Exam Format: Multiple Choice, Clinical Vignettes
Total Questions: 50+ Practice Questions
Target Audience: Medical Students preparing for NBME Pathology Shelf Exam
Reference Standards: NBME-style questions, 2024 Content Updates
Instructions: Choose the single best answer for each question. All rationales are
provided based on verified high-yield pathology concepts frequently tested on NBME
examinations.
SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1–15)
1. A 55-year-old man with chronic hypertension develops left ventricular
hypertrophy. Which mechanism is responsible for this cellular adaptation?
A) Proliferation of stem cells leading to increased cell number
B) Increased gene activation leading to increased structural proteins and organelles
C) Decreased protein synthesis and loss of fibrils/cell mass
D) Replacement of one cell type with another in response to stress
Answer: B
Rationale: Hypertrophy results from increased gene activation leading to increased
numbers of structural proteins and organelles. It occurs in response to increased workload,
such as in chronic hypertension where the left ventricle must pump against higher
pressure .
2. A patient with chronic GERD undergoes endoscopy and is found to have
columnar epithelium in the distal esophagus. This cellular change is termed:
A) Dysplasia
B) Metaplasia
C) Atrophy
D) Hyperplasia
,Answer: B
Rationale: Metaplasia is the reversible replacement of one cell type with another in
response to stress. In Barrett esophagus, the squamous epithelium of the esophagus is
replaced by columnar epithelium to better withstand the acidic environment .
3. A pathologist examines a biopsy showing cells with increased size variation,
hyperchromatic nuclei, and disordered tissue architecture. The process is reversible
if the stressor is removed. This is:
A) Dysplasia
B) Metaplasia
C) Hypertrophy
D) Hyperplasia
Answer: A
Rationale: Dysplasia is characterized by disordered cell growth with high malignant
potential. It is reversible if the inciting stress is removed. If stress persists, dysplasia can
progress to carcinoma, which is irreversible .
4. A 70-year-old woman with a myocardial infarction has histological examination
showing dead heart tissue where the cells have retained their outline. This type of
necrosis is classified as:
A) Liquefactive necrosis
B) Coagulative necrosis
C) Caseous necrosis
D) Fat necrosis
Answer: B
Rationale: Coagulative necrosis is characterized by preservation of cell shape and organ
structure due to coagulation of proteins. It occurs in wedge-shaped infarcts of solid organs
such as the heart, liver, and kidney, but NOT the brain or pancreas .
, 5. A patient with a bacterial abscess has a biopsy showing cells that are
undergoing nuclear fragmentation. This process is called:
A) Pyknosis
B) Karyorrhexis
C) Karyolysis
D) Apoptosis
Answer: B
Rationale: Karyorrhexis is the fragmentation of the nucleus and is a hallmark of
irreversible cell injury (necrosis). Pyknosis is nuclear shrinkage, and karyolysis is dissolution
of the nucleus. Apoptosis is programmed cell death .
6. A patient with tuberculosis has a lung biopsy showing a central area of necrosis
with a "cottage cheese" appearance surrounded by epithelioid histiocytes and
Langhans giant cells. This is:
A) A granuloma with caseous necrosis
B) An abscess
C) A cyst
D) A hematoma
Answer: A
Rationale: Granulomas are organized collections of epithelioid macrophages with
multinucleated giant cells. Caseous necrosis, with a "cottage cheese" appearance, is
characteristic of tuberculosis and fungal infections .
7. A 70-year-old man with heart failure has chronic passive congestion of the liver.
Microscopy shows "nutmeg liver" with centrilobular hemorrhage and necrosis. The
area most affected is:
A) Zone 1 (periportal)
B) Zone 2 (midzonal)
C) Zone 3 (centrilobular)
D) Bile ductules
Total Questions: 50+ Practice Questions
Target Audience: Medical Students preparing for NBME Pathology Shelf Exam
Reference Standards: NBME-style questions, 2024 Content Updates
Instructions: Choose the single best answer for each question. All rationales are
provided based on verified high-yield pathology concepts frequently tested on NBME
examinations.
SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1–15)
1. A 55-year-old man with chronic hypertension develops left ventricular
hypertrophy. Which mechanism is responsible for this cellular adaptation?
A) Proliferation of stem cells leading to increased cell number
B) Increased gene activation leading to increased structural proteins and organelles
C) Decreased protein synthesis and loss of fibrils/cell mass
D) Replacement of one cell type with another in response to stress
Answer: B
Rationale: Hypertrophy results from increased gene activation leading to increased
numbers of structural proteins and organelles. It occurs in response to increased workload,
such as in chronic hypertension where the left ventricle must pump against higher
pressure .
2. A patient with chronic GERD undergoes endoscopy and is found to have
columnar epithelium in the distal esophagus. This cellular change is termed:
A) Dysplasia
B) Metaplasia
C) Atrophy
D) Hyperplasia
,Answer: B
Rationale: Metaplasia is the reversible replacement of one cell type with another in
response to stress. In Barrett esophagus, the squamous epithelium of the esophagus is
replaced by columnar epithelium to better withstand the acidic environment .
3. A pathologist examines a biopsy showing cells with increased size variation,
hyperchromatic nuclei, and disordered tissue architecture. The process is reversible
if the stressor is removed. This is:
A) Dysplasia
B) Metaplasia
C) Hypertrophy
D) Hyperplasia
Answer: A
Rationale: Dysplasia is characterized by disordered cell growth with high malignant
potential. It is reversible if the inciting stress is removed. If stress persists, dysplasia can
progress to carcinoma, which is irreversible .
4. A 70-year-old woman with a myocardial infarction has histological examination
showing dead heart tissue where the cells have retained their outline. This type of
necrosis is classified as:
A) Liquefactive necrosis
B) Coagulative necrosis
C) Caseous necrosis
D) Fat necrosis
Answer: B
Rationale: Coagulative necrosis is characterized by preservation of cell shape and organ
structure due to coagulation of proteins. It occurs in wedge-shaped infarcts of solid organs
such as the heart, liver, and kidney, but NOT the brain or pancreas .
, 5. A patient with a bacterial abscess has a biopsy showing cells that are
undergoing nuclear fragmentation. This process is called:
A) Pyknosis
B) Karyorrhexis
C) Karyolysis
D) Apoptosis
Answer: B
Rationale: Karyorrhexis is the fragmentation of the nucleus and is a hallmark of
irreversible cell injury (necrosis). Pyknosis is nuclear shrinkage, and karyolysis is dissolution
of the nucleus. Apoptosis is programmed cell death .
6. A patient with tuberculosis has a lung biopsy showing a central area of necrosis
with a "cottage cheese" appearance surrounded by epithelioid histiocytes and
Langhans giant cells. This is:
A) A granuloma with caseous necrosis
B) An abscess
C) A cyst
D) A hematoma
Answer: A
Rationale: Granulomas are organized collections of epithelioid macrophages with
multinucleated giant cells. Caseous necrosis, with a "cottage cheese" appearance, is
characteristic of tuberculosis and fungal infections .
7. A 70-year-old man with heart failure has chronic passive congestion of the liver.
Microscopy shows "nutmeg liver" with centrilobular hemorrhage and necrosis. The
area most affected is:
A) Zone 1 (periportal)
B) Zone 2 (midzonal)
C) Zone 3 (centrilobular)
D) Bile ductules
