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) - 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 - 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 - 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 - Answer-Vitamin C deficiency
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 - 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 - Answer-Overwhelming bacterial infection
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
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) - 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 - 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 - 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 - Answer-Vitamin C deficiency
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 - 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 - Answer-Overwhelming bacterial infection
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
