Hepatitis

Question 1

How many types of viral hepatitis are there

Answer 1

5
A-E

Question 2

Which types of viral hepatitis can be acute

Answer 2

A-E

Question 3

Which types of viral hepatitis can be chronic

Answer 3

B,C,D

Question 4

Which types of hepatitis are reportable diseases

Answer 4

A, B, C

Question 5

What type of virus is Hep A

Answer 5

RNA

Question 6

How is hep A spread

Answer 6

fecal- oral route
-contaminated food/water
-person to person contact
-international travel

Question 7

What is the incubation period with Hep A

Answer 7

2 weeks to 6 months

Question 8

Is hep A more severe in adults or children

Answer 8

adults

Question 9

What are the symptoms for hep A

Answer 9

Abrupt/insidious onset
-myalgia & fatigue
-N/V & anorexia
-RUQ / epigastric pain
-URI symptoms
-smoking aversion

Question 10

What is the presentation of someone with Hep A

Answer 10

Low grade fever
hepatosplennomegaly
lymphadenopathy
+/- jaundice later in illness

Question 11

If a patient has and acute HAV infection, what will their antibody panel look like

Answer 11

+IgM
- IgG

Question 12

If a patient has -IgM and +IgG antibodies, what type of HAV infection do they have

Answer 12

prior infection or vaccination

Question 13

When is the Hep A vaccine recommended

Answer 13

children 12-23 months
up to 18 years old

Question 14

What is the post exposure prophylaxis for Hep A

Answer 14

Single dose HAV vaccine between ages 1-40

Immunoglobulins is <1 or 40+

Question 15

What is the treatment for hep A

Answer 15

Self limited in 2-3 weeks
-symptomatic treatment and frequent hand washing

Question 16

How is Hep E transmitted and where is it usually seen

Answer 16

Fecal-oral (H2O contamination)

Primarily in india, Asia, Africa, Middle East, Central America

Question 17

What is the incubation person for Hep E

Answer 17

14-60 days
* avg = 5-6 weeks

Question 18

Which populations of people are at risk for Hep E

Answer 18

Pregnancy
underlying liver disease
HIV
chemo
transplant patients

Question 19

What are the symptoms for Hep E

Answer 19

Immunocompromised symptoms
+
clay colored stool, Dark urine

Question 20

What can occur outside of the liver with Hep E

Answer 20

Arthritis
pancreatitis
TTP
Guillain-Barre
Peripheral neuropathy

Question 21

What is the treatment for Hep E

Answer 21

Prevention (no vaccine)
self limited illness

Question 22

What type of Virus is Hep E

Answer 22

RNA

Question 23

What type of virus is Hep B

Answer 23

Ds-DNA

Question 24

How is Hep B transmitted

Answer 24

Blood borne
-Blood products
-occupational exposure
-IVDU
-Mom to baby during delivery
-Sexual contact

Question 25

How long does Hep B stay infectious on fomites

Answer 25

7 days

Question 26

What is the incubation period for Acute Hep B

Answer 26

6 weeks to 6 months avg = 12-14 weeks

Question 27

What Hepatitis lab is most sensitive / precise for chronic Hep B

Answer 27

HBV DNA (viral load)

Question 28

What in Hepatitis labs indicate Hep B viral infection

Answer 28

+HBsAg and HBeAg

Question 29

What hepatitis markers differentiate between acute, chronic, or carrier Hep B infection

Answer 29

+Anti-HBc (IgM & IgG) *contact with viral DNA

Question 30

What does Anti-HBe indicate on hepatitis labs

Answer 30

Cessation of replication

Question 31

How long does acute illness last with hep B

Answer 31

2-3 weeks *can be up to 16 weeks

Question 32

Can anyone have reactivation of Hep B

Answer 32

yes as long as they were exposed to the actual virus (not the vaccine)

Question 33

How can you prevent hep B

Answer 33

Handwashing standard precautions Safer sex practices PeP Vaccination

Question 34

What time frame indicates chronic hep B

Answer 34

Infection persisting longer than 3-6 months *known. by AST/ALT elevations

Question 35

What risk factors do those with Hep B have

Answer 35

HIV/HCV coinfection Hep D coinfection HCC independant of cirrhosis

Question 36

What pharmacological treatment can be given for chronic hep B

Answer 36

Entecavir Tenofovir *PO admin

Question 37

When can those with chronic hep B be given an antiviral

Answer 37

Only when actively replicating *check HBV and HBeAg levels (+)

Question 38

Why are nucleoside analogues chosen over PEG inf for hepatitis treatment

Answer 38

Most dont tolerate PEG inf

Question 39

What is the goal of treatment with chronic Hep B

Answer 39

Convert the antigens to antibodies and to bring down the viral load

Question 40

What is the prognosis with chronic hep B

Answer 40

5 year mortality

Question 41

What type of virus is Hep D

Answer 41

RNA

Question 42

How is Hep D transmitted

Answer 42

*only occurs as a coinfection with HBV blood borne

Question 43

When is Hep D cleared from the body

Answer 43

When HBsAg is cleared

Question 44

How do you treat hep D

Answer 44

Treat underlying HBV

Question 45

What type of virus is Hep C

Answer 45

single stranded RNA

Question 46

What dictates the type of treatment with Hep C

Answer 46

The type of genotype (there are 7)

Question 47

What coinfection do many with HCV have

Answer 47

HIV

Question 48

How is HCV transmitted

Answer 48

Blood borne

Question 49

What is the incubation period for hep C

Answer 49

2-12 weeks

Question 50

When is HCV typically diagnosed

Answer 50

with routine labs *often asymptomatic

Question 51

Who gets screened for HCV

Answer 51

All US adults at least 1x pregnant female - each preg one time screening regardless of age

Question 52

Which patients get periodic HCV screening

Answer 52

IVDU Dialysis High risk comorbidities

Question 53

What lab confirms HCV infection

Answer 53

HCV RNA Anti-HCV to screen

Question 54

What is the natural progression of HCV

Answer 54

Spontaneous resolution in 50% Progression to chronic HCV in 50%

Question 55

How do you prevent Hep C

Answer 55

Routine screening for transfusions no Vaccine safer sex + standard precautions HBV and HAV vaccine to help chronic HCV

Question 56

What is the treatment for acute Hep C

Answer 56

Nothing for acute illness *can consider PEG +/- ribacvarin if no clearance in 3 months

Question 57

What is the tx for chronic HCV

Answer 57

Goal is sustained virology response (undetectable 12+ weeks) first line: Ledipasvir + Sofosbuvir

Question 58

Which genotypes respond better to chronic HCV tx

Answer 58

1>2>3

Question 59

When is ribavarin added to HCV therapy

Answer 59

Genotype 3 or 1 and 4 with cirrhosis

Question 60

How long do those with chronic HCV need to be treated

Answer 60

8 weeks with low viral load 12 weeks with genotype 1 24 weeks if cirrhosis is present

Question 61

What chronic HCV treatment is better for those with renal impairment

Answer 61

Elbasavir/ Grazoprevie *types 1 and 4 -type 1 needs resistance testing

Question 62

What impacts treatment regimens for chronic hcv

Answer 62

Any previous treatment +/- of cirrhosis

Question 63

Which HCV treatment cannot be given to those with cirrhosis

Answer 63

Glecaprevir/Pibrentasvir

Question 64

Which treatment is best for HCV types 2-6

Answer 64

Sofosbuvir/velpatasvir

Question 65

What is the leading cause of both HCC and liver transplant

Answer 65

HCV *also increases risk of non-hodgkins lymphoma