NURS 5315 ADVANCED PATHOPHYSIOLOGY – EXAM 5
NEWEST 2026/2027 ACTUAL EXAM COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
WITH RATIONALES|ALREADY GRADED A+||
BRAND NEW VERSION!! (UTA)
SECTION A: HEMATOLOGIC SYSTEM (Questions 1–40)
1. A 68-year-old female presents with fatigue, pallor, and shortness of breath on
exertion.
Laboratory findings: Hb 8.2 g/dL, MCV 72 fL, low serum ferritin. Most likely
diagnosis?
A) Pernicious anemia
B) Iron deficiency anemia
C) Anemia of chronic disease
D) Thalassemia minor
Answer: B
Rationale: Low ferritin + microcytic anemia = iron deficiency. Pernicious anemia
is macrocytic;
ACD has normal/high ferritin; thalassemia has elevated RBC count.
2. A 45-year-old male with CKD (stage 4) has Hb 9.0 g/dL, normal MCV, and low
erythropoietin.
Primary pathophysiological mechanism?
A) Autoimmune RBC destruction
B) Impaired erythropoietin production by kidneys
C) Folate deficiency
D) Bone marrow suppression
Answer: B
Rationale: CKD leads to decreased EPO production by peritubular fibroblasts,
causing normocytic
normochromic anemia.
3. A 30-year-old woman with heavy menstrual bleeding has Hb 7.5 g/dL, MCV 68
fL, RDW 18%.
Which additional finding would confirm iron deficiency?
A) Elevated total iron-binding capacity (TIBC)
B) Low platelet count
1
, C) High serum B12
D) Normal serum iron
Answer: A
Rationale: Iron deficiency causes low serum iron, high TIBC, low ferritin, and
high RDW.
4. A 72-year-old male with atrophic gastritis presents with macrocytic anemia,
neuropathy,
and a positive Schilling test. What is the underlying deficiency?
A) Vitamin B12
B) Folate
C) Iron
D) Vitamin C
Answer: A
Rationale: Atrophic gastritis → loss of intrinsic factor → B12 malabsorption →
pernicious anemia,
macrocytic, neurologic symptoms.
5. Which laboratory finding is characteristic of anemia of chronic disease (ACD)?
A) Low serum ferritin, high TIBC
B) High serum ferritin, low TIBC
C) High MCV, low reticulocyte count
D) Low serum B12, elevated methylmalonic acid
Answer: B
Rationale: ACD shows high ferritin (acute-phase reactant) and low TIBC due to
hepcidin
sequestration of iron.
6. A 55-year-old male with alcohol use disorder has macrocytic anemia, normal
B12 levels,
and elevated homocysteine. Likely deficiency?
A) Vitamin B12
B) Folate
C) Iron
D) Copper
Answer: B
Rationale: Folate deficiency causes macrocytic anemia with normal B12,
elevated homocysteine,
2
, but normal MMA (unlike B12 deficiency).
7. What is the most common cause of microcytic anemia worldwide?
A) Thalassemia
B) Iron deficiency
C) Sideroblastic anemia
D) Lead poisoning
Answer: B
Rationale: Iron deficiency is the most common cause of microcytic anemia
globally, mainly due
to inadequate dietary intake or blood loss.
8. A patient with sickle cell disease experiences a vaso-occlusive crisis. Which
trigger is
most likely to precipitate this?
A) High oxygen tension
B) Dehydration and acidosis
C) Alkalosis
D) Increased RBC deformability
Answer: B
Rationale: Dehydration, acidosis, and hypoxia promote HbS polymerization and
sickling,
leading to vaso-occlusion.
9. Which hemoglobin electrophoresis pattern is consistent with sickle cell trait
(AS)?
A) HbA 60%, HbS 40%
B) HbA 100%
C) HbS > 90%, HbF elevated
D) HbA 0%, HbS 100%
Answer: A
Rationale: Sickle cell trait shows ~60% HbA and ~40% HbS; no symptoms under
normal conditions.
10. A newborn with jaundice, splenomegaly, and hemolytic anemia is diagnosed
with hereditary
spherocytosis. What is the underlying defect?
A) Spectrin deficiency
3
, B) Glucose-6-phosphate dehydrogenase deficiency
C) Sickle cell gene
D) Thalassemia gene
Answer: A
Rationale: Hereditary spherocytosis is due to defects in spectrin or ankyrin,
leading to
loss of membrane surface area and spherocytes.
11. G6PD deficiency is an X-linked disorder that causes hemolysis after exposure
to:
A) Fava beans, sulfa drugs, and infection
B) Iron supplements
C) Vitamin K
D) Cold temperatures
Answer: A
Rationale: G6PD deficiency leads to oxidative stress hemolysis triggered by fava
beans,
sulfonamides, and infections.
12. A 60-year-old with chronic lymphocytic leukemia (CLL) develops autoimmune
hemolytic anemia.
Which test is positive?
A) Direct Coombs test
B) Indirect Coombs test
C) Osmotic fragility test
D) Sickle solubility test
Answer: A
Rationale: Direct Coombs detects antibodies bound to RBC surface, indicating
autoimmune
hemolysis.
13. What is the primary defect in thalassemia major?
A) Decreased alpha or beta globin chain synthesis
B) Abnormal hemoglobin S
C) Membrane defect
D) Enzyme deficiency
Answer: A
4
NEWEST 2026/2027 ACTUAL EXAM COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
WITH RATIONALES|ALREADY GRADED A+||
BRAND NEW VERSION!! (UTA)
SECTION A: HEMATOLOGIC SYSTEM (Questions 1–40)
1. A 68-year-old female presents with fatigue, pallor, and shortness of breath on
exertion.
Laboratory findings: Hb 8.2 g/dL, MCV 72 fL, low serum ferritin. Most likely
diagnosis?
A) Pernicious anemia
B) Iron deficiency anemia
C) Anemia of chronic disease
D) Thalassemia minor
Answer: B
Rationale: Low ferritin + microcytic anemia = iron deficiency. Pernicious anemia
is macrocytic;
ACD has normal/high ferritin; thalassemia has elevated RBC count.
2. A 45-year-old male with CKD (stage 4) has Hb 9.0 g/dL, normal MCV, and low
erythropoietin.
Primary pathophysiological mechanism?
A) Autoimmune RBC destruction
B) Impaired erythropoietin production by kidneys
C) Folate deficiency
D) Bone marrow suppression
Answer: B
Rationale: CKD leads to decreased EPO production by peritubular fibroblasts,
causing normocytic
normochromic anemia.
3. A 30-year-old woman with heavy menstrual bleeding has Hb 7.5 g/dL, MCV 68
fL, RDW 18%.
Which additional finding would confirm iron deficiency?
A) Elevated total iron-binding capacity (TIBC)
B) Low platelet count
1
, C) High serum B12
D) Normal serum iron
Answer: A
Rationale: Iron deficiency causes low serum iron, high TIBC, low ferritin, and
high RDW.
4. A 72-year-old male with atrophic gastritis presents with macrocytic anemia,
neuropathy,
and a positive Schilling test. What is the underlying deficiency?
A) Vitamin B12
B) Folate
C) Iron
D) Vitamin C
Answer: A
Rationale: Atrophic gastritis → loss of intrinsic factor → B12 malabsorption →
pernicious anemia,
macrocytic, neurologic symptoms.
5. Which laboratory finding is characteristic of anemia of chronic disease (ACD)?
A) Low serum ferritin, high TIBC
B) High serum ferritin, low TIBC
C) High MCV, low reticulocyte count
D) Low serum B12, elevated methylmalonic acid
Answer: B
Rationale: ACD shows high ferritin (acute-phase reactant) and low TIBC due to
hepcidin
sequestration of iron.
6. A 55-year-old male with alcohol use disorder has macrocytic anemia, normal
B12 levels,
and elevated homocysteine. Likely deficiency?
A) Vitamin B12
B) Folate
C) Iron
D) Copper
Answer: B
Rationale: Folate deficiency causes macrocytic anemia with normal B12,
elevated homocysteine,
2
, but normal MMA (unlike B12 deficiency).
7. What is the most common cause of microcytic anemia worldwide?
A) Thalassemia
B) Iron deficiency
C) Sideroblastic anemia
D) Lead poisoning
Answer: B
Rationale: Iron deficiency is the most common cause of microcytic anemia
globally, mainly due
to inadequate dietary intake or blood loss.
8. A patient with sickle cell disease experiences a vaso-occlusive crisis. Which
trigger is
most likely to precipitate this?
A) High oxygen tension
B) Dehydration and acidosis
C) Alkalosis
D) Increased RBC deformability
Answer: B
Rationale: Dehydration, acidosis, and hypoxia promote HbS polymerization and
sickling,
leading to vaso-occlusion.
9. Which hemoglobin electrophoresis pattern is consistent with sickle cell trait
(AS)?
A) HbA 60%, HbS 40%
B) HbA 100%
C) HbS > 90%, HbF elevated
D) HbA 0%, HbS 100%
Answer: A
Rationale: Sickle cell trait shows ~60% HbA and ~40% HbS; no symptoms under
normal conditions.
10. A newborn with jaundice, splenomegaly, and hemolytic anemia is diagnosed
with hereditary
spherocytosis. What is the underlying defect?
A) Spectrin deficiency
3
, B) Glucose-6-phosphate dehydrogenase deficiency
C) Sickle cell gene
D) Thalassemia gene
Answer: A
Rationale: Hereditary spherocytosis is due to defects in spectrin or ankyrin,
leading to
loss of membrane surface area and spherocytes.
11. G6PD deficiency is an X-linked disorder that causes hemolysis after exposure
to:
A) Fava beans, sulfa drugs, and infection
B) Iron supplements
C) Vitamin K
D) Cold temperatures
Answer: A
Rationale: G6PD deficiency leads to oxidative stress hemolysis triggered by fava
beans,
sulfonamides, and infections.
12. A 60-year-old with chronic lymphocytic leukemia (CLL) develops autoimmune
hemolytic anemia.
Which test is positive?
A) Direct Coombs test
B) Indirect Coombs test
C) Osmotic fragility test
D) Sickle solubility test
Answer: A
Rationale: Direct Coombs detects antibodies bound to RBC surface, indicating
autoimmune
hemolysis.
13. What is the primary defect in thalassemia major?
A) Decreased alpha or beta globin chain synthesis
B) Abnormal hemoglobin S
C) Membrane defect
D) Enzyme deficiency
Answer: A
4
