100+ Free ABPath Anatomic Pathology Practice Questions

The ABPath Anatomic Pathology exam is the primary certification examination offered by the American Board of Pathology for pathologists completing AP-only or combined AP/CP residency training. It is a one-day computer-based exam delivered at Pearson VUE testing centers, with 205 one-best-answer questions in a combined Written/Practical section and 90 Virtual Microscopy questions — 295 total questions over approximately 8 hours.

The AP exam contains 295 multiple-choice one-best-answer questions split into two sections: Combined Written/Practical (205 questions in 3 hours 25 minutes) and Virtual Microscopy (90 questions in 4 hours 30 minutes). There are no glass slides — all histology is viewed through virtual microscopy. Candidates must pass both sections in the same administration.

The 2026 AP blueprint (effective January 2026) allocates the largest weights to Cytopathology (15% W/P + 2% VM), Alimentary/Pancreas/Liver/Biliary (12-13%), Genitourinary (9-14%), Breast (8-9%), Gynecologic/Placenta (7-8%), Respiratory/Pleura/Mediastinum (6-7%), Skin (5-10%), Endocrine (5-6%), Soft Tissue/Bone (5-6%), Lymph Nodes/Spleen (4-6%), Head and Neck (4-7%), CNS (3-6%), Bone Marrow (3-4%), Forensic/Autopsy (2-3%), Cardiovascular (~2%), Medical Kidney (~1-2%), and AP Management & General + Molecular Techniques (~5% combined).

ABPath uses criterion-referenced scoring with a scaled passing standard set by content experts through a modified Angoff process. Candidates are measured against a fixed content standard, not curved against peers. Both the Written/Practical section and the Virtual Microscopy section must be passed in the same administration. Score reports are pass/fail plus diagnostic domain performance.

Candidates must hold an MD or DO degree, have completed ACGME-accredited pathology training (AP-only = 3 years; combined AP/CP = 4 years), maintain an active unrestricted medical or osteopathic license, and submit a satisfactory ACGME autopsy log (50 autopsies required for AP certification). Candidates apply via the PATHway portal during the February 16–May 15 window for Fall primary exams; Spring applications open in September.

The ABPath primary certification exam fee in 2026 is $2,100 for AP-only or $2,600 for combined AP/CP taken in the same window. The fee includes a $200 non-refundable administrative fee. Candidates taking AP and CP in separate windows pay $2,100 each ($4,200 total). There is no late application fee — all applications must be submitted by the May 15 deadline.

Cytopathology carries the largest single topic weight (15% W/P) — master Bethesda cervical/thyroid, Milan salivary, Paris urine, and WHOPSC pancreatobiliary systems. GI is ~12-13% — emphasize MMR/MSI Lynch workup, KRAS in pancreatic adenocarcinoma, HCC IHC. Breast (~8-9%) requires ER/PR/HER2 reporting per ASCO/CAP, E-cadherin for lobular carcinoma, and Oncotype DX/TAILORx. GU (~9-14%) needs Gleason grade groups, RCC subtypes, and urothelial staging. GYN (~7-8%) requires TCGA/ProMisE and p16/HPV interpretation.

Use the official ABPath 2026 AP Blueprint as a roadmap. Build a 12-18 month longitudinal plan through AP/CP residency: start with high-weight surgical pathology (breast, GI, GU, GYN — together >35% of exam), then skin/H&N/lung, then heme/lymphoid/CNS/endocrine/soft tissue, and finish with cytology, forensic/autopsy, molecular, and lab management. Use virtual microscopy practice daily (the VM section is 4.5 hours). Take at least two timed full-length practice exams. Integrate current WHO 2022 classifications (WHO CNS5 2021, WHO breast, WHO digestive) and AJCC 8th edition staging.