Hepatitis

Question 1

How is Hep A transmitted?

Answer 1

Faecal-oral spread

Question 2

Gay men and injecting drug users?

Answer 2

Hep A

Question 3

Acute hepatitis, no chronic infection

Peak incidence of symptomatic disease in older children / young adults

Answer 3

Hep A

Question 4

How do you confirm Hep A?

Answer 4

Clotted blood for serology (gold top)

Hep A IgM

Question 5

Hepatitis more common in the tropics?

Answer 5

Hep E

Question 6

Transmission of Hep E

Answer 6

Faecal oral

Question 7

Evidence of chronic infection in pigs

Cases acquired in UK are thought to be zoonoses?

Answer 7

Hep E

Question 8

This type of hepatitis only found with hep B?

Answer 8

Hep D

-exacerbates Hep B virus

Question 9

How is Hep B transmitted?

Answer 9

Sex
Mother to child
Blood

Question 10

When is HBsAg present?

Answer 10

Present for more than 6 months n chronic infection

Question 11

HBeAg

Answer 11

Present in highly infectious individuals

Question 12

When is Hep B virus DNA present?

Answer 12

Present in high titre in highly infectious agents

Question 13

Why are Hep B DNA tests used?

Answer 13

Hep B DNA present in highly infectious indivudals

Used to predict risk of chronic liver disease and monitor therapy

Question 14

Antigen most likely to be present in recently infected cases?

Answer 14

Hep B IgM

Question 15

When are anti-HB’s present?

Answer 15

In immunity

Question 16

Post-exposure prophylaxis for Hep B?

Answer 16

Vaccine
plus HBIG (hyperimmune Hep B immunoglobulin)

Question 17

What test do you do once Hep C virus antibody confirmed?

Answer 17

Test for Hep C virus RNA by PCR

-this will show you if you have active infection or if infection was in the past

Question 18

How long till an infection is deemed “chronic”

Answer 18

6 months

Question 19

Time from infection to cirrhosis

Answer 19

> 20 years

Question 20

Time from infection to hepatocellular carcinoma?

Answer 20

> 30 years

Question 21

Vaccinations you should give if immunocompromised and have chronic viral hepatitis?

Answer 21

Pneumococcal and influenza

Question 22

How do you screen for hepatocellular carcinoma?

Answer 22

Serum-alpha fetoprotein (AFP and ultrasonography)

Question 23

What does HCV RNA show?

Answer 23

Chronic Hep C infection

Question 24

What does HBsAg and Hep B DNA show?

Answer 24

Chronic Hep B infection

Question 25

Biochemical evidence of liver inflammation?

Answer 25

Increased ALT

Question 26

The higher a chronic HBV patient's starting HBV DNA load, the greater their risk of ____ on follow up?

Answer 26

Cancer :(

Question 27

How is interferon alpha injected?

Answer 27

As pegylated interferon (peginterferon)

Question 28

Therapy for chronic hepatitis B

Answer 28

Option 1) Peginterferon | Option 2) Suppressive antiviral (e.g. entecavir, tenofovir)

Question 29

What does loss of HBsAg mean?

Answer 29

Cure

Question 30

Reduction in HBV DNA and loss of HBeAg means what?

Answer 30

Suppression

Question 31

What is sustained virological response?

Answer 31

Loss of HCV RNA in blood sustained to 6 months after end of therapy

Question 32

Therapy for chronic Hep C?

Answer 32

Peginterferon injections given in combination with ribavirin tablets (PR) this was the standard of care for some years Given for 12 to 48 week courses duration depends on response and HCV genotype of infection and what other antivirals given Protease Inhibitors (PI), protease is product of viral gene NS3 proven in genotype 1 infection to increase responses when given as triple therapy (PR+PI) telaprevir boceprevir

Question 33

Side effects of Peginterferon?

Answer 33

Common -flu like symptoms: chills, sore muscles, malaise etc Less common but more severe - thyroid disease - autoimmune disease - psychiatric disease

Question 34

Adverse effects of Ribavarin?

Answer 34

anaemia, worsened by telaprevir and boceprevir

Question 35

pruritus, nausea, rash, anaemia, rectal pain and diarrhoea

Answer 35

Telaprevir

Question 36

anaemia, dysgeusia

Answer 36

Boceprevir (distortion of taste)

Question 37

What does HepB surface antigen mean?

Answer 37

Active infection of HepB (acute or chronic, just means you have it)

Question 38

HBV core IgM antibody

Answer 38

acute hepatitis | key diagnostic marker of acute infection!

Question 39

HBV 'e' antigen

Answer 39

Acute hep B OR chronic carrier state of HIGH infectivity

Question 40

HBV 'e' antibody

Answer 40

Chronic carrier of low infectivity

Question 41

HBV core antibody (total)

Answer 41

Previous resolved or ongoing infection with HBV

Question 42

HBV surface antigen

Answer 42

Immunity to HBV - vaccine induced or natural

Question 43

Key diagnostic marker of Hep B acute infection

Answer 43

HBV core IgM antibody