NURS 611 Advanced Pathophysiology Midterm Exam 3 Study Guide
2026 |Maryville
1. A patient presents with paresthesia of the hands and feet, a sore beefy red
tongue, and difficulty walking. Laboratory results indicate macrocytic-
normochromic anemia. Which of the following is the most likely underlying
cause?
A. Folate deficiency leading to impaired DNA synthesis
B. Chronic blood loss resulting in iron depletion
C. Lack of intrinsic factor secretion by gastric parietal cells
D. Bone marrow suppression due to viral infection
Answer: C
Rationale: The symptoms describe Pernicious Anemia, a macrocytic-normochromic
anemia caused by Vitamin B12 deficiency. Neurological symptoms (paresthesia, ataxia) and
the ‘beefy red tongue’ distinguish it from folate deficiency, specifically pointing to a lack of
intrinsic factor.
2. In the pathogenesis of Disseminated Intravascular Coagulation (DIC), what is
the primary initiator of the coagulation cascade?
A. Decreased production of antithrombin III by the liver
B. Excessive clearance of fibrin degradation products
C. Massive release of tissue factor (TF) into the circulation
D. Direct activation of plasminogen by bacterial endotoxins
Answer: C
Rationale: DIC is characterized by the widespread activation of coagulation, primarily
triggered by the release of tissue factor (TF) due to endothelial damage, sepsis, or trauma,
leading to systemic fibrin deposition.
,3. Which cellular adaptation is most characteristic of the heart’s response to
chronic untreated hypertension in the left ventricle?
A. Pathologic hyperplasia
B. Pathologic hypertrophy
C. Metaplasia of cardiomyocytes
D. Compensatory atrophy
Answer: B
Rationale: Chronic hypertension increases afterload, forcing the left ventricle to work
harder. Since cardiomyocytes are non-dividing cells, they undergo hypertrophy (increase
in cell size) rather than hyperplasia (increase in cell number) to compensate for the
increased workload.
4. A 65-year-old male with a history of smoking presents with a chronic
productive cough for the past 3 years. Pathological examination of his airways
would most likely show:
A. Destruction of the alveolar septa and loss of elastic recoil
B. Hypertrophy and hyperplasia of mucus-secreting glands in the bronchi
C. Permanent dilation of the bronchioles due to infection
D. Eosinophilic infiltration and airway basement membrane thickening
Answer: B
Rationale: The description of a productive cough for at least 3 months in 2 consecutive
years defines chronic bronchitis. The hallmark is the hypersecretion of mucus and
hypertrophy of the goblet cells and bronchial mucous glands.
, 5. Which mechanism is responsible for the development of pulmonary edema in
a patient with acute left-sided heart failure?
A. Decreased pulmonary capillary oncotic pressure
B. Increased pulmonary capillary hydrostatic pressure
C. Obstruction of lymphatic drainage in the thoracic duct
D. Increased permeability of the alveolar-capillary membrane
Answer: B
Rationale: Left heart failure causes blood to back up into the pulmonary circulation. This
increases the hydrostatic pressure in the pulmonary capillaries, forcing fluid into the
interstitial and alveolar spaces.
6. What is the pathophysiological significance of the ‘Reed-Sternberg cell’?
A. It is the diagnostic marker for Hodgkin Lymphoma found in lymph nodes
B. It is the malignant transformation of a T-cell in Non-Hodgkin Lymphoma
C. It represents a premature erythrocyte found in polycythemia vera
D. It is a specialized macrophage involved in the formation of granulomas
Answer: A
Rationale: Reed-Sternberg cells are large, multinucleated B-cells that are the hallmark
diagnostic feature of Hodgkin Lymphoma.
7. A patient with chronic kidney disease (CKD) develops secondary
hyperparathyroidism. What is the primary trigger for this compensatory
mechanism?
A. Hypophosphatemia due to increased renal excretion
B. Excessive production of erythropoietin
C. Direct stimulation of the parathyroid gland by urea
D. Hypocalcemia resulting from decreased activation of Vitamin D
Answer: D
2026 |Maryville
1. A patient presents with paresthesia of the hands and feet, a sore beefy red
tongue, and difficulty walking. Laboratory results indicate macrocytic-
normochromic anemia. Which of the following is the most likely underlying
cause?
A. Folate deficiency leading to impaired DNA synthesis
B. Chronic blood loss resulting in iron depletion
C. Lack of intrinsic factor secretion by gastric parietal cells
D. Bone marrow suppression due to viral infection
Answer: C
Rationale: The symptoms describe Pernicious Anemia, a macrocytic-normochromic
anemia caused by Vitamin B12 deficiency. Neurological symptoms (paresthesia, ataxia) and
the ‘beefy red tongue’ distinguish it from folate deficiency, specifically pointing to a lack of
intrinsic factor.
2. In the pathogenesis of Disseminated Intravascular Coagulation (DIC), what is
the primary initiator of the coagulation cascade?
A. Decreased production of antithrombin III by the liver
B. Excessive clearance of fibrin degradation products
C. Massive release of tissue factor (TF) into the circulation
D. Direct activation of plasminogen by bacterial endotoxins
Answer: C
Rationale: DIC is characterized by the widespread activation of coagulation, primarily
triggered by the release of tissue factor (TF) due to endothelial damage, sepsis, or trauma,
leading to systemic fibrin deposition.
,3. Which cellular adaptation is most characteristic of the heart’s response to
chronic untreated hypertension in the left ventricle?
A. Pathologic hyperplasia
B. Pathologic hypertrophy
C. Metaplasia of cardiomyocytes
D. Compensatory atrophy
Answer: B
Rationale: Chronic hypertension increases afterload, forcing the left ventricle to work
harder. Since cardiomyocytes are non-dividing cells, they undergo hypertrophy (increase
in cell size) rather than hyperplasia (increase in cell number) to compensate for the
increased workload.
4. A 65-year-old male with a history of smoking presents with a chronic
productive cough for the past 3 years. Pathological examination of his airways
would most likely show:
A. Destruction of the alveolar septa and loss of elastic recoil
B. Hypertrophy and hyperplasia of mucus-secreting glands in the bronchi
C. Permanent dilation of the bronchioles due to infection
D. Eosinophilic infiltration and airway basement membrane thickening
Answer: B
Rationale: The description of a productive cough for at least 3 months in 2 consecutive
years defines chronic bronchitis. The hallmark is the hypersecretion of mucus and
hypertrophy of the goblet cells and bronchial mucous glands.
, 5. Which mechanism is responsible for the development of pulmonary edema in
a patient with acute left-sided heart failure?
A. Decreased pulmonary capillary oncotic pressure
B. Increased pulmonary capillary hydrostatic pressure
C. Obstruction of lymphatic drainage in the thoracic duct
D. Increased permeability of the alveolar-capillary membrane
Answer: B
Rationale: Left heart failure causes blood to back up into the pulmonary circulation. This
increases the hydrostatic pressure in the pulmonary capillaries, forcing fluid into the
interstitial and alveolar spaces.
6. What is the pathophysiological significance of the ‘Reed-Sternberg cell’?
A. It is the diagnostic marker for Hodgkin Lymphoma found in lymph nodes
B. It is the malignant transformation of a T-cell in Non-Hodgkin Lymphoma
C. It represents a premature erythrocyte found in polycythemia vera
D. It is a specialized macrophage involved in the formation of granulomas
Answer: A
Rationale: Reed-Sternberg cells are large, multinucleated B-cells that are the hallmark
diagnostic feature of Hodgkin Lymphoma.
7. A patient with chronic kidney disease (CKD) develops secondary
hyperparathyroidism. What is the primary trigger for this compensatory
mechanism?
A. Hypophosphatemia due to increased renal excretion
B. Excessive production of erythropoietin
C. Direct stimulation of the parathyroid gland by urea
D. Hypocalcemia resulting from decreased activation of Vitamin D
Answer: D
