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00000 GASTRO > ACUTE VIRAL HEPATITIS: CHAPTER 339 > Flashcards

ACUTE VIRAL HEPATITIS: CHAPTER 339 Flashcards

1
Q

mean incubation period of
* HAV
* HBV
* HCV
* HDV
* HEV

A
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2
Q

Hepatitis infection transmitted via fecal-oral route (2)

A
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3
Q

All hepatitis infection can be transmitted via percutanous route except (1)

A
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4
Q

hepatitis type that is not transmitted perinatally (2)

A
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5
Q

only hepatitis type that is not transmitted sexually

A
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6
Q

type of hepatitis that has the highest chance to be fulminant

A
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7
Q

type of hepatitis that does not progress to chronic state (2)

A
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8
Q

type of hepatitis that does not have a carrier (2)

A
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8
Q

type of hepatitis thatv has the highest chance of progressing to a chronic state

A
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9
Q

type of hepatitis that does not cause cancer (2)

A
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10
Q

type of hepatits that has the EXCELLENT vs GOOD prognosis

A
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11
Q

type of hepatitis wherein prognosis is poorer as patients becomes older

A
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12
Q

prophylaxis for :
* HAV
* HBV
* HCV
* HDV
* HEV

A
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12
Q

Treatment for HAV and HEV

A
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13
Q

Common treatment for HBV,HCV,HDV (1)

A
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14
Q

first line treatment for HBV (4)

A
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15
Q

give at least 3 first line treatment for HCV

A
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16
Q

marker for previous HAV infection,

A

anti-HAV

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17
Q

As the frequency of HAV infection declines, the likelihood of clinically apparent, even severe, HAV illnesses increases in the susceptible adult population

true or false

A

true

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18
Q

Percutaneous inoculation is recognized as a major route of hepatitis B transmission

True or False

A

True

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19
Q

most of the hepatitis transmitted by blood transfusion is not caused by HBV

True or False

A

True

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19
Q

Among the nonpercutaneous modes of HBV transmission, oral ingestion has been documented as a potential but inefficient route of exposure.

True or False

A

True

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20
Q

two nonpercutaneous routes considered to have the greatest impact for HBV transmission are (2)

A
  • intimate (especially sexual) contact
  • perinatal transmission
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21
Q

Perinatal transmission of HBV occurs primarily in infants born to mothers with (2)

A
  • chronic hepatitis B
  • or (rarely) mothers with acute hepatitis B during the third trimester of pregnancy or during the early postpartum period.
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22
Q

most important mode of HBV perpetuation in East Asia and developing countries

A

perinatal transmission

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23
Q

breast-feeding is not contraindicated in women with hepatitis B

True or False

A

True

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24
Q

The likelihood of perinatal transmission of HBV correlates with the presence of (2)

A
  • HBeAg
  • and high-level viral replication
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25
Q

In most cases, acute infection in the neonate is clinically asymptomatic…

True or False

A

True

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26
Q

serum marker that is a reflection of previous HBV infection

A

anti-HBs

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27
Q

most commonly affected age group by Hepatitis B in
* East Asia and Africa vs
* North America and Western Europe

A
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28
Q

persons with elevated AST or ALT are considered high risk for HBV infection

True or False

A

True

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29
Q

Blood/plasma/organ/tissue/semen DONORS are considered high risk for HBV infection

true or false

A

true

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30
Q

the prevalence of HDV infection is highest in what subsets of population (2)

A

the prevalence of HDV infection is highest in injection drug users (11–36%) and hemophiliacs (19%).

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31
Q

how many genotypes of HDV are out there… and what HDV genotype is distributed worldwide

A

Of the eight HDV genotypes, genotype 1 is distributed worldwide

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32
Q

Places where the ff HDV genotypes are found:
* 2
* 3
* 4
* 5
* 6
* 7
* 8

A
  • Genotypes 2 and 4 in the Far East,
  • Genotype 3 in South America
  • Genotypes 5–8 in Africa

Of the eight HDV genotypes, genotype 1 is distributed worldwide

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33
Q

hepatitis C screening is warranted is these age groups (2)

A

hepatitis C screening to all
* adolescents and
* adults aged 18–79

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34
Q

Hepatitis B accounts for 40% of chronic liver disease

true or false

A

False… kasi dapat…

Hepatitis C accounts for 40% of chronic liver disease

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35
Q

This hepatitis infection type was the most frequent indication for liver transplantation before the introduction of high-efficacy DAA (direct acting antiviral) therapy

A

Hepatitis C

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36
Q

most common genotype of HCV

A

genotype 1

parang HDV din since genotype 1 ang distributed worldwide

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37
Q

Breast-feeding does not increase the risk of HCV infection

true or false

A

true

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38
Q

According to table 339-4…this age group is high risk for HCV infection

iba yung nakalagay sa text kasi….may dagdag

A
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39
Q

Persons born between WHAT YEARS , have increased frequency of HCV infection

A

Persons born between 1945 and 1965 have increased frequency of HCV infection

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40
Q

This type of hepatitis resembles hepatitis A in its primarily enteric mode of spread.

A

Hepatitis E

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41
Q

The commonly recognized cases of hepatitis E occur WHEN

A

The commonly recognized cases of hepatitis E occur after contamination of water supplies

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42
Q

An epidemiologic feature that distinguishes HEV from other enteric agents is the….

A

An epidemiologic feature that distinguishes HEV from other enteric agents is the rarity of secondary person-to-person spread from infected persons to their close contacts.

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43
Q

Large waterborne outbreaks of hepatitis E in endemic areas are linked to WHAT genotypes (2)

A

Large waterborne outbreaks of hepatitis E in endemic areas are linked to genotypes 1 and 2

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44
Q

HBV infection is the most common cause of acute viral hepatitis.

true or false

A

false… kasi dapat….

HEV infection as the most common cause of acute viral hepatitis.

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45
Q

clinically apparent acute hepatitis E is extremely rare

true or false

A

true

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46
Q

older age was associated with anti-HEV seropositivity

true or false

A

true

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47
Q

Evidence supports a zoonotic reservoir for WHAT HEPATITIS VIRUS… primarily in swine (but also in deer, camels, and rabbits)

A

Evidence supports a zoonotic reservoir for HEV primarily in swine (but also in deer, camels, and rabbits)

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48
Q

incubation period of hepatitis A vs E

A
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49
Q

incubation period of hepatitis B vs C vs D

A
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50
Q

A low-grade fever between 38° and 39°C (100°–102°F) is more often present in hepatitis B and C than in hepatitis A and E

true or false

A

False.. kasi dapat…

A low-grade fever between 38° and 39°C (100°–102°F) is more often present in hepatitis A and E than in hepatitis B or C

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51
Q

when THIS HEPATITIS is heralded by a serum sickness–like syndrome; rarely, a fever of 39.5°–40°C (103°–104°F) may accompany the constitutional symptoms

A

when hepatitis B is heralded by a serum sickness–like syndrome; rarely, a fever of 39.5°–40°C (103°–104°F) may accompany the constitutional symptoms

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52
Q

With the onset of clinical jaundice, the constitutional prodromal symptoms usually diminish

true or false

A

true

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53
Q

After how many months is complete clinical and biochemical recovery is to be expected in :
* hepatitis A
* hepatitis B
* hepatitis C
* hepatitis E

A
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54
Q

the duration of HBV infection determines the duration of HDV infection.

true or false

A

true

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55
Q

Infection with HDV can occur in the presence of acute or chronic HBV infection

true or false

A

true

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56
Q

As opposed to patients with acute HBV infection, patients with chronic HBV infection can support HDV replication indefinitely

true or false

A

true

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57
Q

Superinfection with HDV in a patient with chronic hepatitis B often leads to clinical deterioration

true or false

A

true

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58
Q

What can explain the sometimes emergence acute hepatitis-like clinical events in persons with chronic hepatitis B (3)

A

Acute hepatitis-like clinical events in persons with chronic hepatitis B may accompany :
* superinfections with other hepatitis agent
* spontaneous HBeAg to anti-HBe seroconversion or
* spontaneous reactivation (i.e., reversion from relatively nonreplicative to replicative infection)

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59
Q

serum AST and ALT FOLLOWS the rise in bilirubin level

True or False

A

serum AST and ALT precede the rise in bilirubin level

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60
Q

Peak levels of AST and ALT these levels are usually reached at the time the patient is clinically icteric

True or False

A

True

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60
Q

The level of AST and ALT does not correlate well with the degree of liver cell damage.

True or False

A

True

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61
Q

Jaundice is usually visible in the sclera or skin when the serum bilirubin value is >43 μmol/L (____mg/dL).

A

Jaundice is usually visible in the sclera or skin when the serum bilirubin value is >43 μmol/L (2.5 mg/dL).

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62
Q

The serum bilirubin may continue to rise despite falling serum aminotransferase levels.

True or False

A

True

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63
Q

Bilirubin levels >340 μmol/L (____mg/dL) extending and persisting late into the course of viral hepatitis are more likely to be associated with severe disease.

A

Bilirubin levels >340 μmol/L (20 mg/dL) extending and persisting late into the course of viral hepatitis are more likely to be associated with severe disease.

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64
Q

Measurement of the THIS LAB RESULT is important in patients with acute viral hepatitis, because a prolonged value may reflect a severe hepatic synthetic defect, signify extensive hepatocellular necrosis, and indicate a worse prognosis.

A

Measurement of the prothrombin time (PT) is important in patients with acute viral hepatitis, because a prolonged value may reflect a severe hepatic synthetic defect, signify extensive hepatocellular necrosis, and indicate a worse prognosis.

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65
Q

antibodies to LKM may occur in these 2 types of hepatitis

A

Hepatitis C and D

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66
Q

a diagnosis of hepatitis A is based on detection of ____ during acute illness

A

a diagnosis of hepatitis A is based on detection of IgM anti-HAV during acute illness

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67
Q

____can give rise to false-positive results in tests for IgM anti HAV

A

Rheumatoid factor can give rise to false-positive results in this test.

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67
Q

Infrequently, levels of HBsAg are too low to be detected during acute HBV infection, even with contemporary, highly sensitive immunoassays.
In such cases, the diagnosis can be established by the presence of WHAT SERUM MARKER

A

nfrequently, levels of HBsAg are too low to be detected during acute HBV infection, even with contemporary, highly sensitive immunoassays.
In such cases, the diagnosis can be established by the presence of IgM anti-HBc.

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68
Q

The titer of HBsAg bears little relation to the severity of clinical disease.

True or False

A

True

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69
Q

a DIRECT correlation exists between the serum concentration of HBsAg and the degree of liver cell damage.

True or False

A

False.. kasi dapat

inverse correlation exists between the serum concentration of HBsAg and the degree of liver cell damage.

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70
Q

in hepatitis B the degree of liver cell damage and the clinical course are related to variations in the patient’s immune response to HBV rather than to the amount of circulating HBsAg.

A

True

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71
Q

True or false

A

True

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72
Q

serum marker that is indicator of relative infectivity.

A

HBeAg

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73
Q

After immunization with hepatitis B vaccine, which consists of HBsAg alone, ____is the only serologic marker to appear.

A

After immunization with hepatitis B vaccine, which consists of HBsAg alone, anti-HBs is the only serologic marker to appear.

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74
Q

Like HBeAg, serum ____ is an indicator of HBV replication, but tests for HBV DNA are more sensitive and quantitative.

A

Like HBeAg, serum HBV DNA is an indicator of HBV replication, but tests for HBV DNA are more sensitive and quantitative.

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75
Q

Except for the early decades of life after perinatally acquired HBV infection (see above), in immunocompetent adults with chronic hepatitis B, a general correlation exists between the level of HBV replication, as reflected by the level of serum ____, and the degree of liver injury.

A

Except for the early decades of life after perinatally acquired HBV infection (see above), in immunocompetent adults with chronic hepatitis B, a general correlation exists between the level of HBV replication, as reflected by the level of serum HBV DNA, and the degree of liver injury.

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76
Q

Among patients with chronic hepatitis B, high levels of ____ increase the risk of cirrhosis, hepatic decompensation, and hepatocellular carcinoma

A

Among patients with chronic hepatitis B, high levels of HBV DNA increase the risk of cirrhosis, hepatic decompensation, and hepatocellular carcinoma

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77
Q

Serologic pattern in ACUTE HEPATITIS B, HIGH INFECTIVITY
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe

A
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78
Q

Serologic pattern in CHRONIC HEPATITIS B, HIGH INFECTIVITY
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe

A
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78
Q

Serologic pattern in RECOVERY FROM HEPATITIS B
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe

A
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79
Q

Serologic pattern in IMMUNIZATION WITH HBSAG (after vaccination)
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe

A
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80
Q

Serologic pattern in LATE ACUTE OR CHRONIC HEP B, LOW INFECTIVITY
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe

A
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81
Q

Serologic pattern in PRECORE-MUTANT
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe

A
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82
Q

Serologic pattern in ACUTE HEPATITIS B
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe

A
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83
Q

Serologic pattern in ANTI HBC WINDOW
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe

A
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84
Q

Serologic pattern in LOW LEVEL HEP B CARRIER
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe

A
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84
Q

Serologic pattern in HEPATITIS B IN THE REMOTE PAST
* HBSAg
* anti HBS
* anti HBc
* HBeAg
* anti HBe

A
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85
Q

In patients with hepatitis B, an episodic pattern of aminotransferase elevation is common.

True or False

A

False…. kasi dapat…

In patients with hepatitis C, an episodic pattern of aminotransferase elevation is common.

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86
Q

A specific serologic diagnosis of hepatitis C can be made by demonstrating the presence in serum of ____.

A

A specific serologic diagnosis of hepatitis C can be made by demonstrating the presence in serum of anti-HCV.

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87
Q

When contemporary immunoassays are used, anti-HCV can be detected in acute hepatitis C during the initial phase of elevated aminotransferase activity and remains detectable after recovery (which is rare) and during chronic infection (common).

True or False

A

True

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88
Q

Non-specificity can confound immunoassays for anti-HCV, especially in persons with a low prior probability of infection, such as volunteer blood donors, or in persons with circulating rheumatoid factor, which can bind nonspecifically to assay reagents;
testing for ____ can be used in such settings to distinguish between true-positive and false-positive anti-HCV determinations.

A

Non-specificity can confound immunoassays for anti-HCV, especially in persons with a low prior probability of infection, such as volunteer blood donors, or in persons with circulating rheumatoid factor, which can bind nonspecifically to assay reagents;
testing for HCV RNA can be used in such settings to distinguish between true-positive and false-positive anti-HCV determinations.

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89
Q

____ are the most sensitive tests for HCV infection and represent the “gold standard” in establishing a diagnosis of hepatitis C.

A

Assays for HCV RNA are the most sensitive tests for HCV infection and represent the “gold standard” in establishing a diagnosis of hepatitis C.

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90
Q

If all these serologic tests are negative and the patient has a well-characterized case of hepatitis after percutaneous exposure to blood or blood products, a diagnosis of ____ can be entertained.

A

If all these tests are negative and the patient has a well-characterized case of hepatitis after percutaneous exposure to blood or blood products, a diagnosis of hepatitis caused by an unidentified agent can be entertained.

91
Q

Determination of HCV RNA level is a reliable marker of disease severity or prognosis but is not helpful in predicting relative responsiveness to antiviral therapy.

True or False

A

False… kasi dapat…

Determination of HCV RNA level
* is not a reliable marker of disease severity or prognosis
* but is helpful in predicting relative responsiveness to antiviral therapy.

92
Q

What is the sine qua non for determining on-treatment and durable responsiveness in hepatitis C

A

HCV RNA monitoring during and after antiviral therapy

93
Q

Detectable anti-HCV in the absence of HCV RNA signifies WHAT

A

Detectable anti-HCV in the absence of HCV RNA signifies spontaneous or therapeutically induced recovery from (“cured”) hepatitis C.

94
Q

The presence of HDV infection can be identified HOW (2)

A

The presence of HDV infection can be identified by
* demonstrating intrahepatic HDV antigen
* or, more practically, an anti-HDV seroconversion (a rise in titer of anti-HDV or de novo appearance of antiHDV).

95
Q

When a patient presents with acute hepatitis and has HBsAg and anti-HDV in serum, determination of the ____ is helpful in establishing the relationship between infection with HBV and HDV.

A

When a patient presents with acute hepatitis and has HBsAg and anti-HDV in serum, determination of the class of anti-HBc is helpful in establishing the relationship between infection with HBV and HDV.

96
Q

What class of anti-Hbc will be detectable in …..
* In simultaneous acute HBV and HDV infections
* in acute HDV infection superimposed on chronic HBV infection

A
97
Q

The serologic/virologic course of events during acute hepatitis E is entirely analogous to that of acute hepatitis A

True or False

A

True

98
Q

A patient with acute hepatitis should undergo four serologic tests

A
  • HBsAg
  • IgM anti-HAV
  • IgM anti-HBc
  • anti-HCV
99
Q

Serologic pattern for ACUTE HEP B
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV

A
100
Q

Serologic pattern for CHRONIC HEP B
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV

A
101
Q

Serologic pattern for ACUTE HEP A SUPERIMPOSED ON CHRONIC HEP B
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV

A
102
Q

Serologic pattern for ACUTE HEP A AND B
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV

A
103
Q

Serologic pattern for ACUTE HEP A
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV

A
104
Q

Serologic pattern for ACUTE HEP A and B (HBSAG BELOW DETECTION THRESHOLD)
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV

A
105
Q

Serologic pattern for ACUTE HEP B (HBSAG BELOW DETECTION THRESHOLD)
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV

A
106
Q

Serologic pattern for ACUTE HEP C
* HBsAg
* IgM anti-HAV
* IgM anti-HBc
* anti-HCV

A
107
Q

The presence of WHAT SEROLOGIC MARKER , with or without IgM anti-HBc, represents HBV infection.

A

The presence of HBsAg, with or without IgM anti-HBc, represents HBV infection.

108
Q

A diagnosis of acute hepatitis B can be made in the absence of HBsAg when IgM anti-HBc is detectable.

TRUE OR FALSE

A

TRUE

109
Q

A diagnosis of acute hepatitis A is based on the presence of WHAT SEROLOGIC MARKER

A

A diagnosis of acute hepatitis A is based on the presence of IgM anti-HAV.

110
Q

Absence of all serologic markers is consistent with a diagnosis of “non-A, non-B, non-C” hepatitis

TRUE OR FALSE

A

TRUE

111
Q

In patients with chronic hepatitis, initial testing should consist of WHAT 2 SEROLOGIC MARKERS

A

In patients with chronic hepatitis, initial testing should consist of
* HBsAg
* anti-HCV

112
Q

WHAT SEROLOGIC MARKER supports VS establishes the diagnosis of chronic hepatitis C

A

Anti-HCV supports and HCV RNA testing establishes the diagnosis of chronic hepatitis C.

113
Q

Virtually all previously healthy patients with hepatitis A recover completely with no clinical sequelae.

TRUE OR FALSE

A

TRUE

114
Q

These 4 lab results suggest a more complicated and protracted course of hepatitis

A
  • a prolonged PT,
  • low serum albumin level
  • hypoglycemia
  • very high serum bilirubin values
115
Q

Patients with simultaneous acute hepatitis B and D do not necessarily experience a higher mortality rate than do patients with acute hepatitis B alone

True or False

A

True

116
Q

When HDV superinfection occurs in a person with chronic hepatitis B, the likelihood of fulminant hepatitis and death is increased substantially

True or False

A

True

117
Q

Term for outbreaks of severe HDV superinfection in isolated populations with a high hepatitis B carrier rate and has a mortality rate >20%

A

Lábrea fever

118
Q

Another unusual variant of WHAT HEPATITIS…. is cholestatic hepatitis, characterized by protracted cholestatic jaundice and pruritus

A

Another unusual variant of acute hepatitis A is cholestatic hepatitis, characterized by protracted cholestatic jaundice and pruritus

119
Q

During the prodromal phase of acute hepatitis B, a ____characterized by arthralgia or arthritis, rash, angioedema, and, rarely, hematuria and proteinuria may develop in 5–10% of patients.

A

During the prodromal phase of acute hepatitis B, a serum sickness–like syndrome characterized by arthralgia or arthritis, rash, angioedema, and, rarely, hematuria and proteinuria may develop in 5–10% of patients.

120
Q

____ is an immune-complex disease that can complicate chronic hepatitis C and is part of a spectrum of B-cell lymphoproliferative disorders, which, in rare instances, can evolve to B-cell lymphoma

A

EMC (Essential mixed cryoglobulinemia) is an immune-complex disease that can complicate chronic hepatitis C and is part of a spectrum of B-cell lymphoproliferative disorders, which, in rare instances, can evolve to B-cell lymphoma

121
Q

Hepatitis associated with porphyria cutanea tarda and lichen planus

A

Hepatitis C

122
Q

The most feared complication of viral hepatitis is ____

A

The most feared complication of viral hepatitis is fulminant hepatitis (massive hepatic necrosis)

123
Q

Fulminant hepatitis is seen primarily in what hepatitis (3)

A

Fulminant hepatitis is seen primarily in hepatitis B, D, and E

124
Q

Hepatitis C accounts for >50% of fulminant cases

True or False

A

False… kasi dapat…

Hepatitis B accounts for >50% of fulminant cases

125
Q

In acute hepatitis, the combination of rapidly shrinking liver size, rapidly rising bilirubin level, and marked prolongation of the PT, even as aminotransferase levels fall, together with clinical signs of confusion, disorientation, somnolence, ascites, and edema, indicates that the patient has WHAT COMPLICATION

A

in acute hepatitis, the combination of rapidly shrinking liver size, rapidly rising bilirubin level, and marked prolongation of the PT, even as aminotransferase levels fall, together with clinical signs of confusion, disorientation, somnolence, ascites, and edema, indicates that the patient has hepatic failure with encephalopathy.

126
Q

The likelihood of remaining chronically infected after acute HBV infection is especially high among what subset of population (4)

A

The likelihood of remaining chronically infected after acute HBV infection is especially high among
* neonates,
* persons with Down’s syndrome,
* chronically hemodialyzed patients,
* immunosuppressed patients, including persons with HIV infection.

127
Q

the presence of ____ on liver biopsy during protracted, severe acute viral hepatitis suggest progression of acute hepatitis to chronic hepatitis

A

presence of bridging/interface or multilobular hepatic necrosis on liver biopsy during protracted, severe acute viral hepatitis

128
Q

Acute hepatitis D infection increases the likelihood of chronicity of simultaneous acute hepatitis B

True or False

A

False…. kasi dapat….

Acute hepatitis D infection does not increase the likelihood of chronicity of simultaneous acute hepatitis B

129
Q

This suggests progression of acute hepatitis to chronic hepatitis:
* the persistence of HBeAg for ____months or HBsAg for ____months after acute hepatitis
* failure of the serum aminotransferase, bilirubin, and globulin levels to return to normal within ____ months after the acute illness

A
  • the persistence of HBeAg for >3 months or HBsAg for >6 months after acute hepatitis
  • failure of the serum aminotransferase, bilirubin, and globulin levels to return to normal within 6–12 months after the acute illness
130
Q

hepatitis D has the potential for contributing to the severity of chronic hepatitis B.

True or False

A

True

131
Q

After acute HBV infection, the likelihood of remaining chronically infected approaches 85–90%.

True or False

A

False…. kasi dapat…

After acute HCV infection, the likelihood of remaining chronically infected approaches 85–90%.

132
Q

Among cirrhotic patients with chronic hepatitis C, the annual risk of hepatic decompensation is ___ %

A

Among cirrhotic patients with chronic hepatitis C, the annual risk of hepatic decompensation is ~4%.

133
Q

neither HAV nor HEV causes chronic liver disease in immunocompetent hosts

true or false

A

true

134
Q

Term for the disease in children with hepatitis B that may present rarely with anicteric hepatitis, a nonpruritic papular rash of the face, buttocks, and limbs, and lymphadenopathy

A

In children, hepatitis B may present rarely with anicteric hepatitis, a nonpruritic papular rash of the face, buttocks, and limbs, and lymphadenopathy (papular acrodermatitis of childhood or Gianotti-Crosti syndrome).

135
Q

The finding on liver biopsy of fatty infiltration, a neutrophilic inflammatory reaction, and “____” would be consistent with alcohol-induced rather than viral liver injury.

A

he finding on liver biopsy of fatty infiltration, a neutrophilic inflammatory reaction, and “alcoholic hyaline” would be consistent with alcohol-induced rather than viral liver injury.

136
Q

Viral hepatitis in the elderly is often misdiagnosed as ____

A

Viral hepatitis in the elderly is often misdiagnosed as obstructive jaundice resulting from a common duct stone or carcinoma of the pancreas.

137
Q

These diseases can be confused with viral hepatitis during pregnancy (4)

A
  • Acute fatty liver of pregnancy
  • Cholestasis of pregnancy
  • Eclampsia
  • HELLP (hemolysis, elevated liver tests, and low platelets) syndrome
138
Q

the most potent and least resistance-prone agents for severe acute hepatitis B (2)

A

entecavir or tenofovir

139
Q

Treatment for acute hepatitis B should continue until
* ____ months after HBsAg seroconversion
* ____ months after HBeAg seroconversion.

A

Treatment for acute hepatitis B should continue until
* 3 months after HBsAg seroconversion
* 6 months after HBeAg seroconversion

140
Q

in this type of hepatitis, progression to chronic hepatitis is the rule.

A

acute hepatitis C

141
Q

recommended duration of treatment for acute hepatitis C

A

full 8- to 12-week course

142
Q

Forced and prolonged bed rest is not essential for full recovery in acute hepatitis

true or false

A

true

143
Q

Type of diet recommended for patients with acute hepatitis

A

A high-calorie diet is desirable, and because many patients may experience nausea late in the day, the major caloric intake is best tolerated in the morning.

144
Q

If severe pruritus is present in acute hepatitis , the use of this drug is helpful.

A

If severe pruritus is present in acute hepatitis , the use of the bile salt–sequestering resin cholestyramine is helpful.

145
Q

Glucocorticoid therapy has no value in acute viral hepatitis

True or False

A

True

146
Q

Glucocorticoids can increase the risk of chronicity of hepatitis

True or False

A

True

147
Q

most patients hospitalized with hepatitis A excrete little, if any, HAV

True or False

A

True

148
Q

standard precaution should be applied to acute viral hepatitis patients

true or false

A

false… kasi dapat

universal precautions

149
Q

in fulminant hepatitis, protein intake should be restricted

true or false

A

true

150
Q

oral lactulose should not be administered in fulminant hepatitis

true or false

A

false… it should be administered

151
Q

____ is the one factor that appears to improve survival in fulminant hepatitis

A

prophylactic antibiotic coverage is the one factor that appears to improve survival

152
Q

In clinically severe acute hepatitis E or acute-on-chronic liver failure, successful therapy with____ (600 mg twice daily, 15 mg/kg) has been reported anecdotally.

A

In clinically severe acute hepatitis E or acute-on-chronic liver failure, successful therapy with ribavirin (600 mg twice daily, 15 mg/kg) has been reported anecdotally.

153
Q

when fulminant hepatitis E occurs in pregnant women, Ribavirin can be safely administered.

True or False

A

False… because ribavirin is teratogenic

154
Q

In cases of hepatitis E in organ-transplant recipients,
these 2 methods have been shown to be effective, often without antiviral therapy, in achieving eradication of HEV.

A
  • reduction in overall immunosuppressive drug doses and
  • switching from tacrolimus to cyclosporine A
155
Q

In cases of hepatitis E in organ-transplant recipients, if a change in immunosuppression is inadequate… this drug should be given for 3 months

A

ribavirin

156
Q

active immunization is the preferable approach to prevention for these hepatitis (3)

A

hepatitis A, B, and E

157
Q

For postexposure prophylaxis of intimate contacts (household, sexual, institutional) of persons with hepatitis A, the administration of ____mL/kg is recommended as early after exposure as possible

A

0.02 mL/kg

158
Q

For postexposure prophylaxis of intimate contacts (household, sexual, institutional) of persons with hepatitis A, it may be effective even when administered as late as ____weeks after exposure.

A

as late as 2 weeks after exposure

159
Q

Recommended postexposure prophylaxis for hepatitis A

A

hepatitis A vaccine

160
Q

recommended for preexposure prophylaxis prior to international travel to HAV-endemic areas.

A

hepatitis A vaccine

161
Q

interval of administration of vaccine as preexposure prophylaxis against hepatitis B

A

0, 1,6 months

162
Q

Pregnancy is not a contraindication to vaccination

True or False

A

True

162
Q

Recommended prophylaxis for unvaccinated persons sustaining an exposure to HBV

A

postexposure prophylaxis with a combination of HBIG and hepatitis B vaccine

163
Q

Recommended prophylaxis for perinatal exposure of infants born to HBsAg-positive mothers,

A
  • a single dose of HBIG, 0.5 mL, immediately after birth,
  • then course of three injections of recombinant hepatitis B vaccines approved for children (see doses above) to be started within the first 12 h of life.
164
Q

Recommended prophylaxis for those experiencing a direct percutaneous inoculation or transmucosal exposure to HBsAg-positive blood or body fluids

A
  • a single IM dose of HBIG, 0.06 mL/kg, administered as soon after exposure as possible,
  • then a complete course of hepatitis B vaccine to begin within the first week.
165
Q

For pregnant mothers with high-level HBV DNA (>2 × 10^5 IU/mL), adding WHAT DRUG CLASS during the WHAT trimester of pregnancy reduces perinatal transmission even further.

A

For pregnant mothers with high-level HBV DNA (>2 × 10^5 IU/mL), adding antiviral nucleoside analogues during the third trimester of pregnancy reduces perinatal transmission even further.

166
Q

Recommended prophylaxis for persons exposed by sexual contact to a patient with acute hepatitis B,

A
  • a single IM dose of HBIG, 0.06 mL/kg, should be given within 14 days of exposure,
  • to be followed by a complete course of hepatitis B vaccine.
167
Q

When both HBIG and hepatitis B vaccine are recommended, they may be given at the same time but at separate sites.

True or fFalse

A

True

168
Q

Currently, booster immunizations are not recommended routinely, except in these 2 population….

A

Currently, booster immunizations are not recommended routinely, except in
* immunosuppressed persons who have lost detectable anti-HBs
* or immunocompetent persons who sustain percutaneous HBsAg-positive inoculations after losing detectable antibody.

169
Q

for HD patients, how often is anti-HBs testing recommended

A

Specifically, for hemodialysis patients,
* annual anti-HBs testing is recommended after vaccination;
* booster doses are recommended when anti-HBs levels fall to <10 mIU/mL.

169
Q

for HD patients, booster doses of hep B vaccine are recommended when anti HBs levels fall to ____mIU/mL

A

<10 mIU/mL

170
Q

Infection with hepatitis D can be prevented by vaccinating susceptible persons with WHAT

A

Infection with hepatitis D can be prevented by vaccinating susceptible persons with hepatitis B vaccine.

171
Q

For stable, monogamous sexual partners, sexual transmission of hepatitis C is likely, and sexual barrier precautions are recommended.

True or False

A

False… kasi dapat…

For stable, monogamous sexual partners, sexual transmission of hepatitis C is unlikely, and sexual barrier precautions are not recommended.

172
Q

For persons with multiple sexual partners or with sexually transmitted diseases, the risk of sexual transmission of hepatitis C is increased, and barrier precautions (latex condoms) are recommended.

True or False

A

True

173
Q

A person with hepatitis C should avoid sharing such items as razors, toothbrushes, and nail clippers with sexual partners and family members.

True or False

A

True

174
Q

No special precautions are recommended for babies born to mothers with hepatitis C, and breast-feeding does not have to be restricted.

True or False

A

True

175
Q

timing of giving Hep E vaccine

A

0, 1, and 6 months

176
Q

All these human hepatitis viruses are RNA viruses, except for hepatitis ____, which is a DNA virus but replicates like a retrovirus.

A

All these human hepatitis viruses are RNA viruses, except for hepatitis B, which is a DNA virus but replicates like a retrovirus.

177
Q

all types of viral hepatitis produce clinically similar illnesses.

True or False

A

True

178
Q

Hep A virus replication is limited to the liver

True or False

A

True

179
Q

in hepatitis A, fecal shedding, viremia, and infectivity diminish rapidly once jaundice becomes apparent.

True or False

A

True

180
Q

HAV RNA has been reported to persist at low levels in stool, the liver, and serum for up to several months after acute illness; levels correlate with persistent infectivity, probably because of the presence of neutralizing antibody.

True or False

A

False… kasi dapat….

HAV RNA has been reported to persist at low levels in stool, the liver, and serum for up to several months after acute illness; however this does not correlate with persistent infectivity, probably because of the presence of neutralizing antibody.

181
Q

the diagnosis of hepatitis A is made during acute illness by demonstrating what serologic marker…

A

the diagnosis of hepatitis A is made during acute illness by demonstrating antiHAV of the IgM class.

182
Q

After acute illness, anti-HAV of the IgG class remains detectable indefinitely

True or FAlse

A

True

183
Q

Classification/type of virus of Hepatitis A, B, C, D, vs E

A
184
Q

Of the three particulate forms of HBV (Table 339-1), the most numerous are the 42-nm particles

True or False

A

False… kasi dapat…

Of the three particulate forms of HBV (Table 339-1), the most numerous are the 22-nm particles

185
Q

The envelope protein expressed on the outer surface of the hepatitis virion and on the smaller spherical and tubular structures is referred to as ____.

A

The envelope protein expressed on the outer surface of the virion and on the smaller spherical and tubular structures is referred to as hepatitis B surface antigen (HBsAg).

186
Q

genotype A of hepatitis B appears to be associated with less rapidly progressive liver disease and cirrhosis and a lower likelihood, or delayed appearance, of hepatocellular carcinoma

True or False

A

False…. kasi dapat…

genotype B of hepatitis B appears to be associated with less rapidly progressive liver disease and cirrhosis and a lower likelihood, or delayed appearance, of hepatocellular carcinoma

187
Q

The antigen expressed on the surface of the nucleocapsid core is ____, and its corresponding antibody is ____

A

The antigen expressed on the surface of the nucleocapsid core is hepatitis B core antigen (HBcAg), and its corresponding antibody is anti-HBc.

188
Q

qualitative marker of HBV replication and relative infectivity

A

HBeAg

189
Q

disappearance of WHAT SEROLOGIC MARKERM may be a harbinger of clinical improvement and resolution of infection in hepatitis B

A

HBeAg

190
Q

Persistence of HBeAg in serum beyond the first 3 months of acute infection may be predictive of WHAT

A

Persistence of HBeAg in serum beyond the first 3 months of acute infection may be predictive of the development of chronic infection,

191
Q

largest of the HBV genes

A

the P gene

192
Q

After a person is infected with HBV, the first virologic marker detectable in serum within 1–12 weeks, usually between 8 and 12 weeks, is WHAT

A

HBsAg

193
Q

HBsAg follows elevations of serum aminotransferase activity and clinical symptoms

True or False

A

False… kasi dapat….

HBsAg precedes elevations of serum aminotransferase activity and clinical symptoms by 2–6 weeks

194
Q

This serologic marker remains detectable during the entire icteric or symptomatic phase of acute hepatitis B

A

HBsAg

194
Q

THIS SEROLOGIC MARKER is readily demonstrable in serum, beginning within the first 1–2 weeks after the appearance of HBsAg

A

anti-HBc

195
Q

During the “gap” or “window” period, THIS SEROLOGIC MARKER may represent the only serologic evidence of current or recent HBV infection

A

During this “gap” or “window” period, anti-HBc may represent the only serologic evidence of current or recent HBV infection

196
Q

pano nagkakaron ng gap or window period sa hepatitis B

A
  • Because variability exists in the time of appearance of anti-HBs after HBV infection, occasionally a gap of several weeks or longer may separate the disappearance of HBsAg and the appearance of anti-HBs.
  • During this “gap” or “window” period, anti-HBc may represent the only serologic evidence of current or recent HBV infection
197
Q

most instances of isolated anti-HBc represent active virus replication

true or false

A

false… kasi dapat

isolated anti-HBc does not necessarily indicate active virus replication; most instances of isolated anti-HBc represent hepatitis B infection in the remote past.

198
Q

IgM anti HBc predominates during the first ____ months after acute infection,

A

first 6 months

199
Q

Infrequently, in ≤1–5% of patients with acute HBV infection, levels of HBsAg are too low to be detected; in such cases, the presence of THIS SEROLOGIC MARKER establishes the diagnosis of acute hepatitis B.

A

Infrequently, in ≤1–5% of patients with acute HBV infection, levels of HBsAg are too low to be detected; in such cases, the presence of IgM anti-HBc establishes the diagnosis of acute hepatitis B.

200
Q

Generally, in persons who have recovered from hepatitis B, THESE 2 SEROLOGIC MARKERS persist indefinitely.

A

Generally, in persons who have recovered from hepatitis B, anti-HBs and anti-HBc persist indefinitely.

201
Q

protective antibody for hepatitis B

A

anti-HBs

202
Q

patients with precore mutations who cannot synthesize WHAT SEROLOGIC MARKER

A

patients with precore mutations who cannot synthesize HBeAg

203
Q

2 serologic markers that can be detected during the replicative phase of chronic infection

A
  • HBeAg
  • HBV DBA
204
Q

Seroconversion from the replicative to nonreplicative phase is heralded by elevation of what LAB FINDING

A

elevation of ALT

205
Q

what is the qualitative vs quantitative marker of replicative phase of hepatitis B

A

HBeAg is a qualitative marker and HBV DNA a quantitative marker of this replicative phase of hepatitis B

206
Q

even in the so-called nonreplicative phase, HBV replication can be detected at levels of approximately ≤10^3 virions/mL

True or False

A

True

207
Q

high-titer IgM anti-HBc can reappear during acute exacerbations of chronic hepatitis B,

True or False

A

True

208
Q

Term for this HBV mutant in which a single amino acid substitution, from glycine to arginine, occurs at position 145 of the immunodominant “a” determinant common to all HBsAg subtypes.

A

HBV mutants consists of escape mutants, in which a single amino acid substitution, from glycine to arginine, occurs at position 145 of the immunodominant “a” determinant common to all HBsAg subtypes.

209
Q

this hepatitis virus is a defective RNA virus

A

Hepatitis D

210
Q

HDV RNA requires WHAT ENZYME from the host for its replication

A

HDV RNA requires host RNA polymerase II for its replication

211
Q

Although complete hepatitis D virions and liver injury require the cooperative helper function of HBV, intracellular replication of HDV RNA can occur without HBV.

True or False

A

True

211
Q

Both HBV and HDV enter hepatocytes via WHAT RECEPTOR

A

Both HBV and HDV enter hepatocytes via the sodium taurocholate cotransporting polypeptide receptor

212
Q

Differentiate HDV coinfection vs superinfection

A

HDV can either infect a person simultaneously with HBV (coinfection) or superinfect a person already infected with HBV (superinfection)

213
Q

HDV assumes the HBsAg subtype of the DONOR. True or False

A

False… kasi dapat….
.
.
HDV assumes the HBsAg subtype of the recipient, rather than the donor.

214
Q

the duration of HDV infection is determined by the duration of (and cannot outlast) HBV infection.

True or False

A

True

215
Q

patients with hepatitis D tend to have lower levels of HBV replication.

True or False

A

TRUE
HDV replication tends to suppress HBV replication; therefore, patients with hepatitis D tend to have lower levels of HBV replication.

216
Q

The most sensitive indicator of HCV infection is the presence of WHAT SEROLOGIC MARKER

A

The most sensitive indicator of HCV infection is the presence of HCV RNA

217
Q

precore genetic mutants of HBV have been associated with the more severe outcomes of HBV infection (severe chronic and fulminant hepatitis

True or False

A

True

218
Q
  • in patients who undergo liver transplantation for end-stage chronic hepatitis B, occasionally, rapidly progressive liver injury appears in the new liver.
  • This clinical pattern is associated with an unusual histologic pattern in the new liver is called ____.
A
  • in patients who undergo liver transplantation for end-stage chronic hepatitis B, occasionally, rapidly progressive liver injury appears in the new liver.
  • This clinical pattern is associated with an unusual histologic pattern in the new liver, fibrosing cholestatic hepatitis, which, ultrastructurally, appears to represent a choking of the cell with overwhelming quantities of HBsAg.
219
Q

a period of dissociation between high level HBV replication and a paucity of inflammatory liver injury

A

“immunotolerant” phase

220
Q

when clinically apparent liver injury and progressive fibrosis emerge during later decades

A

immunoreactive, or immunointolerant, phase

221
Q

Persons infected as neonates tend to have
○ a relatively higher level of immunologic tolerance (high replication, low necroinflammatory activity) during the early decades of life

True or False

A

True

222
Q

Persons infected as neonates tend to have a relatively lower level (but only rarely a loss) of tolerance (and necroinflammatory activity reflecting the level of virus replication) in the later decades of life

True or False

A

True

223
Q

rheuma disease associated with Hepatitis B

A

Polyarteritis nodosa

224
Q

nephro condition associated wtih hepatitis C

A

Immune-complex glomerulonephritis

224
Q

neuro condition associated with hepatitis E

A

GBS

225
Q

Term for this histologic finding in hepatitis:
Liver cell damage consists of hepatic cell degeneration and necrosis, cell dropout, ballooning of cells, and acidophilic degeneration of hepatocytes

A

Councilman or apoptotic bodies

226
Q

microvesicular steatosis occurs in what hepatitis

A

microvesicular steatosis occurs in hepatitis D.

227
Q

another term for subacute or confluent necrosis or interface hepatitis

A

bridging hepatic necrosis

228
Q

In massive hepatic necrosis (fulminant hepatitis, “acute yellow atrophy”), the striking feature at postmortem examination is the finding of _____.

A

In massive hepatic necrosis (fulminant hepatitis, “acute yellow atrophy”), the striking feature at postmortem examination is the finding of a small, shrunken, soft liver.

00000 GASTRO (5 decks)

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