Hepatitis Micro

Question 1

Which hepatitis viruses can cause only acute?

Answer 1

A and E

Question 2

Which hepatitis viruses can cause chronic disease and therefore hepatocellular carcinoma?

Answer 2

HBV, HCV, HDV

Question 3

Hepatitis A family

Answer 3

Picornaviridae

Question 4

Hepatitis E family

Answer 4

Caliciviridae

Question 5

HAV structure

Answer 5

+ ssRNA

Question 6

Which herpes virus is associated with significant pregnancy mortality?

Answer 6

E

Question 7

HEV structure

Answer 7

+ ssRNA

Question 8

Which hepatitis virus has the fastest incubation?

Answer 8

HAV

Question 9

Salad bars?

Answer 9

HAV

Question 10

Who is at risk for HAV?

Answer 10

Native Americans, or during outbreaks:

Diners, day care workers, gay men, IV drug user

Question 11

HBV family

Answer 11

Hepadnavirus

Question 12

Which one has the unique life cycle?

Answer 12

HBV

Question 13

What are the four major proteins of HBV?

Answer 13

DNA polymerase
HBsAg
HBcAg
X antigen

Question 14

What kind of enzyme is DNA polymerase?

Answer 14

HBV

Question 15

What is HBV’s attachment protein?

Answer 15

HBsAg

Question 16

What is HBcAg?

Answer 16

The core antigen secreted derivative of HBcAg

An important serologic marker but measured as HbeAg

Question 17

How can HBV be transmitted?

Answer 17

Sexually
Blood
Parenteral

Question 18

Explain HBV replication

Answer 18

• Enters
• Completes second strand ds synthesis
• Translocates to nucleus and makes mRNA for its four proteins AND a full-length + RNA copy of genome
• Reverse transcriptase in cytoplasm uses it to make more
• Results in partially ds DNA molecule
• *dsDNA virus with an RNA intermediate

Question 19

Where is HBV endemic?

Answer 19

China

sub-Saharan Africa

Question 20

Describe HBV pathogenesis

Answer 20

More insidious onset
Close to 16 weeks incubation
Serology: surface antigen E

Three phases: incubation, symptomatic, convalescent

Question 21

Positive HBsAg tells you..

Answer 21

Carrier or acute infection

Question 22

Anti-HBs tells you…

Answer 22

Had HBV previously, or received vaccine

Question 23

HBeAg tells you…

Answer 23

At increased risk for transmission (active marker)

Lingers positive after symptoms resolve

Question 24

Anti-HBc tells you…

Answer 24

Past infection

Question 25

IgM anti-HBc tells you…

Answer 25

Acute or recent infection

Question 26

HDV structure

Answer 26

circular ss RNA genome
incomplete
must incorporate HBsAG to infect hepatocytes

Question 27

HCV family

Answer 27

Flaviviridae

Question 28

Which hepatitis viruses has all those different subtypes

Answer 28

HCV

Question 29

Why can chronic HCV keep appearing in the same patient?

Answer 29

Hypermutable variation so that immune system has to generate new responses

Done via E2 protein

Question 30

In HBV and HCV, what leads to the liver disease?

Answer 30

NOT virus-medaited cytolysis

It’s immune destruction

Question 31

Causes of chronic viral hepatitis

Answer 31

40% HCV

20% HBV

Question 32

What are the three phases of chronic hepatitis?

Answer 32

Immune tolerance
Immune clearance: symptoms start
Residual phase: after seroconversion

Question 33

Most patients who get infected with HBV…

Answer 33

resolves 90%

Question 34

What are some extrahepatic manifestations of chronic HBV?

Answer 34

Polyarteritis nodosum

Glomerulonephritis

Question 35

Most patients who get infected with HCV…

Answer 35

will get chronic disease unless treated

85%

Question 36

HAV dx

Answer 36

Anti-HAV IgM

Question 37

HBV dx

Answer 37

HBsAg, HBeAg, HBe antibody, HBV DNA

Question 38

HCV dx

Answer 38

core antigen, RNA

Question 39

Havrix vaccine

Answer 39

Inactivated
Age 1-2 yrs
for HAV

Question 40

Combo vaccine

Answer 40

HAV and HBV
18 yrs + only
Havrix plus recombinant HBV