole, ceftolozane-tazobactam, ceftazidime-avibactam or cefiderocol.
ExplanationCarbapenems remain first-line for severe ESBL-E infection; the ‘further agents’ list reflects carbapenem-sparing or salvage options increasingly used per local antibiogram and susceptibility confirmation.
SAQ2 Q2 Sample SAQ/OSPE questions, March 2024 3 marks Official mark scheme
QuestionInitial management of probable severe C. difficile infection (see Bacteriology tab for the vignette).
AnswerIsolate and barrier-nurse the patient; treat with oral vancomycin or fidaxomicin; repeat/re-sample the stool test; assess severity (AXR/imaging for toxic megacolon/ileus, blood pressure); consider escalation (surgical input, rectal vancomycin, IV metronidazole, IVIG) if deteriorating.
ExplanationThis mirrors UK severe-CDI management pathways: first-line oral therapy plus close monitoring for red flags requiring surgical or immunomodulatory escalation.
SAQ2 Q3 Sample SAQ/OSPE questions, March 2024 4 marks Official mark scheme
QuestionGive four alternative treatment options (beyond first-line vancomycin/fidaxomicin) for recurrent, refractory or severe C. difficile infection.
AnswerFaecal microbiota transplant; fidaxomicin or a tapering vancomycin course (whichever wasn’t given first-line); IVIG; rectal vancomycin; bezlotoxumab (human monoclonal anti-toxin B antibody). Probiotics and cholestyramine are not accepted answers.
ExplanationThese reflect NICE/UK guidance escalation options once standard first-line oral antibiotics have failed or in recurrent disease.
Complex scenario Q7-Q8 Sample SAQ/OSPE questions, March 2024 5 marks total Official mark scheme
QuestionShigella sonnei stool isolate: trimethoprim-sulfamethoxazole resistant, azithromycin resistant (MIC 256 vs epidemiological breakpoint 16). E. coli blood isolate: ceftazidime-resistant, reduced pefloxacin zone (fluoroquinolone screen positive). (7) Likely resistance mechanisms? (8) Best treatment regime from ceftriaxone/ciprofloxacin/meropenem/fosfomycin, with rationale?
Answer(7) Macrolide resistance via erm(B)/mph(A); trimethoprim-sulfamethoxazole resistance via altered target enzymes (dihydropteroate synthase/dihydrofolate reductase) or acquired dfr/sul genes. (8) Meropenem is the most appropriate regime: ceftriaxone is unsuitable given ceftazidime resistance indicating ESBL production; ciprofloxacin is unsuitable as the pefloxacin screen indicates clinically relevant fluoroquinolone resistance (single gyrA mutation gives a suboptimal clinical response even if the isolate reports ‘susceptible’); fosfomycin is unlicensed/off-label for severe/bacteraemic disease and should be avoided in sepsis or colitis in immunocompromised patients.
ExplanationThis tests the important concept that a fluoroquinolone-‘susceptible’ report with a low-level resistance screen (pefloxacin disc) can still predict clinical failure — a key AMR interpretation pitfall.
Quality control Q4 (media substitute) Sample SAQ/OSPE questions, March 2024 3 marks Official mark scheme
QuestionSubstitute in-house susceptibility testing media were quality-controlled with a reference E. coli strain; all zone diameters were consistently above the acceptable upper limit. Give three possible media-related explanations.
AnswerAgar depth too shallow; agar formulation incorrect (an inhibitor missing, or nutrients absent, allowing excess diffusion/growth); agar degraded or past its expiry date (any other plausible media-related explanation also accepted).
ExplanationShallow or under-formulated agar allows antibiotic to diffuse further before the drug concentration falls below the inhibitory threshold, artefactually enlarging zones — a core disc-diffusion QC troubleshooting concept.
Section B2 (a-d) Part 2 First Written Paper, Spring 2017 (docs 1 & 8, identical) High confidence (~95%)
QuestionWrite short notes on three of: aztreonam, colistin, temocillin, fosfomycin.
AnswerAztreonam: monobactam, Gram-negative activity only, stable to many serine β-lactamases but hydrolysed by most ESBLs/carbapenemases (an exception makes it useful in combination with avibactam-containing agents against metallo-β-lactamase producers), minimal cross-reactivity in penicillin allergy (except shared side-chain with ceftazidime). Colistin: polymyxin, disrupts the Gram-negative outer membrane, reserved for MDR Gram-negatives, dose-limited by nephrotoxicity, needs therapeutic drug monitoring, rising mcr-mediated resistance. Temocillin: narrow-spectrum penicillin stable to most ESBLs/AmpC, active against Enterobacterales only, carbapenem-sparing option for ESBL-E UTI/bacteraemia. Fosfomycin: inhibits MurA (early peptidoglycan synthesis); oral single-dose licensed for uncomplicated UTI; IV form used off-label for MDR infection, best used in combination as resistance can emerge on monotherapy.
ExplanationStandard pharmacology/AMS teaching for these carbapenem-sparing and reserve agents.
Section A2 (Surgical Antibiotic Prophylaxis Policy) Part 2 First Written Paper, Spring 2017 (docs 1 & 8, identical) Claude analysis — verify
QuestionDraft a Surgical Antibiotic Prophylaxis Policy: (a) wound classification and its use in the policy; (b) factors in choosing agents; (c) when to recommend intra-operative re-dosing; (d) how to ensure compliance.
Answer(a) NHSN/CDC wound classes I (clean) to IV (dirty/infected); prophylaxis intensity/duration is tiered accordingly (e.g. usually none for clean surgery except prosthetic/high-risk implants; single dose for clean-contaminated; treatment-length antibiotics for contaminated/dirty cases). (b) Likely pathogens for the operative site, local antibiogram/resistance patterns, patient allergy status, renal/hepatic function and weight-based dosing, MRSA colonisation status, national guidance (e.g. NICE NG125), cost and formulary restrictions. (c) Re-dose when the procedure exceeds two half-lives of the chosen agent, with major blood loss (>1500 mL), prolonged operating time, or cardiopulmonary bypass. (d) WHO Surgical Safety Checklist prompts, electronic prescribing alerts, regular audit with feedback to surgical teams, antimicrobial stewardship ward-round input, and embedding prophylaxis timing into enhanced-recovery pathways.
ExplanationFramework based on standard UK antimicrobial stewardship/surgical-site-infection prevention principles (NICE NG125 and CDC/NHSN wound classification).
Essay-format question with no official model answer in the source PDF; marked holistically by the College.
Section B1 (a-d, carbapenemase detection) Part 2 First Written Paper, Spring 2017 (docs 1 & 8, identical) High confidence (~95%)
QuestionWrite short notes on three of: combination disc methods, genotypic methods, chromogenic agar, MALDI-ToF, as applied to carbapenemase detection.
AnswerCombination disc: meropenem ± inhibitors (phenylboronic acid for KPC, EDTA/dipicolinic acid for metallo-carbapenemases, cloxacillin to exclude AmpC); a ≥5 mm zone increase with an inhibitor supports that carbapenemase class; cheap and phenotypic but class-level only, ~18-24h. Genotypic: PCR/LAMP for major carbapenemase genes (KPC, NDM, VIM, IMP, OXA-48-like), e.g. Xpert Carba-R; rapid (~1h), highly sensitive/specific for known genes but will miss novel variants. Chromogenic agar: selective carbapenem-containing media (e.g. chromID CARBA) for screening (e.g. rectal swabs) rather than mechanism confirmation. MALDI-ToF: primarily used for species ID, but a validated meropenem-hydrolysis assay can detect carbapenemase activity indirectly by monitoring loss of the meropenem mass peak — less standardised than PCR.
ExplanationStandard UKHSA/laboratory diagnostic microbiology content on CPE detection algorithms.
Categorised here as Antibiotic/AMR laboratory method — closely overlaps the Lab Medicine tab, where it is cross-referenced.
MCQ 5 Part 1 / CICE Sample MCQs High confidence (~95%)
Question24F, CAP, CURB-65 = 1, actively trying to conceive, reluctant to take any drug potentially harmful in pregnancy. Most appropriate antibiotic?
AnswerA — Amoxicillin.
ExplanationAmoxicillin is first-line for low-severity CAP (NICE/BTS) and has an extensive pregnancy safety record; doxycycline (teeth/bone effects) and fluoroquinolones (levofloxacin) are generally avoided in pregnancy or when conception is being actively attempted.
MCQ 6 / Part1-MMV MCQ 21 Part 1 / CICE Sample MCQs High confidence (~95%)
Question35F treated empirically with IV vancomycin for a productive cough/breathlessness/rigors. What is vancomycin’s site of action?
AnswerC — Peptidoglycan cross-linking.
ExplanationVancomycin (a glycopeptide) binds the D-Ala-D-Ala terminus of peptidoglycan precursors, blocking transglycosylation/transpeptidation (cross-linking) rather than acting intracellularly.
MCQ 4 / Part1-MMV MCQ 19 Part 1 / CICE Sample MCQs Medium confidence (90-94%)
Question72M ventilated post-AAA repair develops fever/hypoxia; on IV vancomycin for line infection; history of anaphylaxis to penicillin. New right lower lobe infiltrate. Most appropriate addition to antibiotic treatment?
AnswerB — Ciprofloxacin.
ExplanationA fluoroquinolone provides Gram-negative (including Pseudomonas) cover for suspected hospital-acquired/ventilator-associated pneumonia while avoiding all β-lactams given true penicillin anaphylaxis.
No official mark scheme provided; co-trimoxazole is a plausible distractor depending on local VAP protocols — verify against the intended College answer.
Part1-MMV MCQ 4 Part 1 Medical Microbiology & Virology Sample MCQs High confidence (~95%)
QuestionIdentify the mode of action of the aminoglycosides.
AnswerD — Inhibition of protein synthesis.
ExplanationAminoglycosides bind the bacterial 30S ribosomal subunit, causing misreading of mRNA and inhibiting protein synthesis; they are bactericidal (unlike most other protein-synthesis inhibitors) via this mechanism.
Part1-MMV MCQ 12 Part 1 Medical Microbiology & Virology Sample MCQs High confidence (~95%)
Question65M started on standard quadruple TB therapy including rifampicin, with an extensive medication list. Which drug is most likely to have a clinically significant interaction with rifampicin?
AnswerE — Warfarin.
ExplanationRifampicin is a potent CYP450 (and P-glycoprotein) inducer, substantially reducing warfarin’s anticoagulant effect — one of its most clinically important drug interactions.
MCQ 10 / Part1-MMV MCQ 9 & 25 (needlestick, Hep B) Part 1 / CICE Sample MCQs Medium confidence (90-94%)
Question6-year-old accidentally stabbed by a discarded needle found in a park (mother retained the needle); child well with a minor scratch. Most appropriate management? (Two closely related vignettes across the two MCQ papers.)
AnswerD — start an accelerated course of hepatitis B vaccine.
ExplanationCommunity needlestick injuries with an unknown source carry a very low but non-zero risk of HBV transmission (HBV survives longer in the environment than HIV/HCV, and no vaccine exists for HCV); UK guidance favours an accelerated hepatitis B vaccination course, with HIV PEP not routinely indicated for low-risk community exposures and needle testing not considered reliable.
No official mark scheme was provided for either MCQ paper; grouped here for reference under ‘Vaccine’ since the intervention itself is a vaccination decision — cross-referenced from the Vaccine tab.
1 item(s)
Complex scenario Q2 Sample SAQ/OSPE questions, March 2024 2 marks Official mark scheme
Question26M swimmer/veterinary student with severe colitis after recent travel and open-water swimming. List two specific pathogens implicated in freshwater leisure activities/swimming causing gastrointestinal infection.
AnswerPlesiomonas shigelloides and Aeromonas species (both accepted); Leptospira and Cryptosporidium were also accepted as freshwater-associated pathogens in the source mark scheme, spanning bacterial and protozoal causes.
ExplanationThis item spans multiple pathogen classes (bacteria and a protozoan) within a single answer, so it is grouped under the general ‘Infection’ theme rather than a single organism-class tab.
7 item(s)
Section A1 Part 2 First Written Paper, Spring 2017 (docs 1 & 8, identical) Claude analysis — verify
QuestionAs IPC doctor, investigate two fatal hospital-acquired influenza A cases as a serious clinical incident and write a formal governance-board report: (a) investigation process; (b) investigation team; (c) information gathering/sources; (d) report structure; (e) ensuring recommendations are implemented.
Answer(a) Declare a Serious Incident per Trust policy; conduct a structured root-cause analysis (e.g. ‘5 Whys’/Fishbone) and build a timeline. (b) IPC doctor (chair), IPC nurse specialist, virology/microbiology lead, ward manager/matron, medical director representative, risk/patient-safety lead, occupational health, UKHSA public health representative, pharmacy. (c) Case notes, IPC surveillance data, bed-movement records, staff sickness/vaccination status, ventilation/environmental review, hand-hygiene/PPE audit data, and national UKHSA/NHS seasonal flu guidance and local outbreak policy. (d) Executive summary, background/timeline, methodology, findings, root-cause analysis, comparison against national guidance, SMART recommendations, action plan with named leads/deadlines, dissemination plan. (e) Action-plan tracking through the IPC/patient safety committee, defined leads and timescales, re-audit, board-level reporting, and trust-wide shared learning (e.g. safety bulletin).
ExplanationFramework based on standard NHS serious-incident investigation and root-cause-analysis methodology.
Essay-format question with no official model answer in the source PDF; marked holistically.
SAQ2 Q4 Sample SAQ/OSPE questions, March 2024 3 marks Official mark scheme
QuestionThree further patients on the same ward develop diarrhoea (CDI outbreak context). List six infection prevention and control actions.
AnswerIsolate/barrier-nurse symptomatic patients (cohort if required); close the bay/ward to new admissions if needed; stool culture/C. difficile/norovirus testing of symptomatic patients; ribotyping of C. difficile-positive isolates; enhanced cleaning/environmental audit and environmental screening; independent hand-hygiene audit; antibiotic (stewardship) audit; root cause analyses for individual cases.
ExplanationStandard UK outbreak-control bundle for healthcare-associated C. difficile clusters.
OSPE2 Q1 Sample SAQ/OSPE questions, March 2024 2 marks Official mark scheme
QuestionA nationwide media-plate shortage occurs after a warehouse fire, with no alternative supplier able to meet demand. Identify four distinct individuals/groups who should be notified.
AnswerAny four of: clinical lead/clinical director (Pathology), medical director, laboratory manager, executive nurse director, Local Medical Committee/GP liaison group, user groups, IPC team, public health.
ExplanationStandard major-incident/business-continuity escalation pathway for a laboratory supply-chain disruption.
OSPE2 Q3 Sample SAQ/OSPE questions, March 2024 5 marks Official mark scheme
QuestionSusceptibility testing media are in limited supply. List five factors (clinical and laboratory) for prioritising their use.
AnswerPrioritise sterile-site specimens (blood, CSF); prioritise specimens that are difficult to repeat (e.g. BAL); prioritise high-risk patients (ITU, immunosuppressed); prioritise specimens/organisms of medico-legal or public-health importance; consider expected duration of the shortage; consider which organisms will survive storage pending resupply; consider access to alternative susceptibility/inference methods (VITEK, PCR, latex agglutination).
ExplanationReflects standard laboratory business-continuity/clinical-risk prioritisation principles during consumable shortages.
Complex scenario Q9 Sample SAQ/OSPE questions, March 2024 3 marks Official mark scheme
QuestionThe patient with shigellosis reports recent unprotected sex with a man. What should be considered and offered as part of clinical assessment/follow-up?
AnswerConsider a potential outbreak and initiate contact identification/notification; advise on control measures to reduce further sexual transmission; note MSM with shigellosis are at increased risk of other sexually transmitted infections including HIV; offer sexual health advice and testing for other STIs/HIV.
ExplanationThis reflects recognised MSM-associated multi-drug-resistant Shigella sonnei clusters (linked to CTX-M-27-producing strains) and the standard public-health/sexual-health response.
MCQ 7 / Part1-MMV MCQ 22 Part 1 / CICE Sample MCQs High confidence (~95%)
QuestionFour patients on an elderly-care ward diagnosed with norovirus. What is the most appropriate immediate measure to prevent further spread?
AnswerD — isolation of symptomatic patients.
ExplanationPrompt isolation/cohorting of symptomatic patients is the immediate priority for norovirus outbreak control; alcohol hand rub is notably less effective against non-enveloped norovirus than soap-and-water hand hygiene, making it a distractor rather than the best answer.
MCQ 18 Part 1 / CICE Sample MCQs High confidence (~95%)
Question24M Liberian, 4-day fever/headache, recently returned from a funeral in Liberia, active bleeding at venepuncture sites, malaria film negative. In addition to hand hygiene, which infection control measures are most appropriate?
AnswerA — fluid-repellent disposable gown, double gloves, FFP3 respiratory mask, eye protection.
ExplanationThis vignette (West African travel/funeral attendance, fever, bleeding) raises concern for viral haemorrhagic fever (e.g. Ebola/Lassa), requiring full enhanced PPE per UK VHF algorithm pending risk assessment and exclusion.
2 item(s)
MCQ 8 / Part1-MMV MCQ 23 Part 1 / CICE Sample MCQs High confidence (~95%)
Question30M with acute hepatitis A, notified to the Health Protection Unit. He attended a wedding 4 weeks earlier; 8 of the other 50 guests also developed acute hepatitis. Most appropriate approach to investigating the source?
AnswerA — a case-control study.
ExplanationWith a defined, enumerable at-risk population (guest list) and a specific exposure of interest (the buffet menu), a case-control (or, per the closely related Part1-MMV wedding-outbreak question, retrospective cohort) design is the standard first epidemiological approach to identify the responsible food item(s).
Part1-MMV MCQ 7 Part 1 Medical Microbiology & Virology Sample MCQs High confidence (~95%)
QuestionOutbreak of diarrhoea/vomiting among 100 wedding guests, ~two-thirds affected 2-3 days after the reception; guest list and buffet menu are available. Most appropriate epidemiological investigation?
AnswerE — a retrospective cohort study.
ExplanationBecause the entire at-risk population (all 100 guests) is identifiable with known individual exposures (specific menu items eaten), a retrospective cohort study — calculating attack rates by exposure — is the preferred design here, in contrast to a case-control study which is favoured when the total exposed population cannot be fully enumerated.
4 item(s)
Complex scenario Q1 Sample SAQ/OSPE questions, March 2024 2 marks Official mark scheme
Question26M with severe colitis after travel to USA/Mexico, freshwater swimming; on IV co-amoxiclav. Give two appropriate additional (non-routine) laboratory tests to request on the faeces specimen, with target organisms.
AnswerThiosulphate citrate bile salts sucrose (TCBS) agar, targeting Vibrio cholerae and V. parahaemolyticus. Plus a non-culture-based test: microscopy for cysts/trophozoites or specific testing for intestinal amoebiasis or Cyclospora (or referral to a parasitology reference laboratory for Entamoeba PCR/antigen testing). Routine Cryptosporidium/Giardia testing and standard CT-SMAC/XLD/Campylobacter-selective agar do not score, as these are already part of routine UK SMI testing.
ExplanationGiven the travel and freshwater-exposure history, non-routine tests targeting Vibrio and amoebic/Cyclospora causes are specifically indicated beyond the standard UK SMI stool work-up.
Complex scenario Q6 Sample SAQ/OSPE questions, March 2024 1 mark Official mark scheme
QuestionWhat reference laboratory test would you request on the blood and stool isolates as follow-up, and why?
AnswerWhole genome sequencing (WGS), given awareness of an MSM-associated, multi-drug-resistant (CTX-M-27-producing) Shigella sonnei outbreak cluster reported in multiple US states.
ExplanationWGS provides both definitive strain typing (linking cases to a known outbreak cluster) and a full resistance-gene profile in a single test.
OSPE2 Q2 Sample SAQ/OSPE questions, March 2024 4 marks Official mark scheme
QuestionHow could substitute agar plates be used in place of (a) chromogenic agar for carbapenem resistance screening, (b) MRSA chromogenic agar, and (c) XLD agar, during a media shortage?
Answer(a) CLED (or similar) agar plus a carbapenem disc. (b) Mannitol salt agar or a Staph/Strep selective agar (may need additional confirmatory biochemical tests). (c) DCA agar or a Salmonella-selective chromogenic agar.
ExplanationReflects practical laboratory contingency planning: non-chromogenic media combined with supplementary disc testing or confirmatory biochemistry can substitute for purpose-made chromogenic/selective media in a supply shortage.
Part1-MMV MCQ 10 Part 1 Medical Microbiology & Virology Sample MCQs High confidence (~95%)
Question5-year-old with cystic fibrosis, productive cough, specimen sent to the laboratory. Which culture medium is most appropriate to isolate Haemophilus influenzae?
AnswerB — Chocolate bacitracin agar.
ExplanationChocolate agar supplies the X (haemin) and V (NAD) growth factors required by Haemophilus, and the addition of bacitracin selectively suppresses normal respiratory flora that would otherwise overgrow the plate.
1 item(s)
MCQ 10 / Part1-MMV MCQ 9 & 25 (see Antibiotic tab) Part 1 / CICE Sample MCQs Medium confidence (90-94%)
QuestionCommunity needlestick injury in a well child; discarded needle, unknown source. Most appropriate management?
AnswerStart an accelerated course of hepatitis B vaccine (no HIV PEP or needle testing routinely indicated for this low-risk community exposure).
ExplanationCross-referenced from the Antibiotic/Infection Control tabs — grouped here because the definitive action is a vaccination decision. See that tab for full reasoning.
No official mark scheme provided for this MCQ.
3 item(s)
SAQ1 Paper 1 SAQ sample questions 5 marks Official mark scheme
Question12-week pregnant patient: total treponemal antibody (EIA) positive, IgM negative, TPPA positive (>1:1280), RPR negative. (1) How would you report this? (2a) Her partner was treated 3 years ago with IM benzathine penicillin — does she need further treatment? (2b) How to investigate/treat the baby?
Answer(1) Consistent with treponemal infection at some time; advise a repeat specimen to confirm. (2a) If there was adequate previous treatment, no further treatment is necessary. (2b) There is no need for the baby to undergo testing for syphilis or receive treatment.
ExplanationA positive TPPA/EIA with negative RPR and IgM in a patient with a documented history of adequate prior treatment reflects serological ‘scarring’ from past treated infection, not current active disease.
OSPE Sample station 1, Q1 OSPE Sample questions Claude analysis — verify
Question32F antenatal syphilis serology: EIA total antibody positive, IgM negative, TPPA positive (>1:1280), RPR positive (titre 1:2). (a) Interpretation? (b) Advice?
Answer(a) Consistent with treponemal infection, either current/incompletely treated or past infection with a persistently low-titre RPR (‘serofast’ state); the low-titre positive RPR (unlike the negative RPR in the closely related SAQ vignette) means active or recently treated infection cannot be excluded on this result alone. (b) Establish prior treatment history in detail (drug, dose, dates, partner treatment, and any documented RPR titre fall); if untreated or inadequately treated, treat with IM benzathine penicillin (safe and first-line in pregnancy) and refer to genitourinary medicine; screen and treat sexual partner(s); monitor serial RPR titres to confirm response; if treatment before 30 weeks’ gestation cannot be confirmed as adequate, the neonate should be assessed and managed for possible congenital syphilis at delivery.
ExplanationA low-titre positive RPR is genuinely ambiguous without treatment-history context (it can reflect either partially treated/reactivated infection or a serofast state after adequate past treatment), which is precisely the clinical reasoning this station is testing.
No official model answer was included in this source PDF for this OSPE station; this is Claude’s synthesis from standard BASHH/UK antenatal syphilis guidance.
Section B3 (a-d) Part 2 First Written Paper, Spring 2017 (docs 1 & 8, identical) High confidence (~95%)
QuestionWrite short notes on three of: CMV diagnosis in pregnancy; clinical significance of HBsAg mutants in women planning pregnancy; management of varicella zoster in the third trimester; prevention of parvovirus B19 infection in pregnancy.
AnswerCMV: primary infection is diagnosed by IgG seroconversion or IgM with low IgG avidity (high avidity excludes infection in roughly the preceding 3-4 months); amniocentesis for CMV PCR (after 21 weeks’ gestation and at least 6 weeks after maternal infection) with fetal USS assesses fetal infection/damage. HBsAg mutants (e.g. G145R ‘escape’ mutants): may be missed by some HBsAg immunoassays and can evade vaccine-induced immunity, risking neonatal infection despite apparently negative maternal HBsAg or despite standard neonatal immunoprophylaxis — HBV DNA testing may be needed alongside serology. VZV third trimester: risk of severe maternal varicella pneumonia — give oral/IV aciclovir if presenting within 24h of rash onset or with severe disease; the highest neonatal risk is when maternal rash occurs from 5 days before to 2 days after delivery (risk of severe neonatal varicella, needing VZIG and/or aciclovir for the baby); fetal varicella syndrome risk is low after 20 weeks. Parvovirus B19: no vaccine exists; prevention is by avoiding contact with confirmed cases (school/nursery outbreaks), especially <20 weeks, and hand hygiene; if exposed, check maternal IgG/IgM and monitor for fetal anaemia/hydrops with serial USS (MCA Doppler) if non-immune and infected.
ExplanationStandard UK SMI/RCOG-aligned antenatal virology teaching.

Distribution by theme

Bacteriology19
Virology13
Mycology3
Parasitology4
Antibiotic / AMS14
Infection (non-pathogen-specific)1
Infection Control7
Statistics / Epidemiology2
Lab Medicine4
Vaccine1
Pregnancy-related Infection3

Distribution by answer confidence / provenance

Official mark scheme26
High confidence (~95%)26
Medium confidence (90-94%)8
Claude analysis — verify9
Flagged — verify (<90%)2

“Official mark scheme” = the College’s own marking notes were present in the source PDF. All other bands are Claude’s own clinical/microbiological reasoning, applied because the corresponding source PDF (essay questions, and both MCQ papers) did not include a marking scheme or answer key.

Items per source paper

Sample SAQ/OSPE questions, March 202424
Part 1 / CICE Sample MCQs20
Part 1 Medical Microbiology & Virology Sample MCQs12
Part 2 First Written Paper, Spring 2017 (docs 1 & 8, identical)9
Paper 1 Clinical Scenario (Lemierre’s disease)2
OSPE Sample questions2
Paper 1 SAQ sample questions2

Notable observations

  • Coverage is heavily weighted toward Bacteriology, Antibiotic/AMS and Virology (19, 14 and 13 items respectively), consistent with these being the core clinical-microbiology content areas tested across FRCPath Part 1 and Part 2 formats.
  • Vaccine-specific content is thin (1 item(s)) across this question set — the closest related content (post-exposure hepatitis B vaccination decisions, VZIG/passive-immunisation scenarios) is mostly framed as infection-control or antiviral management rather than primary vaccinology, and BCG/IGRA testing appears only as a supporting detail in a TB chemoprophylaxis MCQ. If building a revision set specifically around immunisation policy (schedules, contraindications, cold chain, herd immunity thresholds), this would need supplementing from other sources.
  • Statistics/epidemiology is represented only by two study-design MCQs (case-control vs retrospective cohort), both from outbreak-investigation vignettes. There is no coverage here of diagnostic test statistics (sensitivity/specificity/PPV/NPV), sample-size concepts, or survival analysis, which do appear elsewhere in the FRCPath Part 2 curriculum.
  • Answer-key provenance varies substantially by document. The 2024 SAQ/OSPE set and the two SAQ/OSPE PDFs with red model-answer text (documents 2, 4 and 5) carry official College marking notes throughout. The 2017 First Written Paper (essay/short-notes, document 1/8), the OSPE Sample Questions PDF (document 6) and both MCQ sample papers (documents 3 and 7) were supplied without answer keys — all answers/explanations for these are Claude’s own reasoning and are flagged accordingly; they should be independently verified against the official College mark scheme before being relied on for exam preparation.
  • One genuine single-best-answer ambiguity was identified and flagged rather than resolved with false confidence: the CSF/encephalitis MCQ (CICE Q1 / Part 1 MMV Q16) has a defensible case for either herpes simplex virus type 1 or enterovirus, and no source answer key was available to adjudicate.
  • One [SELF-CORRECTION APPLIED] instance occurred during drafting: the initial answer for the premature-neonate VZV-exposure MCQ (Part 1 MMV Q24) was “no action required” based on maternal immunity alone; on appraisal this was revised to “give VZIG”, because UK Green Book guidance mandates VZIG for infants under 1 kg birthweight or below 28 weeks’ gestation regardless of maternal antibody status. See the Virology tab for the full reasoning.
  • Cross-document duplication: 13 of the 29 MCQs in the Part 1 Medical Microbiology & Virology paper (document 7) are verbatim repeats of MCQs already present in the CICE/Part 1 sample paper (document 3). Duplicates are shown once in the themed tabs, with both source references noted, to avoid redundancy.
  • Mycology item count is small but high-stakes — both items involve neutropenic/haematology-oncology patients (DKA-associated mucormycosis; leukaemia-associated invasive mould infection), reflecting the FRCPath emphasis on invasive fungal disease in immunocompromised hosts rather than superficial/dermatophyte mycology.

How to use the confidence flags

Each item card carries a coloured badge. Official mark scheme (green) means the wording is drawn directly from marking notes present in the source PDF. High confidence (blue) means the answer reflects well-established, stable microbiological fact. Medium confidence and Claude analysis — verify (amber) mean a reasonable best-answer judgement was made without a source key. Flagged (red) marks genuine single-best-answer ambiguity or an answer that depends on interpreting an image/finding that could not be independently confirmed to full certainty. Per your standing preference, none of the non-official answers should be treated as a verified College answer.

Compiled from user-uploaded RCPath sample papers for personal exam-preparation reference. Not an official College publication.

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