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

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

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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
The symptoms of an acute hepatitis infection can range from...
Asymptomatic Symptomatic Fulminant liver failure Death
26
If symptoms are present in an acute hepatitis infection, they will be/ will not be the same regardless of what type of hepatitis infection
The symptoms will be the same regardless of what type of hepatitis infection the patient has
27
What is the most common type of body fluid that hepatitis A is spread in?
Feces
28
What patient populations should be assessed and vaccinated for Hepatitis 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
29
What lab testing is available for hep a testing?
Hep A IgG | Hep A IgM
30
What does the Hep A IgG test evaluate?
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
31
What does the Hep A IgM test evaluate?
Active infection
32
Hepatitis A is/ is not vaccine preventable
Is vaccine preventable
33
Havrix is the vaccination for Hep _
A
34
Havrix vaccination is approved for what age group?
12 months and older
35
What is the dosing regiment for Havrix in children and adolescents?
0.5ml dose, 2 shot series given 6 months apart
36
What is the dosing regiment for Havrix in adults?
1ml dose, 2 shot series given 6 months apart
37
What is Twinrix?
Hep A/B combination vaccine
38
What are the 2 FDA approved dosing schedules for Twinrix?
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)
39
What would be the benefit to giving the accelerated schedule for Twinrix?
Given to patients that will be putting themselves at risk for infection within the next few months (ex: travel)
40
What is the treatment for Hepatitis 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
41
Which virus is the most easily transmittable of all blood borne pathogens?
Hepatitis B
42
Hepatitis B is/ is not more prevalent than HIV
Is more prevalent
43
A hepatitis B infection may lead to...
Cirrhosis and/or cancer of the liver
44
What is the risk of a single needle stick in non immunized patients for Hep B?
6-30%
45
Hep B is/ is not vaccine preventable?
Preventable
46
How effective is the Hep B vaccine?
99.9% effective
47
What body fluids have a high concentration of Hep B?
Blood Serum Wound exudates
48
What body fluids have a moderate concentration of Hep B virus ?
Seminar Vaginal fluid Saliva
49
What body fluids have a low/ not detectable concentration of Hep B?
``` Urine Feces Sweat Tears Breast milk ```
50
How can Hep B be transmitted?
Sexual Parenteral (needle? ) Perinatal (vertical transmission between mother and baby? )
51
HBV infection can be asymptomatic/ symptomatic
Both
52
HBV infection can be chronic or...
Resolved immune
53
What is HBsAg?
Hepatitis B surface antigen | Surface antigens of HBV detectable in large quantity in serum
54
If a person tests positive for HBsAg are they infectious?
Yes
55
What is Anti-HBs?
Antibody to Hep B surface antigen, indicates past infection with immunity to HBV, passive antibody from HBIG, or immune response from HB vaccine
56
What is HBIG?
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
57
What is HBcAg?
Hep B core antigen- no commercial test available, used for research
58
What is anti-HBc?
Antibody to HBcAg- indicates a prior or recent infection with HBV
59
What is IgM anti-HBc?
IgM class antibody-indicates recent infection with HBV, detectable for 4-6 months after infection
60
What is HBeAg?
Hepatitis B e antigen, correlates with higher levels of HBV in serum and increased infectivity (higher possibility for infection)
61
What is Anti HBe?
Antibody to HbeAg- presence in serum of HBsAg carrier, indicates lower tiger of HBV- long term carrier, low level
62
What is the first test to be positive in a Hep B infection?
HBsAg
63
Interpret the labs... HBsAG negative anti-HBc negative anti-HBs negative
Susceptible to HBV, vaccinate for HBV
64
Interpret the labs... HBsAG negative anti-HBc negative Anti-HBs positive
Immune to HBV due to vaccination
65
Interpret the labs... HbsAg negative Anti HBc positive Anti HBs positive
Immune to HBV due to infection
66
``` Interpret the labs... HBsAG positive Anti HBc positive IgM anti HBc positive Anti HBs negative ```
Acute HBV infection
67
``` Interpret the labs... HBsAG positive Anti-HBc positive IgM anti HBc negative Anti HBs negative ```
Chronic HBV infection
68
If these are the lab values, what are the possible interpretations? HBsAG negative AntiHBc positive AntiHBs negative
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
What are the options for Hep B vaccine?
Engerix Recombivax Heplisav TwinRix
70
Which Hep B vaccine has been licensed by the FDA only for adults 18 years and older?
Heplisav
71
What is the dosing regiment for Heplisav?
2 dose series, given at day 0 and at 1 month
72
Which 2 Hep B vaccines are 3 dose series?
Engerix and Recombivax
73
What is the dosing regiment for Engerix and Recombivax?
3 dose series, typically 0, 1-2, 4-6 months- no max time between doses, no need to repeat or restart doses
74
What is the FDA approval age group for Engerix and Recombivax?
Newborns and above
75
What protection do the. 3 dose series of the Hep B vaccine provide?
Dose 1: 20-50% Dose 2: 75% Dose 3: 96%
76
What patient populations have lower protection with the Hep B vaccine?
``` HIV Chronic liver disease Diabetes Obese Smokers ```
77
What are the ACIP Hep B vaccination recommendation?
Routine infant Ages 11-15 "catch up" through age 18 Over 18, especially in high risk
78
What is the VFC program?
Federal program allowing children to receive vaccinations at little to no cost
79
What populations are considered high risk and should be immunized for Hep B?
``` 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
When is pre-vaccination/ post vaccination testing done for Hep B?
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
Hep C is more common/ is less common than HIV
is more common than HIV
82
Hep C infection is ____ times more widespread than HIV infection
5
83
What is the leading cause of liver cancer and liver transplantation in the US?
Hep C infection
84
There is a vaccine available/ there is not a vaccine available for Hep C
there is not a vaccine available
85
What is the risk for Hep C infection following a needle stick injury?
2% (varies, anywhere from 1-3%)
86
What is the incubation period for Hep C?
average is 6-7 weeks | range is 2-26 weeks
87
How many people with a Hep C infection experience an acute illness such as jaundice?
mild- less than 20%
88
What factors in a Hep C infection promote progression or severity of the disease?
``` increased alcohol intake age greater than 40 years HIV co-infection male gender chronic HBV co-infection ```
89
The case fatality rate in a Hep C infection are high/ low
low
90
What factors of Hep C infection are age-related?
chronic infection chronic hepatitis cirrhosis
91
what percentage of those with Hep C infection have a chronic infection?
60-85%
92
what percentage of those with a Hep C infection have chronic hepatitis?
10-70% (most are asymptomatic)
93
what percentage of those with Hep C have cirrhosis?
<5-20%
94
What percentage of those with a Hep C infection have mortality from CLD?
1-5%
95
What exposures are known to be associates with HCV infection in the US ?
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
what is the biggest source of infection with Hep C?
injecting drug use
97
What labs can be done in Hep C?
hepatitis C antibody HCV PCR Genotype
98
which Hep C lab is considered to be confirmatory testing?
HCV PCR
99
What is the range of genotypes in HCV testing?
1-6
100
What is the most common HCV genotype in the US?
genotype 1 is the most common in the US (80%) followed by type 2, 3
101
what HCV genotypes are more common in Asian countries?
4-6
102
What is the interpretation of the test result- HCV antibody nonreactive?
No HCV antibody detected, no further action, consider HCV RNA if recent exposure
103
What is the interpretation of the test result- HCV antibody reactive?
presumptive HCV infection, confirm with HCV RNA
104
What is the interpretation of the test result-HCV antibody reactive, HCV RNA detected?
Current HCV infection, link person to care with ID and GI
105
What is the interpretation of the test result-HCV antibody reactive, HCV RNA not detected?
no current HCV infection, no further action required
106
Who is HCV testing routinely recommended for based on increased risk for infection?
``` 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
Who is HCV testing routinely recommended for based on need for exposure management?
healthcare, emergency, public safety workers after needle stick/mucosal exposures to HCV-positive blood children born to HCV positive mothers
108
What other populations does the CDC recommend be tested for HCV?
anyone born from 1945- 1965
109
People born from 1945-1965 are ___ times more likely to be infected by HCV infection and should be tested
5
110
What is the treatment for Hep A?
supportive
111
The treatment for Hep B is difficult/ is not difficult
is difficult
112
What is the treatment for Hep B?
Adefovir, entecavir, tenofivir
113
What is the treatment for Hep C?
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
What are the polymerase inhibitors for Hep C?
simeprevir (Olysio) sofosbovir (Sovaldi) released Dec 2013
115
What are Hep C polymerase inhibitors used with?
pegylated interferon and ribavirin
116
What is the combination therapy (?) for Hep C?
Harvoni-Sofosbovir/Ledipasvir | Viekira pak-ombitasvir, paritapervir and ritonavir, dasabuvir tabs
117
What is the current treatment for Hep C?
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
What was the recent black box warning in Hep C treatment?
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
What is the most common organism in infectious esophagitis?
candida albicans
120
What are some common organisms in infectious esophagitis?
candida albicans MC | CMV or HSV also common
121
What patient population is at risk for infectious esophagitis?
immunosuppressed- HIV, DM
122
What are the clinical features of infectious esophagitis?
dysphagia, odynophagia, retrosternal chest pain
123
How is infectious esophagitis diagnosed?
endoscopy
124
What is the treatment/ management for infectious esophagitis?
depends on the pathogen
125
What is the treatment/ management for infectious esophagitis with C albicans?
diflucan
126
What is the treatment/ management for infectious esophagitis CMV?
ganciclovir
127
What is the treatment/ management for infectious esophagitis HSV?
acyclovir
128
Helicobacter pylori is a gram...
negative rod
129
Where does H pylori reside?
mucous gel coating of epithelial cells of stomach
130
H pylori occurs in 1 of 6 patients with...
peptic ulcer disease
131
H pylori is a 20 fold increase risk of....
gastric adenocarcinoma
132
What disease process is associated with MALT cell lymphoma?
H pylori infection
133
What are the sxs of h pylori infection?
nausea, abdominal pain
134
How is the diagnosis of H pylori infection made?
stool Ag for h pylori urea breath tests endoscopy
135
What is the treatment for an H pylori infection?
combination of PPI and 2 antibiotic agents- clarithromycin and amoxicillin
136
What lifestyle modification needs to be made with an h pylori infection?
smoking cessation
137
What are the SXS of diverticulitis?
LLQ pain | tenderness, bloody stools, fever
138
what is the treatment for diverticulitis?
combination of metronidazole and fluoroquinolone
139
What is the full name for Botulism?
Clostridium botulinum
140
Botulism is a gram...
positive rod with spore production
141
Why is the toxin in Botulism so bad?
toxin prevents the release of acetylcholine at the neuromuscular junction (flaccid paralysis)
142
How is botulism contracted?
contaminated food
143
Botulism is rapid/ is slow onset
rapid onset following the ingestion of contaminated food
144
What are the clinical sxs of botulism?
``` 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
Botulism causes ascending/descending paralysis
Descending paralysis
146
What can be seen on physical exam in a patient with botulism?
Ophthalmoplegia and ptosis of the eyelids Decreased gag reflex Facial weakness with normal mental status Descending paralysis
147
Someone with Botulism might have a history of eating...
Home canned food
148
If an infant has Botulism they could have contracted it from....
Honey
149
Wound botulism should be suspected with....
IV drug use
150
What is the treatment for Botulism?
ICU management Induce vomiting Antitoxin ABX (controversial) +/- IV penicillin
151
What is the mainstay of treatment for botulism?
Antitoxin

Clin Med II (7 decks)

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