Page 1 of 128
AMERICAN BOARD OF PATHOLOGY (ABPATH)
AP/CP CERTIFICATION EXAM 2026 QUESTIONS
LATEST VERSION QUESTIONS AND ANSWERS
American Board of Pathology (ABPath) AP/CP Certification Exam — 250 Practice
Questions
10-POINT EXAM COVERAGE SUMMARY
Based on the ABPath AP/CP Primary Certification Exam Blueprint:
Weight
# Domain Key Content Covered
(AP)
Cervical/vaginal cytology (Bethesda
System); fine needle aspiration (FNA) of
1 Cytopathology ~15% thyroid, breast, lung, pancreas; urine
cytology; effusion cytology; CSF cytology;
HPV testing; molecular markers
Esophageal (Barrett's, dysplasia,
adenocarcinoma); gastric (H. pylori,
MALToma, adenocarcinoma); intestinal
Gastrointestinal ~12- (Crohn's, ulcerative colitis, polyposis
2
Pathology 13% syndromes, colorectal carcinoma); hepatic
(cirrhosis, HCC, cholangiocarcinoma);
pancreatic (ductal adenocarcinoma, IPMN,
neuroendocrine tumors)
Renal tumors (RCC subtypes); bladder
(urothelial carcinoma); prostate
Genitourinary ~9-
3 (adenocarcinoma, Gleason grading);
Pathology 14%
testicular (germ cell tumors); penile
carcinoma
Invasive ductal/lobular carcinoma;
DCIS/LCIS; prognostic/predictive markers
4 Breast Pathology ~8-9% (ER/PR/HER2); triple-negative breast
cancer; Phyllodes tumor; core biopsy
interpretation
, Page 2 of 128
Weight
# Domain Key Content Covered
(AP)
Ovarian tumors (surface epithelial, germ cell,
sex cord-stromal); endometrial carcinoma
Gynecologic
5 ~7-8% (endometrioid, serous, clear cell); cervical
Pathology
carcinoma; vulvar lesions; gestational
trophoblastic disease
Melanocytic lesions (nevi, melanoma); non-
~5- melanocytic skin tumors (BCC, SCC);
6 Dermatopathology
10% inflammatory dermatoses; soft tissue tumors;
immunofluorescence
Lung carcinoma (adenocarcinoma, SCC,
Pulmonary & Head SCLC, carcinoid); interstitial lung diseases;
7 ~6-7%
& Neck Pathology sinonasal tumors; salivary gland tumors;
thyroid pathology; laryngeal lesions
Leukemias (ALL, AML, CLL, CML);
lymphomas (Hodgkin, NHL subtypes);
Hematopathology & ~25-
plasma cell disorders; myelodysplastic
8 Transfusion 30%
syndromes; flow cytometry; blood banking
Medicine (CP)
(ABO/Rh, antibody ID, transfusion
reactions); coagulation disorders
Electrolytes, renal function, liver function,
~20- cardiac markers, endocrine testing;
Clinical Chemistry
9 25% bacterial/fungal/viral identification,
& Microbiology
(CP) antimicrobial susceptibility, infection
control; molecular diagnostics
Cell injury, inflammation, neoplasia, genetic
General Pathology, disorders; laboratory management (quality
10 Management & ~5% control, regulatory compliance); informatics
Informatics (LIS, digital pathology); autopsy pathology;
forensic pathology
Exam Format: ~500 multiple-choice questions (combined AP/CP) | Time Limit: Two 3.5-
hour sessions | Passing Score: Scaled, determined by standard setting
250 MULTIPLE-CHOICE QUESTIONS WITH RATIONALES
SECTION 1: CYTOPATHOLOGY (Questions 1-25)
, Page 3 of 128
1. A 45-year-old woman presents with a palpable thyroid nodule. Fine needle aspiration
(FNA) reveals a cellular specimen with microfollicular architecture, nuclear crowding,
and nuclear grooves. There is no significant colloid. What is the most likely cytologic
diagnosis?
A. Benign nodular goiter
B. Follicular neoplasm (Bethesda Category IV)
C. Papillary thyroid carcinoma (Bethesda Category VI)
D. Medullary thyroid carcinoma
Answer: B
Rationale: The presence of a microfollicular pattern with nuclear crowding and grooves but
without overt papillary features or psammoma bodies is characteristic of a follicular
neoplasm (Bethesda Category IV). Option A would show abundant colloid and
macrofollicles. Option C would show definitive papillary architecture and nuclear features
including intranuclear pseudoinclusions. Option D would show plasmacytoid cells with
granular chromatin and amyloid.
2. A 55-year-old woman undergoes routine cervical cancer screening. The Pap test
shows clusters of atypical glandular cells with feathering and nuclear enlargement.
There is also a background of tumor diathesis. What is the most likely diagnosis?
A. Endocervical adenocarcinoma in situ (AIS)
B. Squamous cell carcinoma
C. Endometrial adenocarcinoma
D. Reactive endocervical cells
Answer: A
Rationale: The classic cytologic features of endocervical adenocarcinoma in situ include
, Page 4 of 128
feathering (stripes of cells with nuclei aligned at the edges), nuclear enlargement,
hyperchromasia, and tumor diathesis. Option B would show squamous differentiation. Option
C typically shows three-dimensional clusters with vacuolated cytoplasm. Option D would
show uniform nuclei with preserved nuclear-to-cytoplasmic ratio.
3. A 60-year-old man with a history of smoking presents with a lung mass. FNA shows
malignant cells forming three-dimensional clusters with nuclear molding and scant
cytoplasm. Crush artifact is prominent. What is the most likely diagnosis?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Carcinoid tumor
Answer: C
Rationale: Small cell carcinoma is characterized by small cells with scant cytoplasm, nuclear
molding, prominent crush artifact, and three-dimensional clusters. Option A would show
larger cells with prominent nucleoli and gland formation. Option B would show polygonal
cells with dense cytoplasm and intercellular bridges. Option D would show uniform cells
with salt-and-pepper chromatin and organoid growth.
4. A 50-year-old woman presents with a breast lump. FNA shows discohesive cells with
intracytoplasmic mucin, eccentric nuclei, and signet ring forms. What is the most likely
diagnosis?
A. Invasive ductal carcinoma
B. Invasive lobular carcinoma
C. Mucinous carcinoma
AMERICAN BOARD OF PATHOLOGY (ABPATH)
AP/CP CERTIFICATION EXAM 2026 QUESTIONS
LATEST VERSION QUESTIONS AND ANSWERS
American Board of Pathology (ABPath) AP/CP Certification Exam — 250 Practice
Questions
10-POINT EXAM COVERAGE SUMMARY
Based on the ABPath AP/CP Primary Certification Exam Blueprint:
Weight
# Domain Key Content Covered
(AP)
Cervical/vaginal cytology (Bethesda
System); fine needle aspiration (FNA) of
1 Cytopathology ~15% thyroid, breast, lung, pancreas; urine
cytology; effusion cytology; CSF cytology;
HPV testing; molecular markers
Esophageal (Barrett's, dysplasia,
adenocarcinoma); gastric (H. pylori,
MALToma, adenocarcinoma); intestinal
Gastrointestinal ~12- (Crohn's, ulcerative colitis, polyposis
2
Pathology 13% syndromes, colorectal carcinoma); hepatic
(cirrhosis, HCC, cholangiocarcinoma);
pancreatic (ductal adenocarcinoma, IPMN,
neuroendocrine tumors)
Renal tumors (RCC subtypes); bladder
(urothelial carcinoma); prostate
Genitourinary ~9-
3 (adenocarcinoma, Gleason grading);
Pathology 14%
testicular (germ cell tumors); penile
carcinoma
Invasive ductal/lobular carcinoma;
DCIS/LCIS; prognostic/predictive markers
4 Breast Pathology ~8-9% (ER/PR/HER2); triple-negative breast
cancer; Phyllodes tumor; core biopsy
interpretation
, Page 2 of 128
Weight
# Domain Key Content Covered
(AP)
Ovarian tumors (surface epithelial, germ cell,
sex cord-stromal); endometrial carcinoma
Gynecologic
5 ~7-8% (endometrioid, serous, clear cell); cervical
Pathology
carcinoma; vulvar lesions; gestational
trophoblastic disease
Melanocytic lesions (nevi, melanoma); non-
~5- melanocytic skin tumors (BCC, SCC);
6 Dermatopathology
10% inflammatory dermatoses; soft tissue tumors;
immunofluorescence
Lung carcinoma (adenocarcinoma, SCC,
Pulmonary & Head SCLC, carcinoid); interstitial lung diseases;
7 ~6-7%
& Neck Pathology sinonasal tumors; salivary gland tumors;
thyroid pathology; laryngeal lesions
Leukemias (ALL, AML, CLL, CML);
lymphomas (Hodgkin, NHL subtypes);
Hematopathology & ~25-
plasma cell disorders; myelodysplastic
8 Transfusion 30%
syndromes; flow cytometry; blood banking
Medicine (CP)
(ABO/Rh, antibody ID, transfusion
reactions); coagulation disorders
Electrolytes, renal function, liver function,
~20- cardiac markers, endocrine testing;
Clinical Chemistry
9 25% bacterial/fungal/viral identification,
& Microbiology
(CP) antimicrobial susceptibility, infection
control; molecular diagnostics
Cell injury, inflammation, neoplasia, genetic
General Pathology, disorders; laboratory management (quality
10 Management & ~5% control, regulatory compliance); informatics
Informatics (LIS, digital pathology); autopsy pathology;
forensic pathology
Exam Format: ~500 multiple-choice questions (combined AP/CP) | Time Limit: Two 3.5-
hour sessions | Passing Score: Scaled, determined by standard setting
250 MULTIPLE-CHOICE QUESTIONS WITH RATIONALES
SECTION 1: CYTOPATHOLOGY (Questions 1-25)
, Page 3 of 128
1. A 45-year-old woman presents with a palpable thyroid nodule. Fine needle aspiration
(FNA) reveals a cellular specimen with microfollicular architecture, nuclear crowding,
and nuclear grooves. There is no significant colloid. What is the most likely cytologic
diagnosis?
A. Benign nodular goiter
B. Follicular neoplasm (Bethesda Category IV)
C. Papillary thyroid carcinoma (Bethesda Category VI)
D. Medullary thyroid carcinoma
Answer: B
Rationale: The presence of a microfollicular pattern with nuclear crowding and grooves but
without overt papillary features or psammoma bodies is characteristic of a follicular
neoplasm (Bethesda Category IV). Option A would show abundant colloid and
macrofollicles. Option C would show definitive papillary architecture and nuclear features
including intranuclear pseudoinclusions. Option D would show plasmacytoid cells with
granular chromatin and amyloid.
2. A 55-year-old woman undergoes routine cervical cancer screening. The Pap test
shows clusters of atypical glandular cells with feathering and nuclear enlargement.
There is also a background of tumor diathesis. What is the most likely diagnosis?
A. Endocervical adenocarcinoma in situ (AIS)
B. Squamous cell carcinoma
C. Endometrial adenocarcinoma
D. Reactive endocervical cells
Answer: A
Rationale: The classic cytologic features of endocervical adenocarcinoma in situ include
, Page 4 of 128
feathering (stripes of cells with nuclei aligned at the edges), nuclear enlargement,
hyperchromasia, and tumor diathesis. Option B would show squamous differentiation. Option
C typically shows three-dimensional clusters with vacuolated cytoplasm. Option D would
show uniform nuclei with preserved nuclear-to-cytoplasmic ratio.
3. A 60-year-old man with a history of smoking presents with a lung mass. FNA shows
malignant cells forming three-dimensional clusters with nuclear molding and scant
cytoplasm. Crush artifact is prominent. What is the most likely diagnosis?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Carcinoid tumor
Answer: C
Rationale: Small cell carcinoma is characterized by small cells with scant cytoplasm, nuclear
molding, prominent crush artifact, and three-dimensional clusters. Option A would show
larger cells with prominent nucleoli and gland formation. Option B would show polygonal
cells with dense cytoplasm and intercellular bridges. Option D would show uniform cells
with salt-and-pepper chromatin and organoid growth.
4. A 50-year-old woman presents with a breast lump. FNA shows discohesive cells with
intracytoplasmic mucin, eccentric nuclei, and signet ring forms. What is the most likely
diagnosis?
A. Invasive ductal carcinoma
B. Invasive lobular carcinoma
C. Mucinous carcinoma
