MRCOG Part 1: Pathology - Essential Study Guide

This is your essential guide to the Pathology section of the MRCOG Part 1 exam. We built it from our own experience of sitting the exam, the RCOG syllabus and the official reading list. It lists the pathology concepts most often tested, section by section.

Why Pathology matters in MRCOG Part 1

Pathology is crucial in obstetrics and gynaecology as it provides the foundation for understanding the causes, mechanisms, and manifestations of diseases affecting the female reproductive system. A strong grasp of pathology is essential for diagnosing, managing, and treating gynaecological conditions, as well as understanding complications that can arise during pregnancy and childbirth. The MRCOG Part 1 exam will test your knowledge of various pathological processes, particularly those related to gynaecological and obstetric conditions.

Pathology syllabus, section by section

ICellular Response to Disease

Cellular Injury and Death

Causes of Cell Injury
  • Hypoxia (e.g., vascular insufficiency)
  • Physical agents (e.g., burns)
  • Chemical agents (e.g., drug overdose)
  • Infectious agents (e.g., viral agents)
  • Immunological reactions (e.g., graft versus host disease)
  • Genetic derangements (e.g., cystic fibrosis)
  • Nutritional imbalances (e.g., scurvy)
Patterns of Cell Death
  • Apoptosis: programmed cell death, seen in embryogenesis and physiological events
  • Necrosis: cell death in living tissue, characterised by inflammation
  • Autolysis: post-mortem cell death
Types of Necrosis
  • Coagulative necrosis (e.g., myocardial infarction)
  • Colliquative necrosis (e.g., cerebral infarction)
  • Caseous necrosis (e.g., tuberculous lymphadenitis)
  • Fat necrosis (e.g., acute pancreatitis)
  • Gangrenous necrosis (e.g., Clostridial infection)

Inflammation and Healing

Acute Inflammation
  • Vascular and cellular responses
  • Chemical mediators (e.g., histamine, serotonin, prostaglandins, cytokines, kinins)
  • Outcomes: resolution, abscess formation, chronic inflammation
Chronic Inflammation
  • Prolonged inflammation with tissue destruction and repair
  • Granulomatous inflammation (e.g., tuberculosis, sarcoidosis)
Wound Healing
  • First intention vs. secondary intention
  • Factors affecting wound healing

IIBenign Gynaecological Pathology

Sexually Transmitted Infections

Common Pathogens and Diseases
  • Trichomonas vaginalis (vaginitis)
  • Treponema pallidum (syphilis, congenital syphilis)
  • Neisseria gonorrhoeae (gonorrhoea, endometritis, salpingitis, infertility)
  • Chlamydia trachomatis (urethral syndrome, salpingitis, infertility)
  • Human Papillomavirus (genital warts, cervical neoplasia)
  • HIV (AIDS, increased risk of other infections)
Pelvic Inflammatory Disease (PID)
  • Pathogenesis and complications
  • Tubal damage and infertility

Other Benign Conditions

Endometriosis
  • Definition and common sites
  • Theories of pathogenesis
  • Clinical manifestations (pain, infertility)
  • Association with clear cell and endometrioid carcinoma
Fibroids (Leiomyomas)
  • Red degeneration in pregnancy
Polyps
  • Cervical and endometrial polyps
Vulval Diseases
  • Lichen sclerosus: histological features
  • Lichen planus, Lichen simplex

IIIGynaecological Neoplasia

Cervical Neoplasia

Cervical Intraepithelial Neoplasia (CIN)
  • HPV and cervical carcinogenesis
  • CIN grading and cervical screening

Ovarian Neoplasia

Epithelial Ovarian Cancer
  • Type I vs. Type II carcinomas
  • Serous, mucinous, endometrioid types
  • Risk factors (nulliparity, family history, BRCA genes)
  • Association of psammoma bodies with serous tumours
  • Tumour markers: CA-125
Germ Cell Tumors
  • Mature cystic teratoma (dermoid cyst)
Sex Cord Stromal Tumors
  • Granulosa cell tumor
Metastatic Tumors
  • Krukenberg tumour

Endometrial Cancer

Types of endometrial carcinoma
  • Type 1 vs Type 2
  • Role of oestrogen

Vulval Neoplasia

Vulval Intraepithelial Neoplasia (VIN)
  • Classical vs. differentiated VIN

VGeneral Pathology

General Concepts

Thrombosis and Embolism
  • Virchow's triad
  • Types of emboli (pulmonary, amniotic fluid, air, fat)
  • Heritable thrombophilias: Factor V Leiden, Prothrombin G20210A
Infarction
  • Definition and causes
Shock
  • Cardiogenic, hypovolaemic, toxic shock
Electrolyte Disturbances
  • Addison's disease: effects on electrolytes (low sodium)
Tumour Markers
  • CA19-9: pancreatic carcinoma
  • a-FP, CA125, CEA, hCG, LDH for ovarian tumours
Increased Uric Acid Production
  • Association with Hodgkin lymphoma
Caseous Necrosis of Endometrium
  • Suggestive of tuberculosis

How to master Pathology

  • Review: work through each section systematically and understand the core concepts before moving on.
  • Active learning: draw diagrams, build mind maps and explain concepts to someone else.
  • Test yourself: try our free practice questions, then work through the pathology questions in the Uterio question bank.

Additional resources