ABPath Pediatric Pathology Subspecialty Certification Examination Practice Test
Pediatric pathology evaluates disease in fetal, neonatal, and childhood specimens, where age and developmental stage shape the differential diagnosis. The practice bank samples congenital malformations, pediatric tumors, infectious and inflammatory conditions, placental lesions, and disorders of the liver, lung, gastrointestinal tract, and bone. Questions emphasize interpreting microscopic findings alongside the patient’s age and clinical presentation.
Exam overview
About the ABPath Pediatric Pathology Subspecialty Certification Examination Exam
Strong case analysis requires distinguishing developmental abnormalities from acquired disease and recognizing how pediatric lesions differ from adult counterparts. This includes identifying diagnostic tissue patterns, such as abnormal organ architecture, characteristic inflammatory cells, or distinctive bone formation, and connecting them to likely diagnoses. Questions also exercise clinicopathologic reasoning across organ systems: relating cholestatic liver findings to biliary disease, classifying congenital lung and abdominal wall abnormalities, and interpreting placental changes in the setting of fetal growth restriction. For neoplastic and infectious cases, focus on how morphology narrows the differential and which clinical details support an interpretation. These skills reflect the practical work of examining pediatric and perinatal specimens, forming a defensible differential, and integrating histology with age, presentation, and relevant clinical history.
Sample Practice Questions
Review a selection from this exam's published US Practice Tests practice bank.
A child has a slowly enlarging, painless mass in the distal femur. The lesion is composed of uniform cells with grooved nuclei and numerous eosinophils. Which diagnosis is most likely?
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Correct answer: ALangerhans cell histiocytosis in bone is composed of cells with characteristic grooved nuclei, often accompanied by abundant eosinophils. Lesions may be lytic and can arise in the long bones of children.
A newborn has a congenital cystic lung lesion composed of variably sized cysts lined by respiratory epithelium, with bronchiolar-type structures and no normal alveolar architecture in the affected region. Which diagnosis is most likely?
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Correct answer: ACongenital pulmonary airway malformation is characterized by abnormal airway-like cystic structures and disorganized pulmonary architecture. The cysts are typically lined by respiratory-type epithelium; the appearance varies with lesion type.
A child with chronic diarrhea has a colonic biopsy showing numerous macrophages packed with periodic acid–Schiff-positive granular material. Which infectious agent is classically associated with this finding?
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Correct answer: AWhipple disease is caused by Tropheryma whipplei. Involved tissue may contain foamy macrophages with abundant PAS-positive material, reflecting bacterial-laden phagolysosomes.
An infant with a congenital neck mass undergoes excision. The cyst is lined by stratified squamous epithelium and contains skin appendages; lymphoid tissue is present in its wall. Which diagnosis is most likely?
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Correct answer: BA branchial cleft cyst commonly has a squamous epithelial lining and prominent lymphoid tissue in the wall. Skin appendages can be present, particularly in lesions with a more complex epithelial lining.
A child with a history of a slowly enlarging jaw mass undergoes biopsy. The lesion consists of expansile fibrous tissue containing irregular, curvilinear trabeculae of woven bone that lack osteoblastic rimming. Which diagnosis is most likely?
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Correct answer: AFibrous dysplasia is characterized by replacement of normal bone with fibrous stroma containing irregular woven-bone trabeculae, classically described as having a Chinese-character shape and typically lacking osteoblastic rimming.
A liver biopsy from an infant with cholestasis shows portal fibrosis and ductular reaction. The extrahepatic bile ducts are obliterated. Which diagnosis is most consistent with these findings?
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Correct answer: ABiliary atresia is a progressive fibroinflammatory obliteration of the extrahepatic bile ducts. Intrahepatic changes commonly include cholestasis, portal fibrosis, and ductular proliferation.
A newborn has a midline anterior abdominal wall defect at the umbilicus. The herniated bowel is covered by a membranous sac, and the umbilical cord inserts at its apex. Which diagnosis is most likely?
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Correct answer: BOmphalocele is a midline defect at the umbilical ring in which abdominal contents protrude into a sac covered by peritoneum and amnion. The umbilical cord inserts into the sac.
How to use this practice test
Access is free. A practice session draws up to 20 random questions from the 50-question bank and displays results afterward. Use each case to identify the decisive morphologic clue, then review missed items by organ system and explain how age or clinical context changes the differential.
Preparation tips
- For each congenital lesion, map the described anatomy and epithelial lining to the likely developmental abnormality; distinguish cystic lesions by their tissue components.
- Practice pediatric bone tumor differentials by comparing cellular morphology, stromal pattern, and bone formation, including whether osteoblastic rimming is present.
- Review neonatal and childhood liver patterns by separating duct obstruction, portal fibrosis, ductular reaction, and hepatocellular injury.
- For placental cases, connect infarction and villous maturation patterns with maternal vascular and fetal growth findings without relying on a single feature.
- When interpreting infectious biopsies, link special-stain findings and the distribution of affected cells to the likely organism and clinical presentation.