Page 1 of 216
NBME PATHOLOGY FINAL EXAM PREP
2026/2027 WITH COMPLETE 400 ACCURATE
QUESTIONS AND CORRECT
DETAILED ANSWERS (100% CORRECT
VERIFIED SOLUTIONS) LATEST UPDATED
VERSION |GUARANTEED PASS A+ (BRAND
NEW!)
Q1. A 58-year-old man with alcoholism has liver biopsy
showing hepatocytes with swollen, pale cytoplasm containing
clumped material. Mechanism?
A. Apoptosis
B. Caseous necrosis
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C. Fat accumulation
D. Hydropic swelling
E. Glycogen deposition
Answer: D – Hydropic swelling (failure of Na⁺/K⁺ ATPase →
water influx; reversible injury)
Q2. 72-year-old woman, MI one week ago. Infarct shows
macrophages with granular pink cytoplasm and neutrophils at
border. Process?
A. Coagulative necrosis with organization
B. Liquefactive necrosis
C. Caseous necrosis
D. Fibrinoid necrosis
E. Gangrenous necrosis
Answer: A – Coagulative necrosis (heart; neutrophils peak at
1 week; macrophages clear debris)
Q3. 35-year-old man, rusty nail puncture, foot
red/hot/swollen within 24h. Primary cause of heat/redness?
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A. Increased permeability
B. Endothelial injury
C. Vasodilation of arterioles
D. Leukocyte margination
E. Lymphatic obstruction
Answer: C – Vasodilation (histamine, NO → rubor/calor)
Q4. 45-year-old woman with RA on methotrexate, painless leg
ulcer. Biopsy: “dirty” necrosis with neutrophils and basophilic
debris. Diagnosis?
A. Pyoderma gangrenosum
B. Vasculitic ulcer
C. Venous stasis ulcer
D. Diabetic ulcer
E. Arterial ulcer
Answer: A – Pyoderma gangrenosum (associated with
RA/IBD; neutrophilic inflammation)
, Page 4 of 216
Q5. 22-year-old male, fever, sore throat, atypical
lymphocytes with basophilic cytoplasm indented by RBCs.
Cause?
A. EBV
B. HIV
C. CMV
D. Strep pharyngitis
E. Toxoplasmosis
Answer: A – EBV (Downey cells = CD8+ T cells in infectious
mononucleosis)
Q6. 60-year-old woman with atrial fibrillation, sudden
abdominal pain, bloody diarrhea. SMA thrombus. Intestinal
infarct type?
A. White
B. Red (hemorrhagic)
C. Liquefactive
D. Caseous
NBME PATHOLOGY FINAL EXAM PREP
2026/2027 WITH COMPLETE 400 ACCURATE
QUESTIONS AND CORRECT
DETAILED ANSWERS (100% CORRECT
VERIFIED SOLUTIONS) LATEST UPDATED
VERSION |GUARANTEED PASS A+ (BRAND
NEW!)
Q1. A 58-year-old man with alcoholism has liver biopsy
showing hepatocytes with swollen, pale cytoplasm containing
clumped material. Mechanism?
A. Apoptosis
B. Caseous necrosis
,Page 2 of 216
C. Fat accumulation
D. Hydropic swelling
E. Glycogen deposition
Answer: D – Hydropic swelling (failure of Na⁺/K⁺ ATPase →
water influx; reversible injury)
Q2. 72-year-old woman, MI one week ago. Infarct shows
macrophages with granular pink cytoplasm and neutrophils at
border. Process?
A. Coagulative necrosis with organization
B. Liquefactive necrosis
C. Caseous necrosis
D. Fibrinoid necrosis
E. Gangrenous necrosis
Answer: A – Coagulative necrosis (heart; neutrophils peak at
1 week; macrophages clear debris)
Q3. 35-year-old man, rusty nail puncture, foot
red/hot/swollen within 24h. Primary cause of heat/redness?
,Page 3 of 216
A. Increased permeability
B. Endothelial injury
C. Vasodilation of arterioles
D. Leukocyte margination
E. Lymphatic obstruction
Answer: C – Vasodilation (histamine, NO → rubor/calor)
Q4. 45-year-old woman with RA on methotrexate, painless leg
ulcer. Biopsy: “dirty” necrosis with neutrophils and basophilic
debris. Diagnosis?
A. Pyoderma gangrenosum
B. Vasculitic ulcer
C. Venous stasis ulcer
D. Diabetic ulcer
E. Arterial ulcer
Answer: A – Pyoderma gangrenosum (associated with
RA/IBD; neutrophilic inflammation)
, Page 4 of 216
Q5. 22-year-old male, fever, sore throat, atypical
lymphocytes with basophilic cytoplasm indented by RBCs.
Cause?
A. EBV
B. HIV
C. CMV
D. Strep pharyngitis
E. Toxoplasmosis
Answer: A – EBV (Downey cells = CD8+ T cells in infectious
mononucleosis)
Q6. 60-year-old woman with atrial fibrillation, sudden
abdominal pain, bloody diarrhea. SMA thrombus. Intestinal
infarct type?
A. White
B. Red (hemorrhagic)
C. Liquefactive
D. Caseous
