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Hesi Pathophysiology Practice Exam (NEW UPDATED VERSION) LATEST
ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED QUESTIONS AND
ANSWERS) | GUARANTEED PASS A+ UPDATED 2026
1. Case:
A 68-year-old male presents with crushing chest pain radiating to his left arm, diaphoresis, and
nausea. ECG shows ST elevation in V2–V4.
Question: Most likely pathophysiological event?
A. Inferior MI
B. Anterior MI
C. Pulmonary embolism
D. Pericarditis
Rationale:
ST elevation in V2–V4 corresponds to the anterior wall of the left ventricle. Occlusion of the
left anterior descending artery causes myocardial ischemia and necrosis, leading to an anterior
MI.
2. Case:
A 72-year-old female presents with confusion, fever, and dysuria. Labs: WBC 19,000/mm³,
hypotension 88/50 mmHg.
Question: Which pathophysiological process is most likely?
A. Stroke
B. Urosepsis
C. Hypoglycemia
D. Dehydration
Rationale:
Infection leads to systemic inflammatory response syndrome (SIRS). Hypotension, fever, and
leukocytosis suggest sepsis.
3. Case:
A 60-year-old male presents with shortness of breath, tachycardia, and pleuritic chest pain after a
long flight. O₂ sat 85%.
Question: Which pathophysiology explains this presentation?
A. Asthma exacerbation
2026 2027 GRADED A+
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B. Pulmonary embolism
C. Pneumonia
D. Heart failure
Rationale:
A thrombus from deep veins can embolize to the pulmonary artery, causing ventilation-
perfusion mismatch, hypoxemia, and increased pulmonary artery pressure.
4. Case:
A 65-year-old female presents with polyuria, polydipsia, and glucose 680 mg/dL.
Question: Most likely pathophysiological process?
A. DKA
B. HHNS
C. Hypoglycemia
D. Pancreatitis
Rationale:
HHNS involves extreme hyperglycemia without ketosis, causing osmotic diuresis,
dehydration, and electrolyte imbalances.
5. Case:
A 55-year-old male presents with shortness of breath, crackles, and pink frothy sputum.
Question: Which pathophysiology explains this presentation?
A. Pneumonia
B. Pulmonary edema due to left-sided HF
C. Pulmonary embolism
D. COPD exacerbation
Rationale:
Left ventricular failure increases hydrostatic pressure in pulmonary capillaries, leading to
fluid transudation into alveoli → pulmonary edema.
6. Case:
A 70-year-old female presents with sudden right-sided weakness, slurred speech, and facial
droop. CT shows hemorrhage in basal ganglia.
2026 2027 GRADED A+
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Question: Pathophysiological mechanism?
A. Ischemic stroke
B. Hemorrhagic stroke
C. TIA
D. Seizure
Rationale:
Rupture of cerebral vessels due to hypertension causes intracerebral bleeding, leading to
edema, tissue compression, and neurological deficits.
7. Case:
A 65-year-old male presents with nausea, vomiting, and epigastric pain radiating to the back.
Labs: elevated amylase and lipase.
Question: Which pathophysiology explains the findings?
A. Peptic ulcer
B. Acute pancreatitis
C. Cholecystitis
D. Gastroenteritis
Rationale:
Premature activation of pancreatic enzymes causes autodigestion, inflammation, and pain
characteristic of acute pancreatitis.
8. Case:
A 68-year-old female presents with confusion and sodium 123 mEq/L.
Question: What pathophysiological process is causing her symptoms?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypokalemia
Rationale:
Low sodium causes water to shift into brain cells, leading to cerebral edema and neurologic
symptoms (confusion, seizures).
2026 2027 GRADED A+
Hesi Pathophysiology Practice Exam (NEW UPDATED VERSION) LATEST
ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED QUESTIONS AND
ANSWERS) | GUARANTEED PASS A+ UPDATED 2026
1. Case:
A 68-year-old male presents with crushing chest pain radiating to his left arm, diaphoresis, and
nausea. ECG shows ST elevation in V2–V4.
Question: Most likely pathophysiological event?
A. Inferior MI
B. Anterior MI
C. Pulmonary embolism
D. Pericarditis
Rationale:
ST elevation in V2–V4 corresponds to the anterior wall of the left ventricle. Occlusion of the
left anterior descending artery causes myocardial ischemia and necrosis, leading to an anterior
MI.
2. Case:
A 72-year-old female presents with confusion, fever, and dysuria. Labs: WBC 19,000/mm³,
hypotension 88/50 mmHg.
Question: Which pathophysiological process is most likely?
A. Stroke
B. Urosepsis
C. Hypoglycemia
D. Dehydration
Rationale:
Infection leads to systemic inflammatory response syndrome (SIRS). Hypotension, fever, and
leukocytosis suggest sepsis.
3. Case:
A 60-year-old male presents with shortness of breath, tachycardia, and pleuritic chest pain after a
long flight. O₂ sat 85%.
Question: Which pathophysiology explains this presentation?
A. Asthma exacerbation
2026 2027 GRADED A+
,2|Page
B. Pulmonary embolism
C. Pneumonia
D. Heart failure
Rationale:
A thrombus from deep veins can embolize to the pulmonary artery, causing ventilation-
perfusion mismatch, hypoxemia, and increased pulmonary artery pressure.
4. Case:
A 65-year-old female presents with polyuria, polydipsia, and glucose 680 mg/dL.
Question: Most likely pathophysiological process?
A. DKA
B. HHNS
C. Hypoglycemia
D. Pancreatitis
Rationale:
HHNS involves extreme hyperglycemia without ketosis, causing osmotic diuresis,
dehydration, and electrolyte imbalances.
5. Case:
A 55-year-old male presents with shortness of breath, crackles, and pink frothy sputum.
Question: Which pathophysiology explains this presentation?
A. Pneumonia
B. Pulmonary edema due to left-sided HF
C. Pulmonary embolism
D. COPD exacerbation
Rationale:
Left ventricular failure increases hydrostatic pressure in pulmonary capillaries, leading to
fluid transudation into alveoli → pulmonary edema.
6. Case:
A 70-year-old female presents with sudden right-sided weakness, slurred speech, and facial
droop. CT shows hemorrhage in basal ganglia.
2026 2027 GRADED A+
, 3|Page
Question: Pathophysiological mechanism?
A. Ischemic stroke
B. Hemorrhagic stroke
C. TIA
D. Seizure
Rationale:
Rupture of cerebral vessels due to hypertension causes intracerebral bleeding, leading to
edema, tissue compression, and neurological deficits.
7. Case:
A 65-year-old male presents with nausea, vomiting, and epigastric pain radiating to the back.
Labs: elevated amylase and lipase.
Question: Which pathophysiology explains the findings?
A. Peptic ulcer
B. Acute pancreatitis
C. Cholecystitis
D. Gastroenteritis
Rationale:
Premature activation of pancreatic enzymes causes autodigestion, inflammation, and pain
characteristic of acute pancreatitis.
8. Case:
A 68-year-old female presents with confusion and sodium 123 mEq/L.
Question: What pathophysiological process is causing her symptoms?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypokalemia
Rationale:
Low sodium causes water to shift into brain cells, leading to cerebral edema and neurologic
symptoms (confusion, seizures).
2026 2027 GRADED A+
