100+ Free ABPath Hematopathology Practice Questions

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Question 1

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A 65-year-old man presents with bruising and bleeding. Peripheral smear shows hypergranular promyelocytes with Auer rods (some faggot cells). Cytogenetics show t(15;17)(q24;q21). The most likely diagnosis is:

Acute myeloid leukemia with RUNX1-RUNX1T1

Acute promyelocytic leukemia (APL) with PML-RARA

AML with inv(16)

Chronic myeloid leukemia

to track

2026 Statistics

Key Facts: ABPath Hematopathology Exam

265

Total Questions

220 Written/Practical + 45 Virtual Microscopy

~7h 4m

Total Exam Duration

One-day computer-based, Pearson VUE

$2,100

ABPath Exam Fee

2026 subspecialty certification fee

35%

Lymphoid Neoplasms Weight

Largest domain on hematopathology exam

WHO 2022 + ICC

Required Classifications

Both classifications expected

12 months

ACGME Fellowship

Hematopathology fellowship requirement

The ABPath Hematopathology exam is a one-day, computer-based exam of 265 questions — 220 Written/Practical questions in 4 hours 25 minutes plus 45 Virtual Microscopy questions in 2 hours 39 minutes. All questions are single-best-answer multiple choice. 2026 exam window: September 8 – September 28, 2026. Content spans methodology (~10%), non-neoplastic hematology (~15%), myeloid neoplasms (~25%), lymphoid neoplasms (~35%), and coagulation/miscellaneous (~15%). Candidates must be conversant with both WHO 2022 5th edition and 2022 International Consensus Classification (ICC). ABPath subspecialty fee is $2,100 (includes $200 non-refundable administrative fee).

Sample ABPath Hematopathology Practice Questions

Try these sample questions to test your ABPath Hematopathology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 65-year-old man presents with bruising and bleeding. Peripheral smear shows hypergranular promyelocytes with Auer rods (some faggot cells). Cytogenetics show t(15;17)(q24;q21). The most likely diagnosis is:

A.Acute myeloid leukemia with RUNX1-RUNX1T1

B.Acute promyelocytic leukemia (APL) with PML-RARA

C.AML with inv(16)

D.Chronic myeloid leukemia

Explanation: APL is defined by PML-RARA fusion from t(15;17)(q24;q21). Morphology: hypergranular promyelocytes with bundled Auer rods (faggot cells). It classically presents with DIC/coagulopathy. Treatment with ATRA + arsenic trioxide (ATO) has revolutionized outcomes, achieving >90% cure. APL is a medical emergency because of DIC risk and is defined by the genetic abnormality regardless of blast count.

2A 30-year-old woman presents with fatigue. CBC shows WBC 45,000/μL with neutrophilia, basophilia, and left shift with blasts <10%. Cytogenetics show t(9;22)(q34;q11) creating BCR-ABL1. The most likely diagnosis is:

A.Chronic myeloid leukemia (CML), chronic phase

B.Acute lymphoblastic leukemia

C.Myelodysplastic syndrome

D.Essential thrombocythemia

Explanation: CML is defined by BCR-ABL1 fusion from t(9;22)(q34;q11) (Philadelphia chromosome). Chronic phase: leukocytosis with neutrophilia and left shift, basophilia, eosinophilia; blasts <10%; absent dysplasia. Accelerated phase: blasts 10-19% (WHO) or 10-29% (ICC 2022). Blast phase (blast crisis): blasts ≥20% in blood/marrow. TKI therapy (imatinib, dasatinib, nilotinib) is standard of care.

3Peripheral blood flow cytometry in a 70-year-old with lymphocytosis (ALC 15,000/μL) shows a B-cell clone with CD19+, CD5+, CD23+, CD20 dim, FMC7-, surface kappa dim. The diagnosis is:

A.Monoclonal B-cell lymphocytosis (MBL)

B.Chronic lymphocytic leukemia (CLL) — because the absolute monoclonal B-cell count is ≥5,000/μL per iwCLL 2018 criteria

C.Mantle cell lymphoma

D.Follicular lymphoma

Explanation: iwCLL 2018 diagnostic criteria for CLL require an absolute monoclonal B-lymphocyte count ≥5,000/μL with the characteristic immunophenotype (CD19+, CD5+, CD23+, CD20 dim, FMC7-, dim light chain restriction). Monoclonal B-cell lymphocytosis (MBL) is the precursor state with <5,000/μL clonal B cells. SLL is the tissue-based counterpart with <5,000/μL circulating clonal B cells but nodal/extranodal disease.

4A lymph node flow on a 62-year-old man shows a B-cell clone with CD19+, CD5+, CD23-, CD20 bright, FMC7+, kappa restriction. IHC shows cyclin D1+ and SOX11+. The most likely diagnosis is:

A.CLL/SLL

B.Mantle cell lymphoma (MCL)

C.Diffuse large B-cell lymphoma

D.Follicular lymphoma

Explanation: MCL: CD19+, CD5+, CD23-, CD20 bright, FMC7+, cyclin D1+, SOX11+. The defining cytogenetic abnormality is t(11;14)(q13;q32) CCND1-IGH leading to cyclin D1 overexpression. SOX11 is expressed in classical (nodal) MCL. Aggressive blastoid and pleomorphic variants occur. Ibrutinib and BTK inhibitors have improved outcomes substantially.

5A lymph node shows follicular architecture with tightly packed, small follicles containing centrocytes and centroblasts. Flow: CD19+/CD10+/BCL6+/BCL2+/CD5-. Cytogenetics: t(14;18)(q32;q21). The diagnosis is:

A.Reactive follicular hyperplasia

B.Follicular lymphoma (FL)

C.Mantle cell lymphoma

D.Marginal zone lymphoma

Explanation: FL: CD19+/CD20+/CD10+/BCL6+/BCL2+/CD5-/cyclin D1-. t(14;18)(q32;q21) creates BCL2-IGH fusion driving BCL2 overexpression (~85% of FL). WHO 2022 grades FL 1, 2, 3A, and 3B by centroblast counts per HPF. Grade 3B (sheets of centroblasts) is treated like DLBCL. BCL2 positivity in germinal centers distinguishes FL from reactive hyperplasia (BCL2-negative germinal centers).

6A lymph node from a 60-year-old man shows large lymphocytes with vesicular nuclei and prominent nucleoli. IHC: CD20+, CD10+, BCL6+, MUM1-. The Hans algorithm cell-of-origin classification is:

A.Germinal center B-cell-like (GCB) — because CD10+

B.Activated B-cell-like (ABC) / non-GCB

C.T-cell/histiocyte-rich large B-cell lymphoma

D.Primary mediastinal B-cell lymphoma

Explanation: Hans algorithm for DLBCL cell-of-origin: CD10+ → GCB; CD10- and BCL6- → ABC; CD10- and BCL6+ and MUM1- → GCB; CD10- and BCL6+ and MUM1+ → ABC. GCB-type DLBCL has better prognosis than ABC type under standard R-CHOP. Molecular (Nanostring) classifiers are also used. Double-hit (MYC + BCL2/BCL6) is a separate category in WHO/ICC 2022.

7A lymph node shows a 'starry-sky' pattern, medium-sized monomorphic cells with intermediate chromatin and small basophilic nucleoli, vacuolated basophilic cytoplasm. IHC: CD20+, CD10+, BCL6+, BCL2-, Ki-67 ~100%. FISH shows MYC rearrangement with IGH. The diagnosis is:

A.Diffuse large B-cell lymphoma NOS

B.Burkitt lymphoma

C.Follicular lymphoma grade 3

D.Mantle cell lymphoma, blastoid

Explanation: Burkitt lymphoma: medium-sized monomorphic cells with starry-sky pattern (tingible-body macrophages), high mitotic rate, Ki-67 ~100%, MYC rearrangement (t(8;14) most common, or t(2;8) or t(8;22)). IHC: CD20+, CD10+, BCL6+, BCL2 negative or only weakly positive, MUM1-, TdT-. Both WHO 2022 and ICC 2022 retain BL as distinct entity; molecular features differ from HGBL-DH/TH.

8A large B-cell lymphoma shows concurrent MYC rearrangement plus BCL2 rearrangement on FISH. According to WHO 2022 / ICC 2022, this is classified as:

A.Diffuse large B-cell lymphoma, NOS

B.High-grade B-cell lymphoma with MYC and BCL2 rearrangements (HGBL-MYC/BCL2) — 'double-hit lymphoma'

C.Burkitt lymphoma

D.Follicular lymphoma

Explanation: HGBL with MYC and BCL2 rearrangements ('double-hit') is a distinct WHO 2022/ICC 2022 entity with aggressive clinical behavior. Triple-hit (MYC + BCL2 + BCL6) is included. In ICC 2022, HGBL-DH-BCL6 (MYC + BCL6) without BCL2 is less strongly defined, often included as HGBL-NOS. Diagnosis requires FISH break-apart probes for MYC, BCL2, and BCL6. Management is more intensive than R-CHOP.

9A 72-year-old man with fatigue and elevated IgM paraprotein has bone marrow showing small lymphocytes, plasmacytoid lymphocytes, and plasma cells. MYD88 L265P mutation is detected. The most likely diagnosis is:

A.Multiple myeloma

B.Lymphoplasmacytic lymphoma / Waldenström macroglobulinemia

C.CLL/SLL

D.MALT lymphoma

Explanation: Lymphoplasmacytic lymphoma (LPL) / Waldenström macroglobulinemia is characterized by IgM paraprotein, lymphoplasmacytic infiltrate in bone marrow, and MYD88 L265P mutation in ~90%+ of cases. CXCR4 mutations occur in ~30% and influence treatment response. Distinguishes LPL from IgM MGUS (absent marrow infiltrate <10%) and MM (CD20- plasma cell clone, different cytogenetics).

10A gastric biopsy shows small lymphoid cells infiltrating the mucosa and lymphoepithelial lesions. Flow: CD19+/CD20+/CD5-/CD10-/CD23-/surface lambda restricted. The most likely diagnosis is:

A.Follicular lymphoma

B.Extranodal marginal zone lymphoma of MALT (MALToma)

C.Mantle cell lymphoma

D.Burkitt lymphoma

Explanation: Extranodal MZL of MALT type: CD19+/CD20+/CD5-/CD10-/CD23-/BCL6-/cyclin D1-. Gastric MALT is associated with Helicobacter pylori; many regress with antibiotic eradication. t(11;18)(q21;q21) creates API2-MALT1 fusion, especially in H. pylori-resistant cases. Lymphoepithelial lesions (aberrant infiltration of epithelium by B cells) are characteristic but not pathognomonic.

About the ABPath Hematopathology Exam

The ABPath Hematopathology subspecialty exam validates expertise in the diagnosis and classification of benign and malignant disorders of blood, bone marrow, lymph nodes, spleen, and extranodal hematopoietic tissues. The exam incorporates the 5th Edition WHO Classification (2022) and the 2022 International Consensus Classification (ICC) for lymphoid, myeloid, and histiocytic neoplasms. Content spans methodology (flow cytometry, cytogenetics/FISH, NGS, IHC), peripheral blood and marrow morphology, acute myeloid leukemia with defining genetic abnormalities, myelodysplastic syndromes (IPSS-R/IPSS-M), myeloproliferative neoplasms (JAK2/CALR/MPL, BCR-ABL1), B-cell and T-cell lymphomas, plasma cell dyscrasias, and coagulation disorders. Candidates must hold ABPath AP or AP/CP certification and have completed an ACGME-accredited Hematopathology fellowship.

Questions

265 scored questions

Time Limit

~7h 4m (Written/Practical + Virtual Microscopy)

Passing Score

Criterion-referenced (Hematopathology Test Committee)

Exam Fee

$2,100 subspecialty certification fee (ABPath 2026) (American Board of Pathology (ABPath))

ABPath Hematopathology Exam Content Outline

10%

Methodology

Peripheral blood smear preparation and Wright-Giemsa staining, bone marrow aspirate/biopsy technique, H&E, iron stain, reticulin (MF grade 0-3), flow cytometry (gating, panels), cytogenetics (karyotype, FISH), molecular (PCR, NGS myeloid panels, IG/TCR clonality), and IHC panels (CD20/CD3/CD5/CD10/BCL2/BCL6/MUM1/CD30/CD15/PAX5/cyclin D1/SOX11).

15%

Erythrocyte & Leukocyte Disorders

Anemia (microcytic IDA/thalassemia/ACD; macrocytic B12/folate/MDS; normocytic), hemolysis (intrinsic vs extrinsic, G6PD, sickle cell, AIHA), red cell morphology (schistocytes MAHA/TMA, spherocytes HS, echinocytes, target cells), neutrophil disorders (Chediak-Higashi, LAD), reactive leukocytosis, and eosinophilia causes.

25%

Myeloid Neoplasms

AML (WHO 2022 defining genetic abnormalities: RUNX1-RUNX1T1/t(8;21), CBFB-MYH11/inv(16), PML-RARA/t(15;17) APL, KMT2A, NPM1, TP53-mutated, myelodysplasia-related), MDS (IPSS-R, IPSS-M, 5q-, SF3B1-mutated LR-MDS with ring sideroblasts), MDS/MPN overlap (CMML), MPN (PV JAK2 V617F, ET JAK2/CALR/MPL, PMF, CML BCR-ABL1 t(9;22)), systemic mastocytosis (KIT D816V).

35%

Lymphoid Neoplasms

B-cell: CLL/SLL (iwCLL 2018), MCL (t(11;14) cyclin D1+ SOX11+), FL (t(14;18) grade 1-3A vs 3B), DLBCL NOS (GCB vs ABC Hans algorithm), HGBL with MYC + BCL2/BCL6 (double-hit/triple-hit), Burkitt (MYC t(8;14)), MALT (t(11;18)), Waldenström (MYD88 L265P), plasma cell myeloma (IMWG SLIM-CRAB). T-cell: PTCL-NOS, AITL (TFH phenotype), ALCL (ALK+/-), ENKTL. Hodgkin lymphoma (classical and NLPHL).

15%

Coagulation & Miscellaneous

Coagulation (PT, aPTT, INR, factor assays, inhibitor screens, VWD panel, platelet function), hypercoagulability (factor V Leiden, prothrombin G20210A, antithrombin/protein C/S deficiency, antiphospholipid), thrombotic microangiopathies (TTP with ADAMTS13 <10%, HUS, DIC), transfusion reactions, hemoglobinopathies, histiocytic neoplasms (LCH, RDD, ECD), and amyloidosis (AL/AA/ATTR, Congo red apple-green birefringence).

How to Pass the ABPath Hematopathology Exam

What You Need to Know

Passing score: Criterion-referenced (Hematopathology Test Committee)
Exam length: 265 questions
Time limit: ~7h 4m (Written/Practical + Virtual Microscopy)
Exam fee: $2,100 subspecialty certification fee (ABPath 2026)

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 Hematopathology Study Tips from Top Performers

1Memorize the Hans algorithm for DLBCL cell-of-origin: CD10+ → GCB (germinal center B-cell type); CD10- AND BCL6+ AND MUM1- → GCB; all other combinations → non-GCB (activated B-cell-like / ABC). ABC-type DLBCL has worse prognosis than GCB; double-hit high-grade B-cell lymphoma (MYC + BCL2 and/or BCL6) is a separate WHO/ICC category with worse prognosis and different management

2Know the classic B-cell lymphoma immunophenotypes: CLL/SLL (CD5+/CD23+/CD20 dim/FMC7-), MCL (CD5+/CD23-/FMC7+/cyclin D1+/SOX11+), FL (CD10+/BCL6+/BCL2+), Burkitt (CD10+/BCL6+/BCL2-/Ki-67 ~100%), MZL (CD5-/CD23-/CD10-/BCL6-) — these appear on virtually every hematopathology exam

3For AML, memorize WHO 2022/ICC 2022 defining genetic abnormalities that classify AML regardless of blast count: APL with PML-RARA t(15;17), AML with RUNX1-RUNX1T1 t(8;21), AML with CBFB-MYH11 inv(16)/t(16;16), AML with NPM1 mutation, AML with KMT2A rearrangement, AML with MECOM rearrangement, AML with BCR-ABL1 t(9;22), and AML with TP53 mutation

4For MPNs remember the JAK2 V617F mutation is present in ~95% of PV, ~55% of ET, and ~55% of PMF. CALR exon 9 mutations are found in ~20-25% of JAK2-negative ET/PMF, and MPL mutations in ~3-5%. 'Triple-negative' ET/PMF (no JAK2/CALR/MPL) has a distinct clinical profile. PV also requires elevated Hgb/Hct + JAK2 V617F (or JAK2 exon 12)

5Master the IMWG SLIM-CRAB criteria for multiple myeloma: CRAB = hyperCalcemia (>11 mg/dL), Renal insufficiency (Cr >2 mg/dL or eGFR <40), Anemia (Hb <10), Bone lesions; SLIM = plasma cells ≥60%, involved/uninvolved serum Free Light Chain ratio ≥100, MRI >1 focal Lesion ≥5 mm. Any myeloma-defining event on CRAB or SLIM makes the diagnosis regardless of other criteria

Frequently Asked Questions

What is the ABPath Hematopathology subspecialty exam?

The ABPath Hematopathology subspecialty exam is a board certification administered by the American Board of Pathology for pathologists with advanced training in the diagnosis of benign and malignant disorders of blood, bone marrow, lymph nodes, spleen, and extranodal hematopoietic tissues. It requires fluency in morphology (peripheral smear, bone marrow, lymph node histology), flow cytometry immunophenotyping, cytogenetics/FISH, and molecular diagnostics (NGS, IG/TCR clonality, MRD). Candidates must be familiar with both the 2022 WHO 5th edition and 2022 International Consensus Classification (ICC).

How many questions are on the ABPath Hematopathology exam and how long is it?

The exam is a one-day, computer-based examination with 265 total questions — 220 Written/Practical questions in 4 hours 25 minutes plus 45 Virtual Microscopy questions in 2 hours 39 minutes. All questions are multiple-choice, single-best-answer format with no glass slides (virtual microscopy only). Practical questions include blood and bone marrow smears, imprints, body fluid specimens, and tissue sections. The 2026 exam window runs September 8 – September 28, 2026.

What is the passing score for the ABPath Hematopathology exam?

The exam uses a criterion-referenced passing standard set by the Hematopathology Test Committee via a modified Angoff standard-setting process. Score reports provide pass/fail plus diagnostic performance by content domain. Historical first-time pass rates at ABPath subspecialty exams are approximately 80-90% for Hematopathology.

What are the eligibility requirements for the ABPath Hematopathology exam?

Candidates must (1) hold ABPath primary certification in Anatomic Pathology (AP) or AP/Clinical Pathology (AP/CP); (2) successfully complete an ACGME-accredited Hematopathology fellowship of at least 12 months; and (3) maintain an active, unrestricted medical or osteopathic license. Applications are accepted February 16 – May 15, 2026 for the Fall 2026 administration, with exam scheduling via Pearson VUE opening in July 2026.

How much does the ABPath Hematopathology exam cost?

The 2026 ABPath subspecialty certification fee is $2,100, which includes a non-refundable $200 administrative fee. Candidates who fail must reapply and pay the full fee again for the next annual cycle. The application window is February 16 – May 15, 2026. Pearson VUE may charge separate test-center fees in some regions.

What is the difference between the WHO 2022 and ICC 2022 classifications?

The 5th edition WHO Classification (2022) of hematolymphoid tumors and the 2022 International Consensus Classification (ICC) are two parallel efforts that emerged after the prior WHO 4th edition. They agree on most entities but differ on some — for example, ICC retains 'AML with myelodysplasia-related changes' while WHO 2022 restructures this; ICC uses different thresholds for MDS/AML boundary in specific genetic contexts; and there are nuanced differences in terminology for large B-cell lymphomas and DLBCL subtypes. The ABPath Hematopathology Content Specification explicitly requires familiarity with BOTH classifications.

What are the highest-yield topics on the ABPath Hematopathology exam?

Lymphoid neoplasms (35%) dominate — master CLL/SLL (iwCLL 2018: absolute clonal B-lymphocytes ≥5,000/μL), MCL (t(11;14) cyclin D1+ SOX11+), FL (t(14;18) BCL2-IGH, grading 1-3A vs 3B), DLBCL NOS (Hans algorithm: CD10+ or (CD10-/BCL6+/MUM1-) = GCB; others = non-GCB/ABC), HGBL with MYC + BCL2 and/or BCL6 (double-/triple-hit), Burkitt (MYC t(8;14), Ki-67 ~100%), and plasma cell myeloma IMWG SLIM-CRAB. Myeloid neoplasms (25%) emphasize APL (PML-RARA t(15;17)), CBF-AML (t(8;21) RUNX1-RUNX1T1, inv(16) CBFB-MYH11), NPM1-mutated AML, MDS IPSS-R/M, and MPN driver mutations (JAK2 V617F in PV; JAK2/CALR/MPL in ET and PMF). Methodology (10%) includes flow cytometry gating and cytogenetic interpretation.

How should I study for the ABPath Hematopathology exam?

Use a 6-9 month structured plan during or after your Hematopathology fellowship. Start with methodology (peripheral smear review, bone marrow technique, flow cytometry immunophenotyping panels, IHC panels, cytogenetics/FISH). Move to non-neoplastic hematology (anemia, hemolysis, morphology). Cover myeloid neoplasms systematically — WHO 2022/ICC 2022 AML genetic abnormalities, MDS IPSS-R/IPSS-M, MPN driver mutations, CML, mastocytosis. Then cover lymphoid neoplasms by category — CLL, MCL, FL, DLBCL, HGBL, Burkitt, MALT, Waldenström, myeloma IMWG, T-cell (PTCL, AITL, ALCL, ENKTL), and Hodgkin. Finish with coagulation, TMA, histiocytic neoplasms, and amyloidosis. Use Swerdlow/Arber/Campo WHO Blue Book and Jaffe Hematopathology, and take at least two timed full-length VM practice exams.