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Clin Med II > GI Tract Infections, Viral Hepatitis/ Misc (Schoenwald) > Flashcards

GI Tract Infections, Viral Hepatitis/ Misc (Schoenwald) Flashcards

1
Q

What is the source of the virus in Hepatitis A?

A

Feces

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2
Q

Is hepatitis A a chronic infection?

A

No

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3
Q

What is the route of transmission in Hepatitis A?

A

Fecal-oral

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4
Q

How can Hep A be prevented?

A

Pre/post exposure immunization

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5
Q

What is the source of the virus in Hep B?

A

Blood/blood-derived body fluids

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6
Q

What is the route of transmission for Hep B?

A

Percutaneous

Permucosal

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7
Q

Can Hep B be a chronic infection?

A

Yes

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8
Q

What is the prevention for Hep B?

A

Pre/post exposure immunization

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9
Q

What is the source of the virus in Hep C?

A

Blood/ blood-derived body fluids

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10
Q

What is the route of transmission in Hep C?

A

Percutaneous

Permucosal

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11
Q

Is Hep C a chronic infection?

A

Yes

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12
Q

How can Hep C be prevented?

A

Blood donor screening, risk behavior modification

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13
Q

What is the source of the virus in Hep D ?

A

Blood/blood-derived body fluids

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14
Q

What is the route of transmission in Hep D?

A

Percutaneous

Permucosal

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15
Q

Can Hep D be a chronic infection?

A

Yes

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16
Q

How can Hep D be prevented?

A

Pre/post exposure immunization, risk behavior modification

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17
Q

What is the source of Hep E?

A

Feces

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18
Q

What is the route of transmission in Hep E?

A

Fecal-oral

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19
Q

Does Hep E cause a chronic infection?

A

No

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20
Q

What can be done to prevent an infection with Hep E?

A

Ensure safe drinking water

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21
Q

What are the clinical symptoms in a acute hepatitis infection?

A 
Nausea
Vomiting 
Abdominal pain 
Loss of appetite 
Fever 
Diarrhea 
Light (clay colored) stool 
Dark urine 
Jaundice- yellowing of the eyes, skin
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22
Q

Can acute hepatitis be asymptomatic?

A

Yes

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23
Q

What are the possible body fluids that Hep A can be transmitted in?

A

Feces
Serum
Saliva

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24
Q

How is Hep A transmitted?

A

Close personal contact- household, sex, child care
Contaminated food, water, infected food handlers
Blood exposure (rare) IVDU, transfusion (rare)

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25
Q

The symptoms of an acute hepatitis infection can range from…

A

Asymptomatic
Symptomatic
Fulminant liver failure
Death

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26
Q

If symptoms are present in an acute hepatitis infection, they will be/ will not be the same regardless of what type of hepatitis infection

A

The symptoms will be the same regardless of what type of hepatitis infection the patient has

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27
Q

What is the most common type of body fluid that hepatitis A is spread in?

A

Feces

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28
Q

What patient populations should be assessed and vaccinated for Hepatitis A?

A 
Drug users 
Homeless 
Men who have sex with men 
People who are currently incarcerated or were recently incarcerated 
People with chronic liver disease

–what do some of these populations have in common– they have less access to care/ choose not to seek care

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29
Q

What lab testing is available for hep a testing?

A

Hep A IgG

Hep A IgM

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30
Q

What does the Hep A IgG test evaluate?

A

Past infection or immunity- however, there is no way to delineate if the immunity is from the vaccine or from prior infection- this information should be obtained from the history

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31
Q

What does the Hep A IgM test evaluate?

A

Active infection

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32
Q

Hepatitis A is/ is not vaccine preventable

A

Is vaccine preventable

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33
Q

Havrix is the vaccination for Hep _

A

A

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34
Q

Havrix vaccination is approved for what age group?

A

12 months and older

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35
Q

What is the dosing regiment for Havrix in children and adolescents?

A

0.5ml dose, 2 shot series given 6 months apart

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36
Q

What is the dosing regiment for Havrix in adults?

A

1ml dose, 2 shot series given 6 months apart

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37
Q

What is Twinrix?

A

Hep A/B combination vaccine

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38
Q

What are the 2 FDA approved dosing schedules for Twinrix?

A

Standard (3 shot series given at day 0, 1 month, and 6 months)
Accelerated (4 shot series given at day 0, day 7, day 21, and 1 year)

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39
Q

What would be the benefit to giving the accelerated schedule for Twinrix?

A

Given to patients that will be putting themselves at risk for infection within the next few months (ex: travel)

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40
Q

What is the treatment for Hepatitis A?

A

Supportive- fluids, avoid Tylenol (extra stress on the liver), abstain from alcohol (detox?) , healthy diet. Patients can usually recover at home unless they have fulminate liver failure

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41
Q

Which virus is the most easily transmittable of all blood borne pathogens?

A

Hepatitis B

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42
Q

Hepatitis B is/ is not more prevalent than HIV

A

Is more prevalent

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43
Q

A hepatitis B infection may lead to…

A

Cirrhosis and/or cancer of the liver

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44
Q

What is the risk of a single needle stick in non immunized patients for Hep B?

A

6-30%

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45
Q

Hep B is/ is not vaccine preventable?

A

Preventable

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46
Q

How effective is the Hep B vaccine?

A

99.9% effective

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47
Q

What body fluids have a high concentration of Hep B?

A

Blood
Serum
Wound exudates

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48
Q

What body fluids have a moderate concentration of Hep B virus ?

A

Seminar
Vaginal fluid
Saliva

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49
Q

What body fluids have a low/ not detectable concentration of Hep B?

A 
Urine 
Feces 
Sweat 
Tears 
Breast milk
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50
Q

How can Hep B be transmitted?

A

Sexual
Parenteral (needle? )
Perinatal (vertical transmission between mother and baby? )

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51
Q

HBV infection can be asymptomatic/ symptomatic

A

Both

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52
Q

HBV infection can be chronic or…

A

Resolved immune

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53
Q

What is HBsAg?

A

Hepatitis B surface antigen

Surface antigens of HBV detectable in large quantity in serum

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54
Q

If a person tests positive for HBsAg are they infectious?

A

Yes

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55
Q

What is Anti-HBs?

A

Antibody to Hep B surface antigen, indicates past infection with immunity to HBV, passive antibody from HBIG, or immune response from HB vaccine

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56
Q

What is HBIG?

A

Hepatitis B immunoglobulin is a human immunoglobulin that is used to prevent the development of hepatitis B and is used for the treatment of acute exposure to HBsAg

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57
Q

What is HBcAg?

A

Hep B core antigen- no commercial test available, used for research

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58
Q

What is anti-HBc?

A

Antibody to HBcAg- indicates a prior or recent infection with HBV

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59
Q

What is IgM anti-HBc?

A

IgM class antibody-indicates recent infection with HBV, detectable for 4-6 months after infection

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60
Q

What is HBeAg?

A

Hepatitis B e antigen, correlates with higher levels of HBV in serum and increased infectivity (higher possibility for infection)

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61
Q

What is Anti HBe?

A

Antibody to HbeAg- presence in serum of HBsAg carrier, indicates lower tiger of HBV- long term carrier, low level

62
Q

What is the first test to be positive in a Hep B infection?

63
Q

Interpret the labs…
HBsAG negative
anti-HBc negative
anti-HBs negative

A

Susceptible to HBV, vaccinate for HBV

64
Q

Interpret the labs…
HBsAG negative
anti-HBc negative
Anti-HBs positive

A

Immune to HBV due to vaccination

65
Q

Interpret the labs…
HbsAg negative
Anti HBc positive
Anti HBs positive

A

Immune to HBV due to infection

66
Q 
Interpret the labs...
HBsAG positive 
Anti HBc positive 
IgM anti HBc positive 
Anti HBs negative
A

Acute HBV infection

67
Q 
Interpret the labs...
HBsAG positive 
Anti-HBc positive 
IgM anti HBc negative 
Anti HBs negative
A

Chronic HBV infection

68
Q

If these are the lab values, what are the possible interpretations?
HBsAG negative
AntiHBc positive
AntiHBs negative

A

Recovering from actuate HBV
Distantly immune, Low anti HBV in serum
False positive anti HBc, susceptible to HBV
Chronic with low levels of HBsAG in serum

69
Q

What are the options for Hep B vaccine?

A

Engerix
Recombivax
Heplisav
TwinRix

70
Q

Which Hep B vaccine has been licensed by the FDA only for adults 18 years and older?

71
Q

What is the dosing regiment for Heplisav?

A

2 dose series, given at day 0 and at 1 month

72
Q

Which 2 Hep B vaccines are 3 dose series?

A

Engerix and Recombivax

73
Q

What is the dosing regiment for Engerix and Recombivax?

A

3 dose series, typically 0, 1-2, 4-6 months- no max time between doses, no need to repeat or restart doses

74
Q

What is the FDA approval age group for Engerix and Recombivax?

A

Newborns and above

75
Q

What protection do the. 3 dose series of the Hep B vaccine provide?

A

Dose 1: 20-50%
Dose 2: 75%
Dose 3: 96%

76
Q

What patient populations have lower protection with the Hep B vaccine?

A 
HIV
Chronic liver disease 
Diabetes 
Obese 
Smokers
77
Q

What are the ACIP Hep B vaccination recommendation?

A

Routine infant
Ages 11-15 “catch up” through age 18
Over 18, especially in high risk

78
Q

What is the VFC program?

A

Federal program allowing children to receive vaccinations at little to no cost

79
Q

What populations are considered high risk and should be immunized for Hep B?

A 
Occupational risk- health care workers 
Hemodialysis patients 
All STD clinic patients 
Multiple sex partners or prior STD
Inmates in correctional settings 
MSM ?
IDU ?
Institution for developmental disability
80
Q

When is pre-vaccination/ post vaccination testing done for Hep B?

A

pre vaccination testing is done if it is cost effective, post vaccination testing is done 1-2 months after the last shot, is establishing response is critical such as in health care workers

81
Q

Hep C is more common/ is less common than HIV

A

is more common than HIV

82
Q

Hep C infection is ____ times more widespread than HIV infection

83
Q

What is the leading cause of liver cancer and liver transplantation in the US?

A

Hep C infection

84
Q

There is a vaccine available/ there is not a vaccine available for Hep C

A

there is not a vaccine available

85
Q

What is the risk for Hep C infection following a needle stick injury?

A

2% (varies, anywhere from 1-3%)

86
Q

What is the incubation period for Hep C?

A

average is 6-7 weeks

range is 2-26 weeks

87
Q

How many people with a Hep C infection experience an acute illness such as jaundice?

A

mild- less than 20%

88
Q

What factors in a Hep C infection promote progression or severity of the disease?

A 
increased alcohol intake 
age greater than 40 years 
HIV co-infection 
male gender 
chronic HBV co-infection
89
Q

The case fatality rate in a Hep C infection are high/ low

90
Q

What factors of Hep C infection are age-related?

A

chronic infection
chronic hepatitis
cirrhosis

91
Q

what percentage of those with Hep C infection have a chronic infection?

92
Q

what percentage of those with a Hep C infection have chronic hepatitis?

A

10-70% (most are asymptomatic)

93
Q

what percentage of those with Hep C have cirrhosis?

94
Q

What percentage of those with a Hep C infection have mortality from CLD?

95
Q

What exposures are known to be associates with HCV infection in the US ?

A

injecting drug use
transfusion, transplant from infected donor
occupational exposure to blood (mostly needle sticks)
iatrogenic (unsafe injections)
birth to HCV-infected mother
sex with an infected partner (multiple sex partners)

96
Q

what is the biggest source of infection with Hep C?

A

injecting drug use

97
Q

What labs can be done in Hep C?

A

hepatitis C antibody
HCV PCR
Genotype

98
Q

which Hep C lab is considered to be confirmatory testing?

99
Q

What is the range of genotypes in HCV testing?

100
Q

What is the most common HCV genotype in the US?

A

genotype 1 is the most common in the US (80%) followed by type 2, 3

101
Q

what HCV genotypes are more common in Asian countries?

102
Q

What is the interpretation of the test result- HCV antibody nonreactive?

A

No HCV antibody detected, no further action, consider HCV RNA if recent exposure

103
Q

What is the interpretation of the test result- HCV antibody reactive?

A

presumptive HCV infection, confirm with HCV RNA

104
Q

What is the interpretation of the test result-HCV antibody reactive, HCV RNA detected?

A

Current HCV infection, link person to care with ID and GI

105
Q

What is the interpretation of the test result-HCV antibody reactive, HCV RNA not detected?

A

no current HCV infection, no further action required

106
Q

Who is HCV testing routinely recommended for based on increased risk for infection?

A 
ever injected illegal drugs 
received clotting factors made before 1987
received blood/organs before July 1992 
ever on chronic hemodialysis
evidence of liver disease
107
Q

Who is HCV testing routinely recommended for based on need for exposure management?

A

healthcare, emergency, public safety workers after needle stick/mucosal exposures to HCV-positive blood
children born to HCV positive mothers

108
Q

What other populations does the CDC recommend be tested for HCV?

A

anyone born from 1945- 1965

109
Q

People born from 1945-1965 are ___ times more likely to be infected by HCV infection and should be tested

110
Q

What is the treatment for Hep A?

A

supportive

111
Q

The treatment for Hep B is difficult/ is not difficult

A

is difficult

112
Q

What is the treatment for Hep B?

A

Adefovir, entecavir, tenofivir

113
Q

What is the treatment for Hep C?

A

pegylated interferon
ribaviron
protease inhibitors- released May 2011, now obsolete
polymerase inhibitors- released December 2013, now obsolete
combination therapy- non interferon based released late 2014

114
Q

What are the polymerase inhibitors for Hep C?

A

simeprevir (Olysio)
sofosbovir (Sovaldi)
released Dec 2013

115
Q

What are Hep C polymerase inhibitors used with?

A

pegylated interferon and ribavirin

116
Q

What is the combination therapy (?) for Hep C?

A

Harvoni-Sofosbovir/Ledipasvir

Viekira pak-ombitasvir, paritapervir and ritonavir, dasabuvir tabs

117
Q

What is the current treatment for Hep C?

A

Zepatier-elbasvir/grazoprevir (2016)
NS5A inhibitor/NS3/4A inhibitor
need to test for NS5A resistance in genotype 1a

Epclusa-sofosbuvir/velpatasvir (2016) 
NS5B inhibitor/ NS5A inhibitor 
No resistance testing needed 
FDA approved for all genotypes 
12 week treatment

Mavyret (glecaprevir/pibrentasvir) 2017
NS34A protease inhibitor/NS5A inhibitor
approved for all genotypes
8 week treatment

118
Q

What was the recent black box warning in Hep C treatment?

A

risk of hep B reactivation in patients co-infected with Hep C & B
routine testing for Hep B reactivation during and post treatment What tests

119
Q

What is the most common organism in infectious esophagitis?

A

candida albicans

120
Q

What are some common organisms in infectious esophagitis?

A

candida albicans MC

CMV or HSV also common

121
Q

What patient population is at risk for infectious esophagitis?

A

immunosuppressed- HIV, DM

122
Q

What are the clinical features of infectious esophagitis?

A

dysphagia, odynophagia, retrosternal chest pain

123
Q

How is infectious esophagitis diagnosed?

124
Q

What is the treatment/ management for infectious esophagitis?

A

depends on the pathogen

125
Q

What is the treatment/ management for infectious esophagitis with C albicans?

126
Q

What is the treatment/ management for infectious esophagitis CMV?

A

ganciclovir

127
Q

What is the treatment/ management for infectious esophagitis HSV?

128
Q

Helicobacter pylori is a gram…

A

negative rod

129
Q

Where does H pylori reside?

A

mucous gel coating of epithelial cells of stomach

130
Q

H pylori occurs in 1 of 6 patients with…

A

peptic ulcer disease

131
Q

H pylori is a 20 fold increase risk of….

A

gastric adenocarcinoma

132
Q

What disease process is associated with MALT cell lymphoma?

A

H pylori infection

133
Q

What are the sxs of h pylori infection?

A

nausea, abdominal pain

134
Q

How is the diagnosis of H pylori infection made?

A

stool Ag for h pylori
urea breath tests
endoscopy

135
Q

What is the treatment for an H pylori infection?

A

combination of PPI and 2 antibiotic agents- clarithromycin and amoxicillin

136
Q

What lifestyle modification needs to be made with an h pylori infection?

A

smoking cessation

137
Q

What are the SXS of diverticulitis?

A

LLQ pain

tenderness, bloody stools, fever

138
Q

what is the treatment for diverticulitis?

A

combination of metronidazole and fluoroquinolone

139
Q

What is the full name for Botulism?

A

Clostridium botulinum

140
Q

Botulism is a gram…

A

positive rod with spore production

141
Q

Why is the toxin in Botulism so bad?

A

toxin prevents the release of acetylcholine at the neuromuscular junction (flaccid paralysis)

142
Q

How is botulism contracted?

A

contaminated food

143
Q

Botulism is rapid/ is slow onset

A

rapid onset following the ingestion of contaminated food

144
Q

What are the clinical sxs of botulism?

A 
Symmetric impairment of cranial nerves followed by weakness/paralysis of muscles of extremities and trunk
Dysphagia
Dry mouth 
Diploid 
Dysarthria 
Fatigue 
Upper extremity weakness 
Constipation 
Lower extremity weakness 
Dyspnea 
Vomiting 
Dizziness
145
Q

Botulism causes ascending/descending paralysis

A

Descending paralysis

146
Q

What can be seen on physical exam in a patient with botulism?

A

Ophthalmoplegia and ptosis of the eyelids
Decreased gag reflex
Facial weakness with normal mental status
Descending paralysis

147
Q

Someone with Botulism might have a history of eating…

A

Home canned food

148
Q

If an infant has Botulism they could have contracted it from….

149
Q

Wound botulism should be suspected with….

A

IV drug use

150
Q

What is the treatment for Botulism?

A

ICU management
Induce vomiting
Antitoxin
ABX (controversial) +/- IV penicillin

151
Q

What is the mainstay of treatment for botulism?

Clin Med II (7 decks)

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