NBME PATHOLOGY FINAL ACTUAL EXAM – QUESTIONS AND ANSWERS | EXAM
TESTBANK WITH VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES
| DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027
Core Domains
General Pathology
Systemic Pathology
Pathophysiology
Clinical Pathology and Laboratory Medicine
Pathology of Organ Systems (Cardiovascular, Respiratory, Renal, Gastrointestinal,
etc.)
Molecular and Genetic Pathology
Immunopathology and Infectious Disease Pathology
Neoplasia and Tumor Biology
Environmental and Nutritional Pathology
Introduction
This comprehensive examination is designed to rigorously assess a candidate's
mastery of foundational and systemic pathology, integrating core scientific
principles with clinical application. The assessment evaluates knowledge across a
wide spectrum of disorders, emphasizing the mechanisms of disease, pathological
changes, and their correlation with clinical manifestations. Utilizing a multiple-
choice and scenario-based question format, the exam challenges candidates to
apply their understanding of pathophysiology, diagnostic approaches, and
therapeutic rationale. The questions are constructed to foster critical thinking and
sound decision-making in professional practice, ensuring candidates are well-
prepared for the complexities of clinical medicine and advanced studies.
,SECTION ONE: Questions 1–50
1. A 72-year-old male presents with a two-month history of fatigue, night
sweats, and an unintentional weight loss of 15 pounds. On physical
examination, he is found to have a firm, non-tender, 4cm lymph node in the
left cervical chain. Laboratory studies show a normocytic anemia and an
elevated erythrocyte sedimentation rate. A surgical biopsy of the lymph node
reveals the presence of mononuclear Hodgkin and Reed-Sternberg cells.
Immunohistochemical staining is positive for CD30 and CD15, but negative for
CD45 and CD20. Which of the following is the most likely diagnosis?
A. Nodular lymphocyte-predominant Hodgkin lymphoma
B. Anaplastic large cell lymphoma
C. Diffuse large B-cell lymphoma
D. Classical Hodgkin lymphoma, nodular sclerosis type
🟢 Correct Answer: D. Classical Hodgkin lymphoma, nodular sclerosis type
🔴 Explanation: The presence of mononuclear Hodgkin and Reed-Sternberg cells
in a cervical lymph node, along with the immunophenotype (CD30+, CD15+,
CD45-, CD20-), is classic for classical Hodgkin lymphoma. Nodular sclerosis is the
most common subtype of classical Hodgkin lymphoma, frequently presenting
with mediastinal or cervical lymphadenopathy in young adults and older patients.
2. A 65-year-old female with a 40-pack-year smoking history presents with
worsening shortness of breath, a chronic cough, and hemoptysis. A chest CT
reveals a 5cm central mass in the right hilum. A bronchoscopic biopsy is
performed. Pathological examination of the biopsy shows small cells with scant
cytoplasm, finely granular chromatin, and frequent areas of necrosis. Which of
the following immunohistochemical markers would most likely be positive in
this neoplasm?
,A. Cytokeratin 7 (CK7)
B. Thyroid transcription factor-1 (TTF-1)
C. Chromogranin
D. p63
🟢 Correct Answer: C. Chromogranin
🔴 Explanation: The pathological description is consistent with small cell lung
carcinoma (SCLC). SCLC is a high-grade neuroendocrine tumor.
Immunohistochemical markers for neuroendocrine differentiation, such as
chromogranin, synaptophysin, and CD56, are typically positive.
3. A 45-year-old male with a history of alcohol abuse presents with a two-day
history of severe epigastric pain that radiates to the back. The pain is
associated with nausea and vomiting. Laboratory evaluation reveals elevated
serum amylase and lipase. An abdominal CT shows a diffusely enlarged
pancreas with peripancreatic inflammation. Over the next 48 hours, the patient
develops hypotension, acute respiratory distress, and renal failure. Which of the
following is the most likely cause of his rapid clinical deterioration?
A. Systemic inflammatory response syndrome (SIRS)
B. Acute cholangitis
C. Massive gastrointestinal hemorrhage
D. Hepatic encephalopathy
🟢 Correct Answer: A. Systemic inflammatory response syndrome (SIRS)
🔴 Explanation: Severe acute pancreatitis can trigger a massive systemic release
of inflammatory cytokines, leading to SIRS, which can rapidly progress to multi-
organ dysfunction syndrome (MODS), manifesting as the clinical picture of
hypotension, ARDS, and renal failure.
, 4. A 28-year-old female presents with multiple painful, erythematous nodules
on her shins. She also reports fever, arthralgias, and bilateral hilar
lymphadenopathy on chest X-ray. A biopsy of one of the nodules shows a
septal panniculitis with focal vasculitis. Which of the following is the most likely
underlying diagnosis?
A. Systemic lupus erythematosus
B. Sarcoidosis
C. Rheumatoid arthritis
D. Inflammatory bowel disease
🟢 Correct Answer: B. Sarcoidosis
🔴 Explanation: The combination of erythema nodosum (painful shin nodules),
fever, arthralgias, and bilateral hilar lymphadenopathy is a classic presentation of
Lofgren's syndrome, an acute presentation of sarcoidosis.
5. A 60-year-old male with a long history of chronic hepatitis C presents with
increasing abdominal girth and lower extremity edema. A liver biopsy is
performed to assess the extent of liver damage. Microscopic examination
reveals extensive bridging fibrosis and the formation of regenerative nodules.
Which of the following is the most accurate description of this pathological
state?
A. Acute hepatitis
B. Chronic persistent hepatitis
C. Cirrhosis
D. Hepatic adenoma
🟢 Correct Answer: C. Cirrhosis
🔴 Explanation: The pathological features of extensive bridging fibrosis and
regenerative nodules are the hallmark of cirrhosis, the end-stage of chronic liver
TESTBANK WITH VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES
| DOWNLOAD AND PASS | LATEST EXAM UPDATE 2026/2027
Core Domains
General Pathology
Systemic Pathology
Pathophysiology
Clinical Pathology and Laboratory Medicine
Pathology of Organ Systems (Cardiovascular, Respiratory, Renal, Gastrointestinal,
etc.)
Molecular and Genetic Pathology
Immunopathology and Infectious Disease Pathology
Neoplasia and Tumor Biology
Environmental and Nutritional Pathology
Introduction
This comprehensive examination is designed to rigorously assess a candidate's
mastery of foundational and systemic pathology, integrating core scientific
principles with clinical application. The assessment evaluates knowledge across a
wide spectrum of disorders, emphasizing the mechanisms of disease, pathological
changes, and their correlation with clinical manifestations. Utilizing a multiple-
choice and scenario-based question format, the exam challenges candidates to
apply their understanding of pathophysiology, diagnostic approaches, and
therapeutic rationale. The questions are constructed to foster critical thinking and
sound decision-making in professional practice, ensuring candidates are well-
prepared for the complexities of clinical medicine and advanced studies.
,SECTION ONE: Questions 1–50
1. A 72-year-old male presents with a two-month history of fatigue, night
sweats, and an unintentional weight loss of 15 pounds. On physical
examination, he is found to have a firm, non-tender, 4cm lymph node in the
left cervical chain. Laboratory studies show a normocytic anemia and an
elevated erythrocyte sedimentation rate. A surgical biopsy of the lymph node
reveals the presence of mononuclear Hodgkin and Reed-Sternberg cells.
Immunohistochemical staining is positive for CD30 and CD15, but negative for
CD45 and CD20. Which of the following is the most likely diagnosis?
A. Nodular lymphocyte-predominant Hodgkin lymphoma
B. Anaplastic large cell lymphoma
C. Diffuse large B-cell lymphoma
D. Classical Hodgkin lymphoma, nodular sclerosis type
🟢 Correct Answer: D. Classical Hodgkin lymphoma, nodular sclerosis type
🔴 Explanation: The presence of mononuclear Hodgkin and Reed-Sternberg cells
in a cervical lymph node, along with the immunophenotype (CD30+, CD15+,
CD45-, CD20-), is classic for classical Hodgkin lymphoma. Nodular sclerosis is the
most common subtype of classical Hodgkin lymphoma, frequently presenting
with mediastinal or cervical lymphadenopathy in young adults and older patients.
2. A 65-year-old female with a 40-pack-year smoking history presents with
worsening shortness of breath, a chronic cough, and hemoptysis. A chest CT
reveals a 5cm central mass in the right hilum. A bronchoscopic biopsy is
performed. Pathological examination of the biopsy shows small cells with scant
cytoplasm, finely granular chromatin, and frequent areas of necrosis. Which of
the following immunohistochemical markers would most likely be positive in
this neoplasm?
,A. Cytokeratin 7 (CK7)
B. Thyroid transcription factor-1 (TTF-1)
C. Chromogranin
D. p63
🟢 Correct Answer: C. Chromogranin
🔴 Explanation: The pathological description is consistent with small cell lung
carcinoma (SCLC). SCLC is a high-grade neuroendocrine tumor.
Immunohistochemical markers for neuroendocrine differentiation, such as
chromogranin, synaptophysin, and CD56, are typically positive.
3. A 45-year-old male with a history of alcohol abuse presents with a two-day
history of severe epigastric pain that radiates to the back. The pain is
associated with nausea and vomiting. Laboratory evaluation reveals elevated
serum amylase and lipase. An abdominal CT shows a diffusely enlarged
pancreas with peripancreatic inflammation. Over the next 48 hours, the patient
develops hypotension, acute respiratory distress, and renal failure. Which of the
following is the most likely cause of his rapid clinical deterioration?
A. Systemic inflammatory response syndrome (SIRS)
B. Acute cholangitis
C. Massive gastrointestinal hemorrhage
D. Hepatic encephalopathy
🟢 Correct Answer: A. Systemic inflammatory response syndrome (SIRS)
🔴 Explanation: Severe acute pancreatitis can trigger a massive systemic release
of inflammatory cytokines, leading to SIRS, which can rapidly progress to multi-
organ dysfunction syndrome (MODS), manifesting as the clinical picture of
hypotension, ARDS, and renal failure.
, 4. A 28-year-old female presents with multiple painful, erythematous nodules
on her shins. She also reports fever, arthralgias, and bilateral hilar
lymphadenopathy on chest X-ray. A biopsy of one of the nodules shows a
septal panniculitis with focal vasculitis. Which of the following is the most likely
underlying diagnosis?
A. Systemic lupus erythematosus
B. Sarcoidosis
C. Rheumatoid arthritis
D. Inflammatory bowel disease
🟢 Correct Answer: B. Sarcoidosis
🔴 Explanation: The combination of erythema nodosum (painful shin nodules),
fever, arthralgias, and bilateral hilar lymphadenopathy is a classic presentation of
Lofgren's syndrome, an acute presentation of sarcoidosis.
5. A 60-year-old male with a long history of chronic hepatitis C presents with
increasing abdominal girth and lower extremity edema. A liver biopsy is
performed to assess the extent of liver damage. Microscopic examination
reveals extensive bridging fibrosis and the formation of regenerative nodules.
Which of the following is the most accurate description of this pathological
state?
A. Acute hepatitis
B. Chronic persistent hepatitis
C. Cirrhosis
D. Hepatic adenoma
🟢 Correct Answer: C. Cirrhosis
🔴 Explanation: The pathological features of extensive bridging fibrosis and
regenerative nodules are the hallmark of cirrhosis, the end-stage of chronic liver
