E2- Viral Hepatitis

Question 1

What is a common symptom of hepatitis?

Answer 1

Icteric symptoms (jaundice, dark urine, hepatomegaly)

Question 2

What is the most common route of transmission of Hep A and E?

Answer 2

Fecal-oral

Question 3

What two types of hepatitis are acute?

Answer 3

Hep A and E (cannot become chronic)

Question 4

What is the source of Hep B, C, and D?

Answer 4

Blood, serum, semen

Question 5

What three types of hepatitis can cause chronic infection?

Answer 5

Hep B, C, and D

Question 6

What type of hepatitis is “infectious?”

Answer 6

Hep A

Question 7

What type of hepatitis is “serum?”

Answer 7

Hep B

Question 8

What type of hepatitis is “transfusion-associated”/

Answer 8

Hep C

Question 9

What type of hepatitis is “delta agent, only in pts with active HBV infection?

Answer 9

Hep D

Question 10

How does typical acute icteric hepatic present?

Answer 10

Prodrome: fatigue, malaise, anorexia
Icteric phase: dark urine, jaundice, hepatomegaly, elevated ALT, ASP
Convalescent phase: disappearance of symptoms

Question 11

What type of hepatitis has high fatality rates?

Answer 11

Fulminant hepatitis

more likely with HDV

Question 12

How is HAV diagnosed?

Answer 12

IgM antibody demonstration by ELISA

Question 13

How is HAV treated?

Answer 13

Bed rest
Hydration and good nutrition
Avoid hepatotoxins (alcohol, drugs, anesthesia)

Question 14

How is HAV prevented?

Answer 14

Proper hand washing
Avoid contaminated food (uncooked shellfish)
Post exposure prophylaxis with immunoglobin
Killed virus vaccine
Education** commonly transmitted to personal contacts

Question 15

What is a infectious cause of primary hepatocellular carcinoma?

Answer 15

HBV

80% of primary hepatocellular carcinoma is linked to chronic HBV

Question 16

What is a major determinant of whether HBV becomes chronic or not?

Answer 16

Age
Self-limited in most adults
90% of children become chronic

Question 17

What is done to prevent chronic HBV in children?

Answer 17

Vaccine is offered very early in life

Question 18

What is the HBV surface antigen?

Answer 18

HBsAg

Question 19

What is the HBV core antigen?

Answer 19

HBcAg

Question 20

Does the HBcAg provide protection?

Answer 20

No

Question 21

What antigen indicates that the patient is infetious?

Answer 21

HBeAg

Question 22

Can a patient still be infectious if the HBeAg is not present?

Answer 22

Yes

Question 23

What is the infectious form of HBV?

Answer 23

Dane particle

Question 24

How is HBV spread?

Answer 24

Needle sharing, IV drug use, acupuncture, ear piercing, tattooing

Question 25

Who is a major reservoir of HBV?

Answer 25

Chronic hepatitis pts

Question 26

What has reduced the infection from blood and blood products?

Answer 26

Serological screening

Question 27

What is the greatest risk factor for perinatal-congenital infection?

Answer 27

Chronic infection in mother | HBeAg positive mother is greatest risk

Question 28

Who is at greatest risk for HBV infection?

Answer 28

Healthcare workers | IV drug users

Question 29

How is the subclinical infection of HBV recognized?

Answer 29

anti-HBsAg

Question 30

What complications can chronic HBV lead to?

Answer 30

Cirrhosis and liver failure

Question 31

What is the hallmark of initial ongoing HBV infection if present with HBsAg?

Answer 31

IgM anti-HBc

Question 32

What indicates past infection of HBV, if present with HBsAg indicates chronic infection?

Answer 32

IgG anti-HBc

Question 33

What is the best indication of the presence of infectious HBV virus?

Answer 33

HBeAg

Question 34

What do the following test results indicate? HBsAg- negative AntiHBc- positive AntiHBs- positive

Answer 34

Immune due to natural infection

Question 35

What do the following test results indicate? HBsAg- negative AntiHBc- negative AntiHBs- positive

Answer 35

Immune due to hepatitis B vaccination

Question 36

What do the following test results indicate? HBsAg- positive IgM antiHBc- positive AntiHBs- negative

Answer 36

Acutely infected

Question 37

``` What do the following test results indicate? HBsAg- positive AntiHBc- positive IgG antiHBc- positive AntiHBs- negative ```

Answer 37

Chronically infected

Question 38

The HBV vaccine prevents what strains?

Answer 38

HBV and HDV

Question 39

What can be used to treat HBV and HDV?

Answer 39

PEG-interferon

Question 40

Although Hep B, C, and D can all become chronic, which is most likely to progress to a chronic infection?

Answer 40

HCV

Question 41

How is HCV treated?

Answer 41

Direct acting antiviral agents (DAAs) Virus protease or polymerase inhibitors Alpha-interferon (PEG interferon) for some genotypes

Question 42

What might DAA treatment cause in a patient with a HCV and HBV co-infection?

Answer 42

Activation of HBV infection

Question 43

What type of hepatitis requires the presence of HBV for replication?

Answer 43

HDV | increases severity of HBV infection

Question 44

What are the leading causes for liver transplant?

Answer 44

Cirrhosis and hepatocellular carcinoma

Question 45

What is the test to screen for HCV?

Answer 45

Enzyme immunoassay detection of antibody against HCV

Question 46

Why are direct assays for the HCV virus helpfu in confirmation of diagnosis of HCV?

Answer 46

Chronic state and acute phase viremic patients often escape detection