Assessment of the Hematologic Patient Practice Questions

25 multiple-choice questions on Assessment of the hematologic patient 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. Petechiae are:

   1. A. Large, raised, purple bruised areas
   2. B. Itchy raised red welts
   3. C. Tiny red dots that do not blanch
   4. D. Yellowing of the skin
   Show answer

   Answer: C. Tiny red dots that do not blanch

   Petechiae are pinpoint bleeds into the skin. They suggest a low platelet count or a platelet function problem.

2. Purpura differs from petechiae in that purpura are:

   1. A. Larger areas of bleeding
   2. B. Raised, itchy, and red
   3. C. Blanching when pressed
   4. D. Limited to the lower legs
   Show answer

   Answer: A. Larger areas of bleeding

   Purpura are purple patches larger than petechiae. Both result from bleeding under the skin.

3. Bleeding into a joint is called:

   1. A. Hematuria
   2. B. Hemarthrosis
   3. C. Hemoptysis
   4. D. Hematemesis
   Show answer

   Answer: B. Hemarthrosis

   Hemarthrosis is a classic complication of hemophilia, causing a hot, swollen, painful joint.

4. During an abdominal exam you feel a large, firm spleen well below the left ribs. You should:

   1. A. Press firmly to estimate its full size
   2. B. Percuss it hard to check for fluid
   3. C. Have each crew member feel it in turn to confirm
   4. D. Palpate gently and avoid repeated pressure
   Show answer

   Answer: D. Palpate gently and avoid repeated pressure

   An enlarged spleen is fragile and can rupture with forceful or repeated palpation. Note its size gently, avoid deep or repeated pressure, and report it.

5. Which finding suggests a platelet disorder rather than a clotting factor disorder?

   1. A. Bleeding into large joints
   2. B. Deep muscle hematomas
   3. C. Bleeding gums and petechiae
   4. D. Delayed bleeding after surgery
   Show answer

   Answer: C. Bleeding gums and petechiae

   Platelet problems cause mucosal and skin bleeding. Factor deficiencies such as hemophilia cause deep tissue and joint bleeding.

6. Mild jaundice from hemolysis is usually first noticed in the:

   1. A. Sclerae
   2. B. Palms
   3. C. Nail beds
   4. D. Lips
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   Answer: A. Sclerae

   Bilirubin binds to the elastic tissue of the white of the eye, so yellowing shows there first, best seen in natural light. The skin follows as levels rise.

7. In a patient with darkly pigmented skin, where is pallor from anemia easiest to detect?

   1. A. Skin of the forehead
   2. B. Inner eyelids and palms
   3. C. Skin over the shins
   4. D. Backs of the hands and wrists
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   Answer: B. Inner eyelids and palms

   Melanin hides pallor on most skin, so check the conjunctivae, oral mucosa, palms, and nail beds, where pigment is sparse.

8. A patient with chronic anemia may tolerate a low hemoglobin well because:

   1. A. Anemia raises blood oxygen
   2. B. Chronic anemia raises SpO2
   3. C. Red cells live longer in anemia
   4. D. The body has slowly compensated
   Show answer

   Answer: D. The body has slowly compensated

   Over time, cardiac output, red cell oxygen release, and plasma volume all adjust. Acute blood loss of the same amount causes far more symptoms.

9. Which lymph node finding is most concerning for cancer?

   1. A. A tender, mobile node with a sore throat
   2. B. A small, soft node in the groin
   3. C. A hard, painless node fixed in place
   4. D. A node that shrank after a cold
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   Answer: C. A hard, painless node fixed in place

   Hard, painless, fixed, or steadily growing nodes suggest lymphoma or spread of cancer. Tender, mobile nodes during an infection are usually reactive, and small soft groin nodes are common in healthy adults.

10. Common symptoms of anemia include:

    1. A. Fatigue, dyspnea, tachycardia
    2. B. Fever, rash, and painful joints
    3. C. Bradycardia and hypertension
    4. D. Polyuria and polydipsia
    Show answer

    Answer: A. Fatigue, dyspnea, tachycardia

    Reduced oxygen delivery causes weakness, exertional shortness of breath, and a fast heart rate. Severe anemia can cause chest pain.

11. When taking a history from a patient with a bleeding problem, it is most important to ask about:

    1. A. Anticoagulant and antiplatelet use
    2. B. Childhood illnesses such as chickenpox
    3. C. Recent dental cleaning
    4. D. Recent travel outside the country
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    Answer: A. Anticoagulant and antiplatelet use

    Warfarin, DOACs, aspirin, and clopidogrel greatly change bleeding risk and hospital management. Childhood illnesses and recent travel do not change how a bleeding patient is managed, and a routine dental cleaning matters far less than knowing which blood thinners the patient takes.

12. Splenomegaly may cause pain in the:

    1. A. Right upper quadrant
    2. B. Left upper quadrant
    3. C. Left lower quadrant
    4. D. Right lower quadrant
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    Answer: B. Left upper quadrant

    The spleen lies under the lower left ribs. When enlarged it can extend below the costal margin and cause fullness or pain in the left upper quadrant.

13. Pain referred to the left shoulder after abdominal trauma suggests:

    1. A. Liver laceration
    2. B. Appendicitis
    3. C. Splenic injury
    4. D. Kidney stone
    Show answer

    Answer: C. Splenic injury

    Kehr sign is left shoulder pain from blood irritating the diaphragm, classically from a ruptured spleen.

14. Which finding best suggests that a pale patient has chronic anemia rather than hemorrhagic shock?

    1. A. Pale conjunctivae and nail beds
    2. B. Shortness of breath with mild exertion
    3. C. A heart rate of 104 at rest
    4. D. Warm skin with brisk capillary refill
    Show answer

    Answer: D. Warm skin with brisk capillary refill

    Chronic anemia causes pallor with warm, well-perfused skin. Shock adds cool, clammy skin, delayed refill, and anxiety from vasoconstriction. Pallor, exertional dyspnea, and mild tachycardia occur in both.

15. A patient with a platelet count of 6,000/µL has blood-filled blisters inside the mouth. This finding means:

    1. A. Her risk of serious bleeding is high
    2. B. It is a harmless viral mouth rash
    3. C. Her platelet count is rising again
    4. D. She has an allergy to a new medication
    Show answer

    Answer: A. Her risk of serious bleeding is high

    Blood blisters on the mucosa (wet purpura) signal a higher risk of serious bleeding than skin petechiae alone. Handle gently and transport.

16. Which family history detail is most relevant to a hematologic problem?

    1. A. Relatives with high blood pressure
    2. B. Relatives with early heart attacks
    3. C. Relatives with bleeding disorders
    4. D. Relatives with type 2 diabetes
    Show answer

    Answer: C. Relatives with bleeding disorders

    Hemophilia, von Willebrand disease, and sickle cell disease are inherited. A family history of high blood pressure, early heart attacks, or diabetes points to cardiovascular and metabolic risk, not to an inherited problem with the blood itself.

17. Lymphadenopathy refers to:

    1. A. A low lymphocyte count
    2. B. Enlarged lymph nodes
    3. C. Inflamed lymph vessels
    4. D. Absence of the spleen
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    Answer: B. Enlarged lymph nodes

    Swollen nodes may be due to infection or to cancers such as lymphoma and leukemia.

18. A patient with immune thrombocytopenia and a platelet count of 5,000/µL has a sudden, severe headache. You should suspect:

    1. A. A tension headache
    2. B. Bacterial meningitis
    3. C. A migraine with a visual aura
    4. D. Intracranial hemorrhage
    Show answer

    Answer: D. Intracranial hemorrhage

    With very low platelets, a sudden severe headache is a bleed inside the skull until proven otherwise. Check for neurologic deficits and transport rapidly.

19. When documenting bruises on a patient with a possible bleeding disorder, you should:

    1. A. State each bruise's age based on its color
    2. B. List the largest bruise and skip the others
    3. C. Record size, site, and color, not age
    4. D. Label them as signs of abuse in the report
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    Answer: C. Record size, site, and color, not age

    Bruise color changes at different rates by person, depth, and site, so estimating age from color is unreliable. Record objective details and photographs if policy allows, and report concerns through the proper channel rather than labeling the cause.

20. A pale patient with spoon-shaped nails and a craving for ice most likely has:

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

    Koilonychia and pica (craving ice, clay, or starch) are classic findings in iron deficiency.

21. Why is it important to note bruises in different stages of healing?

    1. A. They may signal abuse or a bleeding disorder
    2. B. They let you date each injury precisely by color
    3. C. They point to a localized skin infection
    4. D. They suggest a vitamin B12 deficiency
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    Answer: A. They may signal abuse or a bleeding disorder

    Multiple bruises of different ages can result from a coagulopathy, anticoagulant use, or repeated injury, including abuse. Bruise color cannot reliably date an injury, so describe the bruises rather than estimate their age. Bruises are bleeding under the skin, not infection, and B12 deficiency causes anemia and nerve problems rather than easy bruising.

22. A sickle cell patient's baseline hemoglobin is important to know because:

    1. A. Their values are usually normal
    2. B. It sets their SpO2 goal
    3. C. It predicts how severe a crisis will be
    4. D. Many live with chronic anemia
    Show answer

    Answer: D. Many live with chronic anemia

    Sickle cell patients often run hemoglobin of 6 to 9 g/dL. A drop from baseline matters more than the absolute value. The usual SpO2 target does not change with the baseline hemoglobin, and the baseline value does not predict how severe a given crisis will be.

23. Hematuria in a patient on anticoagulants should:

    1. A. Be expected and not reported
    2. B. Raise concern for excess anticoagulation
    3. C. Be treated at home with extra oral fluids
    4. D. Be reported once pain develops
    Show answer

    Answer: B. Raise concern for excess anticoagulation

    New bleeding of any kind may mean the INR is too high or there is an underlying lesion.

24. Which question best screens for an abnormal bleeding tendency?

    1. A. Have you ever had a clot in your leg?
    2. B. Do you get frequent headaches?
    3. C. Do you often feel tired or dizzy?
    4. D. Do you bleed long after small cuts?
    Show answer

    Answer: D. Do you bleed long after small cuts?

    Prolonged bleeding from minor cuts, dental work, or heavy menstrual periods suggests a bleeding disorder. A past leg clot points to a clotting tendency, the opposite problem. Fatigue and dizziness can come from anemia but do not show whether the patient bleeds abnormally, and headaches are not a screening question for bleeding.

25. The most important prehospital intervention for a patient with a bleeding disorder and active external bleeding is:

    1. A. Direct pressure
    2. B. Elevating the legs
    3. C. Applying ice to the area
    4. D. Giving oral fluids
    Show answer

    Answer: A. Direct pressure

    Direct pressure, held longer than usual, is the first step. Use tourniquets or hemostatic dressings as needed.