100+ Free ABPath Combined AP/CP Primary Certification Practice Questions
Pass your American Board of Pathology Combined Anatomic Pathology / Clinical Pathology Primary Certification Examination exam on the first try — instant access, no signup required.
A 56-year-old woman has a 1.6 cm breast mass. Core biopsy shows invasive carcinoma growing in single-file linear cords with targetoid arrangement around residual ducts. E-cadherin immunostain is negative. The most likely diagnosis is:
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Key Facts: ABPath Combined AP/CP Primary Certification Exam
625
Total Questions
AP 295 + CP 330 (2026 combined route)
~14.5h
Total Exam Time
AP 7h 55m + CP 6h 36m across 2 days
$2,600
Combined Fee (2026)
Saves $1,600 vs separate windows ($4,200)
4 yrs
ACGME Combined Residency
Required vs 3 yrs for AP-only or CP-only
Pearson VUE
Exam Provider
Spring May–June and Fall Oct 2026 windows
50
Required Autopsies
ACGME log for AP component certification
The combined AP/CP route covers two separate exams totaling ~625 questions over two testing days within the same window. AP blueprint emphasizes Cytopathology (15% W/P), GI (12-13%), GU (9-14%), Breast (8-9%), GYN (7-8%), Skin (5-10%), Respiratory (6-7%), plus Heme/Lymphoid, CNS, Endocrine, Soft Tissue, Forensic, Molecular, and Lab Management. CP blueprint allocates Hematopathology 25%, Blood Banking/Transfusion Medicine 23%, Medical Microbiology 23%, Chemical Pathology 20%, and Management/Informatics 9%. Fee: $2,600 combined in the same window vs $4,200 if AP and CP are taken in separate windows ($1,600 savings). Eligibility requires completion of an ACGME-accredited 4-year combined AP/CP residency with satisfactory autopsy log (50 autopsies) and unrestricted medical license.
Sample ABPath Combined AP/CP Primary Certification Practice Questions
Try these sample questions to test your ABPath Combined AP/CP Primary Certification exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 56-year-old woman has a 1.6 cm breast mass. Core biopsy shows invasive carcinoma growing in single-file linear cords with targetoid arrangement around residual ducts. E-cadherin immunostain is negative. The most likely diagnosis is:
2On core needle biopsy of a breast lesion, low-grade nuclei form cribriform and micropapillary architecture confined within duct walls. p63 and calponin highlight an intact peripheral myoepithelial layer; there is no stromal invasion. The diagnosis is:
3Per ASCO/CAP 2023 HER2 testing guidelines, which IHC score requires reflex in situ hybridization to determine HER2 amplification status?
4A 14-year-old girl has a well-circumscribed mobile breast mass. Histology shows biphasic stromal and epithelial proliferation with intracanalicular and pericanalicular patterns. Stromal mitoses are rare and there is no stromal overgrowth. The diagnosis is:
5A triple-negative (ER-/PR-/HER2-) breast carcinoma in a 38-year-old woman with a basal-like phenotype (CK5/6+, EGFR+) and pushing borders with central necrosis is most strongly associated with which germline mutation?
6Paget disease of the nipple shows large pale intraepidermal cells with prominent nucleoli. Which immunoprofile most reliably distinguishes Paget cells from melanoma in pagetoid spread?
7A breast lesion shows cells with apical snouts, abundant eosinophilic cytoplasm, prominent nucleoli, and apocrine differentiation. The cells are AR+, GCDFP-15+, ER-, and PR-. The diagnosis is:
8Per ASCO/CAP preanalytic standards for breast biomarker testing (ER/PR/HER2), formalin fixation in 10% NBF should be:
9Oncotype DX is most useful for guiding adjuvant chemotherapy in which breast cancer subtype?
10On a sentinel lymph node from a breast carcinoma resection, a focus measures 0.4 mm. Per AJCC 8 staging, this is classified as:
About the ABPath Combined AP/CP Primary Certification Exam
The ABPath Combined Anatomic Pathology / Clinical Pathology examination is taken by pathologists completing a 4-year ACGME-accredited combined AP/CP residency. Candidates sit for both the AP exam (295 MCQs across two sections — 205 Combined Written/Practical and 90 Virtual Microscopy, ~7h 55m) and the CP exam (330 MCQs in a combined Written/Practical format, ~6h 36m) within the same Spring or Fall window. Content spans the entirety of pathology: surgical pathology by organ system (GI, GU, GYN, breast, lung, head & neck, soft tissue, dermpath, CNS), cytopathology, hematopathology, blood banking and transfusion medicine, chemical pathology, medical microbiology, molecular pathology, and laboratory management/informatics. Combined certification is awarded only when both AP and CP are passed.
Questions
625 scored questions
Time Limit
Two days: AP ~7h 55m (3:25 W/P + 4:30 VM) + CP ~6h 36m (combined Written/Practical)
Passing Score
Criterion-referenced scaled standard (modified Angoff). Combined certification awarded only when AP (both W/P and VM) and CP are passed in the same window.
Exam Fee
$2,600 combined AP/CP in same window (ABPath 2026; $4,200 if separate) (American Board of Pathology (ABPath) — administered via Pearson VUE)
ABPath Combined AP/CP Primary Certification Exam Content Outline
AP — Surgical Pathology: Breast
DCIS vs ADH (myoepithelial markers p63/calponin), invasive lobular (E-cadherin loss), invasive ductal NST grading (Nottingham), ER/PR/HER2 ASCO/CAP 2023 reporting, HER2-low (1+ or 2+/ISH-) qualifying for trastuzumab-deruxtecan, BRCA-associated triple-negative basal-like, fibroadenoma vs phyllodes (mitoses, stromal overgrowth), Paget disease (HER2+/CK7+), Oncotype DX/TAILORx.
AP — Surgical Pathology: GI / Pancreas / Liver
IBD (UC vs Crohn — distribution, granulomas), H. pylori gastritis, Barrett esophagus and dysplasia, MMR/MSI Lynch workup (BRAF V600E for MLH1/PMS2 loss → sporadic methylation vs Lynch), KRAS in pancreatic ductal adenocarcinoma, IPMN/MCN, HCC IHC (arginase-1/HepPar-1/glypican-3), cholangiocarcinoma, PBC vs PSC, viral hepatitis grading.
AP — Surgical Pathology: GU + GYN
RCC subtypes (clear cell/VHL, papillary type 1/2, chromophobe, MiT-family TFE3/TFEB), urothelial WHO grade and AJCC staging, prostate Gleason grade groups (AMACR/p63 panel), testicular germ cell tumors (seminoma, yolk sac/Schiller-Duval). Endometrial TCGA/ProMisE (POLE, MMRd, NSMP, p53abn), HPV-associated vs -independent endocervical adenocarcinoma (IECC), HSIL p16 block+, HGSOC BRCA/HRD, complete vs partial mole (p57).
AP — Cytopathology
Bethesda cervical (NILM/ASC-US/LSIL/HSIL/AGC), Bethesda thyroid (categories I-VI with risk of malignancy), Milan salivary gland, Paris urine (TPS 2.0 — atypical/suspicious for HGUC), WHOPSC pancreatobiliary system, FNA of thyroid/salivary/lymph node/lung/liver with IHC panels and ROSE for adequacy.
AP — Skin / H&N / Lung / Soft Tissue / Endocrine / Heme / CNS / Forensic / Molecular
Melanoma AJCC 8 (Breslow, ulceration, BRAF/NRAS/KIT), salivary gland fusions (PLAG1, MYB-NFIB, MAML2), lung adenocarcinoma drivers (EGFR/ALK/ROS1/BRAF/KRAS G12C), p40 squamous, mesothelioma (calretinin/WT1/BAP1 loss), sarcoma fusions (Ewing EWSR1-FLI1, synovial SS18-SSX, GIST c-kit/DOG1), thyroid (BRAF V600E PTC, MTC RET/MEN2), pheo Zellballen/SDHx, Hodgkin vs NHL, follicular t(14;18), mantle cell t(11;14), Burkitt MYC, WHO CNS5 integrated diagnosis (IDH, 1p/19q, MGMT), MI timeline, GSW range-of-fire, FISH/NGS, MLH1 methylation, ASCO/CAP preanalytics.
CP — Hematopathology
Microcytic anemia differential (iron deficiency vs thalassemia trait — Mentzer, RDW, ferritin/TSAT), AIHA DAT patterns (warm IgG vs cold IgM+C3), TTP/ADAMTS13 <10% with PEX + caplacizumab, HIT 4Ts → PF4/heparin ELISA → SRA, DIC labs, factor deficiencies (PT vs aPTT mixing studies), AML with recurrent genetics (APL t(15;17) PML-RARA → ATRA+ATO, CBF inv(16)/t(8;21), NPM1/FLT3 risk stratification), CML BCR-ABL1 Philadelphia → TKI, MPN (JAK2 V617F, CALR, MPL), MDS with del(5q) → lenalidomide, multiple myeloma IMWG CRAB/SLiM, CLL/SLL flow (CD5+/CD23+/CD20 dim), B-ALL TdT+/CD10+.
CP — Blood Banking / Transfusion Medicine
ABO/H antigen genetics, weak D testing, DAT (warm IgG vs cold IgM+C3 vs drug-induced), antibody ID panel interpretation, electronic vs serologic crossmatch, massive transfusion 1:1:1 (PROPPR trial), AHTR (clerical error/ABO incompatibility) vs DHTR (anamnestic Kidd antibodies), TRALI (HLA/HNA donor antibodies) vs TACO (volume overload), platelet thresholds (10k prophylactic, 20k fever, 50k procedures, 100k neurosurgery), FFP 10-15 mL/kg, cryoprecipitate (fibrinogen/VIII/XIII/vWF), leukoreduced/irradiated/washed indications, RhIG dosing, ASFA category I-IV (TTP, Guillain-Barré, MG), HPC DMSO cryopreservation, FDA 2023 nondeferral donor policy.
CP — Medical Microbiology
Bacteriology Gram + biochemicals (catalase, coagulase, optochin, bacitracin, PYR), MRSA mecA/cefoxitin disk, VRE vanA (high-level inducible) vs vanB, CRE (KPC vs NDM/VIM/OXA — ceftazidime-avibactam, cefiderocol), Mycobacteria (Ziehl-Neelsen/auramine-rhodamine, Xpert MTB/RIF rapid rifampin resistance), Cryptococcus India ink and serum/CSF CrAg, Aspergillus galactomannan and beta-D-glucan, Pneumocystis jirovecii silver stain, hepatitis serology (acute vs chronic vs immune), HIV 4th-gen Ag/Ab, syphilis reverse algorithm (treponemal then non-treponemal), malaria thick/thin smear, Cryptosporidium acid-fast, C. difficile NAAT + toxin EIA + clinical context, CLSI M100 breakpoints, MALDI-TOF identification, multiplex PCR syndromic panels.
CP — Chemical Pathology
Electrolytes/acid-base (anion gap acidosis: methanol, salicylate, DKA, lactic; osmolar gap: methanol, ethylene glycol, mannitol), HbA1c (NGSP/IFCC, altered by RBC lifespan in hemolysis/transfusion), Friedewald LDL vs direct, hs-troponin (99th percentile + delta change), BNP/NT-proBNP rule-out (<100/<300), TSH-reflex algorithm, cortisol/ACTH/cosyntropin stim, PTH/calcium relationship, lead toxicity (ALA dehydratase/ferrochelatase), acetaminophen Rumack-Matthew nomogram (line from 150 μg/mL at 4 hr), salicylate toxicity (respiratory alkalosis + AG acidosis), TDM (vancomycin AUC 400-600 or trough 15-20, digoxin 0.5-0.9, lithium 0.6-1.2), SPEP/IFE for monoclonal gammopathy, hCG doubling, hemoglobin HPLC, mass spectrometry for vitamin D/steroids/drugs.
CP — Laboratory Management / Informatics
CLIA test complexity (waived/moderate/high), proficiency testing rules (no referral, routine handling), HIPAA TPO + public health/research exceptions, Westgard multi-rules (1_3s, 2_2s, R_4s, 4_1s, 10_x), Levey-Jennings charts, CLSI EP28-A3c reference interval establishment (≥120 samples, 2.5-97.5 percentile), biostatistics (sensitivity/specificity, PPV/NPV, ROC/AUC, prevalence effect on PPV), Six Sigma DPMO, LOINC/SNOMED/CPT/ICD-10/HCPCS coding, FDA 2024 LDT rule, CAP/AMP NGS validation (Jennings 2017), lab director CLIA duties, preanalytic quality indicators.
AP — Pediatric / Perinatal Pathology + Neuropathology integration
Neuroblastoma (MYCN amplification, INPC classification), Wilms tumor (WT1, anaplasia, three-component: blastemal/stromal/epithelial), hepatoblastoma (fetal vs embryonal), placental disorders (acute chorioamnionitis with maternal/fetal response staging, MVM/FVM), MDS in children, congenital leukemia, neonatal autopsy. Neuropathology: WHO CNS5 medulloblastoma molecular groups (WNT/SHH/Group 3/Group 4), ependymoma molecular subgroups, atypical teratoid/rhabdoid tumor (SMARCB1/INI1 loss).
How to Pass the ABPath Combined AP/CP Primary Certification Exam
What You Need to Know
- Passing score: Criterion-referenced scaled standard (modified Angoff). Combined certification awarded only when AP (both W/P and VM) and CP are passed in the same window.
- Exam length: 625 questions
- Time limit: Two days: AP ~7h 55m (3:25 W/P + 4:30 VM) + CP ~6h 36m (combined Written/Practical)
- Exam fee: $2,600 combined AP/CP in same window (ABPath 2026; $4,200 if separate)
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
ABPath Combined AP/CP Primary Certification Study Tips from Top Performers
Frequently Asked Questions
What is the ABPath Combined AP/CP primary certification exam?
The ABPath Combined Anatomic Pathology / Clinical Pathology examination is the primary certification taken by pathologists who complete a 4-year ACGME-accredited combined AP/CP residency. Candidates sit for both the AP exam (295 MCQs across Combined Written/Practical and Virtual Microscopy sections) and the CP exam (330 MCQs in a combined Written/Practical format) within the same Spring or Fall window. Combined certification is awarded only when both AP and CP are passed.
How many questions are on the combined AP/CP exam and how long is the testing?
The combined route totals ~625 questions across two separate exam days within the same window. The AP exam has 295 one-best-answer questions split into Combined Written/Practical (205 questions in 3 hours 25 minutes) and Virtual Microscopy (90 questions in 4 hours 30 minutes) — total ~7 hours 55 minutes. The CP exam has 330 one-best-answer questions in a combined Written/Practical format over ~6 hours 36 minutes. Total testing is approximately 14.5 hours across two days.
What is the 2026 ABPath combined AP/CP blueprint?
The 2026 AP blueprint allocates Cytopathology (15% W/P + 2% VM), Alimentary/Pancreas/Liver (12-13%), Genitourinary (9-14%), Breast (8-9%), Gynecologic/Placenta (7-8%), Respiratory (6-7%), Skin (5-10%), Endocrine (5-6%), Soft Tissue/Bone (5-6%), Lymph/Spleen (4-6%), Head and Neck (4-7%), CNS (3-6%), Bone Marrow (3-4%), Forensic (2-3%), Cardiovascular (~2%), Medical Kidney (~1-2%), and Molecular + Management (~5% combined). The 2026 CP blueprint allocates Hematopathology 25%, Blood Banking/Transfusion Medicine 23%, Medical Microbiology 23%, Chemical Pathology 20%, and Management/Informatics 9%.
What is the passing score for the combined AP/CP exam?
ABPath uses criterion-referenced scoring with a scaled passing standard set by content experts via a modified Angoff process. Candidates are measured against a fixed content standard, not curved against peers. The AP exam requires passing both Written/Practical and Virtual Microscopy sections; the CP exam is a single pass/fail determination. Combined certification is awarded only when both AP and CP are passed. Score reports include diagnostic performance by content domain.
What are the eligibility requirements for the combined AP/CP exam?
Candidates must hold an MD or DO degree, have completed an ACGME-accredited combined AP/CP residency of at least 4 years, maintain an active unrestricted medical or osteopathic license, and submit a satisfactory ACGME autopsy log of at least 50 autopsies (required for the AP component). Candidates apply via the PATHway portal during the February 16 – May 15 window for Fall primary exams; Spring applications open in September of the prior year.
How much does the combined AP/CP exam cost in 2026 and is the discount worth it?
The combined AP/CP fee in 2026 is $2,600 when both exams are taken in the same window (Spring or Fall), versus $4,200 if AP and CP are taken in separate windows ($2,100 each). Taking both in the same window saves $1,600 — virtually all combined-residency candidates choose this option to capture the discount. The $2,600 includes a $200 non-refundable administrative fee. Failed disciplines require a new application and the full $2,100 per-discipline retake fee.
What are the highest-yield topics on the combined AP/CP exam?
On AP: Cytopathology (15% W/P) — Bethesda cervical/thyroid, Milan, Paris, WHOPSC. GI (~12-13%) — MMR/MSI Lynch workup with BRAF V600E reflex, KRAS in pancreas, HCC IHC. GU (~9-14%) — Gleason grade groups, RCC subtypes, urothelial staging. Breast (~8-9%) — ER/PR/HER2 ASCO/CAP, E-cadherin for lobular. GYN (~7-8%) — TCGA/ProMisE endometrial, p16/HPV. On CP: Hematopathology (25%) — TTP/ADAMTS13, HIT 4Ts, APL t(15;17), CML BCR-ABL. Blood Banking (23%) — ABO genetics, antibody ID, MTP 1:1:1, TRALI vs TACO, ASFA categories. Microbiology (23%) — MRSA mecA, CRE carbapenemase typing, CLSI breakpoints. Chemistry (20%) — acid-base/osmolar gap, Rumack-Matthew, TDM (vanc AUC, digoxin, lithium).
How should I study for the combined AP/CP exam?
Plan an 18-24 month longitudinal study schedule across PGY3-PGY4 of the combined residency. Phase 1 (PGY3): high-weight AP surgical pathology — breast, GI, GU (>30% of AP). Phase 2 (PGY3-PGY4): AP — GYN, skin, H&N, lung, heme/lymphoid, CNS, endocrine, soft tissue, plus cytology and forensic. Phase 3 (PGY4): CP hematopathology and blood banking (48% of CP combined). Phase 4 (final 3-4 months): CP microbiology, chemistry, and management/informatics; full-length timed practice exams with virtual microscopy focus for AP. Integrate WHO 2022/CNS5 2021, AJCC 8, AABB 21st ed, CLSI M100 (annual), ASCO/CAP, and the 2024 FDA LDT rule.
Can I take AP and CP in different windows?
Yes — a combined-residency graduate is permitted to schedule AP and CP in different exam windows, but doing so forfeits the combined-fee discount and costs $4,200 total ($2,100 per exam) instead of $2,600. The vast majority of combined AP/CP residents take both exams in the same window (typically the Fall after PGY4 graduation or Spring of PGY4) to capture the $1,600 savings. Combined certification is awarded only after both AP and CP are passed, regardless of whether they are taken in the same window.