ADVANCED PATHOPHYSIOLOGY MIDTERM EXAM
QUESTIONS AND 100% CORRECT ANSWERS 2025
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. Exami- nation of the peripheral
blood smear reveals numerous blasts. The blasts lack peroxidase-positive granules
but do contain periodic acid-Schiff (PAS)-posi- tive aggregates and stain positively
for TdT. Flow cytometry shows the pheno- type 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
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 micro- cytic
red cells. Total serum iron level is normal. The reticulocyte count is 10%.
Hemoglobin electrophoresis shows very little hemoglobin 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
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
A 76-year-old female notices that small, pinpoint to blotchy areas of super- ficial
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
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
Low dose aspirin is commonly used to reduce the risk of arterial thrombo- sis 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
,A 24-year-old presents to the office with fatigue. On physical exam, the NP notices
that she ispale with the following vital signs: HR 112, BP 98/64,
resp 20, O2 sats 99%. Her CBC shows: WBC6,000, Hemoglobin 9.6, Hematocrit
30.2, MCV is decreased at 76. What is the mostly likely causeof this patient's
anemia?
a. Iron deficiency anemia caused by menstruation
b. Beta Thalassemia of genetic origin
c. Pernicious anemia caused by dietary deficiency
d. Folate deficiency caused by alcoholism: Iron deficiency anemia caused by
menstruation
A 65-year-old female presents to your office complaining of fatigue. She has a
long of rheumatoid arthritis. A CBC reveals the following: Hgb=11.6 g/dL,
Hct=34.8%, MCV=87 fL/red cell, platelet count of 268,000/microliter, and WBC
count of 6800/microliter. The serum haptoglobin level is normal, and the serum
iron concentration is 20 micrograms/dL. The total iron binding capacity is 195
micrograms/dL, and the percent saturation is 10.2. The serum ferritin concentration
is 317 ng/mL. No fibrin split products are detected. The reticulocyte concentration
is 1.1%. What is the most likely diagnosis?
a. Beta- thalassemia major
b. Anemia of chronic disease
c. Acute blood loss anemia
d. Iron deficiency anemia: Anemia of chronic disease
A 14-year-old male presents with high fever for ten days. Physical examina- tion
reveals scattered petechial hemorrhages but is negative for enlargement of the liver
or spleen or lymph nodes. Bone marrow examination does not show any abnormal
cells. The complete blood count (CBC) demonstrates a hemoglobin concentration
(HgB) of 13.2 g/dL, hematocrit (Hct) of 38.9%, mean cell volume (MCV) of 93 fL,
platelet count of 175,000/microliter, and white blood cell (WBC) count of
1850/microliter, with the differential count showing 1 segmented neutrophil, 98
lymphocytes, and 1 monocyte per 100 WBCs. What is the most likely cause of these
findings?
a. Overwhelming bacterial infection
b. Acute lymphocytic (or lymphoblastic) leukemia
c. Acute myeloid leukemia
d. Aplastic anemia: Overwhelming bacterial infection
, A 31-year-old male has a history of chronic anemia and painful crises with joint and
abdominal pain. A head computed tomography (CT) scan reveals several small
remote infarctions. During one of these acute crises, he is admitted with severe
dyspnea. A CBC is performed. Which of the following morphologic findings for
RBCs is most likely to be seen on the peripheral blood smear
a. Tear drop cells
b. Schistocytes
c. Sickle cells
d. Spherocytes: Sickle cells
A 50-year-old male has a blood pressure of 160/95 mm Hg. If this condition remains
untreated for years, which of the following cardiovascular alterations will be seen on
a transthoracic echocardiogram and ECG?
a. Left Ventricular Hypertrophy
b. Left Ventricular Atrophy
c. Left Atrial Atrophy
d. Right Ventricular Hypertrophy: Left ventricular hypertrophy
A 65-year-old male with longstanding uncontrolled HTN presents to the of- fice for
evaluation of syncope. His vital signs are temperature=98.3, Pulse=85, RR=17,
BP=165/85. Physical examination reveals a fourth heart sound and a 4/6
crescendo-decrescendo murmur heard at the right upper sternal border with
radiation to the carotid arteries. His ECG reveals enlarged QRS waves, consistent
with left ventricular hypertrophy. What is the most likely cause of his syncopal
episodes?
a. Mitral regurgitation
b. Mitral Stenosis
c. Aortic regurgitation
d. Aortic stenosis: Aortic stenosis
A 63-year-old female presents to the emergency room with sudden onset of severe
chest and back pain. She describes the pain as sharp and different from her anginal
pain. Her past medical history is positive for HTN X 20 years. VS: HR 105, BP
QUESTIONS AND 100% CORRECT ANSWERS 2025
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. Exami- nation of the peripheral
blood smear reveals numerous blasts. The blasts lack peroxidase-positive granules
but do contain periodic acid-Schiff (PAS)-posi- tive aggregates and stain positively
for TdT. Flow cytometry shows the pheno- type 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
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 micro- cytic
red cells. Total serum iron level is normal. The reticulocyte count is 10%.
Hemoglobin electrophoresis shows very little hemoglobin 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
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
A 76-year-old female notices that small, pinpoint to blotchy areas of super- ficial
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
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
Low dose aspirin is commonly used to reduce the risk of arterial thrombo- sis 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
,A 24-year-old presents to the office with fatigue. On physical exam, the NP notices
that she ispale with the following vital signs: HR 112, BP 98/64,
resp 20, O2 sats 99%. Her CBC shows: WBC6,000, Hemoglobin 9.6, Hematocrit
30.2, MCV is decreased at 76. What is the mostly likely causeof this patient's
anemia?
a. Iron deficiency anemia caused by menstruation
b. Beta Thalassemia of genetic origin
c. Pernicious anemia caused by dietary deficiency
d. Folate deficiency caused by alcoholism: Iron deficiency anemia caused by
menstruation
A 65-year-old female presents to your office complaining of fatigue. She has a
long of rheumatoid arthritis. A CBC reveals the following: Hgb=11.6 g/dL,
Hct=34.8%, MCV=87 fL/red cell, platelet count of 268,000/microliter, and WBC
count of 6800/microliter. The serum haptoglobin level is normal, and the serum
iron concentration is 20 micrograms/dL. The total iron binding capacity is 195
micrograms/dL, and the percent saturation is 10.2. The serum ferritin concentration
is 317 ng/mL. No fibrin split products are detected. The reticulocyte concentration
is 1.1%. What is the most likely diagnosis?
a. Beta- thalassemia major
b. Anemia of chronic disease
c. Acute blood loss anemia
d. Iron deficiency anemia: Anemia of chronic disease
A 14-year-old male presents with high fever for ten days. Physical examina- tion
reveals scattered petechial hemorrhages but is negative for enlargement of the liver
or spleen or lymph nodes. Bone marrow examination does not show any abnormal
cells. The complete blood count (CBC) demonstrates a hemoglobin concentration
(HgB) of 13.2 g/dL, hematocrit (Hct) of 38.9%, mean cell volume (MCV) of 93 fL,
platelet count of 175,000/microliter, and white blood cell (WBC) count of
1850/microliter, with the differential count showing 1 segmented neutrophil, 98
lymphocytes, and 1 monocyte per 100 WBCs. What is the most likely cause of these
findings?
a. Overwhelming bacterial infection
b. Acute lymphocytic (or lymphoblastic) leukemia
c. Acute myeloid leukemia
d. Aplastic anemia: Overwhelming bacterial infection
, A 31-year-old male has a history of chronic anemia and painful crises with joint and
abdominal pain. A head computed tomography (CT) scan reveals several small
remote infarctions. During one of these acute crises, he is admitted with severe
dyspnea. A CBC is performed. Which of the following morphologic findings for
RBCs is most likely to be seen on the peripheral blood smear
a. Tear drop cells
b. Schistocytes
c. Sickle cells
d. Spherocytes: Sickle cells
A 50-year-old male has a blood pressure of 160/95 mm Hg. If this condition remains
untreated for years, which of the following cardiovascular alterations will be seen on
a transthoracic echocardiogram and ECG?
a. Left Ventricular Hypertrophy
b. Left Ventricular Atrophy
c. Left Atrial Atrophy
d. Right Ventricular Hypertrophy: Left ventricular hypertrophy
A 65-year-old male with longstanding uncontrolled HTN presents to the of- fice for
evaluation of syncope. His vital signs are temperature=98.3, Pulse=85, RR=17,
BP=165/85. Physical examination reveals a fourth heart sound and a 4/6
crescendo-decrescendo murmur heard at the right upper sternal border with
radiation to the carotid arteries. His ECG reveals enlarged QRS waves, consistent
with left ventricular hypertrophy. What is the most likely cause of his syncopal
episodes?
a. Mitral regurgitation
b. Mitral Stenosis
c. Aortic regurgitation
d. Aortic stenosis: Aortic stenosis
A 63-year-old female presents to the emergency room with sudden onset of severe
chest and back pain. She describes the pain as sharp and different from her anginal
pain. Her past medical history is positive for HTN X 20 years. VS: HR 105, BP
