NUR 6501 ADVANCED PATHOPHYSIOLOGY
MIDTERM EXAM WALDEN UNIVERSITY
COMPLETE ACTUAL 150+ QUESTIONS AND
ANSWERS
1. 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): Acute lymphblastic leukemia
,2. 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: Reduced synthesis of
hemoglobin F
3. 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: Gastrointestinal blood loss
4. 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: Vitamin C deficiency
5. 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: You may have
excessive bleeding following tooth extraction
6. 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: Aggregation of platelets
MIDTERM EXAM WALDEN UNIVERSITY
COMPLETE ACTUAL 150+ QUESTIONS AND
ANSWERS
1. 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): Acute lymphblastic leukemia
,2. 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: Reduced synthesis of
hemoglobin F
3. 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: Gastrointestinal blood loss
4. 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: Vitamin C deficiency
5. 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: You may have
excessive bleeding following tooth extraction
6. 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: Aggregation of platelets
