Viral Hepatitis

Question 1

which hepatitis virus is DNA genome

Answer 1

B

Question 2

hep ___ causes chronic hepatitis in 10%, whiel hep ___ causes it in 70%

Answer 2

B, C

Question 3

hepatitis A is _______ (enveloped/ nonenv), _____ (RNA?DNA) virus

Answer 3

nonenveloped
RNA

Question 4

Hep A transmission is through

Answer 4

fecal oral
ingestion of contaminated food or water

Question 5

immune response by ________ likely cause of hepatocyte damage in Hep A

Answer 5

cytotoxic T cells

Question 6

which of the following is false regarding hep A
1. children are often asymptomatic
2. virus replicates outside of hepatocytes, causing generalized inflammation
3. serology of negative anti-HAV IgM and + AntiHAV-IgG = immunity from past infection or vaccine
4. all of the above are true

Answer 6

2

Question 7

what does + anti HAV IgM and IgG mean

Answer 7

acute or recent HAV infection

Question 8

list 3 ways to prevent hep A infection

Answer 8

Hand washing + contact precautions
Sanitation, Avoid drinking contaminated water
Boil food/ beverages that may be contaminated
Hep A vaccination, Immunoglobulin

Question 9

hep A is generally
1. self limiting
2. requires hospitalization
3. requires immunization if recent infection
4. none of the above

Answer 9

1

Question 10

hep B is a ___ (RNA/ DNA) virus that is ___ (enveloped/ nonenveloped)

Answer 10

DNA
enveloped

Question 11

HBsAG is on the

Answer 11

outer surface

Question 12

HBcAG and HBeAG is the

Answer 12

inner core

Question 13

labs expected to see in No current/ previous HBV infxn
No immunity

Answer 13

negative to HBsAG, antiHBs, antiHBc

Question 14

labs expected to see in HBV immunity due to vaccination

Answer 14

neg HBsAG, antiHBc
+ antiHBs

Question 15

labs expected to see in chronic HBV infection

Answer 15

+HBsAG, - antiHBs, + antiHBc

Question 16

T or F: hep B is curable

Answer 16

F

Question 17

how to prevent Hep B

Answer 17

vaccination
passive immunity in post exposure individuals
barrier protection + avoid sharing products which may have blood

Question 18

hep C disproportionately affects

Answer 18

indigenous
IJDUs
immigrants
homeless or incarcerated
born 1946-1965

Question 19

list 3 ways hep C can be transmitted

Answer 19

Sharing drug injection equipment
Unsterile tattooing or body piercing
Unsterile medical or dental procedures (where skin is pierced)
Blood produce transfusion in Canada before 1992
Parent to child transmission during pregnancy or childbirth (do not need to avoid pregnancy or breastfeeding)
Sexual transmission (even trace blood)
Reusing someone’s personal items with blood on them (ex- razors, nail clippers, toothbrushes)

Question 20

rank the following from lowest to highest risk of transmission by needlestick: HIV, HCV, HBV

Answer 20

HIV < HCV <HBV

Question 21

initial clinical presentation of hep C is usually ______

Answer 21

asymptomatic

Question 22

HCV is detectable within ____ and ____ increases

Answer 22

1-2wks
ALT

Question 23

hep C sx

Answer 23

Fatigue, weakness
Anorexia, abdominal pain
Jaundice, dark urine

Question 24

describe prognosis of untx hep C infection

Answer 24

15-40% resolution
60-80% chronic HCV → 20% cirrhosis @ 20yrs (death/ transplant) → 1-4% hepatocellular carcinoma @ 30 yrs (death/ transplant)

Question 25

what is a way to prevent hep C transmission by up to 80%

Answer 25

Access to opioid agonist tx + needle and syringe programs (NSP) can reduce HCV by up to 80%

Question 26

T or F: dried hep C blood is not contagious

Answer 26

F- is contagious,. should clean with bleach

Question 27

list 3 populations we should test for HCV

Answer 27

Current/ hx IJDU Born or had medical/ dental tx in HCV endemic countries Received healthcare where there is a lack of universal precautions Received blood transfusions, products, or organ transplant in Canada before 1992>18mths born to mothers with HCV Hx incarceration Hx needle stick injury Persistently elevated ALT Other RF: high risk sexual behavior, homelessness, IN drug use, tattooing, body piercing, sharing personal care items with someone who is HCV infxn

Question 28

hep C virus should be tested ____ after exposure for ____

Answer 28

3mths RNA

Question 29

if antibodies for HCV are positive, that indicates

Answer 29

acute, chronic, or past infxn

Question 30

if a PCR HCV RNA is +, what happens

Answer 30

confirm using RNA if RNA - = HCV cleared (past infxn) if RNA + = current infxn

Question 31

pros of POCT hep C

Answer 31

Easy to perform (capillary blood - finger prick) Results in 20min V good sensitivity and spec (96-100%, 99-100%) Easy to adapt to diff practice models/settings Low barrier for testing

Question 32

cons of POCT hep C

Answer 32

Requires confirmation (HCV RNA) Results not on netcare Pt may be at risk of HIV or other STIs Cost of testing

Question 33

pros of dried blood spot hep C test

Answer 33

Easy to perform (capillary blood - finger prick) V good sensitivity and spec Can detect HCV RNA Can test for multiple infections (HIV, HBV, syphilis, etc) Low barrier for testing

Question 34

cons of hep C blood spot test

Answer 34

Not widely available at public health labs Results not immediate

Question 35

T or F: hep C is a notifiable disease in alberta

Answer 35

T

Question 36

what are some counselling tips for adults with HCV infection

Answer 36

reduce/ avoid alcohol Smoking cessation (to ↓ risk hepatocellular carcinoma) Hep A and B vaccines (if nonimmune) Maintain healthy weight and diet avoid/ limit hepatotoxic agents/ drugs

Question 37

list 10 labs to order in HCV infection

Answer 37

anti-hep A IgG antibody hep B surface antigen anti-Hbc antibody anti-HBs antibody AST ALT CBC creatinine

Question 38

if FIB-4 >3.25 =

Answer 38

refer to specialist

Question 39

tx for hep C is recommended for

Answer 39

all pts with chronic HCV infection

Question 40

who do not need hep C tx

Answer 40

those with severe comorb + short life expectancy unrelated to HCV

Question 41

in adults with HCV without cirrhosis and have not received previous hep C tx 1. should receive full hep C tx 2. should receive simplified tx 3. do not need tx- will clear themselves 4. 2 or 3

Answer 41

2

Question 42

the goal of hep B tx is to achieve SVR- absence of detectable HCV ________________ at least _____ after completion of tx

Answer 42

absence of detectable HCV RNA 12 wks

Question 43

____ is a marker for cure of HCV infection

Answer 43

SVR

Question 44

T or F: for a pt to have eradicated the infection, they must be rid of both HCV antibodies and RNA in serum and tissue

Answer 44

F- will still have HCV antibodies

Question 45

3 oral tx classes for hep B

Answer 45

NS3/4A protease inhibitor (-previr) NS5B polymerase inhibitors (-buvir) NS5A inhibitors (-asvir)

Question 46

NS3A4 protease inhibitor ends with

Answer 46

-previr

Question 47

NS5B polymerase inhibitors end with

Answer 47

-buvir

Question 48

NS5A inhibitors end with

Answer 48

-asvir

Question 49

most intx with hep B tx are

Answer 49

CYP3A4 metabolism hepatic/ intestinal transporters

Question 50

describe monitoring for hep B after tx

Answer 50

week 12 after end of tx = do SVR HCV RNA, AST, ALT