Exam Format: Multiple Choice, Clinical Vignettes
Total Questions: 100+ Practice Questions
Target Audience: Medical Students preparing for NBME Pathology Shelf Exam, USMLE
Step 1
Reference Standards: NBME Style Questions, 2026–2027 Content Updates
Instructions: Choose the single best answer for each question. All rationales are
provided in italics to reinforce key concepts from high-yield pathology topics frequently
tested on NBME examinations .
SECTION 1: CELL INJURY, INFLAMMATION, & REPAIR
(Questions 1–15)
1. A 58-year-old man with a history of alcoholism undergoes a liver biopsy.
Histological examination reveals hepatocytes with swollen, pale cytoplasm
containing clumped material. What is the underlying mechanism of this cellular
change?
A) Apoptosis
B) Caseous necrosis
C) Fat accumulation
D) Hydropic swelling
E) Glycogen deposition
Answer: D
Rationale: Hydropic swelling (also known as vacuolar degeneration) results from failure of
,the Na⁺/K⁺ ATPase pump, leading to influx of water into the cell. This is a hallmark of
reversible cell injury and is commonly seen in hepatocytes of patients with alcoholism and
other metabolic conditions .
2. A 72-year-old woman who suffered a myocardial infarction one week ago has a
histology slide showing macrophages with granular pink cytoplasm and
neutrophils at the border of the infarct. Which process is being observed?
A) Coagulative necrosis with organization
B) Liquefactive necrosis
C) Caseous necrosis
D) Fibrinoid necrosis
E) Gangrenous necrosis
Answer: A
Rationale: Coagulative necrosis is the hallmark of ischemic injury in solid organs such as
the heart. Neutrophils peak at about 1 week post-infarction, followed by macrophages
that clear debris. This process represents organization of the infarct .
3. A 35-year-old man presents with a puncture wound from a rusty nail. Within 24
hours, the foot becomes red, hot, and swollen. What is the primary cause of the
heat and redness observed in this patient's foot?
A) Vasodilation mediated by histamine
B) Neutrophil infiltration
C) Prostaglandin synthesis
D) Lymphatic obstruction
E) Fibroblast proliferation
, Answer: A
Rationale: The cardinal signs of acute inflammation (redness, heat, swelling) are primarily
caused by vasodilation and increased vascular permeability mediated by histamine and
other vasoactive mediators. This is the vascular component of the inflammatory response .
4. A 22-year-old male presents with fever, sore throat, and malaise. A blood smear
shows atypical lymphocytes with basophilic cytoplasm that appear to be indented
by adjacent red blood cells. What is the most likely cause of this patient's
presentation?
A) EBV (Epstein-Barr virus)
B) HIV
C) CMV (Cytomegalovirus)
D) Streptococcal pharyngitis
E) Toxoplasmosis
Answer: A
Rationale: The presence of atypical lymphocytes (Downey cells) with basophilic cytoplasm
and indentation by RBCs is characteristic of infectious mononucleosis caused by Epstein-
Barr virus (EBV). These cells are activated CD8+ T lymphocytes responding to EBV-infected
B cells .
5. A 60-year-old woman with atrial fibrillation presents with sudden abdominal
pain and bloody diarrhea. Imaging reveals a thrombus in the superior mesenteric
artery. What type of infarct is most likely to occur in the intestine?
A) White infarct
B) Red (hemorrhagic) infarct
Total Questions: 100+ Practice Questions
Target Audience: Medical Students preparing for NBME Pathology Shelf Exam, USMLE
Step 1
Reference Standards: NBME Style Questions, 2026–2027 Content Updates
Instructions: Choose the single best answer for each question. All rationales are
provided in italics to reinforce key concepts from high-yield pathology topics frequently
tested on NBME examinations .
SECTION 1: CELL INJURY, INFLAMMATION, & REPAIR
(Questions 1–15)
1. A 58-year-old man with a history of alcoholism undergoes a liver biopsy.
Histological examination reveals hepatocytes with swollen, pale cytoplasm
containing clumped material. What is the underlying mechanism of this cellular
change?
A) Apoptosis
B) Caseous necrosis
C) Fat accumulation
D) Hydropic swelling
E) Glycogen deposition
Answer: D
Rationale: Hydropic swelling (also known as vacuolar degeneration) results from failure of
,the Na⁺/K⁺ ATPase pump, leading to influx of water into the cell. This is a hallmark of
reversible cell injury and is commonly seen in hepatocytes of patients with alcoholism and
other metabolic conditions .
2. A 72-year-old woman who suffered a myocardial infarction one week ago has a
histology slide showing macrophages with granular pink cytoplasm and
neutrophils at the border of the infarct. Which process is being observed?
A) Coagulative necrosis with organization
B) Liquefactive necrosis
C) Caseous necrosis
D) Fibrinoid necrosis
E) Gangrenous necrosis
Answer: A
Rationale: Coagulative necrosis is the hallmark of ischemic injury in solid organs such as
the heart. Neutrophils peak at about 1 week post-infarction, followed by macrophages
that clear debris. This process represents organization of the infarct .
3. A 35-year-old man presents with a puncture wound from a rusty nail. Within 24
hours, the foot becomes red, hot, and swollen. What is the primary cause of the
heat and redness observed in this patient's foot?
A) Vasodilation mediated by histamine
B) Neutrophil infiltration
C) Prostaglandin synthesis
D) Lymphatic obstruction
E) Fibroblast proliferation
, Answer: A
Rationale: The cardinal signs of acute inflammation (redness, heat, swelling) are primarily
caused by vasodilation and increased vascular permeability mediated by histamine and
other vasoactive mediators. This is the vascular component of the inflammatory response .
4. A 22-year-old male presents with fever, sore throat, and malaise. A blood smear
shows atypical lymphocytes with basophilic cytoplasm that appear to be indented
by adjacent red blood cells. What is the most likely cause of this patient's
presentation?
A) EBV (Epstein-Barr virus)
B) HIV
C) CMV (Cytomegalovirus)
D) Streptococcal pharyngitis
E) Toxoplasmosis
Answer: A
Rationale: The presence of atypical lymphocytes (Downey cells) with basophilic cytoplasm
and indentation by RBCs is characteristic of infectious mononucleosis caused by Epstein-
Barr virus (EBV). These cells are activated CD8+ T lymphocytes responding to EBV-infected
B cells .
5. A 60-year-old woman with atrial fibrillation presents with sudden abdominal
pain and bloody diarrhea. Imaging reveals a thrombus in the superior mesenteric
artery. What type of infarct is most likely to occur in the intestine?
A) White infarct
B) Red (hemorrhagic) infarct
