Viral Hepatitis

Question 1

microbiology of Hep A

Answer 1

a hepatovirus; a small, unenveloped symmetrical RNA virus which shares many of the characteristics of the picornavirus family

Question 2

prevalence of hep A is highest in? (3 continents, 1 country)

Answer 2

south america, africa, southeast asia, and greenland

Question 3

how is hep A transmitted?

Answer 3

fecal-oral via contaminated food/water

Question 4

how does hep A manifest?

Answer 4

acute illness with flu-like sx, maybe N/V/D, icterus/jaundice

Question 5

HAV IgM indicates?

Answer 5

acute exposure to hep A

Question 6

HAV IgG indicates?

Answer 6

prior exposure OR vaccination

Question 7

treatment of hep A

Answer 7

supportive, usually mild

Question 8

close contacts to a pt with acute exposure to hep A should?

Answer 8

receive hep A immune globulin and vaccination

Question 9

microbiology of Hep B

Answer 9

a member of the hepadnavirus group, double-stranded DNA viruses which replicate, unusually, by reverse transcription

Question 10

prevalence of hep B is highest in?

Answer 10

southeast asia, africa, japan, northern canada and alaska

Question 11

how is hep B transmitted?

Answer 11

parenteral, sexual, or perinatal contact

Question 12

of those exposed to hep B, what % develop chronic HBV? Fulminant?

Answer 12

1%, 4%

Question 13

what does it mean if a pt is positive for the HB surface antigen, and what test must be done next?

Answer 13

they are infected with HBV; the next test is for IgM anti-HBc to determine if it is acute (IgM+) or chronic (IgM-)

Question 14

a person who has received the Hep B vaccine will be negative for all tests except?

Answer 14

antibody to HB surface antigen (HBsAb)

Question 15

positivity to HBcAb and HBsAb implies?

Answer 15

immunity due to natural infection that has been fought off

Question 16

a patient with all negative tests except for HBcAb (anti-HBc+) has?

Answer 16

one of several options: 1) resolved infection, 2) false+, so needs vaccine, 3) “low-level” chronic infxn, or 4) resolving acute infxn (in the window)

Question 17

what is the most common form of HBV transmission in the West? In high prevalence areas (Asia/Africa)?

Answer 17

sexual/parenteral in the West; vertical in Asia, Africa

Question 18

HBV immune tolerance occurs in ______-acquired HBV, manifests with (high/low) viral replication, (+/-) for HBeAg, and (+/-) for liver dz sx

Answer 18

perinatally; high viral replication; HbeAg+; no sx of liver dz (nl ALT)

Question 19

during their 20s or 30s, patient with perinatally acquired HBV progress to the _________ stage, in which they are positive on which HBV tests? What is their ALT level?

Answer 19

immune clearance stage; positive for HBeAg, anti-HBe and sometimes anti-HBc (IgM); ALT spikes

Question 20

inactive carriers of HBV show what lab results? Biopsy results?

Answer 20

low levels of DNA and ALT; HBeAg NEGATIVE, but anti-HBe positive; liver biopsy may show active dz

Question 21

the “pre-core mutant” is?

Answer 21

an HBeAg negative form of chronic hepatitis where the patient has developed an alternate form of the virus that does not produce HBeAg (the patient has anti-HBe but no HBeAg)

Question 22

resolution of chronic HBV infection is (common/rare) and patients who resolve HBV still have ______ even after clearance (risk of reactivation in immunosuppressed)

Answer 22

rare; cccDNA

Question 23

hep D is tranmitted by?

Answer 23

parenteral or sexual

Question 24

hep D is a ____ virus that is only seen in the setting of __________

Answer 24

delta (defective RNA virus); chronic hep B

Question 25

how is hep D dependent on hep B?

Answer 25

requirs HB surface antigen to replicate

Question 26

where is hep D endemic?

Answer 26

Mediterranean area

Question 27

HDV is most likely in a patient with progressive liver dz and _____ hep B DNA

Answer 27

inactive/suppressed

Question 28

microbiology of hep C

Answer 28

enveloped single-stranded RNA virus with 6 major genotypes

Question 29

HCV is transmitted?

Answer 29

parenterally (sexual transmission very rare)

Question 30

HCV is of particularly high prevalence in?

Answer 30

the middle east, Egypt

Question 31

HCV is of intermediate prevalence in?

Answer 31

eastern europe, mediterranean, south america, asia

Question 32

HCV is (more/less) likely to result in chronic hepatitis than HBV

Answer 32

more

Question 33

which HBC serotype is most common in the US? Which is most difficult to treat?

Answer 33

GT 1; GT 1

Question 34

which genotype is found in Egypt and the Middle East?

Answer 34

GT 4

Question 35

the majority of patients infected with HIV (resolve infx/get chronic HCV)

Answer 35

chronic HCV (85%)

Question 36

the majority of patients with chronic HIV (become stable/develop cirrhosis)

Answer 36

become stable (80%)

Question 37

the majority of patients with HCV cirrhosis (are stable/die)

Answer 37

stable (75%)

Question 38

HCV is the leading indication for what procedure?

Answer 38

liver transplant

Question 39

the majority of patients with chronic HCV have what symptoms?

Answer 39

none or fatigue, nonspecific complaints

Question 40

if a screening exam shows a high ALT, what HCV test should be performed?

Answer 40

anti-HCV

Question 41

if a patient is positive for anti-HCV, what test should be performed next?

Answer 41

HCV RNA to determine whether the infection is present or cleared

Question 42

factors promoting progression or severity of HCV infection

Answer 42

alcohol intake, steatosis, age > 40, HIV or chronic HBV co-infection, male gender

Question 43

common extrahepatic manifestations of HCV

Answer 43

arthralgia, skin manifestations, HTN, sicca syndrome (mouth, eyes)

Question 44

hepatitis E is most similar to what other hepatitis?

Answer 44

hep A

Question 45

hep E is (acute/chronic), icteric, and self-limiting

Answer 45

acute

Question 46

how is hep E transmitted?

Answer 46

fecal-oral via contaminated water

Question 47

is there a strong case for animal to human transmission of HEV?

Answer 47

NO

Question 48

how long is the incubation period for HEV, and what causes damage to the liver?

Answer 48

2-10 weeks; immune-mediated rxn

Question 49

clinical manifestations of HEV are ____

Answer 49

highly varied; may cause icterus

Question 50

HCV illness in _____ is milder, but in _____ can be fatal

Answer 50

children; pregnant women