Pathology for the USMLE: Exam Questions and Preparation
How Pathology is tested on the USMLE, the high-yield topics, a preparation approach and original practice questions with explained answers.
Pathology is the largest and most connected subject for the USMLE. It links mechanisms of disease to what you see on examination, in the laboratory and under the microscope, and it supports nearly every organ-system question.
Step 1 is reported as pass/fail, and its questions are integrated across disciplines and organ systems, so the subject labels below are study aids, not separate exams. The practice questions here are original and written to show the style of reasoning the exam rewards; they are not real exam items. Confirm the current content outline on the official USMLE website.
How Pathology is tested
Questions describe a patient and ask for the most likely diagnosis, the underlying mechanism, the expected histology or the next test. General pathology (injury, inflammation, neoplasia, hemodynamics) is tested alongside organ-system pathology.
High-yield topics
- Cell injury, necrosis, apoptosis and the timeline of tissue response after infarction
- Acute and chronic inflammation, wound healing and amyloidosis
- Neoplasia: oncogenes, tumor suppressors, tumor markers and paraneoplastic syndromes
- Thrombosis, embolism, edema and shock
- Immune-mediated disease and hypersensitivity types
- Organ-system pathology: cardiovascular, respiratory, GI, renal, endocrine, hematologic, neurologic, musculoskeletal and skin
Preparation approach
- Study general pathology first, since the same mechanisms recur in every organ system.
- For each disease, know the typical patient, the key finding, the mechanism and the complication.
- Make a table of tumor markers, characteristic translocations and the cancers they point to.
- Do mixed question blocks so you practice choosing among similar diagnoses.
Practice questions
Question 1
A man dies two days after a myocardial infarction. Which histologic finding is most likely in the infarcted myocardium?
- A. Granulation tissue with new capillaries
- B. Coagulative necrosis with neutrophilic infiltrate
- C. Fibrous scar
- D. Macrophages removing necrotic cells
- E. Normal myocardium with wavy fibers only
Answer: B. In the first 1 to 3 days, coagulative necrosis is followed by neutrophil infiltration. Macrophages dominate later, then granulation tissue, then a scar.
Question 2
A man with cirrhosis due to hepatitis B has a new liver mass and a markedly elevated serum alpha-fetoprotein. Which tumor is most likely?
- A. Hepatocellular carcinoma
- B. Cholangiocarcinoma
- C. Hepatic adenoma
- D. Metastatic colorectal cancer
- E. Angiosarcoma
Answer: A. Chronic hepatitis and cirrhosis are the main risk factors for hepatocellular carcinoma, and alpha-fetoprotein is the associated tumor marker.
Question 3
A patient with marked leukocytosis, basophilia and splenomegaly has a t(9;22) translocation. What is the product of the fusion gene?
- A. A constitutively active tyrosine kinase
- B. A transcription factor that blocks myeloid maturation
- C. A tumor suppressor protein
- D. An anti-apoptotic protein
- E. A growth factor receptor
Answer: A. The Philadelphia chromosome produces BCR-ABL, a constitutively active tyrosine kinase, in chronic myeloid leukemia. It is targeted by imatinib.
Make it a plan
Put these subjects inside a dedicated study block with timed question blocks and careful review. See our Step 1 preparation timeline for a schedule and weekly milestones. This article is general educational guidance and not an individualized study plan.
Educational content only. Confirm current exam requirements with USMLE.