Pathology Slides for the USMLE: Exam Questions and Preparation
How Pathology Slides are tested on the USMLE, the findings to know, a preparation approach and original practice questions with explained answers.
Pathology slide questions test recognition of the microscopic signature of a disease: a particular cell, body or pattern. Many of these signatures are repeated across the Steps, so a compact list pays off.
Image-based questions appear on every Step: an ECG tracing, a radiograph, a photograph of the skin, a view of the retina, or a microscopic slide. The skill is the same each time: describe what you see in a fixed order, name the finding, then use it to answer the clinical question. This site does not host exam images, so each finding below is described in words, as many exam stems also do. Practice with an image-rich question bank and the official USMLE sample items to build your pattern recognition. The practice questions here are original and are not real exam items.
How Pathology Slides is tested
A stem shows or describes a biopsy and asks for the diagnosis, a stain, a marker or the associated clinical feature.
High-yield topics
- Signature cells and bodies: Reed-Sternberg cells, psammoma bodies, Auer rods, Councilman bodies and Mallory-Denk bodies
- Granulomas: caseating versus noncaseating
- Kidney patterns: crescents, Kimmelstiel-Wilson nodules and subepithelial humps
- Tumor architecture: rosettes, Schiller-Duval bodies and papillae
- Neurodegenerative inclusions: Lewy bodies and neurofibrillary tangles
- Cell injury patterns: coagulative, liquefactive, caseous and fat necrosis
Preparation approach
- Make a table of each microscopic sign, the disease it indicates and its key association.
- Review histopathology with an atlas, saying the diagnosis out loud before looking at the label.
- Link every finding to its mechanism and its clinical picture so it can be recalled from a vignette.
- Include immunohistochemical markers in your notes, since the stem may give them instead of the image.
Practice questions
Question 1
A lymph node biopsy from a young man with painless cervical lymphadenopathy shows large binucleate cells with prominent eosinophilic nucleoli in an inflammatory background. Which markers do the large cells express?
- A. CD3 and CD4
- B. CD15 and CD30
- C. CD20 and CD10
- D. CD34 and TdT
- E. CD138
Answer: B. These are Reed-Sternberg cells of classic Hodgkin lymphoma, which express CD15 and CD30.
Question 2
A thyroid nodule biopsy shows papillary structures, nuclei with clear, ground-glass chromatin and concentric calcified bodies. What is the diagnosis?
- A. Follicular carcinoma
- B. Papillary carcinoma
- C. Medullary carcinoma
- D. Anaplastic carcinoma
- E. Hashimoto thyroiditis
Answer: B. Papillae, optically clear nuclei and psammoma bodies are features of papillary thyroid carcinoma.
Question 3
A kidney biopsy from a man with long-standing diabetes shows nodular accumulations of mesangial matrix in the glomeruli. What is the diagnosis?
- A. Minimal change disease
- B. Diabetic nephropathy
- C. Poststreptococcal glomerulonephritis
- D. Membranous nephropathy
- E. Alport syndrome
Answer: B. Nodular glomerulosclerosis, or Kimmelstiel-Wilson nodules, is characteristic of diabetic nephropathy.
Make it a plan
Add a short daily image block to your study routine. See our Step 1 and Step 2 CK preparation timelines for schedules and weekly milestones. This article is general educational guidance and not an individualized study plan.
Educational content only. Confirm current exam requirements with USMLE.