NURS 6501 ADVANCED PATHOPHYSIOLOGY MIDTERM LATEST EXAM/ NURS 6501 MIDTERM
EXAM LATEST
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.
Examination of the peripheral blood smear reveals numerous blasts. The blasts lack peroxidase-
positive granules but do contain periodic acid-Schiff (PAS)-positive aggregates and stain
positively for TdT. Flow cytometry shows the phenotype 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) - ANSWER-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 microcytic red cells. Total serum iron level is normal.
The reticulocyte count is 10%. Hemoglobin electrophoresis shows very little hemoglobin A. 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 - ANSWER-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 - ANSWER-Gastrointestinal blood loss
A 76-year-old female notices that small, pinpoint to blotchy areas of superficial 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 - ANSWER-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 - ANSWER-You may have excessive bleeding
following tooth extraction
,Low dose aspirin is commonly used to reduce the risk of arterial thrombosis 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 - ANSWER-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 - ANSWER-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 - ANSWER-Anemia of chronic disease
, A 14-year-old male presents with high fever for ten days. Physical examination 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 - ANSWER-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 - ANSWER-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 - ANSWER-Left ventricular hypertrophy
EXAM LATEST
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.
Examination of the peripheral blood smear reveals numerous blasts. The blasts lack peroxidase-
positive granules but do contain periodic acid-Schiff (PAS)-positive aggregates and stain
positively for TdT. Flow cytometry shows the phenotype 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) - ANSWER-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 microcytic red cells. Total serum iron level is normal.
The reticulocyte count is 10%. Hemoglobin electrophoresis shows very little hemoglobin A. 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 - ANSWER-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 - ANSWER-Gastrointestinal blood loss
A 76-year-old female notices that small, pinpoint to blotchy areas of superficial 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 - ANSWER-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 - ANSWER-You may have excessive bleeding
following tooth extraction
,Low dose aspirin is commonly used to reduce the risk of arterial thrombosis 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 - ANSWER-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 - ANSWER-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 - ANSWER-Anemia of chronic disease
, A 14-year-old male presents with high fever for ten days. Physical examination 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 - ANSWER-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 - ANSWER-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 - ANSWER-Left ventricular hypertrophy
