White Cell Disorders and Blood Cancers Practice Questions

25 multiple-choice questions on White cell disorders and blood cancers 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. A 4-year-old has a limp, bone pain, pallor, and new bruises. You should suspect:

   1. A. Juvenile arthritis
   2. B. A toddler's fracture
   3. C. Growing pains
   4. D. Acute leukemia
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   Answer: D. Acute leukemia

   Leukemic cells crowding the marrow cause bone pain, anemia (pallor), and low platelets (bruising). A fracture or growing pains would not explain pallor and bruising.

2. The most common cancer in children is:

   1. A. Acute lymphocytic leukemia
   2. B. Chronic lymphocytic leukemia
   3. C. Multiple myeloma
   4. D. Hodgkin lymphoma
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   Answer: A. Acute lymphocytic leukemia

   ALL peaks in children aged 2 to 5 and has a high cure rate with treatment.

3. Chronic lymphocytic leukemia (CLL) most often affects:

   1. A. Infants
   2. B. School-age children
   3. C. Older adults
   4. D. Teenagers
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   Answer: C. Older adults

   CLL is the most common leukemia in adults in Western countries and often progresses slowly.

4. Why do leukemia patients often bleed easily?

   1. A. Inherited loss of factor VIII
   2. B. Fragile red cell membranes
   3. C. Low platelet production
   4. D. Brittle capillary walls
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   Answer: C. Low platelet production

   Leukemic cells crowd out megakaryocytes, causing thrombocytopenia. Factor VIII loss is hemophilia, an inherited disorder, and leukemia does not make red cell membranes or capillary walls fragile.

5. Why do leukemia patients have frequent infections despite a high white count?

   1. A. The spleen destroys them
   2. B. The white cells do not work
   3. C. Too many cells block the lymph nodes
   4. D. High counts make bacteria resistant
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   Answer: B. The white cells do not work

   Leukemic white cells are immature and cannot fight infection effectively. The spleen is not destroying the leukemic cells, crowded lymph nodes are not what causes the infections, and a high white count does not make bacteria drug-resistant.

6. Lymphoma is a cancer of:

   1. A. Red blood cells in the marrow
   2. B. Platelets stored in the spleen
   3. C. Plasma proteins made in the liver
   4. D. Lymphocytes in the lymph system
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   Answer: D. Lymphocytes in the lymph system

   Lymphoma arises from lymphocytes, usually starting in lymph nodes or other lymphoid tissue. Leukemia starts in the marrow.

7. Hodgkin lymphoma is characterized by:

   1. A. Reed-Sternberg cells
   2. B. Sickled red cells
   3. C. Philadelphia chromosome
   4. D. Bence Jones proteins
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   Answer: A. Reed-Sternberg cells

   Hodgkin lymphoma often begins in neck nodes and spreads in an orderly pattern.

8. B symptoms in lymphoma include:

   1. A. Bleeding, bruising, and pallor
   2. B. Headache, nausea, and vomiting
   3. C. Joint pain, rash, itching
   4. D. Fever, night sweats, weight loss
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   Answer: D. Fever, night sweats, weight loss

   B symptoms suggest more advanced disease.

9. Multiple myeloma is a cancer of:

   1. A. Neutrophils
   2. B. Plasma cells
   3. C. Megakaryocytes
   4. D. Red blood cells
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   Answer: B. Plasma cells

   Myeloma cells make abnormal antibodies and destroy bone.

10. A classic presentation of multiple myeloma is:

    1. A. Painful swollen joints in a young child
    2. B. Fever and sore throat in a teenager
    3. C. Bone pain, fractures in an older adult
    4. D. Abdominal pain after meals in an adult
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    Answer: C. Bone pain, fractures in an older adult

    Myeloma cells weaken bone, causing back pain and fractures from minor stress, mostly in adults over 60.

11. Multiple myeloma commonly causes which electrolyte abnormality?

    1. A. Hypercalcemia
    2. B. Hypocalcemia
    3. C. Hypernatremia
    4. D. Hypokalemia
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    Answer: A. Hypercalcemia

    Bone destruction releases calcium, causing confusion, constipation, and kidney injury.

12. Why are patients with multiple myeloma prone to serious infections?

    1. A. Their red cells carry bacteria
    2. B. Normal antibody production is suppressed
    3. C. Myeloma raises the neutrophil count
    4. D. Bone pain prevents them from coughing well
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    Answer: B. Normal antibody production is suppressed

    The cancer crowds out normal plasma cells, so the patient makes plenty of one useless antibody and too few working ones. Pneumonia and sepsis are leading causes of death.

13. Neutropenia is defined as:

    1. A. A high neutrophil count
    2. B. A low platelet count
    3. C. A low neutrophil count
    4. D. A high lymphocyte count
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    Answer: C. A low neutrophil count

    An absolute neutrophil count below 500/µL carries a high risk of serious infection.

14. A patient who had chemotherapy 10 days ago has a temperature of 38.4 °C (101.1 °F). You should:

    1. A. Advise acetaminophen and rest at home
    2. B. Wait 24 hours to see if fever persists
    3. C. Give oral fluids and reassess later
    4. D. Treat as possible sepsis and transport
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    Answer: D. Treat as possible sepsis and transport

    Neutrophil counts are lowest about 7 to 14 days after chemo. Febrile neutropenia needs antibiotics within an hour.

15. Signs of infection in a neutropenic patient may be subtle because:

    1. A. Too few white cells to form pus
    2. B. Chemo stops fever from forming
    3. C. Their infections are mostly viral
    4. D. Chemotherapy causes rashes that mask it
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    Answer: A. Too few white cells to form pus

    Without neutrophils, there is little redness, swelling, or pus. Fever may be the only sign. Chemotherapy does not block fever, which is why fever matters so much, and infections in neutropenia are mostly bacterial, not viral.

16. When caring for a neutropenic patient, you should:

    1. A. Skip hand hygiene if gloved
    2. B. Seat a coughing patient beside them
    3. C. Use strict hand hygiene and a mask
    4. D. Give medications by the rectal route
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    Answer: C. Use strict hand hygiene and a mask

    Protect the patient from infection. Avoid rectal temperatures and medications. Gloves do not replace hand hygiene. Seating a coughing patient next to them exposes them to a respiratory infection.

17. Tumor lysis syndrome occurs when:

    1. A. Cancer spreads from the tumor into bone
    2. B. Platelets clump inside small vessels
    3. C. Red cells sickle under low oxygen
    4. D. Dying cancer cells release contents
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    Answer: D. Dying cancer cells release contents

    Rapid cancer cell death releases potassium, phosphate, and uric acid, which can cause arrhythmias and kidney failure.

18. Tumor lysis syndrome is most likely to develop:

    1. A. Several years into remission
    2. B. Within days of starting chemotherapy
    3. C. After a routine blood transfusion
    4. D. As a slow-growing cancer first appears
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    Answer: B. Within days of starting chemotherapy

    It usually appears 1 to 3 days after treatment starts for bulky, fast-growing cancers such as some leukemias and lymphomas, when many cells die at once. Slow-growing cancers rarely cause it.

19. Leukostasis in leukemia is caused by:

    1. A. An extremely high white cell count
    2. B. A very low circulating platelet count
    3. C. A very low hemoglobin concentration
    4. D. A very high serum calcium level
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    Answer: A. An extremely high white cell count

    Huge numbers of white cells thicken the blood, causing stroke-like symptoms and respiratory distress.

20. Superior vena cava syndrome, seen with lymphoma, causes:

    1. A. Swelling of both legs
    2. B. Facial and arm swelling
    3. C. Painless jaundice
    4. D. Bleeding gums and nosebleeds
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    Answer: B. Facial and arm swelling

    A mass in the chest compresses the SVC, causing swelling of the face, neck, and arms and distended chest veins.

21. Which complication of a chest mass can make lying flat dangerous?

    1. A. Cord compression
    2. B. Splenic rupture and bleeding
    3. C. Hypercalcemia from bone loss
    4. D. Airway compression
    Show answer

    Answer: D. Airway compression

    A large mediastinal mass may compress the trachea when supine. Let the patient sit up. Cord compression, splenic rupture, and high calcium are cancer complications, but none of them gets dangerously worse just because the patient lies flat.

22. A woman who finished doxorubicin chemotherapy last year now has orthopnea, leg swelling, and crackles. You should consider:

    1. A. Heart failure from chemotherapy
    2. B. Recurrence of tumor lysis
    3. C. A delayed allergic reaction to chemo
    4. D. Leukostasis in the lungs
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    Answer: A. Heart failure from chemotherapy

    Doxorubicin and related drugs can damage heart muscle, sometimes months or years later. Treat it like any heart failure. Tumor lysis happens in the first days of treatment.

23. In a patient receiving chemotherapy, fever needing urgent evaluation is generally a single temperature of at least:

    1. A. 37.2 °C (99 °F)
    2. B. 39.5 °C (103 °F)
    3. C. 38.3 °C (101 °F)
    4. D. 40.5 °C (105 °F)
    Show answer

    Answer: C. 38.3 °C (101 °F)

    A single reading of 38.3 °C, or 38.0 °C lasting an hour, counts as fever in a neutropenic patient. Waiting for a higher fever delays antibiotics.

24. Hodgkin lymphoma most often first appears in:

    1. A. Infants
    2. B. Young adults
    3. C. Toddlers
    4. D. Adults over 80
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    Answer: B. Young adults

    Hodgkin lymphoma peaks in young adults in their 20s, with a second smaller peak after age 55. It is rare in young children.

25. A patient with chronic myeloid leukemia has a greatly enlarged spleen. Which complaint is most typical?

    1. A. Feeling full after small meals
    2. B. Pain under the right ribs
    3. C. Vomiting blood after meals
    4. D. Pain in the right lower quadrant
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    Answer: A. Feeling full after small meals

    A massive spleen presses on the stomach, causing early fullness and left upper quadrant discomfort. The spleen lies in the left upper quadrant, so the pain is not under the right ribs, and splenic enlargement does not cause vomiting of blood.