NBME PATHOLOGY FINAL EXAM 2024-2025
WITH ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED ANSWERS
|FREQUENTLY TESTED QUESTIONS AND
SOLUTIONS |ALREADY GRADED A+|BRAND
NEW VERSION!!|GUARANTEED PASS |LATEST
UPDATE
What is a hypertrophic scar?
excess scar tissue within wound
What is keloid?
excess scar tissue outside of proportion to the wound itself
(type III collagen)
What is neoplasia?
Unregulated, Irreversible and Monoclonal cell proliferation
How was clonality of a neoplastic mass determined historically?
presence of G-6P-D isoforms.
1:1 ratio in hyperplasia
1:0 ratio in neoplasia
How is clonality of B lymphocytes determined?
Ig light chain phenotype
1|Page
,3:1 Kappa:Lambda is normal
Preserved in hyperplasia
distorted in neoplasia (6:1 = lymphoma)
Which cancers are most common (in order)
Breast/Prostate
Lung
Colorectal
Which cancers cause the most deaths (in order)
Lung
Breast/Prostate
Colorectal
Describe carcinogenesis
DNA damage that is able to bypass DNA repair mechanisms, but is not lethal to the cell
Describe oncogenes
Genes that stimulate cell growth and cause cancer when continuously activated.
Requires only 1 copy of the gene to be turned on.
Describe tumor suppressor genes
Genes that normally inhibit cell growth (P53, RB)
Both copies need to be knocked out for cancer to occur (2 hit)
How are regulators of apoptosis involved in neoplasia?
Anti-apoptotic factors can be pathologically upregulated to prevent cell death.
Ex: BCL2 in Follicular lymphoma (t 14;18)
T/F angiogenesis is crucial for tumor survival and growth?
True
T/F Downregulation of DNA telomerase is common in cancer?
FALSE
Telomerase is upregulated
Review Carcinogens
2|Page
,Page 25 pathoma
What mutations are associated with epithelial tumor invasion?
Downregulation of E-Cadherins (CAMS) which normally attach the tumor cells together.
Production of collagenase to destroy basement membrane
By what route carcinomas metastasize?
Lymphatics
By what route do sarcomas metastasize?
Hematogenous
How do ovarian carcinomas metastasize?
Seeding of body cavities
What is the hallmark sign of malignancy?
Metastases
T/F Benign tumors can be lethal due to mass effect
true
What is a well differentiated tumor?
Tumor cells resemble normal cells.
Benign tumors are usually well differentiated.
What is a poorly differentiated tumor?
Have only some of the characteristics of the tissue from which they were derived.
Immature cells that do not resemble the parent tissue.
What are the 4 steps in Primary hemostasis?
1. Transient vasoconstriction of damaged vessel
2. Platelet adhesion to the surface of disrupted vessels
3. Platelet degranulation
4. Platelet aggregation
Describe the transient vasoconstriction in primary hemostasis
Neural reflex and endothelin mediated
Describe platelet adhesion in primary hemostasis
Sub-endothelial collagen binds soluble vWF which platelets then bind to via GP1B
3|Page
, Describe platelet degranulation
Dense Granules release ADP which induces expression of platelet GP2B3A receptors
TXA2 from platelet COX promotes aggregation
Describe platelet aggregation
GP2B3A receptors bind soluble fibrinogen which cross-links platelets to form the platelet plug that will
be stabilized by the coagulation cascade (2* hemostasis)
What are the sub-types of primary hemostasis disorders?
Qualitative (platelet function)
Quantitative (platelet number)
What are the quantitative platelet disorders?
ITP
MHA (HUS & TTP)
What are the signs of a disorder of primary hemostasis?
Mucosal and skin bleeding
Nosebleeds is most common sx
Petechiae/Brain bleeds are seen more in quantitative disorders.
Describe Immune Thrombocytopenic Purpura (ITP)
Most common cause of thrombocytopenia .
Autoantibodies produced in the spleen destroy platelets.
Low platelet counts, but normal PT/PTT.
Tx: Steroids -> IVIG -> Splenectomy
What is Microangiopathic Hemolytic Anemia (MHA)
Formation of microthrombi in small vessels which consumes platelets & shears RBCs as they pass.
What are the causes of MHA?
Hemolytic Uremic Syndrome
TTP
4|Page
WITH ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED ANSWERS
|FREQUENTLY TESTED QUESTIONS AND
SOLUTIONS |ALREADY GRADED A+|BRAND
NEW VERSION!!|GUARANTEED PASS |LATEST
UPDATE
What is a hypertrophic scar?
excess scar tissue within wound
What is keloid?
excess scar tissue outside of proportion to the wound itself
(type III collagen)
What is neoplasia?
Unregulated, Irreversible and Monoclonal cell proliferation
How was clonality of a neoplastic mass determined historically?
presence of G-6P-D isoforms.
1:1 ratio in hyperplasia
1:0 ratio in neoplasia
How is clonality of B lymphocytes determined?
Ig light chain phenotype
1|Page
,3:1 Kappa:Lambda is normal
Preserved in hyperplasia
distorted in neoplasia (6:1 = lymphoma)
Which cancers are most common (in order)
Breast/Prostate
Lung
Colorectal
Which cancers cause the most deaths (in order)
Lung
Breast/Prostate
Colorectal
Describe carcinogenesis
DNA damage that is able to bypass DNA repair mechanisms, but is not lethal to the cell
Describe oncogenes
Genes that stimulate cell growth and cause cancer when continuously activated.
Requires only 1 copy of the gene to be turned on.
Describe tumor suppressor genes
Genes that normally inhibit cell growth (P53, RB)
Both copies need to be knocked out for cancer to occur (2 hit)
How are regulators of apoptosis involved in neoplasia?
Anti-apoptotic factors can be pathologically upregulated to prevent cell death.
Ex: BCL2 in Follicular lymphoma (t 14;18)
T/F angiogenesis is crucial for tumor survival and growth?
True
T/F Downregulation of DNA telomerase is common in cancer?
FALSE
Telomerase is upregulated
Review Carcinogens
2|Page
,Page 25 pathoma
What mutations are associated with epithelial tumor invasion?
Downregulation of E-Cadherins (CAMS) which normally attach the tumor cells together.
Production of collagenase to destroy basement membrane
By what route carcinomas metastasize?
Lymphatics
By what route do sarcomas metastasize?
Hematogenous
How do ovarian carcinomas metastasize?
Seeding of body cavities
What is the hallmark sign of malignancy?
Metastases
T/F Benign tumors can be lethal due to mass effect
true
What is a well differentiated tumor?
Tumor cells resemble normal cells.
Benign tumors are usually well differentiated.
What is a poorly differentiated tumor?
Have only some of the characteristics of the tissue from which they were derived.
Immature cells that do not resemble the parent tissue.
What are the 4 steps in Primary hemostasis?
1. Transient vasoconstriction of damaged vessel
2. Platelet adhesion to the surface of disrupted vessels
3. Platelet degranulation
4. Platelet aggregation
Describe the transient vasoconstriction in primary hemostasis
Neural reflex and endothelin mediated
Describe platelet adhesion in primary hemostasis
Sub-endothelial collagen binds soluble vWF which platelets then bind to via GP1B
3|Page
, Describe platelet degranulation
Dense Granules release ADP which induces expression of platelet GP2B3A receptors
TXA2 from platelet COX promotes aggregation
Describe platelet aggregation
GP2B3A receptors bind soluble fibrinogen which cross-links platelets to form the platelet plug that will
be stabilized by the coagulation cascade (2* hemostasis)
What are the sub-types of primary hemostasis disorders?
Qualitative (platelet function)
Quantitative (platelet number)
What are the quantitative platelet disorders?
ITP
MHA (HUS & TTP)
What are the signs of a disorder of primary hemostasis?
Mucosal and skin bleeding
Nosebleeds is most common sx
Petechiae/Brain bleeds are seen more in quantitative disorders.
Describe Immune Thrombocytopenic Purpura (ITP)
Most common cause of thrombocytopenia .
Autoantibodies produced in the spleen destroy platelets.
Low platelet counts, but normal PT/PTT.
Tx: Steroids -> IVIG -> Splenectomy
What is Microangiopathic Hemolytic Anemia (MHA)
Formation of microthrombi in small vessels which consumes platelets & shears RBCs as they pass.
What are the causes of MHA?
Hemolytic Uremic Syndrome
TTP
4|Page
