,NSG530/NSG 530 Exam 4 Advanced
Pathophysiology | Wilkes University | Q&A|
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1. In which phase of the cardiac cycle does the majority of coronary artery blood flow occur?
A) Atrial systole
B) Ventricular systole
C) Early ventricular diastole
D) Late ventricular diastole
Correct Answer: Early ventricular diastole
Rationale: Coronary perfusion occurs primarily during ventricular diastole when the myocardium is
relaxed and vascular resistance is lowest. During systole, the contracting myocardium compresses
coronary vessels, reducing flow. Atrial systole contributes minimally to coronary flow. Late diastole
has lower pressure gradients compared to early diastole.
2. A patient with iron deficiency anemia is expected to have which laboratory profile?
A) Low ferritin, low TIBC, high serum iron
B) Low ferritin, high TIBC, low serum iron
C) High ferritin, low TIBC, low serum iron
D) High ferritin, high TIBC, high serum iron
Correct Answer: Low ferritin, high TIBC, low serum iron
Rationale: Iron deficiency anemia depletes iron stores (low ferritin) and reduces serum iron, which
triggers increased transferrin production, elevating total iron-binding capacity (TIBC). High ferritin
with low TIBC is seen in anemia of chronic disease. High ferritin with high iron suggests iron overload.
3. Which form of leukemia is characterized by the presence of the Philadelphia chromosome (t(9;22))?
A) Acute lymphoblastic leukemia
B) Chronic myeloid leukemia
C) Acute myeloid leukemia
D) Chronic lymphocytic leukemia
,Correct Answer: Chronic myeloid leukemia
Rationale: The Philadelphia chromosome is a hallmark of chronic myeloid leukemia (CML), producing
the BCR-ABL fusion protein. It can occasionally appear in ALL but is not characteristic. AML and CLL do
not typically feature this translocation.
4. A patient with Graves disease would most likely exhibit which laboratory finding?
A) Elevated TSH, elevated T4
B) Decreased TSH, elevated T4
C) Elevated TSH, decreased T4
D) Decreased TSH, decreased T4
Correct Answer: Decreased TSH, elevated T4
Rationale: Graves disease causes hyperthyroidism through thyroid-stimulating immunoglobulins,
leading to elevated T4 and suppressed TSH via negative feedback. Elevated TSH with decreased T4
indicates primary hypothyroidism. Decreased TSH with decreased T4 suggests secondary
hypothyroidism.
5. Which pathophysiological mechanism is primarily responsible for the clinical manifestations of
pernicious anemia?
A) Impaired hemoglobin synthesis due to iron deficiency
B) Vitamin B12 deficiency from lack of intrinsic factor
C) Folate deficiency from inadequate dietary intake
D) Autoimmune destruction of red blood cell precursors
Correct Answer: Vitamin B12 deficiency from lack of intrinsic factor
Rationale: Pernicious anemia results from autoimmune destruction of gastric parietal cells, leading to
intrinsic factor deficiency and impaired vitamin B12 absorption. Iron deficiency causes microcytic
anemia. Folate deficiency causes macrocytic anemia without neurologic symptoms. Autoimmune
destruction of precursors is not the primary mechanism.
6. A patient with multiple myeloma develops renal failure. Which factor most directly contributes to
this complication?
A) Hypercalcemia and cast nephropathy from immunoglobulin light chains
B) Direct invasion of the kidneys by plasma cells
, C) Amyloid deposition in the glomeruli
D) Obstructive uropathy from retroperitoneal mass
Correct Answer: Hypercalcemia and cast nephropathy from immunoglobulin light chains
Rationale: Renal failure in multiple myeloma results from hypercalcemia and cast nephropathy caused
by precipitation of immunoglobulin light chains (Bence Jones proteins) in renal tubules. Direct
invasion is less common. Amyloidosis can occur but is not the primary cause. Obstructive uropathy is
not characteristic.
7. Which type of anemia is most likely to present with macrocytic red blood cells and hypersegmented
neutrophils?
A) Iron deficiency anemia
B) Anemia of chronic disease
C) Vitamin B12 deficiency anemia
D) Sickle cell anemia
Correct Answer: Vitamin B12 deficiency anemia
Rationale: Vitamin B12 deficiency causes megaloblastic anemia with macrocytic RBCs and
hypersegmented neutrophils due to impaired DNA synthesis. Iron deficiency causes microcytic
anemia. Anemia of chronic disease is normocytic. Sickle cell anemia is normocytic with characteristic
sickle cells.
8. In type 1 diabetes mellitus, the underlying pathophysiological defect is:
A) Insulin resistance with relative insulin deficiency
B) Autoimmune destruction of pancreatic beta cells
C) Impaired insulin secretion due to pancreatic fibrosis
D) Increased hepatic glucose production
Correct Answer: Autoimmune destruction of pancreatic beta cells
Rationale: Type 1 diabetes is caused by autoimmune destruction of beta cells, leading to absolute
insulin deficiency. Insulin resistance is characteristic of type 2 diabetes. Pancreatic fibrosis is seen in
chronic pancreatitis. Increased hepatic glucose production occurs in both types but is secondary.
9. A patient with Hodgkin lymphoma would have which malignant cell type on biopsy?
A) Reed-Sternberg cell
Pathophysiology | Wilkes University | Q&A|
26/27 (PDF)
1. In which phase of the cardiac cycle does the majority of coronary artery blood flow occur?
A) Atrial systole
B) Ventricular systole
C) Early ventricular diastole
D) Late ventricular diastole
Correct Answer: Early ventricular diastole
Rationale: Coronary perfusion occurs primarily during ventricular diastole when the myocardium is
relaxed and vascular resistance is lowest. During systole, the contracting myocardium compresses
coronary vessels, reducing flow. Atrial systole contributes minimally to coronary flow. Late diastole
has lower pressure gradients compared to early diastole.
2. A patient with iron deficiency anemia is expected to have which laboratory profile?
A) Low ferritin, low TIBC, high serum iron
B) Low ferritin, high TIBC, low serum iron
C) High ferritin, low TIBC, low serum iron
D) High ferritin, high TIBC, high serum iron
Correct Answer: Low ferritin, high TIBC, low serum iron
Rationale: Iron deficiency anemia depletes iron stores (low ferritin) and reduces serum iron, which
triggers increased transferrin production, elevating total iron-binding capacity (TIBC). High ferritin
with low TIBC is seen in anemia of chronic disease. High ferritin with high iron suggests iron overload.
3. Which form of leukemia is characterized by the presence of the Philadelphia chromosome (t(9;22))?
A) Acute lymphoblastic leukemia
B) Chronic myeloid leukemia
C) Acute myeloid leukemia
D) Chronic lymphocytic leukemia
,Correct Answer: Chronic myeloid leukemia
Rationale: The Philadelphia chromosome is a hallmark of chronic myeloid leukemia (CML), producing
the BCR-ABL fusion protein. It can occasionally appear in ALL but is not characteristic. AML and CLL do
not typically feature this translocation.
4. A patient with Graves disease would most likely exhibit which laboratory finding?
A) Elevated TSH, elevated T4
B) Decreased TSH, elevated T4
C) Elevated TSH, decreased T4
D) Decreased TSH, decreased T4
Correct Answer: Decreased TSH, elevated T4
Rationale: Graves disease causes hyperthyroidism through thyroid-stimulating immunoglobulins,
leading to elevated T4 and suppressed TSH via negative feedback. Elevated TSH with decreased T4
indicates primary hypothyroidism. Decreased TSH with decreased T4 suggests secondary
hypothyroidism.
5. Which pathophysiological mechanism is primarily responsible for the clinical manifestations of
pernicious anemia?
A) Impaired hemoglobin synthesis due to iron deficiency
B) Vitamin B12 deficiency from lack of intrinsic factor
C) Folate deficiency from inadequate dietary intake
D) Autoimmune destruction of red blood cell precursors
Correct Answer: Vitamin B12 deficiency from lack of intrinsic factor
Rationale: Pernicious anemia results from autoimmune destruction of gastric parietal cells, leading to
intrinsic factor deficiency and impaired vitamin B12 absorption. Iron deficiency causes microcytic
anemia. Folate deficiency causes macrocytic anemia without neurologic symptoms. Autoimmune
destruction of precursors is not the primary mechanism.
6. A patient with multiple myeloma develops renal failure. Which factor most directly contributes to
this complication?
A) Hypercalcemia and cast nephropathy from immunoglobulin light chains
B) Direct invasion of the kidneys by plasma cells
, C) Amyloid deposition in the glomeruli
D) Obstructive uropathy from retroperitoneal mass
Correct Answer: Hypercalcemia and cast nephropathy from immunoglobulin light chains
Rationale: Renal failure in multiple myeloma results from hypercalcemia and cast nephropathy caused
by precipitation of immunoglobulin light chains (Bence Jones proteins) in renal tubules. Direct
invasion is less common. Amyloidosis can occur but is not the primary cause. Obstructive uropathy is
not characteristic.
7. Which type of anemia is most likely to present with macrocytic red blood cells and hypersegmented
neutrophils?
A) Iron deficiency anemia
B) Anemia of chronic disease
C) Vitamin B12 deficiency anemia
D) Sickle cell anemia
Correct Answer: Vitamin B12 deficiency anemia
Rationale: Vitamin B12 deficiency causes megaloblastic anemia with macrocytic RBCs and
hypersegmented neutrophils due to impaired DNA synthesis. Iron deficiency causes microcytic
anemia. Anemia of chronic disease is normocytic. Sickle cell anemia is normocytic with characteristic
sickle cells.
8. In type 1 diabetes mellitus, the underlying pathophysiological defect is:
A) Insulin resistance with relative insulin deficiency
B) Autoimmune destruction of pancreatic beta cells
C) Impaired insulin secretion due to pancreatic fibrosis
D) Increased hepatic glucose production
Correct Answer: Autoimmune destruction of pancreatic beta cells
Rationale: Type 1 diabetes is caused by autoimmune destruction of beta cells, leading to absolute
insulin deficiency. Insulin resistance is characteristic of type 2 diabetes. Pancreatic fibrosis is seen in
chronic pancreatitis. Increased hepatic glucose production occurs in both types but is secondary.
9. A patient with Hodgkin lymphoma would have which malignant cell type on biopsy?
A) Reed-Sternberg cell
