2026/2027
Wilkes University NSG 530
Advanced Pathophysiology Exam II
2026/2027 Structured Quizzes and
High-Yield Review Guide
Question 1: Hematopoiesis and DNA synthesis
Which of the following coenzymes is/are essential for normal red blood cell nuclear
maturation and DNA synthesis?
A. Vitamin D
B. Folate
C. Calcium
D. Vitamin B12 (cobalamin)
E. Both folate and vitamin B12 (cobalamin)
Correct Answer: E. Both folate and vitamin B12 (cobalamin)
Rationale: Folate and vitamin B12 are both essential for DNA synthesis and proper
maturation of red blood cells. They play a key role in thymidine production, which is
necessary for DNA replication. Deficiency in either leads to megaloblastic anemia
due to impaired nuclear maturation. Vitamin D and calcium are not involved in DNA
synthesis, making them incorrect.
Question 2: Von Willebrand factor function
Von Willebrand factor is directly involved in:
A. Platelet production
B. Platelet adhesion and aggregation
C. Formation of fibrin clot
D. Clot dissolution
Correct Answer: B. Platelet adhesion and aggregation
Rationale: Von Willebrand factor (vWF) is crucial for platelet adhesion to damaged
endothelium and stabilizing factor VIII. It does not directly form fibrin (that is
thrombin/fibrinogen), nor does it dissolve clots. Platelet production occurs in the bone
marrow, not via vWF.
Question 3: Coagulation cofactors
,2026/2027
Which of the following are two important cofactors in the coagulation cascade?
A. Fibrinogen and von Willebrand factor
B. Thromboxane A2 and calcium
C. Fibrin and thrombin
D. Fibrinogen and calcium
Correct Answer: D. Fibrinogen and calcium
Rationale: Calcium is an essential cofactor for multiple steps in the coagulation
cascade, and fibrinogen is the precursor of fibrin, the final clot mesh. Thrombin is an
enzyme, not a cofactor, and thromboxane A2 mainly promotes platelet aggregation
rather than acting as a coagulation cofactor.
Question 4: Mechanism of tPA
Recombinant tissue plasminogen activator (tPA) promotes fibrinolysis by:
A. Decreasing platelet adhesion
B. Increasing clotting time
C. Promoting fibrinolysis
D. Causing coronary vasodilation
Correct Answer: C. Promoting fibrinolysis
Rationale: tPA converts plasminogen into plasmin, which breaks down fibrin clots,
leading to fibrinolysis. It does not directly affect vasodilation or platelet adhesion, and
its primary effect is clot breakdown, not prolongation of clotting time.
Question 5: Hodgkin lymphoma presentation
A young woman presents with painless lymphadenopathy, night sweats, weight loss,
and fever. Most likely diagnosis is:
A. Non-Hodgkin lymphoma
B. Hodgkin lymphoma
C. Burkitt lymphoma
D. Multiple myeloma
Correct Answer: B. Hodgkin lymphoma
Rationale: Hodgkin lymphoma classically presents with painless lymph node
enlargement and B symptoms (fever, night sweats, weight loss). Non-Hodgkin
lymphoma is more variable and often more widespread at diagnosis. Burkitt
lymphoma is aggressive and rapidly growing, while multiple myeloma involves
plasma cells and bone lesions.
,2026/2027
Question 6: Genetic defect in Hodgkin lymphoma
Hodgkin lymphoma is commonly associated with:
A. T-cell inactivation of B cells
B. Premature apoptosis due to lack of differentiation
C. Errors in immunoglobulin gene rearrangement
D. Increased plasma cell transformation
Correct Answer: C. Errors in immunoglobulin gene rearrangement
Rationale: Hodgkin lymphoma originates from B cells that have undergone abnormal
immunoglobulin gene rearrangement, leading to malignant transformation. T-cell
inactivation and plasma cell transformation are not primary mechanisms.
Question 7: Mediastinal mass lymphoma
A patient with a mediastinal mass and mediastinal lymphadenopathy most likely has:
A. Hodgkin lymphoma
B. Non-Hodgkin lymphoma
C. Myelodysplastic syndrome
D. Ewing sarcoma
Correct Answer: A. Hodgkin lymphoma
Rationale: Hodgkin lymphoma commonly involves mediastinal lymph nodes and may
present as a mediastinal mass. Non-Hodgkin lymphoma can occur anywhere but is
less classically mediastinal in presentation.
Question 8: Non-Hodgkin lymphoma characteristic
Which of the following is characteristic of non-Hodgkin lymphoma compared to
Hodgkin lymphoma?
A. Rare occurrence
B. Reed-Sternberg cells present
C. Multiple lymph node regions involved
D. Common in young adults only
Correct Answer: C. Multiple lymph node regions involved
Rationale: Non-Hodgkin lymphoma often presents with widespread lymph node
involvement. Reed-Sternberg cells are specific to Hodgkin lymphoma. NHL is more
common overall and affects a broader age range.
, 2026/2027
Question 9: Burkitt lymphoma
A child from Africa presents with jaw swelling and facial bone distortion. Most likely
diagnosis:
A. Burkitt lymphoma
B. Large cell lymphoma
C. Lymphoblastic lymphoma
D. Hodgkin lymphoma
Correct Answer: A. Burkitt lymphoma
Rationale: Endemic Burkitt lymphoma is strongly associated with Epstein-Barr virus
and presents with jaw/facial bone tumors in African children. Other lymphomas do
not typically present with jaw involvement.
Question 10: Multiple myeloma marker
Which is characteristic of multiple myeloma?
A. Low calcium levels
B. High platelet count
C. High neutrophil count
D. Punched-out lytic bone lesions
Correct Answer: D. Punched-out lytic bone lesions
Rationale: Multiple myeloma causes osteolytic lesions due to bone destruction. It also
typically causes hypercalcemia, not hypocalcemia. Platelets and neutrophils are not
primary diagnostic features.
Question 11: Leukemia progression risk
Myelodysplastic syndrome most commonly progresses to:
A. Acute myelogenous leukemia
B. Acute lymphocytic leukemia
C. Multiple myeloma
D. Chronic lymphocytic leukemia
Correct Answer: A. Acute myelogenous leukemia
Rationale: Myelodysplastic syndromes are pre-leukemic conditions that often
transform into AML due to accumulation of genetic mutations in myeloid stem cells.
Question 12: Philadelphia chromosome
Wilkes University NSG 530
Advanced Pathophysiology Exam II
2026/2027 Structured Quizzes and
High-Yield Review Guide
Question 1: Hematopoiesis and DNA synthesis
Which of the following coenzymes is/are essential for normal red blood cell nuclear
maturation and DNA synthesis?
A. Vitamin D
B. Folate
C. Calcium
D. Vitamin B12 (cobalamin)
E. Both folate and vitamin B12 (cobalamin)
Correct Answer: E. Both folate and vitamin B12 (cobalamin)
Rationale: Folate and vitamin B12 are both essential for DNA synthesis and proper
maturation of red blood cells. They play a key role in thymidine production, which is
necessary for DNA replication. Deficiency in either leads to megaloblastic anemia
due to impaired nuclear maturation. Vitamin D and calcium are not involved in DNA
synthesis, making them incorrect.
Question 2: Von Willebrand factor function
Von Willebrand factor is directly involved in:
A. Platelet production
B. Platelet adhesion and aggregation
C. Formation of fibrin clot
D. Clot dissolution
Correct Answer: B. Platelet adhesion and aggregation
Rationale: Von Willebrand factor (vWF) is crucial for platelet adhesion to damaged
endothelium and stabilizing factor VIII. It does not directly form fibrin (that is
thrombin/fibrinogen), nor does it dissolve clots. Platelet production occurs in the bone
marrow, not via vWF.
Question 3: Coagulation cofactors
,2026/2027
Which of the following are two important cofactors in the coagulation cascade?
A. Fibrinogen and von Willebrand factor
B. Thromboxane A2 and calcium
C. Fibrin and thrombin
D. Fibrinogen and calcium
Correct Answer: D. Fibrinogen and calcium
Rationale: Calcium is an essential cofactor for multiple steps in the coagulation
cascade, and fibrinogen is the precursor of fibrin, the final clot mesh. Thrombin is an
enzyme, not a cofactor, and thromboxane A2 mainly promotes platelet aggregation
rather than acting as a coagulation cofactor.
Question 4: Mechanism of tPA
Recombinant tissue plasminogen activator (tPA) promotes fibrinolysis by:
A. Decreasing platelet adhesion
B. Increasing clotting time
C. Promoting fibrinolysis
D. Causing coronary vasodilation
Correct Answer: C. Promoting fibrinolysis
Rationale: tPA converts plasminogen into plasmin, which breaks down fibrin clots,
leading to fibrinolysis. It does not directly affect vasodilation or platelet adhesion, and
its primary effect is clot breakdown, not prolongation of clotting time.
Question 5: Hodgkin lymphoma presentation
A young woman presents with painless lymphadenopathy, night sweats, weight loss,
and fever. Most likely diagnosis is:
A. Non-Hodgkin lymphoma
B. Hodgkin lymphoma
C. Burkitt lymphoma
D. Multiple myeloma
Correct Answer: B. Hodgkin lymphoma
Rationale: Hodgkin lymphoma classically presents with painless lymph node
enlargement and B symptoms (fever, night sweats, weight loss). Non-Hodgkin
lymphoma is more variable and often more widespread at diagnosis. Burkitt
lymphoma is aggressive and rapidly growing, while multiple myeloma involves
plasma cells and bone lesions.
,2026/2027
Question 6: Genetic defect in Hodgkin lymphoma
Hodgkin lymphoma is commonly associated with:
A. T-cell inactivation of B cells
B. Premature apoptosis due to lack of differentiation
C. Errors in immunoglobulin gene rearrangement
D. Increased plasma cell transformation
Correct Answer: C. Errors in immunoglobulin gene rearrangement
Rationale: Hodgkin lymphoma originates from B cells that have undergone abnormal
immunoglobulin gene rearrangement, leading to malignant transformation. T-cell
inactivation and plasma cell transformation are not primary mechanisms.
Question 7: Mediastinal mass lymphoma
A patient with a mediastinal mass and mediastinal lymphadenopathy most likely has:
A. Hodgkin lymphoma
B. Non-Hodgkin lymphoma
C. Myelodysplastic syndrome
D. Ewing sarcoma
Correct Answer: A. Hodgkin lymphoma
Rationale: Hodgkin lymphoma commonly involves mediastinal lymph nodes and may
present as a mediastinal mass. Non-Hodgkin lymphoma can occur anywhere but is
less classically mediastinal in presentation.
Question 8: Non-Hodgkin lymphoma characteristic
Which of the following is characteristic of non-Hodgkin lymphoma compared to
Hodgkin lymphoma?
A. Rare occurrence
B. Reed-Sternberg cells present
C. Multiple lymph node regions involved
D. Common in young adults only
Correct Answer: C. Multiple lymph node regions involved
Rationale: Non-Hodgkin lymphoma often presents with widespread lymph node
involvement. Reed-Sternberg cells are specific to Hodgkin lymphoma. NHL is more
common overall and affects a broader age range.
, 2026/2027
Question 9: Burkitt lymphoma
A child from Africa presents with jaw swelling and facial bone distortion. Most likely
diagnosis:
A. Burkitt lymphoma
B. Large cell lymphoma
C. Lymphoblastic lymphoma
D. Hodgkin lymphoma
Correct Answer: A. Burkitt lymphoma
Rationale: Endemic Burkitt lymphoma is strongly associated with Epstein-Barr virus
and presents with jaw/facial bone tumors in African children. Other lymphomas do
not typically present with jaw involvement.
Question 10: Multiple myeloma marker
Which is characteristic of multiple myeloma?
A. Low calcium levels
B. High platelet count
C. High neutrophil count
D. Punched-out lytic bone lesions
Correct Answer: D. Punched-out lytic bone lesions
Rationale: Multiple myeloma causes osteolytic lesions due to bone destruction. It also
typically causes hypercalcemia, not hypocalcemia. Platelets and neutrophils are not
primary diagnostic features.
Question 11: Leukemia progression risk
Myelodysplastic syndrome most commonly progresses to:
A. Acute myelogenous leukemia
B. Acute lymphocytic leukemia
C. Multiple myeloma
D. Chronic lymphocytic leukemia
Correct Answer: A. Acute myelogenous leukemia
Rationale: Myelodysplastic syndromes are pre-leukemic conditions that often
transform into AML due to accumulation of genetic mutations in myeloid stem cells.
Question 12: Philadelphia chromosome
