NBME PATHOLOGY FINAL EXAM 2024
150 Practice Questions with Verified Answers & Detailed
Rationales | A+ Graded
EXAM INSTRUCTIONS
Exam: NBME Pathology Final Exam 2024
Format: Multiple Choice, Clinical Vignettes
Content Areas: Cellular Adaptation, Cell Injury & Death, Inflammation & Immunity,
Neoplasia, Genetics, Cardiovascular Pathology, Pulmonary Pathology, Renal Pathology,
GI Pathology, Hematopathology, Endocrine Pathology, Reproductive Pathology,
Infectious Disease
Administration: Computer-Based (Shelf/Step Prep)
Passing Score: Varies by institution (typically 70%+)
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH
(Questions 1-35)
1. A cellular adaptation characterized by increased gene activation leading to
increased numbers of structural proteins and organelles is:
a) Hyperplasia
b) Hypertrophy
c) Atrophy
d) Metaplasia
e) Dysplasia
Rationale: Hypertrophy is a cellular adaptation characterized by increased gene activation
leading to increased numbers of structural proteins and organelles, resulting in increased
,cell size. This occurs when cells cannot divide, such as cardiac muscle cells in response to
increased workload .
2. A cellular adaptation characterized by proliferation of stem cells leading to an
increased total number of cells is:
a) Hypertrophy
b) Hyperplasia
c) Atrophy
d) Metaplasia
e) Dysplasia
Rationale: Hyperplasia is a cellular adaptation involving proliferation of stem cells leading
to an increased total number of cells. This occurs in tissues capable of cell division, such as
the endometrium during the menstrual cycle .
3. A cellular adaptation characterized by a decrease in tissue mass due to decrease
in size and/or number of cells is:
a) Hypertrophy
b) Hyperplasia
c) Atrophy
d) Metaplasia
e) Dysplasia
Rationale: Atrophy is characterized by decreased tissue mass due to reduced size and/or
number of cells. Initially, it involves decreased protein synthesis and loss of fibrils/cell
mass; later stages involve apoptosis .
4. A cellular adaptation characterized by replacement of one cell type with another
in response to stress, which is reversible if the stressor is removed, is:
a) Hypertrophy
b) Hyperplasia
c) Atrophy
d) Metaplasia
e) Dysplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with another in
response to stress. It represents an adaptive change to a new environment, and removal of
the stressor allows return to normal .
5. A cellular adaptation characterized by disordered cell growth with high
malignant potential, which is reversible if the stressor is removed, is:
a) Hypertrophy
,b) Hyperplasia
c) Atrophy
d) Metaplasia
e) Dysplasia
Rationale: Dysplasia is disordered cell growth characterized by abnormal cell size, shape,
and organization. It has high malignant potential but can be reversible if the causative
stimulus is removed .
6. Which of the following is a hallmark of REVERSIBLE cell injury?
a) Nuclear pyknosis
b) Karyorrhexis
c) Na+/K+ ATPase dysfunction
d) Lysosomal rupture
e) Mitochondrial permeability
Rationale: Na+/K+ ATPase dysfunction is a hallmark of reversible cell injury, leading to
cellular swelling. Other features include membrane blebbing, chromatin clumping, and
decreased protein synthesis (ribosome detachment). Nuclear changes (pyknosis,
karyorrhexis) and lysosomal rupture indicate irreversible injury .
7. Which of the following is a hallmark of IRREVERSIBLE cell injury?
a) Cellular swelling
b) Na+/K+ ATPase dysfunction
c) Chromatin clumping
d) Pyknosis
e) Ribosomal detachment
Rationale: Pyknosis (nuclear shrinkage), karyorrhexis (nuclear fragmentation), and
karyolysis (nuclear dissolution) are hallmarks of irreversible cell injury. Other signs include
membrane damage/rupture, lysosomal rupture, leakage of cytosolic enzymes into serum,
and mitochondrial permeability with cytochrome C release .
8. What is pyknosis?
a) Nuclear fragmentation
b) Dissolution of the nucleus
c) Nucleus shrinks into dark blobs
d) Membrane blebbing
e) Cellular swelling
, Rationale: Pyknosis is characterized by the nucleus shrinking into dark blobs ("pick blobs").
It is a hallmark of irreversible cell injury. Karyorrhexis is nuclear fragmentation, and
karyolysis is dissolution of the nucleus .
9. What is karyorrhexis?
a) Nuclear shrinkage
b) Nuclear fragmentation
c) Nuclear dissolution
d) Membrane blebbing
e) Cellular swelling
Rationale: Karyorrhexis is the fragmentation of the nucleus, which occurs during
irreversible cell injury. Pyknosis is nuclear shrinkage, and karyolysis is nuclear dissolution .
10. What is karyolysis?
a) Nuclear shrinkage
b) Nuclear fragmentation
c) Dissolution of the nucleus
d) Membrane blebbing
e) Cellular swelling
Rationale: Karyolysis is the dissolution of the nucleus, which is a sign of necrosis. It
represents the final stage of nuclear degradation in irreversible cell injury .
11. Which type of necrosis features cell shape and organ structure preservation
due to coagulation of proteins?
a) Liquefactive necrosis
b) Coagulative necrosis
c) Caseous necrosis
d) Fat necrosis
e) Fibrinoid necrosis
Rationale: Coagulative necrosis preserves cell shape and organ structure because proteins
are denatured and coagulated. This is characteristic of ischemic injury in solid organs like
the heart, liver, and kidney .
12. In which tissues is coagulative necrosis typically seen?
a) Brain and pancreas
b) Wedge-shaped infarcts of solid organs (not brain or pancreas)
c) Lungs and intestines
d) Skin and subcutaneous tissue
e) Bone and cartilage
150 Practice Questions with Verified Answers & Detailed
Rationales | A+ Graded
EXAM INSTRUCTIONS
Exam: NBME Pathology Final Exam 2024
Format: Multiple Choice, Clinical Vignettes
Content Areas: Cellular Adaptation, Cell Injury & Death, Inflammation & Immunity,
Neoplasia, Genetics, Cardiovascular Pathology, Pulmonary Pathology, Renal Pathology,
GI Pathology, Hematopathology, Endocrine Pathology, Reproductive Pathology,
Infectious Disease
Administration: Computer-Based (Shelf/Step Prep)
Passing Score: Varies by institution (typically 70%+)
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH
(Questions 1-35)
1. A cellular adaptation characterized by increased gene activation leading to
increased numbers of structural proteins and organelles is:
a) Hyperplasia
b) Hypertrophy
c) Atrophy
d) Metaplasia
e) Dysplasia
Rationale: Hypertrophy is a cellular adaptation characterized by increased gene activation
leading to increased numbers of structural proteins and organelles, resulting in increased
,cell size. This occurs when cells cannot divide, such as cardiac muscle cells in response to
increased workload .
2. A cellular adaptation characterized by proliferation of stem cells leading to an
increased total number of cells is:
a) Hypertrophy
b) Hyperplasia
c) Atrophy
d) Metaplasia
e) Dysplasia
Rationale: Hyperplasia is a cellular adaptation involving proliferation of stem cells leading
to an increased total number of cells. This occurs in tissues capable of cell division, such as
the endometrium during the menstrual cycle .
3. A cellular adaptation characterized by a decrease in tissue mass due to decrease
in size and/or number of cells is:
a) Hypertrophy
b) Hyperplasia
c) Atrophy
d) Metaplasia
e) Dysplasia
Rationale: Atrophy is characterized by decreased tissue mass due to reduced size and/or
number of cells. Initially, it involves decreased protein synthesis and loss of fibrils/cell
mass; later stages involve apoptosis .
4. A cellular adaptation characterized by replacement of one cell type with another
in response to stress, which is reversible if the stressor is removed, is:
a) Hypertrophy
b) Hyperplasia
c) Atrophy
d) Metaplasia
e) Dysplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with another in
response to stress. It represents an adaptive change to a new environment, and removal of
the stressor allows return to normal .
5. A cellular adaptation characterized by disordered cell growth with high
malignant potential, which is reversible if the stressor is removed, is:
a) Hypertrophy
,b) Hyperplasia
c) Atrophy
d) Metaplasia
e) Dysplasia
Rationale: Dysplasia is disordered cell growth characterized by abnormal cell size, shape,
and organization. It has high malignant potential but can be reversible if the causative
stimulus is removed .
6. Which of the following is a hallmark of REVERSIBLE cell injury?
a) Nuclear pyknosis
b) Karyorrhexis
c) Na+/K+ ATPase dysfunction
d) Lysosomal rupture
e) Mitochondrial permeability
Rationale: Na+/K+ ATPase dysfunction is a hallmark of reversible cell injury, leading to
cellular swelling. Other features include membrane blebbing, chromatin clumping, and
decreased protein synthesis (ribosome detachment). Nuclear changes (pyknosis,
karyorrhexis) and lysosomal rupture indicate irreversible injury .
7. Which of the following is a hallmark of IRREVERSIBLE cell injury?
a) Cellular swelling
b) Na+/K+ ATPase dysfunction
c) Chromatin clumping
d) Pyknosis
e) Ribosomal detachment
Rationale: Pyknosis (nuclear shrinkage), karyorrhexis (nuclear fragmentation), and
karyolysis (nuclear dissolution) are hallmarks of irreversible cell injury. Other signs include
membrane damage/rupture, lysosomal rupture, leakage of cytosolic enzymes into serum,
and mitochondrial permeability with cytochrome C release .
8. What is pyknosis?
a) Nuclear fragmentation
b) Dissolution of the nucleus
c) Nucleus shrinks into dark blobs
d) Membrane blebbing
e) Cellular swelling
, Rationale: Pyknosis is characterized by the nucleus shrinking into dark blobs ("pick blobs").
It is a hallmark of irreversible cell injury. Karyorrhexis is nuclear fragmentation, and
karyolysis is dissolution of the nucleus .
9. What is karyorrhexis?
a) Nuclear shrinkage
b) Nuclear fragmentation
c) Nuclear dissolution
d) Membrane blebbing
e) Cellular swelling
Rationale: Karyorrhexis is the fragmentation of the nucleus, which occurs during
irreversible cell injury. Pyknosis is nuclear shrinkage, and karyolysis is nuclear dissolution .
10. What is karyolysis?
a) Nuclear shrinkage
b) Nuclear fragmentation
c) Dissolution of the nucleus
d) Membrane blebbing
e) Cellular swelling
Rationale: Karyolysis is the dissolution of the nucleus, which is a sign of necrosis. It
represents the final stage of nuclear degradation in irreversible cell injury .
11. Which type of necrosis features cell shape and organ structure preservation
due to coagulation of proteins?
a) Liquefactive necrosis
b) Coagulative necrosis
c) Caseous necrosis
d) Fat necrosis
e) Fibrinoid necrosis
Rationale: Coagulative necrosis preserves cell shape and organ structure because proteins
are denatured and coagulated. This is characteristic of ischemic injury in solid organs like
the heart, liver, and kidney .
12. In which tissues is coagulative necrosis typically seen?
a) Brain and pancreas
b) Wedge-shaped infarcts of solid organs (not brain or pancreas)
c) Lungs and intestines
d) Skin and subcutaneous tissue
e) Bone and cartilage
