USMLE Step 1 · Pathology and Microbiology

Systemic Pathology

23 practice questions, each with the answer and an explanation.

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Random questions from this topic, one at a time. You see the answer and the explanation straight after each one.

All 23 questions

  1. A 60-year-old smoker has a central lung mass, hypercalcemia and a serum calcium of 13.4 mg/dL. Which histologic type of lung cancer is most likely?
  2. Which cell is the hallmark of Hodgkin lymphoma on biopsy?
  3. A 45-year-old woman has fatigue, weight gain, cold intolerance and a firm, painless goiter. Biopsy shows lymphocytic infiltrate with germinal centers and Hurthle cells. Which antibody is most specific…
  4. A 6-year-old boy has periorbital edema after a sore throat 3 weeks ago, with cola-colored urine and hypertension. Which finding is expected on electron microscopy of the kidney?
  5. A 55-year-old alcoholic man has cirrhosis. Which finding on liver histology is typical of alcoholic hepatitis?
  6. A 30-year-old woman has episodic flushing, wheezing and diarrhea, and a right-sided heart murmur. Which urinary metabolite is elevated?
  7. A 68-year-old man has crushing chest pain for 2 hours. At which time after the onset of a myocardial infarction does coagulative necrosis with neutrophil infiltration first appear most prominently?
  8. A 62-year-old man presents with painless jaundice, weight loss and a palpable nontender gallbladder. What is the most likely diagnosis?
  9. A 25-year-old man has recurrent oral ulcers, bloody diarrhea and a colonoscopy showing continuous mucosal inflammation from the rectum upward with crypt abscesses. Which complication is most specifica…
  10. A 50-year-old woman has a thyroid nodule. Which histologic finding is characteristic of papillary thyroid carcinoma?
  11. A 7-year-old girl has an abdominal mass, and her urinary catecholamines are high. The tumor has Homer-Wright rosettes. What is the diagnosis?
  12. A 40-year-old man has hemoptysis and hematuria. Biopsy shows linear immunofluorescence for IgG along the glomerular basement membrane. Against which target are the antibodies directed?
  13. Which genetic abnormality is characteristic of chronic myeloid leukemia?
  14. A 35-year-old woman has a malar rash, arthralgia and proteinuria. Which antibody is the most specific for her likely disease?
  15. A 72-year-old woman has a headache, jaw claudication and a tender temporal artery. Which complication must be prevented by starting corticosteroids immediately?
  16. A 28-year-old man has a testicular mass, and his serum alpha-fetoprotein is elevated. Which tumor is most likely?
  17. A 55-year-old man with long-standing reflux has a biopsy of the distal esophagus that shows columnar epithelium with goblet cells. What is this change called?
  18. A patient with a long history of rheumatoid arthritis develops nephrotic-range proteinuria. Kidney biopsy shows Congo red positive deposits with apple-green birefringence under polarized light. Which…
  19. Which hormone is produced by the zona glomerulosa of the adrenal cortex?
  20. A 30-year-old woman has headache, sweating and palpitations with a blood pressure of 210/120 mmHg. Imaging shows an adrenal mass. Which drug should be started first, before a beta-blocker?
  21. A 65-year-old man has a slowly growing, painless prostate nodule and an elevated PSA. Where do prostate adenocarcinomas most commonly arise?
  22. A 24-year-old man has a swollen, painful left calf after a long flight. Which Virchow triad component is mainly responsible for venous thrombosis in this setting?
  23. A 3-year-old child has a fever, conjunctivitis, a strawberry tongue, cervical lymphadenopathy and swelling of the hands for 6 days. Which complication should be looked for with echocardiography?

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