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Pathology — Step 1 practice questions
379 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
Pathology is the largest discipline on Step 1. Questions typically describe a specimen or a clinical course and ask for the underlying process. Mechanism matters more than nomenclature: knowing why a tissue looks the way it does will carry you further than memorising the name of the appearance.
Sample questions
Sample question 1
A 28-year-old woman taking combined oral contraceptives develops a progressively worsening headache over a week, papilledema, and a seizure. CT shows a hemorrhagic infarct that does not conform to an arterial territory. Which of the following is the most likely diagnosis?
Explanations
A. Hypertensive intracerebral hemorrhage
Hypertensive hemorrhage occurs in deep structures in older hypertensive patients.
B. Arterial ischemic stroke requiring thrombolysis
Arterial strokes respect vascular territories and present abruptly.
C. Migraine with aura
Migraine does not cause papilledema or hemorrhagic infarction.
D. Cerebral venous sinus thrombosis, treated with anticoagulation despite the hemorrhagic component · correct
Cerebral venous sinus thrombosis presents with subacute headache, papilledema from impaired CSF absorption, seizures, and infarcts that cross arterial boundaries and are frequently hemorrhagic because of venous congestion. Risk factors include estrogen-containing contraceptives, pregnancy and the puerperium, thrombophilias, dehydration, and local infection. Counterintuitively, ANTICOAGULATION is the treatment even with hemorrhage, since the underlying problem is venous outflow obstruction.
E. Subarachnoid hemorrhage from aneurysm rupture
Subarachnoid hemorrhage is a thunderclap event with blood in the cisterns.
Sample question 2
A 60-year-old woman presents with abdominal distension and dyspnea. Imaging shows a solid unilateral ovarian mass, ascites, and a right-sided pleural effusion. Following removal of the tumor, the ascites and effusion resolve completely. Histology shows spindle-shaped fibroblasts. Which of the following is the most likely tumor?
Explanations
A. Mucinous cystadenocarcinoma
Mucinous carcinoma can cause pseudomyxoma peritonei, not a transudative resolving effusion.
B. Dysgerminoma
Dysgerminomas are solid tumors of young women without this fluid syndrome.
C. Metastatic gastric carcinoma
Metastases would not produce a fully reversible effusion.
D. Serous cystadenocarcinoma
Serous carcinoma causes malignant ascites that does not resolve with resection of the primary alone.
E. Ovarian fibroma · correct
Meigs syndrome is the triad of ovarian FIBROMA (benign sex cord–stromal tumor of spindle fibroblasts), ascites, and (usually right-sided) hydrothorax, all of which resolve on tumor removal. The mechanism is transudation from the tumor surface with transdiaphragmatic passage of fluid. Fibromas may cause "pulling" pelvic sensations.
Sample question 3
A patient with sarcoidosis develops tender, red nodules on the anterior shins. Which of the following best describes this skin finding?
Explanations
A. Necrotizing fasciitis
Necrotizing fasciitis is a rapidly progressive, severe soft tissue infection, a very different and more acute/severe presentation.
B. Squamous cell carcinoma
This does not describe a malignant skin lesion.
C. A direct infectious process requiring antibiotics
Erythema nodosum is not itself a direct infection requiring antibiotics; it is a hypersensitivity/inflammatory reaction, though it can sometimes be triggered by an underlying infection.
D. Erythema nodosum, a panniculitis/hypersensitivity reaction associated with sarcoidosis and other systemic conditions · correct
Erythema nodosum presents as tender, erythematous nodules typically on the shins, representing a panniculitis (inflammation of subcutaneous fat) associated with sarcoidosis, inflammatory bowel disease, streptococcal infection, and certain medications.
E. Psoriasis
Psoriasis presents with well-demarcated silvery scaling plaques, a different appearance than these tender nodules.
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