WALDEN UNIVERSITY NUR 6501 ADVANCED
PATHOPHYSIOLOGY MIDTERM EXAM | 300+ REAL
QUESTIONS AND ANSWERS 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 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 - 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 - 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 - 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 - 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
PATHOPHYSIOLOGY MIDTERM EXAM | 300+ REAL
QUESTIONS AND ANSWERS 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 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 - 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 - 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 - 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 - 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
