1|Page
HESI Pathophysiology Practice Exam (NEW UPDATED VERSION) LATEST ACTUAL
EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED QUESTIONS AND
ANSWERS) | GUARANTEED PASS A+ UPDATED 2026
1. Case:
A 65-year-old male presents with crushing chest pain radiating to the left arm, diaphoresis, and
nausea. ECG shows ST elevation in leads V1–V4.
Question: Most likely pathophysiological event?
A. Inferior MI
B. Anterior MI
C. Pulmonary embolism
D. Pericarditis
Rationale:
ST elevation in V1–V4 indicates anterior wall MI, usually caused by occlusion of the left
anterior descending artery, leading to myocardial ischemia and necrosis.
2. Case:
A 72-year-old female presents with acute confusion and tachycardia. Labs: Na+ 115 mEq/L.
Question: Pathophysiology behind her symptoms?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypokalemia
Rationale:
Severe hyponatremia causes cellular swelling, particularly in neurons, leading to confusion,
lethargy, and potential seizures.
3. Case:
A 60-year-old male presents with acute shortness of breath, hypotension, and chest pain. History:
recent hip replacement.
2026 2027 GRADED A+
,2|Page
Question: Most likely pathophysiology?
A. Asthma exacerbation
B. Pulmonary embolism
C. Pneumonia
D. Heart failure
Rationale:
Postoperative venous stasis → DVT → pulmonary embolism, causing V/Q mismatch,
hypoxemia, and right ventricular strain.
4. Case:
A 58-year-old female presents with anxiety, tremors, weight loss. Labs: TSH low, T3/T4
elevated.
Question: Underlying pathophysiology?
A. Hypothyroidism
B. Hyperthyroidism
C. Thyroid storm
D. Hashimoto’s thyroiditis
Rationale:
Excess thyroid hormone increases basal metabolic rate and sympathetic activity, causing
tachycardia, tremors, weight loss, and heat intolerance.
5. Case:
A 70-year-old male presents with confusion, fever, hypotension. Labs: WBC 20,000/mm³,
lactate elevated.
Question: Pathophysiology?
A. Stroke
B. Sepsis
C. Hypoglycemia
D. Dehydration
Rationale:
Infection triggers systemic inflammatory response syndrome (SIRS) → vasodilation, capillary
leak, hypotension, tissue hypoperfusion, and risk for multi-organ failure.
2026 2027 GRADED A+
,3|Page
6. Case:
A 65-year-old female presents with epigastric pain radiating to the back, nausea, vomiting,
amylase/lipase elevated.
Question: Pathophysiology?
A. Acute pancreatitis
B. Peptic ulcer
C. Cholecystitis
D. Gastroenteritis
Rationale:
Premature activation of pancreatic enzymes causes autodigestion, inflammation, and local tissue
damage, leading to severe abdominal pain.
7. Case:
A 68-year-old male presents with SOB, pink frothy sputum, crackles, and elevated BNP.
Question: Which pathophysiology explains this?
A. COPD exacerbation
B. Pulmonary edema due to HF
C. Pneumonia
D. Pulmonary embolism
Rationale:
Left ventricular failure increases pulmonary capillary hydrostatic pressure, leading to fluid
accumulation in alveoli and impaired gas exchange.
8. Case:
A 72-year-old female presents with right-sided weakness, facial droop, slurred speech. CT shows
basal ganglia hemorrhage.
Question: Pathophysiology?
A. Ischemic stroke
B. Hemorrhagic stroke
C. TIA
D. Seizure
2026 2027 GRADED A+
, 4|Page
Rationale:
High BP or vessel rupture causes intracerebral hemorrhage, leading to neuronal injury,
cerebral edema, and focal neurological deficits.
9. Case:
A 60-year-old male presents with polyuria, polydipsia, glucose 720 mg/dL, no ketones.
Question: Pathophysiology?
A. DKA
B. HHNS
C. Hypoglycemia
D. Pancreatitis
Rationale:
Severe hyperglycemia without ketosis → osmotic diuresis, dehydration, electrolyte
imbalance, and altered mental status.
10. Case:
A 58-year-old female presents with palpitations, tremors, anxiety. Labs: TSH low, T3/T4 high.
Question: Pathophysiology?
A. Hyperthyroidism
B. Hypothyroidism
C. Thyroid storm
D. Hashimoto’s thyroiditis
Rationale:
Excess thyroid hormone → increased metabolic rate, sympathetic overactivity, tachycardia,
tremors.
11. Case:
A 70-year-old male presents with acute shortness of breath, hypotension, unilateral leg swelling
post-hip surgery.
Question: Pathophysiology?
A. Heart failure
B. Pulmonary embolism
2026 2027 GRADED A+
HESI Pathophysiology Practice Exam (NEW UPDATED VERSION) LATEST ACTUAL
EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED QUESTIONS AND
ANSWERS) | GUARANTEED PASS A+ UPDATED 2026
1. Case:
A 65-year-old male presents with crushing chest pain radiating to the left arm, diaphoresis, and
nausea. ECG shows ST elevation in leads V1–V4.
Question: Most likely pathophysiological event?
A. Inferior MI
B. Anterior MI
C. Pulmonary embolism
D. Pericarditis
Rationale:
ST elevation in V1–V4 indicates anterior wall MI, usually caused by occlusion of the left
anterior descending artery, leading to myocardial ischemia and necrosis.
2. Case:
A 72-year-old female presents with acute confusion and tachycardia. Labs: Na+ 115 mEq/L.
Question: Pathophysiology behind her symptoms?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypokalemia
Rationale:
Severe hyponatremia causes cellular swelling, particularly in neurons, leading to confusion,
lethargy, and potential seizures.
3. Case:
A 60-year-old male presents with acute shortness of breath, hypotension, and chest pain. History:
recent hip replacement.
2026 2027 GRADED A+
,2|Page
Question: Most likely pathophysiology?
A. Asthma exacerbation
B. Pulmonary embolism
C. Pneumonia
D. Heart failure
Rationale:
Postoperative venous stasis → DVT → pulmonary embolism, causing V/Q mismatch,
hypoxemia, and right ventricular strain.
4. Case:
A 58-year-old female presents with anxiety, tremors, weight loss. Labs: TSH low, T3/T4
elevated.
Question: Underlying pathophysiology?
A. Hypothyroidism
B. Hyperthyroidism
C. Thyroid storm
D. Hashimoto’s thyroiditis
Rationale:
Excess thyroid hormone increases basal metabolic rate and sympathetic activity, causing
tachycardia, tremors, weight loss, and heat intolerance.
5. Case:
A 70-year-old male presents with confusion, fever, hypotension. Labs: WBC 20,000/mm³,
lactate elevated.
Question: Pathophysiology?
A. Stroke
B. Sepsis
C. Hypoglycemia
D. Dehydration
Rationale:
Infection triggers systemic inflammatory response syndrome (SIRS) → vasodilation, capillary
leak, hypotension, tissue hypoperfusion, and risk for multi-organ failure.
2026 2027 GRADED A+
,3|Page
6. Case:
A 65-year-old female presents with epigastric pain radiating to the back, nausea, vomiting,
amylase/lipase elevated.
Question: Pathophysiology?
A. Acute pancreatitis
B. Peptic ulcer
C. Cholecystitis
D. Gastroenteritis
Rationale:
Premature activation of pancreatic enzymes causes autodigestion, inflammation, and local tissue
damage, leading to severe abdominal pain.
7. Case:
A 68-year-old male presents with SOB, pink frothy sputum, crackles, and elevated BNP.
Question: Which pathophysiology explains this?
A. COPD exacerbation
B. Pulmonary edema due to HF
C. Pneumonia
D. Pulmonary embolism
Rationale:
Left ventricular failure increases pulmonary capillary hydrostatic pressure, leading to fluid
accumulation in alveoli and impaired gas exchange.
8. Case:
A 72-year-old female presents with right-sided weakness, facial droop, slurred speech. CT shows
basal ganglia hemorrhage.
Question: Pathophysiology?
A. Ischemic stroke
B. Hemorrhagic stroke
C. TIA
D. Seizure
2026 2027 GRADED A+
, 4|Page
Rationale:
High BP or vessel rupture causes intracerebral hemorrhage, leading to neuronal injury,
cerebral edema, and focal neurological deficits.
9. Case:
A 60-year-old male presents with polyuria, polydipsia, glucose 720 mg/dL, no ketones.
Question: Pathophysiology?
A. DKA
B. HHNS
C. Hypoglycemia
D. Pancreatitis
Rationale:
Severe hyperglycemia without ketosis → osmotic diuresis, dehydration, electrolyte
imbalance, and altered mental status.
10. Case:
A 58-year-old female presents with palpitations, tremors, anxiety. Labs: TSH low, T3/T4 high.
Question: Pathophysiology?
A. Hyperthyroidism
B. Hypothyroidism
C. Thyroid storm
D. Hashimoto’s thyroiditis
Rationale:
Excess thyroid hormone → increased metabolic rate, sympathetic overactivity, tachycardia,
tremors.
11. Case:
A 70-year-old male presents with acute shortness of breath, hypotension, unilateral leg swelling
post-hip surgery.
Question: Pathophysiology?
A. Heart failure
B. Pulmonary embolism
2026 2027 GRADED A+
