Libre Pathology talk:Study Group
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Michael's thoughts on the exam
- I wrote it and passed it in 2012. I also did the American exam the same year and passed that.
- The pass rate for the FRCPC exam is pretty high.
- 2009-2011 it was 96+/-3.9% for Canadian medical school grads on their first attempt.
Written
- I though it was picking at details. Some things are very relevant to practise... other less so.
- The pocketbook version of Robbins covers most of it.
Practical (slide) exam
- You should know the answer almost immediately.
- If you don't know, write something down and move on.
- It is set to broadly cover everything.
- If it isn't a spot diagnosis... it should not be on.
- Somethings are PGY2/PGY3 stuff. One should not overthink things.
- Anecdotally, the first impression is usually the right one.
- I think one should stick with the first impression.
Gross exam
- Go with the most probable if you're uncertain.
- I worked through the Atlas of Gross Pathology with Histologic Correlation (see Pathology books for the reference).
- I am not sure this is necessary... but I thought it was useful.
- Flickr.com/Google images has a lot to offer in this respect.
- Gross spot diagnosis.
Forensic exam
- I thought this was tricky... and I liked forensics.
- Residents that took the exam prior to me said the same.
Cytology exam
- Some of the cases have several images.
- I remember being confused... the first three images were from one case. I remember thinking... I have the same diagnosis three times.
- Like the forensics and gross sections - this section isn't too long. From an exam strategy point-of-view, this makes it less likely that a diagnosis is repeated.
Oral exam
- I think this is to test if you are safe and useful.
- By "safe" I mean: knowing your limits and consulting with a colleague when appropriate.
- By "useful" I mean: you don't need to consult on everything.
- The examiners ask a pre-determined list of questions.
- Questions may depend on one another and, in fairness, they are told to redirect you.
- Example: You see a lung biopsy with hyaline material... and you go down the fibrosis route-- but it is really amyloidosis.
- The examiners will say something like "how would one work-up suspected amyloid?" or "lets assume this is amyloid..."
- Example: You see a lung biopsy with hyaline material... and you go down the fibrosis route-- but it is really amyloidosis.
- Questions may depend on one another and, in fairness, they are told to redirect you.
- If you're a Canadian resident, you cannot be examined by someone within your residency program.
- As far as I know, examiners are told to be stone-faced, i.e. show no emotion.
- Some of the cases were very straight forward.
- I didn't think anything was really exotic.
Short answer questions on genetics and molecular pathology.
These are some questions I came up with that are plausible to me... let me know if they are out to lunch.
UNIT 1
1. List three differences between DNA and RNA.
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2. What are the three stop codons?
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3. Where does transcription begin?
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4. List three enzymes necessary for transcription and their function.
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5. List and describe four post transcription modifications of RNA.
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6. List three differences between somatic and germline mutations.
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7. What is the difference between a missense and a non-sense mutation?
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8. Define a frameshift mutation.
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9. Why are inversion mutations difficult to detect?
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10. Describe the potential sequelae of a translocation mutation.
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UNIT 2
1. Translate the following: c.1524_1527delCGTA.
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2. List 5 features of SNPs.
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3. Define a regulatory SNP and a synonymous SNP?
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4. What is the difference between a microstalellite and a minisattelite?
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5. Describe Hardy-Weinberg Equilibrium?
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6. What factors can disrupt the H-W equilibrium?
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7. What is linkage disequilibrium?
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UNIT 3
1. What are the three major steps of PCR?
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2. What is the hallmark of PCR?
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3. What factors affect the method of genotyping chosen?
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4. Define sensitivity, specificity, positive predictive value and negative predictive value.
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5. Define reproducibility and accuracy of an analytical test.
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6. Describe briefly Sanger sequencing.
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7. Describe briefly how Taqman automated genotyping is used for allele detection.
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8. How are DNA microarrays used to identify drug disposition or responses?
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UNIT 4
1. Describe the procedure for submitting FFPE slides for KRAS for colorectal cancer.
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2. Compare and contrast uniplex versus multiplex genotyping.
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3. Compare and contrast conventional vs massively parallel sequencing.
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4. What is multiplex ligation-dependent ligation (MLPA)?
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5. What is fragment analysis?
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6. Compare and contrast RT-PCR vs qRTPCR.
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7. What is MSI?
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8. What is methylation analysis?
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UNIT 5
1. What are the four test features required to be documented by the CLIA?
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2. What are "in vitro diagnostics" vs "laboratory developed tests"?
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3. What does validation mean?
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4. What are the four performance characteristics that need to be verified for FDA cleared/approved tests?
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5. What are the six performance characteristics that need to be verified for FDA cleared LDTs or modified FDA cleared/approved tests?
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UNIT 6
1. List the components of a molecular pathology report.
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2. Define analytical sensitivity and clinical sensitivity.
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3. What should be said in a report of a molecular test on a patient for residual disease if no previous positive assay was confirmed?
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4. Define ammended report versus addendum report.
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5. Whose responsibility is it to sythesize the test results with other clinico-pathological information?
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6. How long are cytogenetic reports required to be kept by CAP?
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7, What is the recommended process to use test results if an assay is not yet validated for clinical use?
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8. Give three examples of "grey areas" which warrant discretion of professionals involved to use a non-validated test?
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9. What reference standard is available for gene nomenclature?
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10. Create a table of the most common gene rearrangements associated with heme and soft tissue diseases.
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11. What is a "DNA fingerprint" and what can it be used for?
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Hi Michael, I've started, but mostly just with the questions for now, as I study I will keep working on it. Can you help me, maybe we can make additional discussion pages for each of my "study" exams,e.g. molecular, robbins chapters, cap protocols etc.