Bloodborne Diseases: HIV and Hepatitis Practice Questions

25 multiple-choice questions on Bloodborne diseases: HIV and hepatitis for paramedic and EMT students, from Chapter 27 (Infectious Diseases). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The risk of HIV infection after a needlestick from an HIV-positive patient is about:

   1. A. 3%
   2. B. 30%
   3. C. 90%
   4. D. 0.3%
   Show answer

   Answer: D. 0.3%

   The risk is much lower than for hepatitis B. PEP reduces it further.

2. A woman with chronic hepatitis B delivers her baby in the ambulance. At the hospital, the newborn should receive:

   1. A. HBIG and the first vaccine dose
   2. B. No treatment for now
   3. C. A 10-day course of oral antibiotics
   4. D. Formula feeding in place of breast milk
   Show answer

   Answer: A. HBIG and the first vaccine dose

   Babies of mothers with hepatitis B need hepatitis B immune globulin and the first vaccine dose within 12 hours of birth, which prevents most infections. Breastfeeding is allowed, and antibiotics do not treat a virus. Tell the receiving staff the mother's status.

3. Hepatitis B can survive on surfaces for up to:

   1. A. 1 minute
   2. B. 1 hour
   3. C. 7 days
   4. D. 1 year
   Show answer

   Answer: C. 7 days

   Dried blood on surfaces can remain infectious for a week.

4. After completing the hepatitis B vaccine series, an EMT's antibody test shows no protective level. The usual next step is to:

   1. A. Repeat the series and retest
   2. B. Accept that she is fully immune
   3. C. Start lifelong antiviral drugs
   4. D. Stop all patient contact for good
   Show answer

   Answer: A. Repeat the series and retest

   About 5% to 10% of people do not respond to the first series. CDC advises a second series followed by retesting. Those who still do not respond are considered susceptible and need HBIG after any exposure.

5. Large hepatitis A outbreaks in recent years have mostly affected people who:

   1. A. Recently received blood transfusions
   2. B. Had hepatitis B vaccination as children
   3. C. Work in office buildings
   4. D. Are homeless or use drugs
   Show answer

   Answer: D. Are homeless or use drugs

   Since 2016, US hepatitis A outbreaks have spread mainly among people experiencing homelessness and people who use drugs, through poor sanitation and close contact. ACIP now recommends vaccination for these groups. Transfusion is not a typical route.

6. A patient who was cured of hepatitis C last year still injects drugs with shared needles. Regarding hepatitis C, he:

   1. A. Is now immune for life
   2. B. Can be infected again
   3. C. Is protected by the vaccine
   4. D. Cannot spread it to others
   Show answer

   Answer: B. Can be infected again

   Cure with antivirals does not create immunity, so reinfection is possible with new exposures. There is no hepatitis C vaccine. Harm reduction, such as sterile syringes, is the best prevention.

7. The most common route of hepatitis C transmission in the US today is:

   1. A. Blood transfusions
   2. B. Needlesticks in health care
   3. C. Casual household contact
   4. D. Injection drug use
   Show answer

   Answer: D. Injection drug use

   Shared needles are the main route. Sexual and perinatal transmission are less common. Blood donor screening has made transfusion spread rare in the US, needlestick infections are uncommon, and casual contact does not spread hepatitis C.

8. Hepatitis D can only infect people who also have:

   1. A. Hepatitis B
   2. B. Hepatitis A
   3. C. Hepatitis C
   4. D. HIV
   Show answer

   Answer: A. Hepatitis B

   Hepatitis D needs hepatitis B to replicate. The hepatitis B vaccine prevents both.

9. Classic signs of acute hepatitis include:

   1. A. Blood in the urine
   2. B. Pale skin and pale gums
   3. C. Jaundice and dark urine
   4. D. Left upper quadrant pain
   Show answer

   Answer: C. Jaundice and dark urine

   Patients may also have fatigue, nausea, right upper quadrant pain, and pale stools. The dark urine is from bilirubin, not blood. Pale skin without jaundice suggests anemia, and the liver lies in the right upper quadrant, not the left.

10. Hepatitis C is now:

    1. A. Preventable with a vaccine
    2. B. Curable with antivirals
    3. C. Treated with antibiotics
    4. D. Fatal in most cases
    Show answer

    Answer: B. Curable with antivirals

    There is no hepatitis C vaccine, but direct-acting antivirals cure most patients.

11. A paramedic has a deep needlestick from a patient whose HIV status is unknown. The source's test results will take a day. Regarding HIV PEP, she should:

    1. A. Wait for the source patient's test results first
    2. B. Wait to see if she develops a fever or rash
    3. C. Start now if advised; stop if negative
    4. D. Skip PEP for now
    Show answer

    Answer: C. Start now if advised; stop if negative

    PEP works best when started within hours, so it should not be delayed while waiting for the source's results. If the source tests negative, PEP can be stopped. Waiting for symptoms is too late.

12. A patient with untreated HIV and weeks of cough, fever, and weight loss is especially likely to have:

    1. A. Seasonal allergies
    2. B. Active tuberculosis
    3. C. A common cold
    4. D. Acid reflux disease
    Show answer

    Answer: B. Active tuberculosis

    HIV greatly raises the risk that latent TB becomes active, and TB is a leading cause of death in people with HIV. Weeks of cough, fever, and weight loss call for an N95 and airborne precautions.

13. Patients taking antiretroviral therapy with an undetectable viral load:

    1. A. Do not transmit HIV sexually
    2. B. Are cured of HIV
    3. C. Can pass HIV through saliva
    4. D. No longer need viral load checks
    Show answer

    Answer: A. Do not transmit HIV sexually

    Undetectable equals untransmittable (U=U). Treatment suppresses but does not cure HIV, saliva does not transmit it, and regular viral load checks are needed to confirm the virus stays suppressed.

14. Current US recommendations say hepatitis B vaccination should be given to:

    1. A. Health care workers and first responders
    2. B. People who have chronic liver disease
    3. C. Travelers to Asia
    4. D. All adults age 19 to 59
    Show answer

    Answer: D. All adults age 19 to 59

    In 2022, ACIP moved to universal hepatitis B vaccination for adults 19 to 59, and for older adults with risk factors, because risk-based vaccination missed many people. Health care workers remain a priority group.

15. Kaposi sarcoma in a patient with HIV appears as:

    1. A. Yellow jaundice of the skin
    2. B. White oral plaques
    3. C. Purple skin lesions
    4. D. Red streaks
    Show answer

    Answer: C. Purple skin lesions

    It is a cancer linked to a herpesvirus that is common in advanced HIV.

16. CDC now recommends hepatitis C screening for:

    1. A. People who currently inject drugs
    2. B. All adults at least once
    3. C. People born between 1945 and 1965
    4. D. People with jaundice
    Show answer

    Answer: B. All adults at least once

    Because many people with hepatitis C have no symptoms for years, CDC recommends a one-time test for all adults 18 and older and for every pregnancy, with repeat testing for those with ongoing risk. Cure is now possible, so finding cases matters.

17. A patient's lab report shows a positive hepatitis B surface antigen (HBsAg). This means the patient:

    1. A. Is currently infected
    2. B. Was vaccinated in the past
    3. C. Cleared the virus long ago
    4. D. Has hepatitis C as well
    Show answer

    Answer: A. Is currently infected

    HBsAg is part of the virus itself, so a positive test means active infection, acute or chronic, and the blood is infectious. A vaccinated or recovered person has antibody (anti-HBs) instead.

18. Compared with a needlestick, a splash of HIV-positive blood into the eyes carries:

    1. A. No risk, since intact eyes block HIV
    2. B. A much higher risk than a needlestick
    3. C. Risk mainly if the eyes are rubbed afterward
    4. D. A lower but real risk of infection
    Show answer

    Answer: D. A lower but real risk of infection

    The risk of HIV after blood splashes onto mucous membranes is about 0.09%, much lower than after a needlestick. It is still a significant exposure: flush the eyes, report it right away, and be evaluated for PEP.

19. A pregnant woman with HIV takes antiretroviral therapy and has an undetectable viral load. The risk that her baby will be infected is:

    1. A. Under 1% with treatment
    2. B. About 50% regardless
    3. C. About 25% with treatment
    4. D. Certain at vaginal birth
    Show answer

    Answer: A. Under 1% with treatment

    Effective antiretroviral therapy during pregnancy, plus medication for the newborn, cuts mother-to-child transmission to under 1%. Without treatment the risk is about 25%.

20. Chronic hepatitis B and C can lead to:

    1. A. Gallstones and cholecystitis
    2. B. Chronic pancreatitis
    3. C. Cirrhosis and liver cancer
    4. D. Pulmonary fibrosis
    Show answer

    Answer: C. Cirrhosis and liver cancer

    Many patients have no symptoms for decades. Chronic viral hepatitis damages the liver itself; it is not a cause of gallstones, pancreatitis, or lung fibrosis.

21. A patient tells you he takes a daily pill called PrEP. This most likely means he:

    1. A. Has AIDS with a very low CD4 count
    2. B. Takes it to avoid getting HIV
    3. C. Is being treated for hepatitis B
    4. D. Was exposed to HIV in the last hour
    Show answer

    Answer: B. Takes it to avoid getting HIV

    Pre-exposure prophylaxis (PrEP) is taken by HIV-negative people at ongoing risk to prevent infection. It is different from PEP, which is started after a single exposure, and from treatment of established HIV. Standard precautions apply as for any patient.

22. Which body fluid is least likely to transmit HIV?

    1. A. Blood
    2. B. Semen
    3. C. Breast milk
    4. D. Saliva
    Show answer

    Answer: D. Saliva

    Saliva, sweat, tears, and urine without visible blood are not considered infectious for HIV.

23. Post-exposure prophylaxis for HIV is usually taken for:

    1. A. 1 day
    2. B. 3 days
    3. C. 28 days
    4. D. 1 year
    Show answer

    Answer: C. 28 days

    Follow-up testing continues for several months.

24. Hepatitis E is most dangerous in:

    1. A. Young children
    2. B. Endurance athletes
    3. C. Elderly men
    4. D. Pregnant women
    Show answer

    Answer: D. Pregnant women

    Hepatitis E has a high mortality rate in pregnancy.

25. An EMS provider with chronic hepatitis B should:

    1. A. Leave health care work for good
    2. B. Follow medical advice on duties
    3. C. Stop wearing gloves on calls
    4. D. Keep the condition from the employer
    Show answer

    Answer: B. Follow medical advice on duties

    Most can work safely with standard precautions.