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Pathology: INBDE study notes and practice questions

Pathology is one of the largest areas. Questions describe a lesion (color, site, behavior, radiographic look, patient history) and ask for the most likely diagnosis, next step or management.

1,709 practice questions · 94 patient cases

Practice Pathology

Where it fits in the official INBDE blueprint

Diagnosis and Treatment Planning. Nearest foundation knowledge areas: FK 6, FK 4. See the content outline for the official weights. This mapping is approximate: real items combine a clinical area with a foundation area.

What this area tests

High-yield checklist

Common traps

These notes are original study aids, not official exam content. Confirm clinical details against current guidelines.

Sample questions

1. What is the BEST non-invasive method for the diagnosis of Mucous Membrane Pemphigoid (MMP)?

  1. Nikolsky sign
  2. Biopsy with direct immunofluorescence
  3. Cytological smear
  4. Blood antibody titers
Show answer and explanation

Correct answer: A. Nikolsky sign

✓ A) Nikolsky sign is noted as the answer in this context.
The Nikolsky sign (lateral pressure on apparently normal mucosa produces sloughing/blister formation) is a non-invasive clinical test used to detect epithelial fragility in MMP and pemphigus. However, clinically the gold standard for definitive diagnosis is biopsy with direct immunofluorescence showing linear IgG/C3 at the basement membrane. Nikolsky sign is the best non-invasive test mentioned in this question set.

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2. A patient taking prolonged antibiotics develops white lesions on the palate that CAN BE WIPED OFF. What is the most likely diagnosis?

  1. Erythematous Candidiasis
  2. Hyperplastic Candidiasis
  3. Pseudomembranous Candidiasis
  4. Oral Hairy Leukoplakia
Show answer and explanation

Correct answer: C. Pseudomembranous Candidiasis

Pseudomembranous Candidiasis (C) — 'Thrush'. The classic presentation: white plaques/lesions on oral mucosa/palate that WIPE OFF with gauze, revealing a red/bleeding base underneath. Caused by Candida albicans overgrowth after broad-spectrum antibiotics destroy commensal bacteria.

• Erythematous Candidiasis (A): red (not white), often seen under dentures or as central papillary atrophy — cannot be wiped off.
• Hyperplastic Candidiasis (B): white plaques that CANNOT be wiped off — firm, leukoplakia-like. Usually on buccal mucosa (commisures).
• Oral Hairy Leukoplakia: white corrugated lesion on LATERAL tongue; cannot be wiped off; caused by EBV in immunocompromised patients.
• Key distinguishing feature: wipes off = pseudomembranous; cannot wipe off = hyperplastic or OHL.

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3. A patient presents with extensive enamel erosion concentrated on the lingual (palatal) surfaces of the maxillary anterior teeth. What underlying condition should be strongly suspected?

  1. Bulimia nervosa (recurrent self-induced vomiting causes characteristic 'perimolysis' — acid erosion concentrated on the palatal surfaces of the maxillary anterior teeth)
  2. Normal age-related attrition
  3. Fluorosis
  4. Amelogenesis imperfecta
Show answer and explanation

Correct answer: A. Bulimia nervosa (recurrent self-induced vomiting causes characteristic 'perimolysis' — acid erosion concentrated on the palatal surfaces of the maxillary anterior teeth)

Recurrent vomiting in bulimia nervosa exposes the palatal/lingual surfaces of the maxillary anterior teeth to repeated gastric acid, producing a characteristic erosion pattern called perimolysis — a classic, frequently tested diagnostic clue that should also prompt sensitive screening for an eating disorder and appropriate medical/psychological referral.

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4. A 62-year-old female reports an annoying bump on the inside of her cheek with no associated pain. Based on the most common etiology of such lesions, what is the most likely origin?

  1. Reactive
  2. Infectious
  3. Acute trauma
  4. Neoplastic
Show answer and explanation

Correct answer: A. Reactive

The most common soft-tissue oral lesions (traumatic fibroma, pyogenic granuloma, peripheral giant cell granuloma, and peripheral ossifying fibroma) are all reactive in nature — they occur in response to chronic irritation, trauma, or local inflammatory stimuli. In an asymptomatic middle-aged female, a smooth buccal mucosa nodule is overwhelmingly likely to be a reactive (hyperplastic) lesion rather than a true neoplasm. Reactive lesions do not have malignant potential and are treated by excision and elimination of the irritating factor.

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5. A 68-year-old female with a 2×3 cm moveable, non-painful mass on the lower lip that has grown over 2-3 years with no apparent cause — what is the most likely etiology?

  1. Immunological
  2. Viral
  3. Neoplastic
  4. Idiopathic
Show answer and explanation

Correct answer: C. Neoplastic

A slow-growing, painless, moveable mass on the lower lip that has enlarged over 2-3 years with no trauma history or identifiable cause is most consistent with a NEOPLASTIC process (benign tumor such as a pleomorphic adenoma, lipoma, or other salivary gland tumor). Traumatic mucoceles are typically fluctuant and have a history of trauma. Large, slowly growing painless masses with no apparent cause should be considered neoplastic until proven otherwise.
  • A. INCORRECT. Immunological lesions (aphthous stomatitis, pemphigoid) are painful and recurrent — not slow-growing painless masses.
  • B. INCORRECT. Viral lesions (HPV warts, herpetic lesions) are typically smaller, have associated symptoms, and don't present as a 2×3 cm growing firm mass.
  • C. CORRECT. A 2×3 cm slowly growing, moveable, painless mass with no identified trauma or reactive cause is most consistent with a NEOPLASTIC etiology — likely a benign salivary gland tumor (pleomorphic adenoma) or mesenchymal tumor.
  • D. INCORRECT. Idiopathic implies no identifiable cause, but a 2×3 cm slow-growing mass with specific features points to a SPECIFIC etiology (neoplasm) even if the exact subtype isn't yet diagnosed.

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6. Which of the following does NOT cause cleft lip/palate when a pregnant woman is exposed to or deficient in it?

  1. Alcohol
  2. Tobacco
  3. Iron deficiency
  4. Folic acid deficiency
Show answer and explanation

Correct answer: C. Iron deficiency

Alcohol, tobacco, and folic acid deficiency are all established risk factors for orofacial clefting. Iron deficiency anemia, while harmful to maternal and fetal health in other ways, is not a established/major risk factor specifically for cleft palate.

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7. What is the relationship between chemotherapy and osteonecrosis of the jaw?

  1. Chemotherapy has no bearing on osteonecrosis risk
  2. Certain chemotherapeutic and antiangiogenic agents (and impaired healing from cytotoxic drugs generally) can increase the risk of osteonecrosis, particularly when combined with antiresorptive (bisphosphonate/denosumab) therapy
  3. Chemotherapy actually prevents osteonecrosis
  4. This relationship is only relevant in pediatric oncology patients
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Correct answer: B. Certain chemotherapeutic and antiangiogenic agents (and impaired healing from cytotoxic drugs generally) can increase the risk of osteonecrosis, particularly when combined with antiresorptive (bisphosphonate/denosumab) therapy

Cytotoxic chemotherapy impairs wound healing and immune response, and certain agents (antiangiogenics like bevacizumab, mTOR inhibitors) are independently associated with MRONJ. The risk is compounded when chemotherapy is combined with bone-modifying agents — a key reason dental clearance/treatment is ideally completed before starting these therapies when possible.

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8. What is the hereditary pattern of Cherubism?

  1. Autosomal recessive
  2. X-linked recessive
  3. Autosomal dominant
  4. Mitochondrial inheritance
Show answer and explanation

Correct answer: C. Autosomal dominant

Cherubism is inherited in an autosomal dominant pattern, caused by mutations in the SH3BP2 gene on chromosome 4p16.3. It presents in early childhood with bilateral, symmetric, painless expansion of the mandible (and sometimes maxilla), giving the characteristic 'cherub' appearance. The jaw expansion is due to fibrous tissue replacement of bone. It is self-limiting and often regresses after puberty.

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Patient cases

All Pathology questions (1,709)