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The PP exam has 235 questions and runs 6 hours 23 minutes.
These 10 free PP questions are organized by exam domain, so you can see how each part of the Certification in Pathology: Pediatric Pathology (PP) blueprint is tested. Reveal the answer and explanation under each question.
A placenta delivered at 30 weeks shows acute chorioamnionitis. In the umbilical cord, neutrophils infiltrate the walls of the vein and both arteries. There is no concentric necrotic debris around the vessels in Wharton jelly. How should the cord findings be classified under the Amsterdam consensus?
Correct answer: C - Fetal inflammatory response, stage 2
At autopsy, a 24-week fetus has ascites, pleural effusions, and marked pallor. Maternal red-cell antibody screening was negative. Liver and placental sections contain enlarged erythroid precursors with dense eosinophilic intranuclear inclusions; the surrounding parenchymal cells lack comparable inclusions. The combination of hydrops and this cellular tropism most strongly implicates:
Correct answer: D - Parvovirus B19 infection
Born at 25 weeks, an infant required invasive ventilation for the first 18 days. At 36 weeks postmenstrual age, the infant consistently receives heated humidified nasal cannula support at 4 L/min with an inspired oxygen fraction of 0.21. Using the Jensen 2019 support-based definition, which classification belongs in the follow-up record?
Correct answer: B - Grade 2 BPD, based on the current nasal cannula flow
A posterior fossa tumor from a 14-month-old is predominantly composed of primitive small cells, with focal epithelioid cells containing eccentric nuclei and abundant eosinophilic cytoplasm. Tumor nuclei completely lack INI1 staining, while endothelial and inflammatory-cell nuclei stain strongly. Which integrated diagnosis is favored over medulloblastoma?
Correct answer: D - Atypical teratoid/rhabdoid tumor
Biopsy of a solitary yellow-red scalp papule in an 8-month-old shows a circumscribed dermal histiocytic proliferation, focal foamy change, and occasional Touton-type giant cells. The lesional cells express CD68 but not CD1a, langerin, or tryptase. There is no cytologic atypia. The most appropriate classification is:
Correct answer: C - Juvenile xanthogranuloma
A term newborn is investigated for delayed passage of meconium. Rectal suction biopsies obtained 3 cm above the dentate line contain ample submucosa. Serial sections demonstrate several unequivocal, although small, ganglion cells, and calretinin highlights fine nerve fibers in the lamina propria and muscularis mucosae. Which conclusion should the pathologist communicate?
Correct answer: B - Ganglionated rectum, without histologic evidence of Hirschsprung disease
A 5-week-old has persistent conjugated hyperbilirubinemia and repeatedly acholic stools. Liver biopsy shows portal edema, ductular proliferation, and bile plugs within ductules; scattered multinucleated giant hepatocytes are also present. Ultrasound shows no dilated extrahepatic bile ducts. What is the most important implication of this biopsy?
Correct answer: A - Prompt evaluation of extrahepatic duct patency is needed for suspected biliary atresia
A 3-year-old undergoes upfront nephrectomy for unilateral Wilms tumor without prior biopsy or chemotherapy. Viable tumor extends into the extrarenal portion of the renal vein but is removed en bloc with the kidney. All resection margins and sampled lymph nodes are negative, there was no rupture or operative spill, and staging identifies no distant disease. Under the COG/NWTS system, the appropriate stage is:
Correct answer: B - Stage II
After initial surgery for a paratesticular rhabdomyosarcoma in a 13-year-old, no gross tumor remains. The spermatic-cord margin is microscopically involved, and two removed regional retroperitoneal lymph nodes contain tumor. The most distal sampled regional node is negative, and there are no distant metastases. Which postsurgical COG Clinical Group records both the nodal disease and the residual tumor burden?
Correct answer: C - Clinical Group IIC
At 16 weeks of gestation, a prenatal cytogenetic consultation reviews a positive cell-free DNA screen for trisomy 13. Chorionic villus sampling performed at 12 weeks detected trisomy 13 in the direct trophoblast preparation, while cultured villous mesenchymal cells were 46,XX. No major fetal structural anomaly is seen. To distinguish confined placental mosaicism from fetal involvement, the next cytogenetic specimen should be:
Correct answer: C - Amniotic fluid containing fetal-derived cells
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