Updated Comprehensive NBME-Style Pathology
Question Bank With 200 High-Yield Practice Questions,
Verified Detailed Rationales, Expert Clinical
Explanations, and Answer Keys for Medical Students
Preparing for USMLE Step 1, Shelf Exams, and Board
Review Success in 2026.
GENERAL PATHOLOGY
Question 1
A 45-year-old man with chronic
alcoholism is found to have a firm,
nodular liver on physical examination. A
liver biopsy shows pale, eosinophilic
cytoplasmic inclusions in hepatocytes.
These inclusions are composed of which
of the following?
,A. Amyloid protein
B. Alpha-1 antitrypsin
C. Aggregated intermediate filaments
(cytokeratins)
D. Glycogen
E. Lipofuscin
☑VERIFIED ANSWER: C
Rationale: Mallory bodies (hyaline
inclusions) are seen in alcoholic liver
disease and consist of aggregated
intermediate filaments (cytokeratins).
They are eosinophilic cytoplasmic
inclusions found in hepatocytes. Amyloid
(A) appears as extracellular pink
deposits, alpha-1 antitrypsin (B)
accumulates in the endoplasmic
,reticulum of hepatocytes as PAS-positive
globules, glycogen (D) appears as clear
vacuoles, and lipofuscin (E) is a brownish
"wear-and-tear" pigment.
Question 2
A 68-year-old man presents with sudden
onset of severe chest pain radiating to
the back. Autopsy reveals a transmural
myocardial infarction with coagulative
necrosis. Which of the following best
describes the gross appearance of this
infarct at 48 hours?
A. Red, hemorrhagic
B. Pale, well-demarcated
, C. Yellow-brown with hyperemic border
D. Fibrotic scar
E. Cavitary lesion
☑VERIFIED ANSWER: C
Rationale: At 48 hours, a myocardial
infarct appears yellow-brown (due to
neutrophil infiltration and breakdown of
dead myocytes) with a hyperemic border
(zone of inflammation). Grossly, it is soft
and poorly demarcated. Red,
hemorrhagic (A) is seen in hemorrhagic
infarcts (e.g., lung, bowel). Pale (B) is
seen in early (first 24 hours) or older
infarcts. Fibrotic scar (D) develops after
weeks to months.
Question Bank With 200 High-Yield Practice Questions,
Verified Detailed Rationales, Expert Clinical
Explanations, and Answer Keys for Medical Students
Preparing for USMLE Step 1, Shelf Exams, and Board
Review Success in 2026.
GENERAL PATHOLOGY
Question 1
A 45-year-old man with chronic
alcoholism is found to have a firm,
nodular liver on physical examination. A
liver biopsy shows pale, eosinophilic
cytoplasmic inclusions in hepatocytes.
These inclusions are composed of which
of the following?
,A. Amyloid protein
B. Alpha-1 antitrypsin
C. Aggregated intermediate filaments
(cytokeratins)
D. Glycogen
E. Lipofuscin
☑VERIFIED ANSWER: C
Rationale: Mallory bodies (hyaline
inclusions) are seen in alcoholic liver
disease and consist of aggregated
intermediate filaments (cytokeratins).
They are eosinophilic cytoplasmic
inclusions found in hepatocytes. Amyloid
(A) appears as extracellular pink
deposits, alpha-1 antitrypsin (B)
accumulates in the endoplasmic
,reticulum of hepatocytes as PAS-positive
globules, glycogen (D) appears as clear
vacuoles, and lipofuscin (E) is a brownish
"wear-and-tear" pigment.
Question 2
A 68-year-old man presents with sudden
onset of severe chest pain radiating to
the back. Autopsy reveals a transmural
myocardial infarction with coagulative
necrosis. Which of the following best
describes the gross appearance of this
infarct at 48 hours?
A. Red, hemorrhagic
B. Pale, well-demarcated
, C. Yellow-brown with hyperemic border
D. Fibrotic scar
E. Cavitary lesion
☑VERIFIED ANSWER: C
Rationale: At 48 hours, a myocardial
infarct appears yellow-brown (due to
neutrophil infiltration and breakdown of
dead myocytes) with a hyperemic border
(zone of inflammation). Grossly, it is soft
and poorly demarcated. Red,
hemorrhagic (A) is seen in hemorrhagic
infarcts (e.g., lung, bowel). Pale (B) is
seen in early (first 24 hours) or older
infarcts. Fibrotic scar (D) develops after
weeks to months.
