100+ Free ABPath Neuropathology Practice Questions

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Question 1

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A 42-year-old woman presents with a new-onset seizure. MRI shows a non-enhancing, T2-hyperintense, infiltrative mass in the right frontal lobe. Biopsy shows a moderately cellular astrocytic neoplasm with atypia but no microvascular proliferation or necrosis. IHC shows IDH1 R132H positive and ATRX loss. 1p/19q is retained. Which diagnosis per WHO CNS 2021 is most appropriate?

Astrocytoma, IDH-mutant, CNS WHO grade 2

Oligodendroglioma, IDH-mutant and 1p/19q-codeleted, CNS WHO grade 2

Glioblastoma, IDH-wildtype, CNS WHO grade 4

Diffuse midline glioma, H3 K27-altered

to track

2026 Statistics

Key Facts: ABPath Neuropathology Exam

230

Total MCQ Items

168 Written/Practical + 62 Virtual Microscopy

6h 12m

Total Exam Time

3h 6m W/P + 3h 6m VM

40%

Tumor Content (VM)

Non-pituitary 26% + Pituitary 7% + Developmental neoplasms

$2,100

2026 Exam Fee

Includes $200 admin fee

12 mo

Minimum Fellowship

ACGME Neuropathology fellowship (most 2 years)

10 yr

Certification Validity

Time-limited; CC/MOC required

The ABPath Neuropathology exam is a 1-day 230-question computer-based test from the American Board of Pathology — 168 Written/Practical items (3h 6m) + 62 Virtual Microscopy items (3h 6m). The 2026 blueprint weights tumor pathology (Non-pituitary 14% W/P + 26% VM plus Pituitary 5% W/P + 7% VM), neurodegenerative 11%, muscle 6%, peripheral nerve 3%, vascular 8%, infectious 8%, demyelinating 6%, developmental 7%, trauma 6%, prion 3%, epilepsy 4%, ophthalmic 3%. The 2026 fee is $2,100 (includes $200 nonrefundable administrative fee). Testing window: September 8-28, 2026.

Sample ABPath Neuropathology Practice Questions

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

1A 42-year-old woman presents with a new-onset seizure. MRI shows a non-enhancing, T2-hyperintense, infiltrative mass in the right frontal lobe. Biopsy shows a moderately cellular astrocytic neoplasm with atypia but no microvascular proliferation or necrosis. IHC shows IDH1 R132H positive and ATRX loss. 1p/19q is retained. Which diagnosis per WHO CNS 2021 is most appropriate?

A.Astrocytoma, IDH-mutant, CNS WHO grade 2

B.Oligodendroglioma, IDH-mutant and 1p/19q-codeleted, CNS WHO grade 2

C.Glioblastoma, IDH-wildtype, CNS WHO grade 4

D.Diffuse midline glioma, H3 K27-altered

Explanation: Per WHO CNS 2021, diffuse astrocytic tumors with IDH mutation, ATRX loss, and retained 1p/19q are classified as 'Astrocytoma, IDH-mutant' (grades 2-4). Absence of microvascular proliferation or necrosis and a low-grade morphology supports grade 2. CDKN2A/B homozygous deletion would upgrade to grade 4 regardless of histology. IDH-mutant astrocytomas have a better prognosis than IDH-wildtype tumors.

2A 55-year-old man has a left frontal cortical tumor with calcifications on CT. Histology shows monotonous round cells with perinuclear halos ('fried egg'), chicken-wire capillaries, and microcalcifications. Molecular testing shows IDH1 mutation and 1p/19q codeletion. Which diagnosis is correct?

A.Astrocytoma, IDH-mutant

B.Oligodendroglioma, IDH-mutant and 1p/19q-codeleted

C.Glioblastoma, IDH-wildtype

D.Central neurocytoma

Explanation: Per WHO CNS 2021, a diffuse glioma with IDH mutation AND 1p/19q whole-arm codeletion is definitionally oligodendroglioma. Classic features include perinuclear halos, chicken-wire vasculature, and calcifications. TERT promoter mutation and CIC/FUBP1 mutations are additional molecular features. Grading is 2 or 3 based on mitotic activity and microvascular proliferation/necrosis.

3A 65-year-old man has a rapidly growing, ring-enhancing right temporal mass. Biopsy shows a highly cellular astrocytic tumor with microvascular proliferation, pseudopalisading necrosis, and brisk mitoses. IDH1/2 are wild-type. Which molecular finding is sufficient by WHO CNS 2021 criteria to classify this as glioblastoma, IDH-wildtype grade 4, even without necrosis or microvascular proliferation?

A.ATRX loss

B.TERT promoter mutation, EGFR amplification, or +7/-10 chromosome signature

C.MGMT promoter methylation

D.BRAF V600E mutation

Explanation: Per WHO CNS 2021, an IDH-wildtype diffuse astrocytic glioma in adults can be diagnosed as glioblastoma grade 4 based on any ONE of: TERT promoter mutation, EGFR gene amplification, or combined gain of chromosome 7 + loss of chromosome 10 (+7/-10) — even in the absence of histologic microvascular proliferation or necrosis. MGMT methylation is prognostic/predictive but not diagnostic.

4A 9-year-old child has a midline pontine infiltrative tumor. Biopsy shows a high-grade diffuse astrocytic neoplasm. IHC shows loss of H3 K27me3 and positivity for H3 K27M. This defines which WHO CNS 2021 entity?

A.Pilocytic astrocytoma

B.Diffuse midline glioma, H3 K27-altered, CNS WHO grade 4

C.Diffuse hemispheric glioma, H3 G34-mutant

D.Medulloblastoma, SHH-activated

Explanation: Diffuse midline glioma, H3 K27-altered is defined by midline location, diffuse glioma morphology, and loss of H3 K27me3 with H3 K27M mutation (H3F3A or HIST1H3B/C), EZHIP overexpression, or EGFR mutation. It is always WHO grade 4 regardless of histology. The loss of H3 K27me3 by IHC is a hallmark. Median survival is under 2 years; DIPG is the prototypic example.

5A 22-year-old presents with a hemispheric high-grade glioma. Sequencing shows H3.3 G34R mutation with ATRX loss and TP53 mutation. Which WHO CNS 2021 tumor is this?

A.Diffuse midline glioma, H3 K27-altered

B.Diffuse hemispheric glioma, H3 G34-mutant, CNS WHO grade 4

C.Infant-type hemispheric glioma

D.Glioblastoma, IDH-wildtype

Explanation: Diffuse hemispheric glioma, H3 G34-mutant (G34R/V in H3F3A) is a new WHO CNS 2021 entity affecting adolescents/young adults. It occurs in the cerebral hemispheres, frequently with ATRX loss and TP53 mutation. By definition it is grade 4. OLIG2 is often negative, distinguishing it from other gliomas. Prognosis is poor.

6A 7-year-old has a well-circumscribed cerebellar mass. Biopsy shows a biphasic pattern of compact areas with Rosenthal fibers and loose areas with eosinophilic granular bodies and microcysts. Which molecular alteration is most typical?

A.IDH1 R132H mutation

B.KIAA1549-BRAF fusion

C.H3 K27M mutation

D.EWSR1-FLI1 fusion

Explanation: Pilocytic astrocytoma (WHO grade 1) classically shows biphasic compact/loose architecture with Rosenthal fibers and eosinophilic granular bodies. The hallmark molecular alteration is KIAA1549-BRAF tandem duplication/fusion (about 70% of cerebellar pilocytics). BRAF V600E point mutation is more common in supratentorial pilocytic astrocytomas, ganglioglioma, and PXA.

7A 15-year-old has a superficial temporal lobe tumor with cyst and mural nodule. Histology shows pleomorphic, lipidized cells with eosinophilic granular bodies and reticulin deposition. Which molecular alteration is most commonly associated with this entity?

A.IDH1 R132H

B.BRAF V600E with CDKN2A/B homozygous deletion

C.H3 K27M

D.1p/19q codeletion

Explanation: Pleomorphic xanthoastrocytoma (PXA) is a superficial, often temporal tumor in young patients with pleomorphic lipidized cells, EGBs, and reticulin. BRAF V600E mutation occurs in 60-80% of PXAs and CDKN2A/B homozygous deletion is common. Anaplastic features (≥5 mitoses/10 HPF, necrosis) define grade 3. Targeted BRAF/MEK therapy may be used.

8A 6-year-old with tuberous sclerosis develops a large intraventricular tumor near the foramen of Monro composed of large ganglion-like cells with eccentric nuclei and prominent nucleoli, GFAP+. Which diagnosis is correct?

A.Subependymal giant cell astrocytoma (SEGA)

B.Central neurocytoma

C.Medulloblastoma

D.Ependymoma

Explanation: SEGA (WHO grade 1) is the characteristic CNS tumor of tuberous sclerosis complex (TSC1/TSC2 mutations), arising near the foramen of Monro. Tumor cells are large, ganglion-like with eccentric nuclei, and GFAP/S100+. mTOR inhibitors (everolimus, sirolimus) are approved targeted therapies.

9A 4-year-old has a supratentorial intraventricular tumor. Histology shows perivascular pseudorosettes and ependymal rosettes. Molecular testing shows a ZFTA-RELA fusion. Which diagnosis applies?

A.Supratentorial ependymoma, ZFTA fusion-positive

B.Supratentorial ependymoma, YAP1 fusion-positive

C.Posterior fossa ependymoma group A (PFA)

D.Myxopapillary ependymoma

Explanation: Per WHO CNS 2021, supratentorial ependymomas are now classified by fusion status: ZFTA (formerly C11orf95)–RELA fusion defines the most common subtype, and YAP1 fusion (especially YAP1-MAMLD1) defines the second. ZFTA-fused tumors express L1CAM and show NF-κB activation. Pseudorosettes around vessels and true ependymal rosettes are typical morphology.

10A 3-year-old has a posterior fossa ependymoma. IHC shows loss of H3 K27me3 expression with retained trimethylation on internal control. Which molecular subgroup does this define?

A.Posterior fossa ependymoma, group A (PFA)

B.Posterior fossa ependymoma, group B (PFB)

C.Supratentorial ependymoma, ZFTA fusion

D.Spinal ependymoma, MYCN-amplified

Explanation: PFA ependymomas (young children, posterior fossa, poor prognosis) show global loss of H3 K27 trimethylation due to EZHIP overexpression, with essentially no recurrent mutations and a CpG island hypermethylator phenotype. PFB tumors retain H3 K27me3, occur in older children/adults, and have better outcomes. H3 K27me3 IHC is a practical surrogate marker.

About the ABPath Neuropathology Exam

The ABPath Neuropathology subspecialty certification validates expert-level diagnostic knowledge across CNS tumors (per WHO CNS 2021), neurodegenerative disease (Alzheimer NIA-AA ABC, Lewy body, FTLD, tauopathies), vascular, demyelinating, developmental, infectious/inflammatory, muscle biopsy, peripheral nerve, ophthalmic pathology, and prion disease. The 1-day computer-based exam has 168 Written/Practical + 62 Virtual Microscopy items (230 total). Requires primary ABPath AP or AP/CP certification plus a 12-month ACGME-accredited Neuropathology fellowship.

Questions

230 scored questions

Time Limit

1-day CBT (3h 6m Written/Practical + 3h 6m Virtual Microscopy)

Passing Score

Scaled criterion-referenced pass score (modified Angoff)

Exam Fee

$2,100 (includes $200 nonrefundable administrative fee) (American Board of Pathology (ABPath) / Pearson VUE)

ABPath Neuropathology Exam Content Outline

14% W/P • 26% VM

Neoplasms — Non-Pituitary

WHO CNS 2021 adult diffuse gliomas (astrocytoma IDH-mutant, oligodendroglioma IDH-mutant & 1p/19q-codeleted, glioblastoma IDH-wildtype = grade 4 with +7/-10, EGFR amp, TERT), pediatric gliomas (H3 K27-altered DMG, H3 G34-mutant), circumscribed gliomas (pilocytic BRAF fusion, ganglioglioma BRAF V600E, PXA, SEGA), ependymomas (ZFTA, YAP1, PFA/PFB), medulloblastoma (WNT, SHH, Gp3, Gp4), meningiomas (WHO 1-3, CDKN2A/B loss = grade 3), PNST, CNS lymphoma, metastases.

5% W/P • 7% VM

Pituitary

PitNET (WHO 2022 — PIT1/SF1/TPIT lineage), Rathke cleft cyst, craniopharyngioma (adamantinomatous CTNNB1 vs papillary BRAF V600E), hypophysitis.

11% W/P • 7% VM

Aging & Neurodegenerative Diseases

Alzheimer NIA-AA ABC (Thal Aβ phase + Braak NFT stage + CERAD neuritic plaque), Lewy body disease (α-synuclein, DLB McKeith), FTLD (TDP-43 A-E, FUS, tau 3R/4R), PSP tufted astrocytes, CBD astrocytic plaques, Pick, MSA glial inclusions, CTE sulcal-depth p-tau, CAA.

8% W/P • 10% VM

General Neuroanatomy, Pathology & Staining

Neuroanatomy, LFB, Bielschowsky/Gallyas silver stains, IHC (GFAP, OLIG2, synaptophysin, NeuN, neurofilament, α-syn, p-tau AT8, Aβ, TDP-43), frozen sections, autopsy brain handling.

8% W/P • 5% VM

Vascular Disorders

Ischemic infarct time course (red neurons 0-12h → neutrophils → macrophages → cavitation), hemorrhage (hypertensive, SAH, AVM, CAA lobar), CADASIL NOTCH3, PACNS, cavernous malformation, moyamoya.

8% W/P • 10% VM

Infectious & Inflammatory Diseases

Bacterial/TB/cryptococcal meningitis, viral encephalitides (HSV temporal, rabies Negri, CMV owl-eye, PML JC, HIV MGCs), toxoplasma, neurocysticercosis, Whipple, neurosarcoidosis.

7% W/P • 5% VM

Developmental Neuropathology

Neural tube defects, Chiari, Dandy-Walker, FCD (ILAE IIA/IIB balloon cells), lissencephaly, polymicrogyria, holoprosencephaly, phakomatoses (NF1/NF2/TSC/VHL/SWS), MELAS, Leigh, leukodystrophies (MLD/Krabbe/Alexander/ALD).

6% W/P • 8% VM

Skeletal Muscle

Frozen-section muscle biopsy (ATPase, NADH, SDH, COX, modified Gomori trichrome — ragged red fibers), neurogenic (grouped atrophy, fiber-type grouping), dystrophinopathies (DMD/BMD), IBM rimmed vacuoles, dermatomyositis (perifascicular atrophy), IMNM, congenital myopathies (central core, nemaline).

6% W/P • 3% VM

Trauma

Diffuse axonal injury (β-APP IHC), contusions (coup/contrecoup), subdural/epidural/SAH, chronic traumatic encephalopathy (perivascular p-tau at sulcal depths — McKee criteria).

6% W/P • 7% VM

Demyelinating Diseases

MS active/chronic active plaques (LFB pallor, CD68 macrophages), NMOSD (AQP4-IgG), MOG-IgG disease, ADEM, central pontine myelinolysis, Marburg, Balo, PML.

6% W/P • 2% VM

Complications of Systemic Disorders

Paraneoplastic (anti-Hu/Yo/NMDAR/LGI1), Wernicke, hepatic encephalopathy (Alzheimer type II astrocytes), HIE, hypoglycemic injury, radiation necrosis.

3% W/P • 5% VM

Peripheral Nerve

Sural nerve biopsy, semi-thin sections, teased fibers, vasculitic neuropathy, amyloid (Congo red, transthyretin), CIDP onion bulbs, CMT (PMP22), leprosy, PNSTs (schwannoma, neurofibroma, MPNST).

4% W/P • 0% VM

Epilepsy

Hippocampal sclerosis (ILAE 1-3), focal cortical dysplasia I/II/III (balloon cells in IIB), DNET, ganglioglioma, Rasmussen encephalitis, hypothalamic hamartoma.

3% W/P • 3% VM

Prion Diseases

Spongiform change, PrPSc IHC, sporadic CJD (MM1/VV2), variant CJD (florid plaques), familial CJD (PRNP), GSS, FFI, iatrogenic CJD; diagnostic RT-QuIC, 14-3-3, CSF tau.

3% W/P • 2% VM

Ophthalmic Pathology

Retinoblastoma (RB1, Flexner-Wintersteiner rosettes), uveal melanoma (BAP1, monosomy 3), optic nerve glioma, ocular lymphoma.

2% W/P • 0% VM

Management & Informatics — General

QA, CAP PT, IHC validation, molecular validation, CLIA, biobanking, digital pathology/VM workflows.

How to Pass the ABPath Neuropathology Exam

What You Need to Know

Passing score: Scaled criterion-referenced pass score (modified Angoff)
Exam length: 230 questions
Time limit: 1-day CBT (3h 6m Written/Practical + 3h 6m Virtual Microscopy)
Exam fee: $2,100 (includes $200 nonrefundable administrative fee)

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 Neuropathology Study Tips from Top Performers

1WHO CNS 2021 rule that trips many candidates: a diffuse astrocytic tumor that is IDH-wildtype with EGFR amplification, whole-chromosome 7 gain + whole-chromosome 10 loss (+7/-10), or TERT promoter mutation is diagnosed as glioblastoma (grade 4) regardless of histologic grade. Oligodendroglioma requires BOTH IDH mutation AND 1p/19q codeletion

2Alzheimer NIA-AA ABC score = Thal Aβ phase (A0-3) + Braak NFT stage (B0-3) + CERAD neuritic plaque score (C0-3). The combined ABC score determines AD neuropathologic change level (Not, Low, Intermediate, High). Use Bielschowsky or Gallyas silver for plaques/tangles or IHC (4G8/6E10 for Aβ, AT8 for p-tau)

3Medulloblastoma has 4 molecular subgroups with prognostic and therapeutic implications: WNT (best prognosis, β-catenin nuclear, CTNNB1), SHH (TP53-wild vs TP53-mutant, PTCH1/SMO/SUFU, age bimodal), Group 3 (MYC amplification, worst prognosis), Group 4 (most common, intermediate prognosis). WHO 2021 separates WNT and SHH histologically; Gp3/4 require DNA methylation profiling

4Ischemic infarct time course: 0-12h 'red neurons' (eosinophilic cytoplasm, pyknotic nucleus); 12-48h neutrophils; 48h-1wk macrophages and gemistocytic astrocytes; 1-2wk microvascular proliferation; 2+ wk cavitation with gliotic wall. β-APP IHC highlights axonal spheroids in diffuse axonal injury

5Muscle biopsy patterns: neurogenic atrophy shows grouped atrophy, fiber-type grouping (from reinnervation), and target fibers (NADH). Dermatomyositis shows perifascicular atrophy and MAC deposits in capillaries. Inclusion body myositis shows rimmed vacuoles and β-amyloid/p-tau/TDP-43 inclusions. Ragged red fibers (modified Gomori) with COX-negative/SDH-positive fibers suggest mitochondrial myopathy

Frequently Asked Questions

What is the ABPath Neuropathology subspecialty certification?

The ABPath Neuropathology subspecialty certification is awarded by the American Board of Pathology to diplomates who demonstrate expert-level diagnostic knowledge of CNS and peripheral nervous system pathology — including CNS tumors (per WHO CNS 2021), neurodegenerative disease, vascular, demyelinating, infectious, developmental, muscle biopsy, peripheral nerve, ophthalmic pathology, and prion disease. It qualifies pathologists to lead neuropathology services and brain/muscle/nerve biopsy sign-out.

Who is eligible to take the ABPath Neuropathology exam?

Candidates must hold primary ABPath certification in good standing in AP or AP/CP and have completed 12 months of full-time training in an ACGME-accredited Neuropathology fellowship. Most programs are 2 years (typically 1 year surgical neuropathology + 1 year autopsy/forensic neuropathology), though the minimum for board eligibility is 12 months. A valid unrestricted medical license is required.

What is the format of the ABPath Neuropathology exam?

The exam is a 1-day computer-based examination administered at Pearson VUE. It consists of 168 Written/Practical items (3 hours 6 minutes) plus 62 Virtual Microscopy items (3 hours 6 minutes) for a total of 230 one-best-answer multiple-choice questions. No glass slides are used — all images are digital. The VM section tests whole-slide image diagnostic interpretation.

How much does the 2026 ABPath Neuropathology exam cost?

The 2026 examination fee is $2,100, which includes a $200 nonrefundable administrative fee. Cancellations by June 15 forfeit $500; cancellations after June 15 forfeit the full fee. Retakes within the 7-year qualification window require re-registration and full fee payment.

When is the 2026 exam administered?

The 2026 ABPath Neuropathology Subspecialty Certification Exam is offered September 8-28, 2026 at Pearson VUE Professional Testing Centers. Applications open February 16, 2026 and must be submitted by May 15, 2026 (11:59 PM EST). There are no late application deadlines. Scheduling with Pearson VUE opens in July after the application is complete.

How is the exam scored?

ABPath uses criterion-referenced scoring with a cut-score set in advance by subject-matter experts using the modified Angoff method. A candidate's result depends on performance relative to the cut-score, not on other candidates. Results are posted to the Board Correspondence tab in PATHway approximately 6 weeks after the final week of subspecialty exams.

What are the highest-yield topics?

CNS tumors dominate (Non-pituitary 14% W/P + 26% VM plus Pituitary 5% W/P + 7% VM). Master WHO CNS 2021 — an IDH-wildtype diffuse astrocytic tumor is glioblastoma (grade 4) even with low-grade histology when EGFR amp, +7/-10, or TERT promoter mutation is present; oligodendroglioma requires IDH mutation AND 1p/19q codeletion. For neurodegenerative (11% W/P), know NIA-AA Alzheimer ABC scoring (Thal Aβ phase A, Braak NFT stage B, CERAD neuritic plaque C). Medulloblastoma has 4 molecular groups (WNT, SHH, Group 3, Group 4) per WHO 2021. Muscle biopsy (6% W/P) and peripheral nerve (3% W/P) round out the frozen-section content.

How should I study for this exam?

Use a structured 6-12 month plan during or after fellowship. Lead with WHO CNS 2021 (largest domain), then neurodegenerative disease with silver stains and IHC (Bielschowsky, p-tau AT8, α-synuclein, TDP-43, Aβ), then muscle/nerve biopsy, then vascular/infectious/demyelinating/developmental. Complete heavy VM practice (whole-slide review is the differentiator — 62 VM items in 3h 6m). Take 2-3 timed full-length mock exams. Integrate ABPath blueprint, WHO CNS 2021, NIA-AA 2012 Alzheimer guidelines, and AANP resources.