IDIS GI Infections

Question 1

Infectious esophagitis is associated with ____ and ____. What are the 3 main etiologies?

Answer 1

dysphagia and odynophagia

GERD, infections, medications

Question 2

Infectious causes of esophagitis are:

What is most common?

Answer 2

1. candida albicans (most common)
2. CMV
3. HSV
4. HIV
5. VZV

Question 3

What is unique to esophagitis?

Answer 3

odynophagia

Question 4

What is key with esophagitis caused by HSV?

Answer 4

abrupt onset

Question 5

What is key with esophagitis caused by CMV?

Answer 5

gradual onset of Sx

only occurs in IC hosts

Question 6

What is the most common cause of chronic active gastritis and peptic ulcer disease?

Answer 6

Helicobacter pylori

Question 7

Often asymptomatic, pain or discomfort in pit of stomach, pain in LUQ, pain from belly to back, burning gnawing sore vague discomfort, belching without relief, N/V

Dx?

Answer 7

chronic active gastritis

Question 8

Gnawing or burning epigastric pain, bleeding that results in anemia weakness or fatigue, hematemesis melena or hematochezia, gastric or duodenal ulcers

Dx?

Answer 8

peptic ulcer disease

Question 9

Pain is made worse by eating in ___ ulcers, but better with eating or taking antacids in ___ ulcers.

Answer 9

gastric ulcers- worse

duodenal ulcers- better

Question 10

Most common cause of esophagitis?

1. HSV
2. CMV
3. HIV
4. Candida albicans
5. Streptococcus pyogenes

Answer 10

Candida albicans

Question 11

60 y/o, epigastric pain, hurts most in morning and 2hr after eating, melena noted. Ulcer noted in duodenum on EGD. Most likely diagnosis?

1. Esophagitis
2. Gastritis
3. Peptic ulcer disease
4. Hepatitis

Answer 11

Peptic ulcer disease

Question 12

Which hepatitis would need a history of travel?

Answer 12

HEV- 20% mortality rate in pregnant women

Question 13

Which hepatitis has a chronic carrier state?

Answer 13

HBV and HCV have chronic carrier states

HAV and HEV do NOT

Question 14

____ has a mortality rate 10 times that of ____.

Answer 14

HEV, HAV

Question 15

Eating raw or undercooked shellfish, daycare facilities, areas with poor sanitation practices, travel to developing countries, MSM, healthcare institutions, food service, illicit drug users

Answer 15

HAV

Question 16

EIA for IgM and IgG for ____.

• Positive for IgM = _______ infection
• Positive for IgG = _______ infection

Answer 16

HAV
acute HAV- IgM
previous HAV- IgG

Question 17

Chronic hepatitis: ___ is more likely to be asymptomatic compared to ___.

Answer 17

HCV, HBV

Question 18

Fulminant hepatitis occurs in ____ of patients.

Answer 18

1%

Question 19

HCV has __ to __% of chronic cases compared to HBV having __ to __%

Answer 19

HCV 70-85%

HBV 5-10%

Question 20

Primary hepatocellular carcinoma: ___ is associated with 80% of the cases of liver carcinoma.

Answer 20

HBV

Question 21

Most common route for transmission of HBV?

Answer 21

sexual contact

Question 22

Most common route for transmission of HCV?

Answer 22

percutaneous routes: injection of drug use (most common), blood transfusion, hemodialysis, renal transplantation

Question 23

If you have an acute disease HCV- the RNA tests ____ and serology is ____.

Answer 23

RNA tests positive serology negative

Question 24

What are the serology tests for HBV and what are they looking for?

Answer 24

HBsAg is looking for the virus circulating in the bloodstream

Anti-HBs and Anti-HBc detects antibodies to HBV antigens

Question 25

Positive for HBsAg, Anti-HBc IgM What stage?

Answer 25

acute

Question 26

Positive for Anti-HBc IgM What stage?

Answer 26

window

Question 27

Positive for Anti-HBs and Anti-HBc IgG What stage?

Answer 27

early convalescence

Question 28

Positive for Anti-HBc IgG What stage?

Answer 28

late convalescence

Question 29

What is the clinical definition of chronic hepatitis?

Answer 29

S antigen in blood stream for 6 months or longer

Question 30

If someone has anti-HBe are they more or less infectious? More or less liver damage?

Answer 30

less infectious to others and less severe liver damage

Question 31

If someone does not have anti-HBe are they more or less infectious? More or less liver damage?

Answer 31

more infectious to others and have more severe liver damage

Question 32

Serology for chronic persistent HBV? Serology for chronic active HBV?

Answer 32

Chronic persistent: Positive for HBsAg, Anti-HBc IgG, Anti-HBe Chronic active: Positive for HBsAg, Anti-HBc, IgG, HBeAg

Question 33

Which virus is most likely to cause chronic hepatitis? 1. HAV 2. HBV 3. HCV 4. HDV 5. HEV

Answer 33

HCV

Question 34

Which virus, if acquired during pregnancy has a high mortality rate? 1. HAV 2. HBV 3. HCV 4. HDV 5. HEV

Answer 34

HEV

Question 35

HBV serology: HBs-Ag- positive, anti-HBs- negative, anti-HBc-IgM- positive 1. early acute HBV 2. window period 3. convalescent HBV 4. chronic HBV 5. vaccinated for HBV

Answer 35

early acute HBV

Question 36

HBV serology: HBs-Ag- negative, anti-HBs- negative, anti-HBc-IgM- positive 1. early acute HBV 2. window period 3. convalescent HBV 4. chronic HBV 5. vaccinated for HBV

Answer 36

window period

Question 37

HBV serology: HBs-Ag- negative, anti-HBs- positive, anti-HBc-IgM- positive 1. early acute HBV 2. window period 3. convalescent HBV 4. chronic HBV 5. vaccinated for HBV

Answer 37

convalescent HBV

Question 38

HBV serology: HBs-Ag- negative, anti-HBs- positive, anti-HBc-IgM- negative 1. early acute HBV 2. window period 3. convalescent HBV 4. chronic HBV 5. vaccinated for HBV

Answer 38

vaccinated for HBV

Question 39

HBV serology: HBs-Ag- positive for 8 months, anti-HBs- negative, anti-HBc-IgG- positive, HBeAg- positive, Anti-HBe- negative 1. early acute HBV 2. window period 3. convalescent HBV 4. chronic active HBV 5. chronic persistent HBV 6. vaccinated for HBV

Answer 39

chronic active HBV

Question 40

Pt with fever, malaise, RUQ pain, jaundice, and hepatomegaly. No Hx of travel. Blood work: elevated AST and ALT, IgM to HAV- negative, IgG to HAV- positive, HBsAg- negative, anti-HBs- positive, anti-HBc- negative, HCV-RNA- positive, IgG to HCV- negative, IgG to HDV- negative. Which virus is causing this patient's CURRENT condition? 1. HAV 2. HBV 3. HCV 4. HDV 5. HEV

Answer 40

HCV pt likely had HAV in the past, but since there is no IgM for HAV it is not the current problem