Hepatitis

Question 1

Viral Hepatitis is a disease which

Answer 1

should be notified to health protection

Question 2

what is the mean incubation period in hepatitis a

Answer 2

28 days

Question 3

how many days after initial symptoms in hep a does jaundice present

Answer 3

3-10 days

Question 4

why does urine become dark in hepatitis

Answer 4

conjugated bilirubin

Question 5

how is hepatitis a spread

Answer 5

faecal oral route

Question 6

when are patients infectious in jaundice

Answer 6

a week before onset of jaundice

Question 7

what type of virus is Hep A

Answer 7

Picornavirus - RNA

Question 8

which antibodies are present in serum for hep A

Answer 8

IgM

Question 9

how long does it take for hep A antibodies to decline

Answer 9

3-6 months

Question 10

treatment for hep a

Answer 10

none

Question 11

Acute clinical hepatitis may occur when after infection with HBV

Answer 11

Few Weeks to 6 Months

Question 12

What type of virus is hep b virus

Answer 12

Hepadnavirus

Question 13

what are markers of viral replication in Her B

Answer 13

Serum HbeAg and HBV-DNA

Question 14

what is major marker for identifying acutee and chronic HBV infection

Answer 14

HbSAg

Question 15

which patients are highly infectious and at risk of developing chronic liver disease and primary liver cell cancer (hepatoma)

Answer 15

patients with HBeAg

Question 16

Route of transmission in patients with Hep B

Answer 16

Vertical (Perinatal)

Horizontal (sexual, Parenteral eg Needlestick)

Question 17

Transmission from family or person living close is form of what transmission in Hepatitis

Answer 17

Horizontal

Question 18

Factors predisposing to increased risk of Hepatitis in UK

Answer 18

1. Injecting Drugs
2. Multiple Sexual Partners regardless of sexuality
3. Immigration
4. Learning Disability in Residential Care
5. Haemodialysis Patients
6. Haemophilia Patients
7. when a sexual partner has risk factors
8. Babies born to mothers with risks
9. Tattooing or Body Piercing with Non Sterile

Question 19

Babies born to mothers with what Hepatitis antigen are at high risk of perinatal infection and become chronically infected if no preventative immunisation given

Answer 19

HBeAg

Question 20

Diagnosis of Acute HBV Infection can be made if

Answer 20

high levels of anti HbC IGM antibodies present

Question 21

Chronic HBV Infection definition

Answer 21

Presence of HBsAg in serum for more than 6 months.

Question 22

Who is particularly at risk of chronic HBV infection

Answer 22

infants
Male
Immunodeficient

Question 23

what can chronic hbv infection lead to

Answer 23

chronic liver disease
membranous glomerulonephritis
Cirrhosis
Hepatoma

Question 24

who is more likely to progress to chronic infection

Answer 24

Patients with asymptomatic or mild

Question 25

Which Hepatitis complication is the third most common cause of cancer in world

Answer 25

Hepatoma

Question 26

Treatment for Asymptomatic Chronic HBV Infection with Raised ALT HBeAG Positive and with Liver Disease or Cirrhosis

Answer 26

Anti Viral Therapy

Question 27

Indications for Antiviral for those without Cirrhosis 2 out of three of

Answer 27

HBV DNA >2000 Raised ALT Significant Liver inflammation or fibrosis

Question 28

The active immunisation for Hepatitis contains

Answer 28

HbsAG

Question 29

When should you test for adequate protective antibody after immunisation in hepatitis

Answer 29

2-4 months after last dose

Question 30

How to tell further antibody checks not needed after immunisation

Answer 30

>100 Post Vacine Anti Hbs

Question 31

When are boosters of Hepatitis vaccine needed

Answer 31

Every 5 Years

Question 32

What is a reliable indicator of liver inflammation in Hep C

Answer 32

ALT and Increasing AST

Question 33

Hep C is a type of which virus

Answer 33

Blood Borne

Question 34

Rate of transmission from mother to baby with Hep C is high when mother has

Answer 34

HIV

Question 35

Hep C mainly affects

Answer 35

injecting drugs Haemophiliacs Needle Stick Blood Transfusion

Question 36

Hep C is in what virus family

Answer 36

RNA of Flavirus

Question 37

how to test for Hep C

Answer 37

Sequencing

Question 38

Treatment for Hep C

Answer 38

Pegylated A Interferon | Ribavirin

Question 39

Which hepatitis is always found in patients who have hepatitis B

Answer 39

Hepatitis D

Question 40

commonest mode of transmission for hep d

Answer 40

Parenteral Infection

Question 41

tests for hepatitis D

Answer 41

IgG | IgM

Question 42

treatment for hepatitis d

Answer 42

pegylated a interferon

Question 43

Symptoms develop in Hepatitis E how soon after incubation

Answer 43

40 days

Question 44

most common cause of acute viral hepatitis

Answer 44

Hepatitis E

Question 45

Hepatitis E is what type of virus

Answer 45

RNA Henevirus

Question 46

Hepatitis E tests

Answer 46

IgG and IgM and HEV

Question 47

When can healthcare workers with hepatitis not perform EPP

Answer 47

Hepatitis B Antigen Pos Hep B surface Antigen Pos and HBV DNA of 1000 or more Hep C Pos

Question 48

Which hepatitis viruses can be transmitted by the faecal-oral route?

Answer 48

Hep A and E

Question 49

How can these infections be prevented?

Answer 49

Hygiene, Clean Water, Immunisation (Hep A)

Question 50

. How is hepatitis Adiagnosed in the virus laboratory?

Answer 50

Detection of hepatitis A lgM antibody | in a serum sample.

Question 51

Which hepatitis viruses are spread by infected blood?

Answer 51

Heb B,C and D

Question 52

What is the purpose of testing serum for anti-HBc IgM antibody?

Answer 52

Its presence indicates recent hepatitis B infection. If a patient is tested late in the course of illness, HBsAg may have disappeared but the presence of IgM-anti HBc indicates recent infection.

Question 53

Define chronic hepatitis B infection.

Answer 53

HBsAg is present in serum for at least 6 months.

Question 54

What percentages of people will become chronically infected following acute infection with HBV in i) infants ii) children iii) adults

Answer 54

i) 90% ii) 40% iii) 5-10%

Question 55

What is the clinical significance of prolonged HBsAg and HBeAg carriage?

Answer 55

Patients are at risk of long-term sequelae including chronic liver disease, cirrhosis and increased risk of hepatoma.

Question 56

What is the clinical importance of infection with hepatitis C?

Answer 56

60-80% of patients will show evidence of chronic liver disease and are at risk of progression to cirrhosis.

Question 57

What laboratory assessment would you make of someone with antibodies to HCV?

Answer 57

. Serum ALT, HCV RNA.

Question 58

What factor is essential for the transmission of hepatitis D?

Answer 58

Presence of HBsAg.

Question 59

What is the commonest mode of hepatitis D transmission?

Answer 59

Injection of Drugs

Question 60

History of recent jaundice in a 26 year old homosexual. Hepatitis B surface antigen negative. Hepatitis B core antibody negative. Hepatitis A IgM positive.

Answer 60

MSM are at increased risk of hepatitis A as well as hepatitis B. Prevention of hepatitis A is possible by active immunisation with the killed vaccine. Evidence for recent hepatitis A infection. No evidence for infection with hepatitis B.

Question 61

Antenatal screen in a 30 year old woman. Hepatitis B surface antigen positive. Hepatitis B e antigen positive. Hepatitis B e antibody negative. Hepatitis B core IgM antibody negative. Hepatitis B core total antibody positive.

Answer 61

Results consistent with chronic hepatitis B infection. The presence of surface antigen indicates infectivity. The presence of e antigen indicates high infectivity. The absence of IgM anti-core indicates the infection is not recent. Comment: Arrangements should be made in advance so that active (hepatitis B vaccine) and passive (hepatitis B immunoglobulin) can be given immediately after birth to the neonate. Follow up arrangements should be made so that the infant gets the second dose of hepatitis B vaccine at age 4 weeks, the third dose at 8 weeks, and a fourth dose at 12 months, when hepatitis B serology (surface antigen) should also be checked to ensure the child is not infected.

Question 62

History of past injecting drug use. Hepatitis A antibody negative Hepatitis B surface antigen negative. Hepatitis B core total antibody positive. Hepatitis B surface antibody positive. Hepatitis C antibody positive. Hepatitis C RNA positive. 5.

Answer 62

No recent or past infection with hepatitis A. Results consistent with past hepatitis B. Results indicate on-going hepatitis C infection. Comment: Both hepatitis B and C are common in PWIDs. Persistent infection is more common with hepatitis C than hepatitis B. Immunisation against hepatitis B is NOT indicated. Immunisation against hepatitis Ashould be offered. Assess suitability for hepatitis C treatment.

Question 63

Recent onset jaundice in a 65 year old diabetic man who has not been abroad recently. Hepatitis A IgM negative. Hepatitis B surface antigen negative. Hepatitis B core total antibody negative. Hepatitis C antibody negative. Hepatitis E IgG antibody positive. Hepatitis E IgM antibody positive. Hepatitis E RNA positive

Answer 63

Results consistent with recent hepatitis E. No evidence for recent hepatitis Adetected. No evidence for infection with hepatitis B detected. Comment: Both hepatitis A and E may be acquired in the UK (although HAV infection is now uncommon) and abroad. The incubation period of hepatitis E (mean 40 days) is longer than hepatitis A (mean 28 days). Remember to mention travel history on laboratory request forms.

Question 64

Going to live in Africa. Is immunisation needed? Hepatitis A total antibody positive. Hepatitis B core total antibody negative

Answer 64

Evidence for past infection with hepatitis A. Immunisation not indicated. No evidence for previous hepatitis B infection. Immunisation indicated. Comment: A person who plans to stay for a lengthy period in an area of high prevalence is in a category for whom immunisation against both hepatitis Aand B should be considered. Immunisation against Yellow Fever and typhoid may also be indicated.