ADVANCED PATHOPHYSIOLOGY MIDTERM NUR
6501 WALDEN UNIVERSITY / COMPLETE
ACTUAL EXAM / 150+ QUESTIONS AND
CORRECT DETAILED ANSWERS / 2025/2026
A 4-year-old child appears listless for the last week. He complains of pain when he is
picked up by his mother, and he is irritable when touching his arms or legs. Several
large ecchymotic lesions have appeared on his right thigh and left shoulder. A complete
blood count reveals a HgB=10.2, Hct=30.5%, MCV=96fL, platelet count of 45,000/ML,
and WBC count of 13,990/ML. Examination of the peripheral blood smear reveals
numerous blasts. The blasts lack peroxidase-positive granules but do contain periodic
acid-Schiff (PAS)-positive aggregates and stain positively for TdT. Flow cytometry
shows the phenotype of blasts to be CD19+, CD3-, and sIg-. What is the most likely
diagnosis?
A. Acute lymphoblastic leukemia (ALL)
B. Chronic lymphocytic leukemia (CLL)
C. Acute myelogenous leukemia (AML)
D. Chronic myelogenous leukemia (CML) - CORRECT ANSWER - Acute lymphblastic
leukemia
A 3-year-old child of Italian ancestry presents with failure to thrive. Physical examination
indicates hepatosplenomegaly. His hemoglobin concentration is 6 g/dL, and the
peripheral blood smear reveals severely hypochromic microcytic red cells. Total serum
iron level is normal. The reticulocyte count is 10%. Hemoglobin electrophoresis shows
very little hemoglobin A. A radiograph of the skull shows maxillofacial deformities. What
is the principle cause of anemia and other abnormalities in this patient?
A. Reduced synthesis of hemoglobin F
B. Reduced red blood cell survival from imbalance in the production of alpha and beta
globin chains
C. Relative deficiency of vitamin B12
D. Increased fragility of the erythrocyte membrane - CORRECT ANSWER - Reduced
synthesis of hemoglobin F
A 68-year-old previously healthy female has been feeling increasingly tired and weak for
several months. She states that she has had black, tarry stools for several weeks. She
is found to be anemic with a hemoglobin concentration of 9.3g/dL. The peripheral blood
smear reveals microcytic and hypochromic blood cells. Which of the following conditions
should be suspected as the most likely of her condition as indicated by the peripheral
blood smear?
A. Aplastic anemia
B. Beta thalassemia
,C. Gastrointestinal blood loss
D. Pernicious anemia - CORRECT ANSWER - Gastrointestinal blood loss
A 76-year-old female notices that small, pinpoint to blotchy areas of superficial
hemorrhage have appeared on her gums and on the skin of her arms and legs over
several weeks. She is found to have a normal prothrombin time(PT) and partial
thromboplastin time (PTT). Her CBC shows hemoglobin concentration of 12.7 g/dL,
hematocrit of 37.2%. MCV of 80 fL/red cell, platelet count of 276,000/microliter, and
WBC of 5600/microliter. Her template bleeding time is 3 minutes. Her fibrinogen level is
normal, and there are no fibrin split products detectable. Which of the following
conditions best explain these findings?
A. Chronic renal failure
B. Macronodular cirrhosis
C. Vitamin B12 deficiency
D. Vitamin C deficiency - CORRECT ANSWER - Vitamin C deficiency
A young adult patient has just been diagnosed with Von Willebrand disease. Which of
the following statements should you make to advise the patient of potential
consequences of this disease?
A. You may need an allogeneic bone marrow transplant
B. You may have excessive bleeding following tooth extraction
C. A splenectomy may be necessary to control the disease
D. Expect increasing difficulties with joint mobility - CORRECT ANSWER - You may
have excessive bleeding following tooth extraction
Low dose aspirin is commonly used to reduce the risk of arterial thrombosis in patients
who have suffered a myocardial infarction. Which one of the following steps in
homeostasis is inhibited by aspirin?
A. Synthesis of von Willebrand factor
B. Aggregation of platelets
C. Activation of factor Xa
D. Synthesis of antithrombin III - CORRECT ANSWER - Aggregation of platelets
A 24-year-old presents to the office with fatigue. On physical exam, the NP notices that
she ispale with the following vital signs: HR 112, BP 98/64, resp 20, O2 sats 99%. Her
CBC shows: WBC6,000, Hemoglobin 9.6, Hematocrit 30.2, MCV is decreased at 76.
What is the mostly likely causeof this patient's anemia?
A. Iron deficiency anemia caused by menstruation
B. Beta Thalassemia of genetic origin
C. Pernicious anemia caused by dietary deficiency
D. Folate deficiency caused by alcoholism - CORRECT ANSWER - Iron deficiency
anemia caused by menstruation
,A 65-year-old female presents to your office complaining of fatigue. She has a long of
rheumatoid arthritis. A CBC reveals the following: Hgb=11.6 g/dL, Hct=34.8%, MCV=87
fL/red cell, platelet count of 268,000/microliter, and WBC count of 6800/microliter. The
serum haptoglobin level is normal, and the serum iron concentration is 20
micrograms/dL. The total iron binding capacity is 195 micrograms/dL, and the percent
saturation is 10.2. The serum ferritin concentration is 317 ng/mL. No fibrin split products
are detected. The reticulocyte concentration is 1.1%. What is the most likely diagnosis?
A. Beta- thalassemia major
B. Anemia of chronic disease
C. Acute blood loss anemia
D. Iron deficiency anemia - CORRECT ANSWER - Anemia of chronic disease
A 14-year-old male presents with high fever for ten days. Physical examination reveals
scattered petechial hemorrhages but is negative for enlargement of the liver or spleen
or lymph nodes. Bone marrow examination does not show any abnormal cells. The
complete blood count (CBC) demonstrates a hemoglobin concentration (HgB) of 13.2
g/dL, hematocrit (Hct) of 38.9%, mean cell volume (MCV) of 93 fL, platelet count of
175,000/microliter, and white blood cell (WBC) count of 1850/microliter, with the
differential count showing 1 segmented neutrophil, 98 lymphocytes, and 1 monocyte per
100 WBCs. What is the most likely cause of these findings?
A. Overwhelming bacterial infection
B. Acute lymphocytic (or lymphoblastic) leukemia
C. Acute myeloid leukemia
D. Aplastic anemia - CORRECT ANSWER - Overwhelming bacterial infection
A 31-year-old male has a history of chronic anemia and painful crises with joint and
abdominal pain. A head computed tomography (CT) scan reveals several small remote
infarctions. During one of these acute crises, he is admitted with severe dyspnea. A
CBC is performed. Which of the following morphologic findings for RBCs is most likely
to be seen on the peripheral blood smear?
A. Tear drop cells
B. Schistocytes
C. Sickle cells
D. Spherocytes - CORRECT ANSWER - Sickle cells
A 50-year-old male has a blood pressure of 160/95 mm Hg. If this condition remains
untreated for years, which of the following cardiovascular alterations will be seen on a
transthoracic echocardiogram and ECG?
A. Left Ventricular Hypertrophy
B. Left Ventricular Atrophy
C. Left Atrial Atrophy
, D. Right Ventricular Hypertrophy - CORRECT ANSWER - Left ventricular hypertrophy
A 65-year-old male with longstanding uncontrolled HTN presents to the office for
evaluation of syncope. His vital signs are temperature=98.3, Pulse=85, RR=17,
BP=165/85. Physical examination reveals a fourth heart sound and a 4/6 crescendo-
decrescendo murmur heard at the right upper sternal border with radiation to the carotid
arteries. His ECG reveals enlarged QRS waves, consistent with left ventricular
hypertrophy. What is the most likely cause of his syncopal episodes?
A. Mitral regurgitation
B. Mitral Stenosis
C. Aortic regurgitation
D. Aortic stenosis - CORRECT ANSWER - Aortic stenosis
A 63-year-old female presents to the emergency room with sudden onset of severe
chest and back pain. She describes the pain as sharp and different from her anginal
pain. Her past medical history is positive for HTN X 20 years. VS: HR 105, BP 160/105,
RR 17. On physical examination, the NP notices that her pedal and radial pulses are not
equal. What is the most likely cause of her chest pain?
A. Unstable angina
B. Aortic dissection
C. Prinzmetal angina
D. Acute myocardial infarction - CORRECT ANSWER - Aortic dissection
A 45-year-old male collapsed suddenly while playing basketball. Bystander CPR and
defibrillation was performed using an automatic external defibrillator or AED. When
EMS arrived, the gentleman was awake and alert. The recorded rhythm strip on the
AED shows tachycardia with AV dissociation (rate, approximately 220 bpm). Which
arrhythmia induced his arrest?
A. Nonsustained supraventricular tachycardia
B. Sustained wide complex atrial tachycardia
C. Wide complex ventricular tachycardia
D. Narrow complex ventricular tachycardia - CORRECT ANSWER - Wide complex
tachycardia
A 44-year-old previously healthy male presents to the office complaining of increasing
dyspnea on exertion and exercise intolerance over the last six months. The NP order a
chest XRAY and transthoracic echocardiogram. The chest XRAY shows an enlarged
heart and mild pulmonary edema. The echocardiogram reveals four-chamber cardiac
dilation with an ejection fraction of 30% and mitral and tricuspid valve regurgitation. The
patient is referred to the cardiologist who orders a CAT scan of the coronary arteries
which is negative for obstructive coronary artery disease. What is the most likely
underlying cause of the dyspnea?
6501 WALDEN UNIVERSITY / COMPLETE
ACTUAL EXAM / 150+ QUESTIONS AND
CORRECT DETAILED ANSWERS / 2025/2026
A 4-year-old child appears listless for the last week. He complains of pain when he is
picked up by his mother, and he is irritable when touching his arms or legs. Several
large ecchymotic lesions have appeared on his right thigh and left shoulder. A complete
blood count reveals a HgB=10.2, Hct=30.5%, MCV=96fL, platelet count of 45,000/ML,
and WBC count of 13,990/ML. Examination of the peripheral blood smear reveals
numerous blasts. The blasts lack peroxidase-positive granules but do contain periodic
acid-Schiff (PAS)-positive aggregates and stain positively for TdT. Flow cytometry
shows the phenotype of blasts to be CD19+, CD3-, and sIg-. What is the most likely
diagnosis?
A. Acute lymphoblastic leukemia (ALL)
B. Chronic lymphocytic leukemia (CLL)
C. Acute myelogenous leukemia (AML)
D. Chronic myelogenous leukemia (CML) - CORRECT ANSWER - Acute lymphblastic
leukemia
A 3-year-old child of Italian ancestry presents with failure to thrive. Physical examination
indicates hepatosplenomegaly. His hemoglobin concentration is 6 g/dL, and the
peripheral blood smear reveals severely hypochromic microcytic red cells. Total serum
iron level is normal. The reticulocyte count is 10%. Hemoglobin electrophoresis shows
very little hemoglobin A. A radiograph of the skull shows maxillofacial deformities. What
is the principle cause of anemia and other abnormalities in this patient?
A. Reduced synthesis of hemoglobin F
B. Reduced red blood cell survival from imbalance in the production of alpha and beta
globin chains
C. Relative deficiency of vitamin B12
D. Increased fragility of the erythrocyte membrane - CORRECT ANSWER - Reduced
synthesis of hemoglobin F
A 68-year-old previously healthy female has been feeling increasingly tired and weak for
several months. She states that she has had black, tarry stools for several weeks. She
is found to be anemic with a hemoglobin concentration of 9.3g/dL. The peripheral blood
smear reveals microcytic and hypochromic blood cells. Which of the following conditions
should be suspected as the most likely of her condition as indicated by the peripheral
blood smear?
A. Aplastic anemia
B. Beta thalassemia
,C. Gastrointestinal blood loss
D. Pernicious anemia - CORRECT ANSWER - Gastrointestinal blood loss
A 76-year-old female notices that small, pinpoint to blotchy areas of superficial
hemorrhage have appeared on her gums and on the skin of her arms and legs over
several weeks. She is found to have a normal prothrombin time(PT) and partial
thromboplastin time (PTT). Her CBC shows hemoglobin concentration of 12.7 g/dL,
hematocrit of 37.2%. MCV of 80 fL/red cell, platelet count of 276,000/microliter, and
WBC of 5600/microliter. Her template bleeding time is 3 minutes. Her fibrinogen level is
normal, and there are no fibrin split products detectable. Which of the following
conditions best explain these findings?
A. Chronic renal failure
B. Macronodular cirrhosis
C. Vitamin B12 deficiency
D. Vitamin C deficiency - CORRECT ANSWER - Vitamin C deficiency
A young adult patient has just been diagnosed with Von Willebrand disease. Which of
the following statements should you make to advise the patient of potential
consequences of this disease?
A. You may need an allogeneic bone marrow transplant
B. You may have excessive bleeding following tooth extraction
C. A splenectomy may be necessary to control the disease
D. Expect increasing difficulties with joint mobility - CORRECT ANSWER - You may
have excessive bleeding following tooth extraction
Low dose aspirin is commonly used to reduce the risk of arterial thrombosis in patients
who have suffered a myocardial infarction. Which one of the following steps in
homeostasis is inhibited by aspirin?
A. Synthesis of von Willebrand factor
B. Aggregation of platelets
C. Activation of factor Xa
D. Synthesis of antithrombin III - CORRECT ANSWER - Aggregation of platelets
A 24-year-old presents to the office with fatigue. On physical exam, the NP notices that
she ispale with the following vital signs: HR 112, BP 98/64, resp 20, O2 sats 99%. Her
CBC shows: WBC6,000, Hemoglobin 9.6, Hematocrit 30.2, MCV is decreased at 76.
What is the mostly likely causeof this patient's anemia?
A. Iron deficiency anemia caused by menstruation
B. Beta Thalassemia of genetic origin
C. Pernicious anemia caused by dietary deficiency
D. Folate deficiency caused by alcoholism - CORRECT ANSWER - Iron deficiency
anemia caused by menstruation
,A 65-year-old female presents to your office complaining of fatigue. She has a long of
rheumatoid arthritis. A CBC reveals the following: Hgb=11.6 g/dL, Hct=34.8%, MCV=87
fL/red cell, platelet count of 268,000/microliter, and WBC count of 6800/microliter. The
serum haptoglobin level is normal, and the serum iron concentration is 20
micrograms/dL. The total iron binding capacity is 195 micrograms/dL, and the percent
saturation is 10.2. The serum ferritin concentration is 317 ng/mL. No fibrin split products
are detected. The reticulocyte concentration is 1.1%. What is the most likely diagnosis?
A. Beta- thalassemia major
B. Anemia of chronic disease
C. Acute blood loss anemia
D. Iron deficiency anemia - CORRECT ANSWER - Anemia of chronic disease
A 14-year-old male presents with high fever for ten days. Physical examination reveals
scattered petechial hemorrhages but is negative for enlargement of the liver or spleen
or lymph nodes. Bone marrow examination does not show any abnormal cells. The
complete blood count (CBC) demonstrates a hemoglobin concentration (HgB) of 13.2
g/dL, hematocrit (Hct) of 38.9%, mean cell volume (MCV) of 93 fL, platelet count of
175,000/microliter, and white blood cell (WBC) count of 1850/microliter, with the
differential count showing 1 segmented neutrophil, 98 lymphocytes, and 1 monocyte per
100 WBCs. What is the most likely cause of these findings?
A. Overwhelming bacterial infection
B. Acute lymphocytic (or lymphoblastic) leukemia
C. Acute myeloid leukemia
D. Aplastic anemia - CORRECT ANSWER - Overwhelming bacterial infection
A 31-year-old male has a history of chronic anemia and painful crises with joint and
abdominal pain. A head computed tomography (CT) scan reveals several small remote
infarctions. During one of these acute crises, he is admitted with severe dyspnea. A
CBC is performed. Which of the following morphologic findings for RBCs is most likely
to be seen on the peripheral blood smear?
A. Tear drop cells
B. Schistocytes
C. Sickle cells
D. Spherocytes - CORRECT ANSWER - Sickle cells
A 50-year-old male has a blood pressure of 160/95 mm Hg. If this condition remains
untreated for years, which of the following cardiovascular alterations will be seen on a
transthoracic echocardiogram and ECG?
A. Left Ventricular Hypertrophy
B. Left Ventricular Atrophy
C. Left Atrial Atrophy
, D. Right Ventricular Hypertrophy - CORRECT ANSWER - Left ventricular hypertrophy
A 65-year-old male with longstanding uncontrolled HTN presents to the office for
evaluation of syncope. His vital signs are temperature=98.3, Pulse=85, RR=17,
BP=165/85. Physical examination reveals a fourth heart sound and a 4/6 crescendo-
decrescendo murmur heard at the right upper sternal border with radiation to the carotid
arteries. His ECG reveals enlarged QRS waves, consistent with left ventricular
hypertrophy. What is the most likely cause of his syncopal episodes?
A. Mitral regurgitation
B. Mitral Stenosis
C. Aortic regurgitation
D. Aortic stenosis - CORRECT ANSWER - Aortic stenosis
A 63-year-old female presents to the emergency room with sudden onset of severe
chest and back pain. She describes the pain as sharp and different from her anginal
pain. Her past medical history is positive for HTN X 20 years. VS: HR 105, BP 160/105,
RR 17. On physical examination, the NP notices that her pedal and radial pulses are not
equal. What is the most likely cause of her chest pain?
A. Unstable angina
B. Aortic dissection
C. Prinzmetal angina
D. Acute myocardial infarction - CORRECT ANSWER - Aortic dissection
A 45-year-old male collapsed suddenly while playing basketball. Bystander CPR and
defibrillation was performed using an automatic external defibrillator or AED. When
EMS arrived, the gentleman was awake and alert. The recorded rhythm strip on the
AED shows tachycardia with AV dissociation (rate, approximately 220 bpm). Which
arrhythmia induced his arrest?
A. Nonsustained supraventricular tachycardia
B. Sustained wide complex atrial tachycardia
C. Wide complex ventricular tachycardia
D. Narrow complex ventricular tachycardia - CORRECT ANSWER - Wide complex
tachycardia
A 44-year-old previously healthy male presents to the office complaining of increasing
dyspnea on exertion and exercise intolerance over the last six months. The NP order a
chest XRAY and transthoracic echocardiogram. The chest XRAY shows an enlarged
heart and mild pulmonary edema. The echocardiogram reveals four-chamber cardiac
dilation with an ejection fraction of 30% and mitral and tricuspid valve regurgitation. The
patient is referred to the cardiologist who orders a CAT scan of the coronary arteries
which is negative for obstructive coronary artery disease. What is the most likely
underlying cause of the dyspnea?
