NR 507 NP
MIDTERM EXAM
Verified Questions & Answers With Rationales
Advanced Pathophysiology
Chamberlain
CONSINST OF 100 QUESTIONS
WEEKS 1 – 4 COVERED
,1. Which of the following is the underlying pathology for hay fever?
A. Formation of autoantibodies.
B. Activation of complement.
C. Destruction by T-cells.
D. Mast cell degranulation.
Correct Answer:
Mast Cell Degranulation
Expert Rationale:
Hay fever (allergic rhinitis) is a Type I hypersensitivity reaction. Upon allergen exposure,
IgE bound to mast cells triggers cross-linking and degranulation, releasing histamine,
leukotrienes, and prostaglandins that produce the classic rhinorrhea, sneezing, and
nasal congestion.
2. Which of the following assessment findings would be expected in a patient
who presents with urticaria?
A. Eosinophilia.
B. Decreased thyroid-stimulation hormone level.
C. Thrombocytopenia.
D. Leukopenia.
Correct Answer:
Eosinophilia
Expert Rationale:
Urticaria is a localized Type I hypersensitivity reaction involving mast cell degranulation
in the skin. The inflammatory cascade recruits eosinophils, making eosinophilia a
characteristic laboratory finding in allergic-mediated urticaria.
3. The diagnosis for an individual who presents to the office with sudden swollen
lips and eyes, shortness of breath and throat tightness after a bee sting is:
A. Anaphylaxis.
B. Asthma.
C. Angioedema.
D. Reactive airway disease.
,Correct Answer:
Anaphylaxis
Expert Rationale:
The acute onset of angioedema (swollen lips/eyes), respiratory compromise (shortness
of breath, throat tightness), and known allergen exposure (bee sting) constitutes
anaphylaxis—a systemic, life-threatening IgE-mediated reaction requiring immediate
epinephrine administration.
4. Damage occurs with ABO incompatibility because:
A. Complement damages RBC membrane causing cell lysis.
B. Mast cell degranulation.
C. Autoantibodies specific for thyroid tissue impairs the receptors for TSH.
D. Antigen/Antibody complexes attack the RBC.
Correct Answer:
Complement damages RBC membrane causing cell lysis
Expert Rationale:
ABO incompatibility triggers a Type II cytotoxic hypersensitivity reaction. Pre-formed
anti-A or anti-B antibodies bind to foreign RBC surface antigens, activating the classical
complement cascade and causing intravascular hemolysis via membrane attack
complex (MAC) formation.
5. Which is true about a primary immunodeficiency?
A. It is the result of a single gene defect.
B. It appears primarily in older adults.
C. It is usually inherited.
D. It is the result of multiple gene defects.
Correct Answer:
It is the result of a single gene defect.
Expert Rationale:
Primary immunodeficiencies are congenital disorders arising from genetic mutations—
most commonly single gene defects (e.g., SCID, CGD, Wiskott-Aldrich). They are
present from birth and are distinct from secondary (acquired) immunodeficiencies.
,6. _____________ is a predominant cause of secondary immune deficiencies
worldwide.
Correct Answer:
Malnutrition
7. An example of a secondary immunodeficiency is:
A. Job Syndrome.
B. Common Variable Immunodeficiency.
C. Familial Mediterranean Fever.
D. Pneumocystis Carinii.
Correct Answer:
Pneumocystis Carinii.
Expert Rationale:
Pneumocystis jirovecii (formerly carinii) pneumonia is an opportunistic infection that
occurs in immunocompromised hosts, most notably HIV/AIDS patients. It represents a
secondary (acquired) immunodeficiency resulting from viral destruction of CD4+ T-
helper cells.
8. An example of a primary immunodeficiency is:
A. Sinus Infection.
B. Human Immunodeficiency virus.
C. Pneumonia.
D. Chronic Granulomatous Disease.
Correct Answer:
Chronic Granulomatous Disease
Expert Rationale:
Chronic Granulomatous Disease (CGD) is a genetic defect in the NADPH oxidase
complex, impairing the phagocyte respiratory burst. It is a classic primary
immunodeficiency with X-linked or autosomal recessive inheritance.
9. True or False: Cancer is a secondary immunodeficiency.
Correct Answer:
True
,10. Sinusitis is considered a primary immunodeficiency.?
Correct Answer:
False
11. Select the best statement below that describes a primary immunodeficiency:
A. Are less common and occur due to a defect on the development of the immune
system.
B. Conditions where the immune system becomes compromised because of something
else.
Correct Answer:
Are less common and occur due to a defect on the development of the immune system.
Expert Rationale:
Primary immunodeficiencies are congenital or inherited defects in immune cell
development or function. They are less common than secondary immunodeficiencies
and are distinct from conditions where external factors (infection, drugs, malnutrition)
compromise an otherwise normal immune system.
12. A patient with human immunodeficiency virus (HIV) was admitted to the acute
care facility with difficulty breathing. He is diagnosed with Pneumocytis carinii.
Pneumocystis carinii an example of:
A. A primary immune disease.
B. A secondary immune disease.
Correct Answer:
A secondary immune disease
Expert Rationale:
Pneumocystis pneumonia in an HIV-positive patient is an opportunistic infection
secondary to the acquired immunodeficiency caused by HIV-mediated depletion of
CD4+ T-lymphocytes.
13. The major immune system change associated with Sjogren's Syndrome is:
A. Autoantibodies and auto-reactive T-cells against apoptotic cells.
B. Autoantibodies and auto-reactive T-cells and B-cells against joint-associated
,antigens.
C. Autoantibodies and auto-reactive T-cells against brain antigens.
D. Autoantibodies and auto-active T-cells against DNA and nucleoprotein antigens
Correct Answer:
Autoantibodies and auto-reactive T-cells against apoptotic cells.
Expert Rationale:
Sjögren's syndrome is characterized by lymphocytic infiltration of exocrine glands
(salivary and lacrimal). The pathogenesis involves autoantibodies (anti-SSA/Ro, anti-
SSB/La) and autoreactive T-cells targeting glandular epithelial cells undergoing
apoptosis, leading to glandular dysfunction and dryness.
14. Which of the following findings can be used to diagnose Systemic Lupus
Erythematosus (SLE)?
A. Facial rash confined to the cheeks.
B. Low back pain.
C. Fever.
D. Headache.
Correct Answer:
Facial rash confined to the cheeks.
Expert Rationale:
The malar or "butterfly" rash across the cheeks and nasal bridge is a pathognomonic
cutaneous manifestation of SLE and is one of the 11 classification criteria established
by the American College of Rheumatology (ACR).
15. The ____________ test is positive in 90% of patients diagnosed with Systemic
Lupus Erythematosus (SLE).
Correct Answer:
Antinuclear Antibody (ANA)
16. A renal disease most often associated with autoimmunity is:
A. Cystitis.
B. Renal lithiasis.
C. Urinary Tract Infection.
D. Glomerulonephritis.
,Correct Answer:
Glomerulonephritis.
Expert Rationale:
Glomerulonephritis is the most common renal manifestation of systemic autoimmune
diseases, particularly SLE (lupus nephritis), where immune complex deposition in the
glomerular basement membrane triggers complement activation and inflammatory
damage.
17. The presence of a low number of autoantibodies is an indicator that the
individual will develop an autoimmune disease.
Correct Answer:
False
18. The following immune components can be involved in autoimmune diseases:
T-Cells, B-cells and autoantibodies.
Correct Answer:
true
19. Which of the following assessment findings would support a diagnosis of
Rheumatoid Arthritis (RA)?
A. Muscle weakness and ataxia.
B. Inflammation in the salivary and lacrimal glands.
C. A butterfly rash across the facial cheeks.
D. Swollen metacarpophalangeal joints.
Correct Answer:
Swollen metacarpophalangeal joints.
Expert Rationale:
Rheumatoid arthritis is a symmetric inflammatory polyarthritis primarily affecting the
small joints of the hands and feet, particularly the metacarpophalangeal (MCP) and
proximal interphalangeal (PIP) joints, causing characteristic swelling, pain, and morning
stiffness.
,20. The presenting signs and symptoms of an autoimmune disease is similar
across all autoimmune diseases.
Correct Answer:
False
21. Which of the following indices measures the average size of red blood cells?
A. Mean Corpuscular Volume (MCV).
B. Hemoglobin (Hb).
C. Reticulocyte count.
D. Mean Corpuscular Hemoglobin Concentration (MCHC).
Correct Answer:
Mean Corpuscular Volume (MCV).
Expert Rationale:
MCV measures the average volume of individual erythrocytes in femtoliters (fL). It is the
primary index used to morphologically classify anemias as microcytic (<80 fL),
normocytic (80–100 fL), or macrocytic (>100 fL).
22. Which of the following is not a clinical characteristic of anemia?
A. Pallor
B. Bradycardia
C. Dyspnea
D. Fatigue
Correct Answer:
Bradycardia
Expert Rationale:
Anemia reduces oxygen-carrying capacity, triggering compensatory mechanisms
including tachycardia (not bradycardia) to maintain cardiac output. Pallor, dyspnea, and
fatigue are classic manifestations of tissue hypoxia.
23. Which of the following microcytic anemias is characterized by hyperchromic
RBCs?
A. Folate deficiency.
B. Hereditary spherocytosis.
, C. Iron deficiency.
D. B12 deficiency.
Correct Answer:
Hereditary spherocytosis.
Expert Rationale:
Hereditary spherocytosis is a microcytic anemia due to loss of membrane surface area,
but it is characterized by hyperchromic RBCs (increased MCHC) because hemoglobin
concentration is preserved relative to the reduced cell volume. Folate and B12
deficiencies produce macrocytic anemias; iron deficiency is microcytic-hypochromic.
24. Anemia can be caused from which of the following? (Select all that apply.)
A. Impaired red blood cell production.
B. Increased red blood cell destruction.
C. Excessive blood loss.
Correct Answer:
Impaired red blood cell production. Increased red blood cell destruction. Excessive
blood loss.
Expert Rationale:
Anemia results from three fundamental mechanisms: (1) decreased erythropoiesis
(nutritional deficiency, bone marrow failure), (2) increased hemolysis (intrinsic RBC
defects, autoimmune destruction), and (3) blood loss (acute or chronic hemorrhage).
25. The terms normocytic, microcytic, and macrocytic characterizes red blood
cells by their:
A. Shape
B. Color
C. Size
D. Variability
Correct Answer:
size
Expert Rationale:
These terms classify erythrocytes by their size (volume) as measured by MCV.
Normocytic = normal size; microcytic = small; macrocytic = large. Shape is described by
terms such as spherocyte, elliptocyte, or schistocyte.
MIDTERM EXAM
Verified Questions & Answers With Rationales
Advanced Pathophysiology
Chamberlain
CONSINST OF 100 QUESTIONS
WEEKS 1 – 4 COVERED
,1. Which of the following is the underlying pathology for hay fever?
A. Formation of autoantibodies.
B. Activation of complement.
C. Destruction by T-cells.
D. Mast cell degranulation.
Correct Answer:
Mast Cell Degranulation
Expert Rationale:
Hay fever (allergic rhinitis) is a Type I hypersensitivity reaction. Upon allergen exposure,
IgE bound to mast cells triggers cross-linking and degranulation, releasing histamine,
leukotrienes, and prostaglandins that produce the classic rhinorrhea, sneezing, and
nasal congestion.
2. Which of the following assessment findings would be expected in a patient
who presents with urticaria?
A. Eosinophilia.
B. Decreased thyroid-stimulation hormone level.
C. Thrombocytopenia.
D. Leukopenia.
Correct Answer:
Eosinophilia
Expert Rationale:
Urticaria is a localized Type I hypersensitivity reaction involving mast cell degranulation
in the skin. The inflammatory cascade recruits eosinophils, making eosinophilia a
characteristic laboratory finding in allergic-mediated urticaria.
3. The diagnosis for an individual who presents to the office with sudden swollen
lips and eyes, shortness of breath and throat tightness after a bee sting is:
A. Anaphylaxis.
B. Asthma.
C. Angioedema.
D. Reactive airway disease.
,Correct Answer:
Anaphylaxis
Expert Rationale:
The acute onset of angioedema (swollen lips/eyes), respiratory compromise (shortness
of breath, throat tightness), and known allergen exposure (bee sting) constitutes
anaphylaxis—a systemic, life-threatening IgE-mediated reaction requiring immediate
epinephrine administration.
4. Damage occurs with ABO incompatibility because:
A. Complement damages RBC membrane causing cell lysis.
B. Mast cell degranulation.
C. Autoantibodies specific for thyroid tissue impairs the receptors for TSH.
D. Antigen/Antibody complexes attack the RBC.
Correct Answer:
Complement damages RBC membrane causing cell lysis
Expert Rationale:
ABO incompatibility triggers a Type II cytotoxic hypersensitivity reaction. Pre-formed
anti-A or anti-B antibodies bind to foreign RBC surface antigens, activating the classical
complement cascade and causing intravascular hemolysis via membrane attack
complex (MAC) formation.
5. Which is true about a primary immunodeficiency?
A. It is the result of a single gene defect.
B. It appears primarily in older adults.
C. It is usually inherited.
D. It is the result of multiple gene defects.
Correct Answer:
It is the result of a single gene defect.
Expert Rationale:
Primary immunodeficiencies are congenital disorders arising from genetic mutations—
most commonly single gene defects (e.g., SCID, CGD, Wiskott-Aldrich). They are
present from birth and are distinct from secondary (acquired) immunodeficiencies.
,6. _____________ is a predominant cause of secondary immune deficiencies
worldwide.
Correct Answer:
Malnutrition
7. An example of a secondary immunodeficiency is:
A. Job Syndrome.
B. Common Variable Immunodeficiency.
C. Familial Mediterranean Fever.
D. Pneumocystis Carinii.
Correct Answer:
Pneumocystis Carinii.
Expert Rationale:
Pneumocystis jirovecii (formerly carinii) pneumonia is an opportunistic infection that
occurs in immunocompromised hosts, most notably HIV/AIDS patients. It represents a
secondary (acquired) immunodeficiency resulting from viral destruction of CD4+ T-
helper cells.
8. An example of a primary immunodeficiency is:
A. Sinus Infection.
B. Human Immunodeficiency virus.
C. Pneumonia.
D. Chronic Granulomatous Disease.
Correct Answer:
Chronic Granulomatous Disease
Expert Rationale:
Chronic Granulomatous Disease (CGD) is a genetic defect in the NADPH oxidase
complex, impairing the phagocyte respiratory burst. It is a classic primary
immunodeficiency with X-linked or autosomal recessive inheritance.
9. True or False: Cancer is a secondary immunodeficiency.
Correct Answer:
True
,10. Sinusitis is considered a primary immunodeficiency.?
Correct Answer:
False
11. Select the best statement below that describes a primary immunodeficiency:
A. Are less common and occur due to a defect on the development of the immune
system.
B. Conditions where the immune system becomes compromised because of something
else.
Correct Answer:
Are less common and occur due to a defect on the development of the immune system.
Expert Rationale:
Primary immunodeficiencies are congenital or inherited defects in immune cell
development or function. They are less common than secondary immunodeficiencies
and are distinct from conditions where external factors (infection, drugs, malnutrition)
compromise an otherwise normal immune system.
12. A patient with human immunodeficiency virus (HIV) was admitted to the acute
care facility with difficulty breathing. He is diagnosed with Pneumocytis carinii.
Pneumocystis carinii an example of:
A. A primary immune disease.
B. A secondary immune disease.
Correct Answer:
A secondary immune disease
Expert Rationale:
Pneumocystis pneumonia in an HIV-positive patient is an opportunistic infection
secondary to the acquired immunodeficiency caused by HIV-mediated depletion of
CD4+ T-lymphocytes.
13. The major immune system change associated with Sjogren's Syndrome is:
A. Autoantibodies and auto-reactive T-cells against apoptotic cells.
B. Autoantibodies and auto-reactive T-cells and B-cells against joint-associated
,antigens.
C. Autoantibodies and auto-reactive T-cells against brain antigens.
D. Autoantibodies and auto-active T-cells against DNA and nucleoprotein antigens
Correct Answer:
Autoantibodies and auto-reactive T-cells against apoptotic cells.
Expert Rationale:
Sjögren's syndrome is characterized by lymphocytic infiltration of exocrine glands
(salivary and lacrimal). The pathogenesis involves autoantibodies (anti-SSA/Ro, anti-
SSB/La) and autoreactive T-cells targeting glandular epithelial cells undergoing
apoptosis, leading to glandular dysfunction and dryness.
14. Which of the following findings can be used to diagnose Systemic Lupus
Erythematosus (SLE)?
A. Facial rash confined to the cheeks.
B. Low back pain.
C. Fever.
D. Headache.
Correct Answer:
Facial rash confined to the cheeks.
Expert Rationale:
The malar or "butterfly" rash across the cheeks and nasal bridge is a pathognomonic
cutaneous manifestation of SLE and is one of the 11 classification criteria established
by the American College of Rheumatology (ACR).
15. The ____________ test is positive in 90% of patients diagnosed with Systemic
Lupus Erythematosus (SLE).
Correct Answer:
Antinuclear Antibody (ANA)
16. A renal disease most often associated with autoimmunity is:
A. Cystitis.
B. Renal lithiasis.
C. Urinary Tract Infection.
D. Glomerulonephritis.
,Correct Answer:
Glomerulonephritis.
Expert Rationale:
Glomerulonephritis is the most common renal manifestation of systemic autoimmune
diseases, particularly SLE (lupus nephritis), where immune complex deposition in the
glomerular basement membrane triggers complement activation and inflammatory
damage.
17. The presence of a low number of autoantibodies is an indicator that the
individual will develop an autoimmune disease.
Correct Answer:
False
18. The following immune components can be involved in autoimmune diseases:
T-Cells, B-cells and autoantibodies.
Correct Answer:
true
19. Which of the following assessment findings would support a diagnosis of
Rheumatoid Arthritis (RA)?
A. Muscle weakness and ataxia.
B. Inflammation in the salivary and lacrimal glands.
C. A butterfly rash across the facial cheeks.
D. Swollen metacarpophalangeal joints.
Correct Answer:
Swollen metacarpophalangeal joints.
Expert Rationale:
Rheumatoid arthritis is a symmetric inflammatory polyarthritis primarily affecting the
small joints of the hands and feet, particularly the metacarpophalangeal (MCP) and
proximal interphalangeal (PIP) joints, causing characteristic swelling, pain, and morning
stiffness.
,20. The presenting signs and symptoms of an autoimmune disease is similar
across all autoimmune diseases.
Correct Answer:
False
21. Which of the following indices measures the average size of red blood cells?
A. Mean Corpuscular Volume (MCV).
B. Hemoglobin (Hb).
C. Reticulocyte count.
D. Mean Corpuscular Hemoglobin Concentration (MCHC).
Correct Answer:
Mean Corpuscular Volume (MCV).
Expert Rationale:
MCV measures the average volume of individual erythrocytes in femtoliters (fL). It is the
primary index used to morphologically classify anemias as microcytic (<80 fL),
normocytic (80–100 fL), or macrocytic (>100 fL).
22. Which of the following is not a clinical characteristic of anemia?
A. Pallor
B. Bradycardia
C. Dyspnea
D. Fatigue
Correct Answer:
Bradycardia
Expert Rationale:
Anemia reduces oxygen-carrying capacity, triggering compensatory mechanisms
including tachycardia (not bradycardia) to maintain cardiac output. Pallor, dyspnea, and
fatigue are classic manifestations of tissue hypoxia.
23. Which of the following microcytic anemias is characterized by hyperchromic
RBCs?
A. Folate deficiency.
B. Hereditary spherocytosis.
, C. Iron deficiency.
D. B12 deficiency.
Correct Answer:
Hereditary spherocytosis.
Expert Rationale:
Hereditary spherocytosis is a microcytic anemia due to loss of membrane surface area,
but it is characterized by hyperchromic RBCs (increased MCHC) because hemoglobin
concentration is preserved relative to the reduced cell volume. Folate and B12
deficiencies produce macrocytic anemias; iron deficiency is microcytic-hypochromic.
24. Anemia can be caused from which of the following? (Select all that apply.)
A. Impaired red blood cell production.
B. Increased red blood cell destruction.
C. Excessive blood loss.
Correct Answer:
Impaired red blood cell production. Increased red blood cell destruction. Excessive
blood loss.
Expert Rationale:
Anemia results from three fundamental mechanisms: (1) decreased erythropoiesis
(nutritional deficiency, bone marrow failure), (2) increased hemolysis (intrinsic RBC
defects, autoimmune destruction), and (3) blood loss (acute or chronic hemorrhage).
25. The terms normocytic, microcytic, and macrocytic characterizes red blood
cells by their:
A. Shape
B. Color
C. Size
D. Variability
Correct Answer:
size
Expert Rationale:
These terms classify erythrocytes by their size (volume) as measured by MCV.
Normocytic = normal size; microcytic = small; macrocytic = large. Shape is described by
terms such as spherocyte, elliptocyte, or schistocyte.
