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Oral board studying Prep book > Hepatitis, HIV, HSV > Flashcards

Hepatitis, HIV, HSV Flashcards

1
Q

What is the incidence of hepatitis A in pregnancy?

A

33%

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2
Q

What is the incidence of hepatitis B in pregnancy?

A

40%

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3
Q

What is the incidence of hepatitis C in pregnancy?

A

<1%

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4
Q

What is the route of transmission for hepatitis A?

A

Fecal-oral
Associated with travel

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5
Q

What is the route of transmission for hepatitis B?

A

Parenteral
IV drug use

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6
Q

What is the route of transmission for hepatitis C?

A

Parenteral
IV drug use

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7
Q

What pregnancy effects are seen with hepatitis A infection?

A

Self limited,
no fetal effects

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8
Q

What pregnancy effects are seen with hepatitis B infection?

A

Risk of vertical transmission
Just HBS ag+= 20% risk
HBS eAg= 90% risk

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9
Q

What pregnancy effects are seen with hepatitis C infection?

A

neonatal infection

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10
Q

Are you able to breastfeed if you have hepatitis A infection?

A

Yes

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11
Q

Are you able to breastfeed if you have hepatitis B infection?

A

Yes, if active disease give vaccine

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12
Q

Are you able to breastfeed with hepatitis C infection?

A

Yes

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13
Q

What is the treatment for hepatitis A infection during pregnancy?

A

Vaccine + HBIG within 2 weeks of exposure

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14
Q

what is the treatment for hepatitis B infection in pregnancy?

A

Vaccine at 0,1,6 months + HBIG within 24hrs of exposure

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15
Q

HBsAg?

A

Hepatitis B surface antigen
Found in serum

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16
Q

HBcAg?

A

Hepatitis B core antigen
Found in hepatocytes

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17
Q

HBeAg?

A

Hepatitis e antigen
Found in hepatocytes
High infectivity
Associated with cirrhosis and liver cancer

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18
Q

HBsAb?

A

Hepatitis antibody
Indicated immunity

19
Q

When is vertical transmission for hepaitis B virus highest in pregnancy?

A

3rd trimester

20
Q

What should the infant of seropositive mother receive post delivery?

A

Vaccine and HBIG simultaneously within 12hrs of delivery

21
Q

What is the definition of AIDS?

A

HIV+ and CD4 count < 200

22
Q

What is the screening test for HIV?

23
Q

What is the confirmatory test for HIV?

A

Western blot

24
Q

What is the next step if HIV testing positive?

A

CD4 count
viral load
HBsAg, HBCAb, CBC and LFTs

25
Q

When would you perform rapid HIV testing?

A

Recommended for all patients presenting in labor with unknown HIV status

26
Q

What should you do if there is a positive rapid HIV test when a woman presents in labor with unknown HIV status?

A
  1. Inform patient of positive result and risk to fetus
  2. Perform confirmatory test
  3. Treat for HIV until test returns
  4. Consider C-section if ,labor and SROM has not happened
  5. Postpone breastfeeding until results
27
Q

What is the vertical transmission rate without treatment for HIV in pregnancy?

28
Q

What is the vertical transmission rate with treatment with zidovudine?

29
Q

What is the vertical transmission rate with treatment with zidovudine and CD?

30
Q

What is the vertical transmission rate with viral load< 1000 copies and no CD?

31
Q

What is the prenatal treatment of HIV in pregnancy?

A
  1. Zidovudine 200mg TID
  2. CART
32
Q

What is the intrapartum treatment of HIV in pregnancy?

A

IV zidovudine 1mg/kg until delivery

If CD planned should receive 3hrs of treatment before c-section

If viral load consistently <1000 in late pregnancy and med compliant no zidovudine needed

33
Q

What is the route of delivery for HIV patient with viral load > 1000?

A

C-section prior to labor and ROM

34
Q

What is the route of delivery for HIV patient with viral load < 1000?

A

Scheduled induction of labor

35
Q

What is the route of delivery for HIV patient with unknown viral load?

A

C-section if labor and SROM have not occurred

36
Q

What is the timing for planned c-section in regards to HIV positive patient?

37
Q

How do you classify primary HSV infection?

A

Antibody negative
IgM positive

38
Q

How do you classify non primary 1st episode?

A

Antibody positive
IgM positive but don’t match each other

39
Q

How do you classify recurrent HSV infection

A

Antibody positive
HSV positive with match

40
Q

How can you diagnose HSV?

A
  1. Culture
  2. Clinical ID
  3. Serology with PCR
41
Q

What is the test of choice for HSV diagnosis?

A

Serology with PCR

42
Q

What is the risk of transmission of HSV during delivery?

A

Primary infection= 50%
non primary 1st episode= 33%
recurrent infection= 3%

43
Q

What is the rationale for suppressive therapy for HSV during pregnancy?

A

Reduces risk of recurrence which reduces the need for C-section

44
Q

If a patient is ruptured with active HSV lesions on presentation what mode of delivery is indicated?

A

If term c-section as soon as possible

If preterm expectant management and delivery based on if lesions still active at time of delivery

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