Anemia and Red Cell Disorders Practice Questions

25 multiple-choice questions on Anemia and red cell disorders for paramedic and EMT students, from Chapter 25 (Hematologic Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Iron deficiency anemia produces red cells that are:

   1. A. Large and oval
   2. B. Sickle-shaped
   3. C. Small and pale
   4. D. Normal but fewer
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   Answer: C. Small and pale

   Without enough iron the cells make less hemoglobin, so they are small (microcytic) and pale (hypochromic). Large oval cells point to B12 or folate deficiency.

2. The most common cause of anemia worldwide is:

   1. A. Iron deficiency
   2. B. Sickle cell disease
   3. C. Vitamin C deficiency
   4. D. Leukemia
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   Answer: A. Iron deficiency

   Iron deficiency is common from blood loss (menstrual or GI), poor diet, and pregnancy.

3. In an older adult man, iron deficiency anemia should raise concern for:

   1. A. Vitamin B12 deficiency
   2. B. Viral infection
   3. C. Occult GI bleeding
   4. D. Chronic kidney disease
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   Answer: C. Occult GI bleeding

   Slow bleeding from a colon cancer or ulcer is a common hidden cause. B12 deficiency causes large red cells, not the small iron-deficient cells, and kidney disease causes anemia through low erythropoietin rather than iron loss.

4. Which patient is at highest risk of vitamin B12 deficiency?

   1. A. A patient who takes iron tablets every day
   2. B. A patient who had gastric bypass surgery
   3. C. An adult with sickle cell trait
   4. D. A patient who takes a daily vitamin C tablet
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   Answer: B. A patient who had gastric bypass surgery

   Bypass surgery removes most of the stomach's acid and intrinsic factor, which are needed to absorb B12. Strict vegans, older adults with atrophic gastritis, and long-term metformin users are also at risk. Daily iron and vitamin C tablets do not block B12 absorption, and sickle cell trait does not affect it.

5. Vitamin B12 deficiency can cause neurologic signs such as:

   1. A. Resting tremor and rigidity
   2. B. One-sided facial droop
   3. C. Pinpoint pupils
   4. D. Numbness and poor balance
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   Answer: D. Numbness and poor balance

   B12 is needed for nerve health. Deficiency causes peripheral neuropathy, ataxia, and memory problems. A resting tremor with rigidity suggests parkinsonism, a sudden one-sided facial droop suggests stroke or Bell palsy, and pinpoint pupils suggest opioids. None of these is a typical B12 finding.

6. Hemolytic anemia results from:

   1. A. Poor absorption of dietary iron
   2. B. Low erythropoietin from kidneys
   3. C. Early destruction of red cells
   4. D. Marrow replaced by fat cells
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   Answer: C. Early destruction of red cells

   Red cells may be destroyed by antibodies, mechanical damage, infections, or inherited defects.

7. Signs of acute hemolysis include:

   1. A. Black, tarry stools
   2. B. Bright red bloody vomit
   3. C. Clear, dilute urine
   4. D. Jaundice, dark urine
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   Answer: D. Jaundice, dark urine

   Released hemoglobin colors the urine dark, and bilirubin causes jaundice.

8. G6PD deficiency can cause hemolysis after exposure to:

   1. A. Dairy or lactose products
   2. B. Fava beans or sulfa drugs
   3. C. Penicillin or amoxicillin
   4. D. Cold water or ice packs
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   Answer: B. Fava beans or sulfa drugs

   These triggers create oxidative stress that red cells lacking G6PD cannot handle.

9. Aplastic anemia is:

   1. A. Bone marrow failure
   2. B. A form of iron deficiency
   3. C. Rapid splenic destruction
   4. D. Low erythropoietin from dehydration
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   Answer: A. Bone marrow failure

   Causes include drugs, toxins such as benzene, radiation, viral infections, and immune attack on the marrow stem cells.

10. Pancytopenia means:

    1. A. Low red cells, white cells, platelets
    2. B. High red cells with normal platelets
    3. C. Low platelets with normal red cells
    4. D. High white cells and high platelets
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    Answer: A. Low red cells, white cells, platelets

    It occurs with marrow failure, chemotherapy, leukemia, and some infections.

11. A patient with a hemoglobin of 6 g/dL has a soft new systolic murmur. The most likely cause is:

    1. A. A ruptured chord of the mitral valve
    2. B. Fast flow of thin, dilute blood
    3. C. Infective endocarditis
    4. D. A pericardial effusion
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    Answer: B. Fast flow of thin, dilute blood

    Severe anemia raises cardiac output and lowers blood viscosity, producing a flow murmur that fades once the anemia is treated. A ruptured chord or endocarditis would come with other findings, and effusions muffle heart sounds rather than add a murmur.

12. A patient with severe anemia may develop:

    1. A. Severe symptomatic bradycardia
    2. B. Hypertensive crisis
    3. C. High-output heart failure
    4. D. Hyperglycemia
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    Answer: C. High-output heart failure

    The heart pumps harder and faster to deliver oxygen, which can eventually lead to failure, especially in older patients.

13. A thalassemia is:

    1. A. An acquired iron overload disorder
    2. B. An inherited clotting factor deficiency
    3. C. A cancer of red blood cells
    4. D. An inherited hemoglobin defect
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    Answer: D. An inherited hemoglobin defect

    Thalassemias reduce production of normal hemoglobin chains. Severe forms need regular transfusions.

14. Patients who receive many transfusions over years are at risk of:

    1. A. Iron deficiency
    2. B. Iron overload
    3. C. Vitamin K excess
    4. D. Polycythemia
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    Answer: B. Iron overload

    Each unit of blood adds iron that the body cannot excrete. Iron builds up in the heart, liver, and endocrine glands.

15. Polycythemia means:

    1. A. Too few red blood cells in blood
    2. B. Too many platelets
    3. C. Too many red blood cells
    4. D. Too few white cells
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    Answer: C. Too many red blood cells

    The blood becomes thick, raising the risk of clots, stroke, and MI.

16. The main treatment used to lower the red cell mass in polycythemia vera is:

    1. A. Iron supplements
    2. B. Erythropoietin shots
    3. C. Vitamin B12 injections
    4. D. Regular phlebotomy
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    Answer: D. Regular phlebotomy

    Removing blood lowers the hematocrit and the risk of clots; many patients also take low-dose aspirin. Iron and erythropoietin would drive red cell production further.

17. Polycythemia vera is:

    1. A. Marrow overproduction of red cells
    2. B. Dehydration with a high hematocrit
    3. C. Anemia caused by blood loss
    4. D. A reaction to a transfusion
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    Answer: A. Marrow overproduction of red cells

    This myeloproliferative disease also raises white cells and platelets. Dehydration only concentrates the blood, and blood loss or transfusion reactions do not cause it.

18. A common complaint in polycythemia vera is itching after a:

    1. A. Meal with shellfish
    2. B. Warm bath or shower
    3. C. Walk in cold air
    4. D. Daily dose of aspirin
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    Answer: B. Warm bath or shower

    Aquagenic pruritus is classic. Patients may also have headache, ruddy skin, and an enlarged spleen. Itching after shellfish suggests food allergy, and itching in cold air suggests cold urticaria. Low-dose aspirin is part of polycythemia vera care and often eases this itching rather than causing it.

19. A patient with cold agglutinin disease has blue fingertips and dark urine after waiting outside in winter. The most helpful field care is:

    1. A. Applying ice packs to the fingertips
    2. B. Giving a large bolus of cool saline
    3. C. Keeping her and any IV fluids warm
    4. D. Giving her usual oral iron tablets
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    Answer: C. Keeping her and any IV fluids warm

    In cold agglutinin disease, antibodies coat red cells and destroy them when the blood cools, so cold exposure triggers hemolysis and blue extremities. Warm the patient, the room, and any fluids. Iron does not help hemolysis.

20. Which finding is most typical of acute blood loss anemia?

    1. A. Spoon nails and pica
    2. B. Numbness and tingling in the feet
    3. C. Bronze skin
    4. D. Tachycardia and pallor
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    Answer: D. Tachycardia and pallor

    Acute loss causes signs of shock long before red cell size or iron stores change. The other choices develop over months or reflect other deficiencies.

21. Folate deficiency is most common in:

    1. A. People with alcohol use disorder
    2. B. Adults who take a daily statin pill
    3. C. Endurance athletes in training
    4. D. Heavy coffee drinkers
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    Answer: A. People with alcohol use disorder

    Poor diet and alcohol both reduce folate. Pregnancy also increases folate needs. Statins, endurance training, and coffee do not meaningfully deplete folate.

22. Why may an anemic patient have angina without coronary disease?

    1. A. Anemia causes coronary spasm directly
    2. B. Anemia ruptures coronary plaque
    3. C. Low hemoglobin blocks the arteries
    4. D. Heart muscle gets too little oxygen
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    Answer: D. Heart muscle gets too little oxygen

    Low oxygen-carrying capacity combined with a fast heart rate creates an oxygen supply and demand mismatch.

23. Hemolysis caused by a damaged mechanical heart valve is an example of:

    1. A. Autoimmune red cell destruction
    2. B. Bone marrow production failure
    3. C. Mechanical red cell destruction
    4. D. Iron deficiency from bleeding
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    Answer: C. Mechanical red cell destruction

    Turbulent flow across an artificial valve can shear red cells apart.

24. Supplemental oxygen in a severely anemic patient helps mainly by:

    1. A. More dissolved and bound oxygen
    2. B. Raising the hemoglobin level
    3. C. Stimulating the bone marrow
    4. D. Lowering the heart rate back to normal
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    Answer: A. More dissolved and bound oxygen

    Oxygen cannot replace missing hemoglobin, but it maximizes saturation and slightly increases dissolved oxygen. Transfusion corrects the cause.

25. A woman with heavy menstrual periods reports fatigue and shortness of breath on stairs. The most likely cause is:

    1. A. Polycythemia vera flare
    2. B. Iron deficiency anemia
    3. C. Sickle cell crisis
    4. D. Hemophilia A bleeding
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    Answer: B. Iron deficiency anemia

    Chronic menstrual blood loss depletes iron stores over time.