1|Page
NBME Pathology Final Exam Preparation With
Complete Questions And Correct Answers With
Rationales Already Graded A+Brand New Version!!
1. A 58-year-old man with alcoholism has a liver biopsy showing
hepatocytes with swollen, pale cytoplasm containing clumped material.
What is the mechanism?
A. Apoptosis
B. Caseous necrosis
C. Fat accumulation
D. Hydropic swelling
E. Glycogen deposition
Answer: D – Hydropic swelling. This is caused by failure of the Na⁺/K⁺
ATPase pump, leading to an influx of water into the cell. It is a reversible
form of cellular injury often seen in conditions like hypoxia or toxin
exposure, including alcoholism.
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2. A 72-year-old woman who had a myocardial infarction one week ago
shows an infarct with macrophages containing granular pink cytoplasm
and neutrophils at the border. What process is occurring?
A. Coagulative necrosis with organization
B. Liquefactive necrosis
C. Caseous necrosis
D. Fibrinoid necrosis
E. Gangrenous necrosis
Answer: A – Coagulative necrosis with organization. In the heart,
coagulative necrosis is the typical pattern following ischemia. At one
week, neutrophils are at their peak, and macrophages begin to appear
to clear the cellular debris, a process that leads to organization and scar
formation.
3. A 67-year-old smoker with a blood pressure of 200/110 mmHg has
fundoscopy showing copper-wire arterioles and arteriovenous (AV)
nicking. What is the direct cause of the AV nicking?
A. Hyaline arteriolosclerosis
B. Hyperplastic arteriolosclerosis
C. Atherosclerosis
D. Medial calcific sclerosis
E. Amyloid angiopathy
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Answer: A – Hyaline arteriolosclerosis. This is a hallmark of chronic
hypertension, where protein deposition thickens the arteriolar wall,
causing it to compress the adjacent vein at the point of crossing, which
is seen as AV nicking on fundoscopy.
4. A 60-year-old man with a history of alcohol use disorder presents
with ascites and jaundice. Liver biopsy shows hepatocytes with
irregular, pink cytoplasmic inclusions. These inclusions are most likely
composed of:
A. Glycogen
B. Lipid
C. Mallory bodies (intermediate filaments)
D. Alpha-1 antitrypsin globules
Answer: C – Mallory bodies. These are hyaline inclusions seen in
alcoholic liver disease and consist of aggregated intermediate filaments
(cytokeratins). They appear as irregular, eosinophilic cytoplasmic
inclusions.
5. A 45-year-old woman undergoes a breast biopsy. Microscopy shows
a pink, amorphous material within blood vessel walls. This material
stains positive with Congo red and shows apple-green birefringence
under polarized light. The substance is:
A. Hyaline
B. Amyloid
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C. Fibrin
D. Collagen
Answer: B – Amyloid. Congo red staining with apple-green birefringence
under polarized light is pathognomonic for amyloid deposition.
6. What areas of the brain are most susceptible to ischemia?
A. Basal ganglia
B. Watershed areas between ACA/MCA/PCA territories
C. Brainstem
D. Cerebellar hemispheres
Answer: B – Watershed areas. These border zones between the anterior,
middle, and posterior cerebral artery territories are most vulnerable to
systemic hypoperfusion. Pyramidal cells of the hippocampus and
Purkinje cells of the cerebellum are also particularly sensitive.
7. What is a red infarct and where does it typically occur?
A. Pale infarct in solid organs like heart and kidney
B. Hemorrhagic infarct in loose tissues with dual blood supply like lung
and intestine
C. Infarct with prominent neutrophil infiltration
D. Infarct that heals without scarring
NBME Pathology Final Exam Preparation With
Complete Questions And Correct Answers With
Rationales Already Graded A+Brand New Version!!
1. A 58-year-old man with alcoholism has a liver biopsy showing
hepatocytes with swollen, pale cytoplasm containing clumped material.
What is the mechanism?
A. Apoptosis
B. Caseous necrosis
C. Fat accumulation
D. Hydropic swelling
E. Glycogen deposition
Answer: D – Hydropic swelling. This is caused by failure of the Na⁺/K⁺
ATPase pump, leading to an influx of water into the cell. It is a reversible
form of cellular injury often seen in conditions like hypoxia or toxin
exposure, including alcoholism.
,2|Page
2. A 72-year-old woman who had a myocardial infarction one week ago
shows an infarct with macrophages containing granular pink cytoplasm
and neutrophils at the border. What process is occurring?
A. Coagulative necrosis with organization
B. Liquefactive necrosis
C. Caseous necrosis
D. Fibrinoid necrosis
E. Gangrenous necrosis
Answer: A – Coagulative necrosis with organization. In the heart,
coagulative necrosis is the typical pattern following ischemia. At one
week, neutrophils are at their peak, and macrophages begin to appear
to clear the cellular debris, a process that leads to organization and scar
formation.
3. A 67-year-old smoker with a blood pressure of 200/110 mmHg has
fundoscopy showing copper-wire arterioles and arteriovenous (AV)
nicking. What is the direct cause of the AV nicking?
A. Hyaline arteriolosclerosis
B. Hyperplastic arteriolosclerosis
C. Atherosclerosis
D. Medial calcific sclerosis
E. Amyloid angiopathy
,3|Page
Answer: A – Hyaline arteriolosclerosis. This is a hallmark of chronic
hypertension, where protein deposition thickens the arteriolar wall,
causing it to compress the adjacent vein at the point of crossing, which
is seen as AV nicking on fundoscopy.
4. A 60-year-old man with a history of alcohol use disorder presents
with ascites and jaundice. Liver biopsy shows hepatocytes with
irregular, pink cytoplasmic inclusions. These inclusions are most likely
composed of:
A. Glycogen
B. Lipid
C. Mallory bodies (intermediate filaments)
D. Alpha-1 antitrypsin globules
Answer: C – Mallory bodies. These are hyaline inclusions seen in
alcoholic liver disease and consist of aggregated intermediate filaments
(cytokeratins). They appear as irregular, eosinophilic cytoplasmic
inclusions.
5. A 45-year-old woman undergoes a breast biopsy. Microscopy shows
a pink, amorphous material within blood vessel walls. This material
stains positive with Congo red and shows apple-green birefringence
under polarized light. The substance is:
A. Hyaline
B. Amyloid
, 4|Page
C. Fibrin
D. Collagen
Answer: B – Amyloid. Congo red staining with apple-green birefringence
under polarized light is pathognomonic for amyloid deposition.
6. What areas of the brain are most susceptible to ischemia?
A. Basal ganglia
B. Watershed areas between ACA/MCA/PCA territories
C. Brainstem
D. Cerebellar hemispheres
Answer: B – Watershed areas. These border zones between the anterior,
middle, and posterior cerebral artery territories are most vulnerable to
systemic hypoperfusion. Pyramidal cells of the hippocampus and
Purkinje cells of the cerebellum are also particularly sensitive.
7. What is a red infarct and where does it typically occur?
A. Pale infarct in solid organs like heart and kidney
B. Hemorrhagic infarct in loose tissues with dual blood supply like lung
and intestine
C. Infarct with prominent neutrophil infiltration
D. Infarct that heals without scarring
