Hepatitis

Question 1

transmitted via oral-fecal

Answer 1

acute hepatitis A

Question 2

when does acute hepatitis A present in feces before clinical illness?

Answer 2

2 weeks before

Question 3

what is the major risk factor of acute hepatitis A?

Answer 3

international travel

Question 4

a patient presents with fever, fatigue, anorexia, N/V/D, RUQ pain, muscle and joint pain, jaundice, distaste for smoking and +/- white (acholic) stools. Dx?

Answer 4

acute hepatitis A

Question 5

in a patient with acute hepatitis A, what coincides (occurs) with improvement of fever?

Answer 5

jaundice

Question 6

what will be seen in labs in a patient with acute hepatitis A? (4)

Answer 6

large atypical lymphocytes
markedly elevated AST/ALT
elevated total bilirubin
elevated alk phos

Question 7

what will be seen in labs before jaundice in acute Hep A? (2)

Answer 7

mild proteinuria
bilirubinuria

Question 8

a patient’s labs show + anti-HAV IgM, +/- anti-HAV IgG, and + HAV. Dx?

Answer 8

acute HAV infection

Question 9

a patient’s labs show - anti-HAV IgM, + anti-HAV IgG, and - HAV. Dx?

Answer 9

prior HAV vaccine or infection

Question 10

a patient’s labs show - anti-HAV IgM, - anti-HAV IgG, and - HAV. Dx?

Answer 10

not infected or vaccinated

Question 11

what is the treatment for acute hepatitis A? (2)

Answer 11

supportive tx
no hepatotoxins

Question 12

what is the treatment for acute hepatitis A with encephalopathy or coagulopathy? (2)

Answer 12

hospitalization
liver transplant

Question 13

when do most patients clinically recover from acute hepatitis A?

Answer 13

within 3 months

Question 14

a patient between 1-40 yo who has been exposed to HAV should have which prophylaxis vaccine?

Answer 14

HAV vaccine

Question 15

a patient younger than 1 and older than 40 yo who has been exposed to HAV should have which prophylaxis vaccine?

Answer 15

HAV immune globulin + vaccine

Question 16

transmitted by infected blood, blood products, sexual contact, and can be transmitted from mothers to infant during delivery

Answer 16

acute hepatitis B

Question 17

a patient presents with fever, fatigue, anorexia, nausea, RUQ pain, jaundice, and hepatomegaly on palpation and percussion. Dx?

Answer 17

acute hepatitis B

Question 18

what lab is associated with increased mortality in acute hepatitis B?

Answer 18

prolonged PT

Question 19

found on outer shell of virus, an early sign of infection; can indicate acute or chronic HBV infection

Answer 19

HBsAG (surface antigens)

Question 20

antibody to outer shell of virus, shows immunity from vaccine or previous exposure to Hep B virus

Answer 20

anti-HBs

Question 21

antibody to protein found inside virus; indicates active infection or previous exposure, not from vaccine

Answer 21

anti-HBc

Question 22

indicates the Hep B virus is actively replicating

Answer 22

HBeAg

Question 23

antibody to envelope antigen; differentiates early from diminishing or sub-acute infection

Answer 23

anti-HBe

Question 24

a patient presents with + HBsAg. Dx?

Answer 24

early acute HBV infection

Question 25

a patient presents with + anti-HBc IgM and + HBsAg. Dx?

Answer 25

acute HBV infection

Question 26

a patient presents with + anti-HBc IgG and + anti-HBs. Dx?

Answer 26

resolved acute HBV infection

Question 27

a patient presents with + anti-HBc IgG and + HBsAg. Dx?

Answer 27

chronic HBV infection

Question 28

a patient presents with + anti-HBs. Dx?

Answer 28

prior vaccination, no infection

Question 29

a patient presents with - anti-HBc IgM, anti-HBc IgG, HBsAg, and anti-HBs. Dx?

Answer 29

no infection or prior vaccination

Question 30

what is the treatment for acute hep B?

Answer 30

supportive tx

Question 31

what is the management for acute hep B with encephalopathy or coagulopathy?

Answer 31

hospitalization

Question 32

what is the treatment for severe acute hep B with elevated INR and jaundice > 4 weeks, and acute liver failure?

Answer 32

tenofovir / entecavir D/C meds after HBsAg is negative in 2 tests, 4 weeks apart

Question 33

what indicates a transition from acute hep B to chronic hepatitis?

Answer 33

elevated liver enzymes for > 6 months

Question 34

what is the prophylaxis in an unvaccinated patient post-exposure to HBV?

Answer 34

hep B immune globulin + Hep B vaccine series

Question 35

transmitted via infected blood and blood products.

Answer 35

acute hepatitis C

Question 36

what does acute HCV develop into in most patients?

Answer 36

chronic HCV

Question 37

what is the most common risk factor for acute hepatitis C?

Answer 37

IV drug use

Question 38

a patient presents without symptoms, but can present with +/- viral syndrome, jaundice, and abdominal pain. Dx?

Answer 38

acute hepatitis C

Question 39

what is the first line diagnostic test for acute hepatitis C?

Answer 39

enzyme immunoassay (EIA) for HCV antibodies

Question 40

what other test can be done to confirm acute hepatitis C if EIA is positive?

Answer 40

HCV RNA PCR

Question 41

what is the CDC diagnostic criteria for acute hep C infection?

Answer 41

ALT over 7x the upper limit of normal

Question 42

what is the treatment for acute hep C?

Answer 42

antiviral meds based on genotype testing

Question 43

what only causes hepatitis in association with acute or chronic HBV?

Answer 43

hepatitis D

Question 44

what does hepatitis D increase the risk of?

Answer 44

hepatocellular carcinoma

Question 45

inflammation of the liver with elevated AST/ALT over > 6 months.

Answer 45

chronic hepatitis B

Question 46

what is treatment for chronic hep B based on? (3)

Answer 46

presence of cirrhosis ALT HBV levels

Question 47

what is important to note in labs of a patient with chronic hep C?

Answer 47

AST/ALT normal in 40% of cases

Question 48

what diagnostic are used for chronic hep C? (2)

Answer 48

anti-HCV by ELISA for screening HCV RNA by PCR for confirmation

Question 49

what is the treatment for chronic hep C?

Answer 49

antiviral depending on genotype testing