Pathology — Specimens, Reports and Test Interpretation, NMC MBBS licence examination syllabus (Nepal Medical Council).
NMC-style practice questions written for this site. They are not past questions, and no past paper has been reproduced.
Cytology from a breast lump reports malignant cells. Why is a core biopsy still required before planning surgery?
Answer: Cytology examines loose cells and cannot demonstrate invasion, because invasion is a relationship between cells and the surrounding tissue rather than a feature of a cell. A core biopsy preserves the architecture, confirms invasion and types the tumour — and those determine the operation and the adjuvant treatment.
A biopsy of a hard, growing neck lump returns "normal lymphoid tissue". The lump is unchanged. What is the appropriate response?
Answer: Treat the discordance as a sampling problem rather than reassurance. The report is accurate about the tissue examined; it does not establish that the lesion was sampled. Discuss with the pathologist whether the specimen was adequate and consider repeating. Accepting a reassuring report that contradicts a strong clinical picture is how these diagnoses are delayed.
Tissue from a chronically discharging sinus is placed in formalin and sent for histology and culture. What has been lost?
Answer: Culture. Fixative preserves tissue architecture and kills organisms, so no organism will grow. In a discharging wound the organism is usually the clinical question, so a separate fresh specimen was needed for microbiology alongside the fixed one for histology.
A test with a good reputation returns positive in a young patient with no symptoms and no risk factors. Why should this be interpreted cautiously?
Answer: Because a result modifies the probability of disease rather than establishing it. When disease is unlikely beforehand, a large proportion of positive results are false, and acting on one starts an investigation with its own risks. Confirming or repeating is usually more appropriate than beginning treatment.
Why does labelling a specimen at the bedside rather than at the desk matter?
Answer: Because a mislabelled specimen can give one patient another patient's diagnosis, with surgery or treatment following from it. Labelling against the patient at the point of collection is the step that prevents it; labelling afterwards relies on memory and on pots not being confused in transit.
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