NBME PATHOLOGY FINAL EXAM STUDY
GUIDE 2025/2026 COMPLETE QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES || 100% GUARANTEED PASS
<RECENT VERSION>
1. Apoptosis: - ANSWER ✓ Programmed cell death. REQUIRES ATP. Can
occur via the intrinsic or extrinsic pathways, both of which involve
activation of cytosolic caspases which mediate cellular breakdown.
***Unlike necrosis, apoptosis does not involve significant inflammation.
Involves eosinophilic cytoplasm, cell shrinkage, pyknosis and basophilia,
membrane blebbing and karyorrhexis, and formation of apoptotic bodies
which are phagocytosed. **DNA laddering is a sensitive indicator of
apoptosis** Occurs because during karyorrhexis endonucleases yield 180bp
fragments.
2. Radiation therapy does what? - ANSWER ✓ Causes apoptosis of cancer
cells because it causes formation of free radicals which lead to dsDNA
breakage. rapidly dividing cells like skin and GI mucosa are highly
susceptible to radiation-induced apoptosis.
3. Intrinsic pathway of apoptosis: what is its general purpose / when does it
occur? - ANSWER ✓ It's involved in tissue remodeling in embryogenesis.
Often occurs when a regulating factor is withdrawn from a proliferating cell
population. For example, low IL-2 after completion of an immunological
reaction causes apoptosis of proliferating effector cells. Also occurs in
response to injury from radiation, toxins, hypoxia,etc. Changes in
proportions of pro- and anti-apoptotic factors leads to an increase in
mitochondrial permeability and cyt c release.
4. BAK, BAX, Bcl-2: Which of these are pro- and which are anti-apoptotic? -
ANSWER ✓ BAX and BAK are pro. Bcl-2 is anti-apoptotic.
,5. How does Bcl-2 function? - ANSWER ✓ It prevents cyt c release by binding
to an inhibiting Apaf-1, which normally INDUCES caspases.
6. What happens if Bcl-2 is overexpressed? - ANSWER ✓ This occurs in
follicular lymphoma. Apaf-1 is over-inhibited which leads to tumorigenesis
because of lowered caspase activation.
7. Extrinsic pathway of apoptosis: 2 basic pathways? - ANSWER ✓ 1. Ligand
receptor interactions. FasL binding to Fas (CD95). 2. Immune cell--
>cytotoxic T-cell release of perforin and granzyme B.
8. Where is Fas-FasL interaction required? - ANSWER ✓ In thymic medullary
negative selection. Mutations in Fas increases the numbers of circulating
self-reactive lymphocytes due to failure of clonal deletion. **Defective fas-
fasL interactions is the basis of autoimmune disorders**
9. beta-hCG: - ANSWER ✓ hydatidiform moles and choriocarcinoma
(gestational trophoblastic disease), testicular cancer. Normally associated
with pregnancy.
10.CA-15-3/ CA-27-29: - ANSWER ✓ breast cancer
11.CA 19-9: - ANSWER ✓ pancreatic adenocarcinoma
12.CA 125: - ANSWER ✓ ovarian cancer
13.Calcitonin: - ANSWER ✓ medullary thyroid carcinoma
14.CEA: - ANSWER ✓ CarcinoEmbryonic Antigen. Very nonspecific but
produced by 70% of colorectal and pancreatic cancers; also produced by
gastric, breast and medullary thyroid carcinomas
15.PSA: - ANSWER ✓ prostate-specific antigen. Used to follow prostate
adenocarcinoma. Can also be elevated in BPH (benign prostatic hyperplasia)
and prostatitis. Questionable risk / benefit for screening.
16.S-100: - ANSWER ✓ neural crest origin, ie melanomas, neural tumors,
schwannomas, langerhan's cell histiocytosis.
,17.TRAP: - ANSWER ✓ Tatrate-resistant acid phosphatase. Hairy cell
leukemia--a B cell neoplasm.
18.ONCOGENIC MICROBES--EBV: - ANSWER ✓ Burkitt lymphoma,
Hodgkin lymphoma, nasopharyngeal carcinoma, CNS lymphoma in
immunocompromised patients.
19.HBV, HCV: - ANSWER ✓ hepatocellular carcinoma.
20.HHV-8: - ANSWER ✓ aka kaposi sarcoma-related herpes virus. kaposi
sarcoma, body fluid cavity B-cell lymphoma
21.HPV: - ANSWER ✓ cervical and penile / anal carcinoma (16,18), head and
neck or throat cancer
22.H pylori: - ANSWER ✓ gastric adenocarcinoma and MALT lymphoma
23.HTLV-1: - ANSWER ✓ Adult T-cell leukemia / lymphoma
24.Liver fluke (Clonorchis sinensis): - ANSWER ✓ Cholangiocarcinoma
25.Schistosoma haematobium: - ANSWER ✓ bladder cancer (squamous cell)
26.CARCINOGENS--Aflatoxins: - ANSWER ✓ Aspergillus. liver--
hepatocellular carcinoma
27.Alkylating agents: - ANSWER ✓ blood--leukemia / lymphoma
28.Adaptation to stress - ANSWER ✓ Hypertrophy - due to increase size or cell
adapts to increase workload or hypertensive heart (LV enlarges)
hyperplasia - increase in number (glandular proliferation during pregnancy)
it can occur together with hypertrophy in uterus smooth muscle
Atrophy - decrease organ size due to oxygen deprivation or aging *(feature:
intracytoplasmic vacuoles or degraded organelles)*
, 29.Metaplasia - squamous metaplasia at squamocolumnar junction) due to
chronic irritation *can become dysplasia*
30.Hypoxia injuries - ANSWER ✓ Cellular swelling - increase intracelular Na
and H2O and decrease intracelular K+ *(Feature: hydropic change or large
vacuoles on cytoplasm; ER or mitochondrial swelling) are reversible
damage*
Ribosome disaggregation - no protein synthesis
PKU stimulation- decrease pH result in clumping of nuclear chromatin
31.Cell death - *irreversible damage* massive calcium influx and mitochondria
calcification
- myocardium infarct enzymes, LDH, CK and AST and myocardial
necrosis proteins, troponin I/T and myoglobin
32.free radical injury is - ANSWER ✓ Repercussion injury
33.New systolic murmur after MI (which is fixed after reperfusion) may be due
to.. - ANSWER ✓ Papillary muscle dysfunction and mitral regurg
34.Most common cause of renal infarction (seen as wedged shape).. -
ANSWER ✓ systemic thromboembolism from LV or LA
35.Most common heart defect in down syndrome.. - ANSWER ✓ Single AV
valve, ventricular septal defect, failure of endocardial cushions to fuse.
Complete AV canal defect
36.Young adult with sudden syncopal episode and prolonged QT interval may
have a defect in.. - ANSWER ✓ cardiac membrane K+ channel proteins
37.Low myocardial blood flow (transient ischemia) causes myocardial cells to
swell because.. - ANSWER ✓ Transition to anaerobic glycolysis leads to
low ATP and build up of metabolites which leads to low function of
sarcoplasmic ATPases that pump Ca+ out of cytosol. Ca+ BUILDS UP IN
CYTOSOL
GUIDE 2025/2026 COMPLETE QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES || 100% GUARANTEED PASS
<RECENT VERSION>
1. Apoptosis: - ANSWER ✓ Programmed cell death. REQUIRES ATP. Can
occur via the intrinsic or extrinsic pathways, both of which involve
activation of cytosolic caspases which mediate cellular breakdown.
***Unlike necrosis, apoptosis does not involve significant inflammation.
Involves eosinophilic cytoplasm, cell shrinkage, pyknosis and basophilia,
membrane blebbing and karyorrhexis, and formation of apoptotic bodies
which are phagocytosed. **DNA laddering is a sensitive indicator of
apoptosis** Occurs because during karyorrhexis endonucleases yield 180bp
fragments.
2. Radiation therapy does what? - ANSWER ✓ Causes apoptosis of cancer
cells because it causes formation of free radicals which lead to dsDNA
breakage. rapidly dividing cells like skin and GI mucosa are highly
susceptible to radiation-induced apoptosis.
3. Intrinsic pathway of apoptosis: what is its general purpose / when does it
occur? - ANSWER ✓ It's involved in tissue remodeling in embryogenesis.
Often occurs when a regulating factor is withdrawn from a proliferating cell
population. For example, low IL-2 after completion of an immunological
reaction causes apoptosis of proliferating effector cells. Also occurs in
response to injury from radiation, toxins, hypoxia,etc. Changes in
proportions of pro- and anti-apoptotic factors leads to an increase in
mitochondrial permeability and cyt c release.
4. BAK, BAX, Bcl-2: Which of these are pro- and which are anti-apoptotic? -
ANSWER ✓ BAX and BAK are pro. Bcl-2 is anti-apoptotic.
,5. How does Bcl-2 function? - ANSWER ✓ It prevents cyt c release by binding
to an inhibiting Apaf-1, which normally INDUCES caspases.
6. What happens if Bcl-2 is overexpressed? - ANSWER ✓ This occurs in
follicular lymphoma. Apaf-1 is over-inhibited which leads to tumorigenesis
because of lowered caspase activation.
7. Extrinsic pathway of apoptosis: 2 basic pathways? - ANSWER ✓ 1. Ligand
receptor interactions. FasL binding to Fas (CD95). 2. Immune cell--
>cytotoxic T-cell release of perforin and granzyme B.
8. Where is Fas-FasL interaction required? - ANSWER ✓ In thymic medullary
negative selection. Mutations in Fas increases the numbers of circulating
self-reactive lymphocytes due to failure of clonal deletion. **Defective fas-
fasL interactions is the basis of autoimmune disorders**
9. beta-hCG: - ANSWER ✓ hydatidiform moles and choriocarcinoma
(gestational trophoblastic disease), testicular cancer. Normally associated
with pregnancy.
10.CA-15-3/ CA-27-29: - ANSWER ✓ breast cancer
11.CA 19-9: - ANSWER ✓ pancreatic adenocarcinoma
12.CA 125: - ANSWER ✓ ovarian cancer
13.Calcitonin: - ANSWER ✓ medullary thyroid carcinoma
14.CEA: - ANSWER ✓ CarcinoEmbryonic Antigen. Very nonspecific but
produced by 70% of colorectal and pancreatic cancers; also produced by
gastric, breast and medullary thyroid carcinomas
15.PSA: - ANSWER ✓ prostate-specific antigen. Used to follow prostate
adenocarcinoma. Can also be elevated in BPH (benign prostatic hyperplasia)
and prostatitis. Questionable risk / benefit for screening.
16.S-100: - ANSWER ✓ neural crest origin, ie melanomas, neural tumors,
schwannomas, langerhan's cell histiocytosis.
,17.TRAP: - ANSWER ✓ Tatrate-resistant acid phosphatase. Hairy cell
leukemia--a B cell neoplasm.
18.ONCOGENIC MICROBES--EBV: - ANSWER ✓ Burkitt lymphoma,
Hodgkin lymphoma, nasopharyngeal carcinoma, CNS lymphoma in
immunocompromised patients.
19.HBV, HCV: - ANSWER ✓ hepatocellular carcinoma.
20.HHV-8: - ANSWER ✓ aka kaposi sarcoma-related herpes virus. kaposi
sarcoma, body fluid cavity B-cell lymphoma
21.HPV: - ANSWER ✓ cervical and penile / anal carcinoma (16,18), head and
neck or throat cancer
22.H pylori: - ANSWER ✓ gastric adenocarcinoma and MALT lymphoma
23.HTLV-1: - ANSWER ✓ Adult T-cell leukemia / lymphoma
24.Liver fluke (Clonorchis sinensis): - ANSWER ✓ Cholangiocarcinoma
25.Schistosoma haematobium: - ANSWER ✓ bladder cancer (squamous cell)
26.CARCINOGENS--Aflatoxins: - ANSWER ✓ Aspergillus. liver--
hepatocellular carcinoma
27.Alkylating agents: - ANSWER ✓ blood--leukemia / lymphoma
28.Adaptation to stress - ANSWER ✓ Hypertrophy - due to increase size or cell
adapts to increase workload or hypertensive heart (LV enlarges)
hyperplasia - increase in number (glandular proliferation during pregnancy)
it can occur together with hypertrophy in uterus smooth muscle
Atrophy - decrease organ size due to oxygen deprivation or aging *(feature:
intracytoplasmic vacuoles or degraded organelles)*
, 29.Metaplasia - squamous metaplasia at squamocolumnar junction) due to
chronic irritation *can become dysplasia*
30.Hypoxia injuries - ANSWER ✓ Cellular swelling - increase intracelular Na
and H2O and decrease intracelular K+ *(Feature: hydropic change or large
vacuoles on cytoplasm; ER or mitochondrial swelling) are reversible
damage*
Ribosome disaggregation - no protein synthesis
PKU stimulation- decrease pH result in clumping of nuclear chromatin
31.Cell death - *irreversible damage* massive calcium influx and mitochondria
calcification
- myocardium infarct enzymes, LDH, CK and AST and myocardial
necrosis proteins, troponin I/T and myoglobin
32.free radical injury is - ANSWER ✓ Repercussion injury
33.New systolic murmur after MI (which is fixed after reperfusion) may be due
to.. - ANSWER ✓ Papillary muscle dysfunction and mitral regurg
34.Most common cause of renal infarction (seen as wedged shape).. -
ANSWER ✓ systemic thromboembolism from LV or LA
35.Most common heart defect in down syndrome.. - ANSWER ✓ Single AV
valve, ventricular septal defect, failure of endocardial cushions to fuse.
Complete AV canal defect
36.Young adult with sudden syncopal episode and prolonged QT interval may
have a defect in.. - ANSWER ✓ cardiac membrane K+ channel proteins
37.Low myocardial blood flow (transient ischemia) causes myocardial cells to
swell because.. - ANSWER ✓ Transition to anaerobic glycolysis leads to
low ATP and build up of metabolites which leads to low function of
sarcoplasmic ATPases that pump Ca+ out of cytosol. Ca+ BUILDS UP IN
CYTOSOL
