Bleeding Disorders Practice Questions

25 multiple-choice questions on Bleeding 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. Hemophilia is inherited in which pattern?

   1. A. Autosomal dominant
   2. B. Autosomal recessive
   3. C. X-linked recessive
   4. D. Mitochondrial
   Show answer

   Answer: C. X-linked recessive

   Hemophilia mainly affects males. Females are usually carriers.

2. A man with hemophilia has groin pain, holds his hip bent, and has numbness on the front of the thigh. You should suspect:

   1. A. A kidney stone in the ureter
   2. B. An incarcerated inguinal hernia
   3. C. A hip dislocation
   4. D. An iliopsoas muscle bleed
   Show answer

   Answer: D. An iliopsoas muscle bleed

   A bleed into the iliopsoas muscle presses on the femoral nerve and makes straightening the hip painful. It can hide a large blood loss and needs factor replacement and transport.

3. A man with severe hemophilia A says his knee feels like a bleed is starting, though it looks normal. You should:

   1. A. Wait for swelling before acting
   2. B. Apply heat to improve blood flow
   3. C. Have him walk on it to test the joint
   4. D. Believe him and treat it as a bleed
   Show answer

   Answer: D. Believe him and treat it as a bleed

   Patients often sense a joint bleed (tingling, warmth, tightness) before swelling appears. Early factor replacement limits joint damage. Immobilize, apply cold, and follow his care plan; heat and weight bearing worsen bleeding.

4. The most important treatment for a significant bleed in hemophilia is:

   1. A. Aspirin for pain
   2. B. Factor replacement
   3. C. Platelet transfusion
   4. D. Vitamin K injection
   Show answer

   Answer: B. Factor replacement

   Many patients carry their own factor concentrate. Assist per protocol and transport.

5. Which pain medication should be avoided in hemophilia?

   1. A. Ibuprofen
   2. B. Acetaminophen
   3. C. Fentanyl
   4. D. Morphine
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   Answer: A. Ibuprofen

   NSAIDs and aspirin impair platelet function and worsen bleeding.

6. IM injections should be avoided in hemophilia because they can cause:

   1. A. Factor inhibitor antibodies
   2. B. Severe allergic reaction
   3. C. Muscle hematoma
   4. D. Clots at the injection site
   Show answer

   Answer: C. Muscle hematoma

   Use the IV or intranasal route when possible. Inhibitor antibodies develop from exposure to factor concentrate, not from IM injections, and patients with hemophilia bleed into the muscle rather than form clots there.

7. The most common inherited bleeding disorder is:

   1. A. Hemophilia A
   2. B. Von Willebrand disease
   3. C. Hemophilia B
   4. D. Factor XIII deficiency
   Show answer

   Answer: B. Von Willebrand disease

   Von Willebrand disease affects up to about 1% of people, though many have mild symptoms and are never diagnosed. Hemophilia A and B are much rarer.

8. A patient with a platelet count of 9,000/µL needs airway support. Which adjunct carries the greatest bleeding risk?

   1. A. Oropharyngeal airway
   2. B. Bag-valve-mask ventilation
   3. C. Nasal cannula
   4. D. Nasopharyngeal airway
   Show answer

   Answer: D. Nasopharyngeal airway

   Nasal airways often cause nosebleeds, which can be heavy and hard to stop with very low platelets. Use an oral airway and BVM when possible.

9. Immune thrombocytopenia (ITP) is caused by:

   1. A. Cancer cells crowding the marrow
   2. B. Dietary vitamin K deficiency
   3. C. Antibodies destroying platelets
   4. D. Inherited factor VIII deficiency
   Show answer

   Answer: C. Antibodies destroying platelets

   The spleen removes the antibody-coated platelets. Marrow production is normal, and clotting factors are not affected.

10. A child develops petechiae and bruises two weeks after a viral illness but appears well. The most likely cause is:

    1. A. ITP
    2. B. Hemophilia A
    3. C. Leukemia
    4. D. Henoch-Schonlein purpura
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    Answer: A. ITP

    ITP commonly follows a viral infection by a few weeks, causing an isolated drop in platelets with petechiae and bruising in a child who otherwise looks well. Hemophilia A is a clotting-factor deficiency, mostly in boys, that causes deep and joint bleeding rather than petechiae. Leukemia usually comes with pallor, fever, bone pain, or an ill appearance, though it must still be considered. Henoch-Schonlein purpura also follows infections but causes raised purpura on the legs and buttocks with joint or abdominal pain and normal platelets. Abuse must still be considered whenever a child has unexplained bruises.

11. Thrombotic thrombocytopenic purpura (TTP) classically includes:

    1. A. High platelets, stroke, and high fever
    2. B. Joint bleeding, fever, and rash
    3. C. Polycythemia, itching, and headache
    4. D. Low platelets, hemolysis, neuro signs
    Show answer

    Answer: D. Low platelets, hemolysis, neuro signs

    TTP also causes fever and kidney injury. Untreated, it is usually fatal, so it needs plasma exchange.

12. Hemolytic uremic syndrome (HUS) most commonly follows:

    1. A. E. coli diarrhea in children
    2. B. Strep throat in adults
    3. C. Lyme disease after a tick bite
    4. D. Influenza vaccination
    Show answer

    Answer: A. E. coli diarrhea in children

    Shiga toxin damages small vessels, causing hemolysis, low platelets, and acute kidney injury.

13. An older man who lives alone and eats almost no fruit or vegetables has bleeding gums and tiny bleeds around his hair follicles. The most likely cause is:

    1. A. Hemophilia A
    2. B. Iron overload from transfusions
    3. C. Vitamin C deficiency
    4. D. Polycythemia vera
    Show answer

    Answer: C. Vitamin C deficiency

    Scurvy weakens collagen in vessel walls and gums, causing gum bleeding, bruising, and bleeds around hair follicles. It still occurs with poor diets, alcohol use, and social isolation.

14. Common triggers of DIC include:

    1. A. Warfarin, heparin, and aspirin use
    2. B. Sepsis, trauma, obstetric problems
    3. C. Hemophilia, ITP, and von Willebrand disease
    4. D. Chronic iron deficiency from poor diet
    Show answer

    Answer: B. Sepsis, trauma, obstetric problems

    DIC is always secondary to a serious illness such as sepsis, major trauma, placental abruption, or cancer. Anticoagulants, inherited factor deficiencies, ITP, and iron deficiency can cause bleeding or anemia, but they do not set off the widespread clotting and factor consumption of DIC.

15. Which set of lab findings best fits DIC?

    1. A. High platelets, high fibrinogen, low D-dimer
    2. B. Low platelets, low fibrinogen, high D-dimer
    3. C. Low platelets, normal clotting, normal D-dimer
    4. D. Normal platelets, a long aPTT, normal INR
    Show answer

    Answer: B. Low platelets, low fibrinogen, high D-dimer

    DIC uses up platelets and fibrinogen while breaking down many clots, so D-dimer climbs and the INR and aPTT lengthen. Low platelets with normal clotting suggests ITP, and an isolated long aPTT suggests hemophilia or heparin.

16. Treatment of DIC focuses on:

    1. A. High-dose IV steroids
    2. B. Giving aspirin to thin the blood
    3. C. Treating the underlying cause
    4. D. Removing the spleen
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    Answer: C. Treating the underlying cause

    Support circulation and transport. Hospitals give blood products and treat the trigger. Steroids and splenectomy do not treat DIC, and aspirin adds bleeding risk without stopping the process.

17. A patient with TTP has a platelet count of 9,000/µL. Platelet transfusions are generally avoided because they:

    1. A. Will be quickly destroyed by the spleen
    2. B. Cannot be given through an IV
    3. C. Raise the hemoglobin too far
    4. D. May fuel more small-vessel clots
    Show answer

    Answer: D. May fuel more small-vessel clots

    TTP is driven by platelet clumping in small vessels. Extra platelets may feed new clots in the brain and kidneys, so treatment is plasma exchange unless bleeding is life-threatening.

18. A boy with severe hemophilia A has anaphylaxis from a bee sting. Regarding IM epinephrine, you should:

    1. A. Give it IM; the benefit outweighs the risk
    2. B. Withhold it because of the bleeding risk
    3. C. Give it subcutaneously to avoid muscle
    4. D. Wait until his own factor has been infused
    Show answer

    Answer: A. Give it IM; the benefit outweighs the risk

    IM injections are avoided for routine drugs in hemophilia, but anaphylaxis is immediately life-threatening. Give IM epinephrine in the thigh with a fine needle and then hold firm pressure on the site. Subcutaneous epinephrine is absorbed too slowly.

19. A man has had frequent nosebleeds since childhood and has small red spots on his lips and tongue. His father had the same. The most likely cause is:

    1. A. Immune thrombocytopenia after a virus
    2. B. Hereditary hemorrhagic telangiectasia
    3. C. Hemophilia A passed from his father
    4. D. Aplastic anemia from a toxin in the marrow
    Show answer

    Answer: B. Hereditary hemorrhagic telangiectasia

    HHT is an inherited disorder of fragile, dilated vessels that bleed easily, especially in the nose and gut. The red spots on the lips and tongue are telangiectasias. Hemophilia is not passed from father to son.

20. A man with hemophilia A has a deep thigh wound with bright red bleeding that direct pressure is not controlling. You should:

    1. A. Apply a tourniquet as for any patient
    2. B. Avoid a tourniquet because of bruising
    3. C. Give his factor before any bleeding control
    4. D. Use light pressure to avoid a hematoma
    Show answer

    Answer: A. Apply a tourniquet as for any patient

    Life-threatening extremity bleeding gets a tourniquet regardless of a bleeding disorder. Factor replacement is important but comes after the bleeding is controlled.

21. Prolonged nosebleeds in a patient with von Willebrand disease may be treated in the hospital with:

    1. A. Warfarin by mouth
    2. B. Heparin by IV drip
    3. C. Clopidogrel by mouth
    4. D. Desmopressin (DDAVP)
    Show answer

    Answer: D. Desmopressin (DDAVP)

    Desmopressin releases stored von Willebrand factor and factor VIII.

22. Splenomegaly can cause thrombocytopenia because:

    1. A. The spleen suppresses the marrow
    2. B. The spleen bleeds into itself
    3. C. The spleen traps platelets
    4. D. The spleen dilutes clotting factors
    Show answer

    Answer: C. The spleen traps platelets

    An enlarged spleen can sequester a large share of the platelets. The marrow keeps making platelets normally; they are pooled in the spleen. Bleeding into the spleen is not how it lowers the count, and platelets are cells, not clotting factors that can be diluted.

23. After a failed IV attempt in a patient with severe hemophilia, you should:

    1. A. Massage the site to spread the blood out evenly
    2. B. Apply a tight band above the site
    3. C. Hold firm pressure for at least 5 minutes
    4. D. Apply heat to open the vein again
    Show answer

    Answer: C. Hold firm pressure for at least 5 minutes

    Venipuncture sites bleed longer in hemophilia. Hold pressure longer than usual and check for a growing hematoma.

24. Spontaneous bleeding from low platelets becomes likely below about:

    1. A. 20,000/µL
    2. B. 100,000/µL
    3. C. 150,000/µL
    4. D. 250,000/µL
    Show answer

    Answer: A. 20,000/µL

    Below about 10,000 to 20,000/µL, spontaneous bleeding becomes a serious risk. Most procedures are considered safe above about 50,000/µL.

25. The best way to control a nosebleed in a patient with a bleeding disorder is:

    1. A. Tilt the head back and pinch
    2. B. Lie flat and swallow the blood
    3. C. Pack the nostril with ice
    4. D. Firm pinch, leaning forward
    Show answer

    Answer: D. Firm pinch, leaning forward

    Hold pressure for at least 10 to 15 minutes, longer than for other patients.