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Block X-Week 4-M > Hepatitis-Verma > Flashcards

Hepatitis-Verma Flashcards

1
Q

What is hepatitis? WHat can cause it?

A

inflammation of the liver

caused by bacteria, drugs, toxins, or excess alcohol

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2
Q

What are the most common causes of hepatitis in the US? Transmission?

A

Viral Hepatitis
Hep A, B, C, D, E
Fecal-borne Hep: A & E
Blood-borne Hep: B, C, D

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3
Q

What is acute hepatitis? Which viruses can cause this?

A

<6 mo

all viruses can cause

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4
Q

What is chronic hepatitis? Which viruses can cause this?

A

> 6 mo

B, C, D viruses can cause

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5
Q

What can be ending complications of chronic hepatitis?

A

cirrhosis

liver failure or cancer

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6
Q

What are some symptoms of hepatitis?

A 
fever
N/V
fatigue
abdominal pain
hepatomegaly
jaundice or scleral icterus
clay-colored stool
dark urine
labs may show elevated ALT/AST
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7
Q

A 25-year-old man is seen in an outpatient clinic with a chief complaints of fatigue, nausea and vomiting for the past several days. He has noticed that morning that his urine was dark yellow. On physical examination, the patient has a low grade fever and mild abdominal pain and is jaundiced. He denies intravenous drug use or multiple sex partners. He attended a 5-day outdoor rock concert in North Carolina 3 weeks earlier and reveals drinking tap water.
Diagnosis? Tests ordered?

A

fecal-oral transmission

order viral IgM antibodies for HepA & E.

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8
Q

A 15-year-old boy presents to his family physician in a small Georgia town with an acute onset of nausea, vomiting, and abdominal pain. Hepatomegaly and icteric sclera are noted on physical exam. Alanine transferase and aspartate transferase levels are markedly elevated. Over the next 3 days, 10 more people in the town seek medical attention with similar complaints. What will be the most appropriate and definitive diagnosis for this outbreak?

A. Antigen detection in the stool
B. Culture of organism on MacConkey agar
C. Demonstration of IgM antibodies against the agent
D. Ova and parasite exam
E. Virus isolation from the blood

A

probably infected with Hep A or E.
fecal-oral

Answer: C look for IgM antibodies

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9
Q

What are some means of transmission of Hep A?

A

fecal-oral: where hygiene is poor or in childhood
close personal contact: day care, MSM
contaminated food/water: int’l travelers
Blood exposure is very rare.

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10
Q

When can you see clinical symptoms of HAV infection? Viremia? HAV in stool? High ALT? IgM? IgG?

A 
Viremia & stool around weeks 1-5
ALT peak is around week 4
IgM good for acute infection, weeks 1-9ish
IgG is only helpful long-term (climbs)
Clinical illness weeks 2-8
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11
Q

A 45-year-old male is seen in the medical clinic with complaints of fatigue, anorexia, nausea, vomiting and low grade fever for the past 5-days. This morning, he noticed that his urine was dark and stools were clay colored. On examination, his liver was enlarged and tender. He reveals that he recently returned from a week-long trip to Nepal.
Diagnosis? Tests?

A

Fecal-oral: Hep A or E
test for IgM & IgG for these two.
No specific vaccine or treatment for Hep E. Vaccine available for Hep A.

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12
Q

For HEV, when do you see clinical symptoms? Virus in stool? IgM? IgG? ALT?

A

Symptoms: 4-8 wks
Virus in stool 2-3 weeks after get it.
IgM during clinical. IgG are there for longer time.
ALT peaks at 5-6 weeksl.

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13
Q

T/F Hep E is more common in the US in overcrowded areas than HepA.

A

False. Hep A is more common. Hep E very rare in the US.

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14
Q 
A 56-year-old Southeast Asian immigrant is diagnosed with chronic hepatitis B virus infection. Considering the epidemiology of this infection in endemic countries, what is the most likely way that this man became infected? 
A. Heterosexual sex
B.  Homosexual sex
C.  Intravenous drug abuse
D.  Needlestick injury
E.  Perinatally
A

E. Perinatally is most common b/c of location.

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15
Q

A 23-year-old woman presented with an insidious onset of fever, fatigue, joint pain, nausea, anorexia, and abdominal pain. Physical exam revealed hepatomegaly. Serologic tests indicated acute infection with hepatitis B virus. Considering the epidemiology of this disease in the United States, what would the history of the above patient most likely include?
A. Alcoholism
B. Cocaine addiction
C. Intravenous drug abuse
D. Recent transfusion
E. Unprotected sex with multiple partners

A

E.

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16
Q

Talk about the structure of the Hep B virus.

A

enveloped & has DNA
antigens & host antibodies used for detection
antigens: HBsAg (surface), HBcAg (core), HBeAg

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17
Q

Talk about HBsAg.

A

forms a part of the envelope of the hep virus
large quantities found in the serum
If pos. have infection, but not necessarily a liver problem

18
Q 
What has likely happened? 
HBsAg (-)
anti-IgM HBc (-)
anti-Hbc (-)
anti-Hbs (-)
A

susceptible to infection, no immunity

19
Q 
What has likely happened? 
HBsAg (-)
anti-IgM HBc (-)
anti-Hbc (-)
anti-Hbs (+)
A

immune b/c they had a Hep B vaccination

20
Q 
What has likely happened?
HBsAg (-)
anti-IgM HBc (-)
anti-Hbc (+)
anti-Hbs (+)
A

immune due to natural infection

21
Q 
What has likely happened? 
HBsAg (+)
anti-IgM HBc (+)
anti-Hbc (+)
anti-Hbs (-)
A

acute infection

22
Q 
What has likely happened? 
HBsAg (+)
anti-IgM HBc (-)
anti-Hbc (+)
anti-Hbs (-)
A

chronic infection

23
Q 
What has likely happened?
HBsAg (-)
anti-IgM HBc (-)
anti-Hbc (+)
anti-Hbs (-)
A 
unclear
1. resolving infection
OR 2. false +
OR 3. low level chronic infection
OR 4. resolving acute infection
24
Q

A 23-year-old woman presented with an insidious onset of fever, fatigue, joint pain, nausea, anorexia, and abdominal pain. Physical exam revealed hepatomegaly. A hepatitis panel revealed:
• HBsAg-positive
• Anti-HBsAg-negative
• Anti-HBcAg IgM-positive
• HBeAg-positive
• Anti-HAV IgG-positive
What is a correct interpretation of the hepatitis panel?

A. Acute infection with HBV
B.  Chronic infection with HAV
C.  Co-infection with HAV and HBV
D.  Past infection with HBV
E.  Vaccinated against HBV
A

Answer: C.

25
Q 
A 44-year-old man is concerned about abnormal liver tests drawn for his pre-employment physical 6 months ago. His serum aminotransferase levels were two times normal at that time and remain unchanged after repeat testing. On further questioning, he denies regular alcohol use but states that he used to inject heroin. Currently, he reports some fatigue but says he feels well otherwise. His primary care physician orders serologic testing, which reveals HBsAg-positive, anti-HBs-negative, and anti-HBc-positive IgG. Anti-HDV and anti-HCV test results are both negative. 
A..  Acute infection with HBV
B.  Chronic infection with HBV
C.  Co-infection with HCV and HBV
D.  Past infection with HBV
A

B. Chronic infection.

26
Q

A 42-year-old single white male went to his physician with complaints of fatigue, abdominal pain and loss of appetite.
Past medical history:
·He had no history of hepatitis A vaccination or hepatitis B vaccination.
·He reported one male sex contact in the recent past.

Physical examination:
·the whites of his eyes were yellow
·liver was slightly enlarged and tender to palpation.
A.IgM anti-HAV, IgM anti-HBc, HBsAg, and anti-HCV
B. HBsAg
C. IgM anti-HAV and IgM anti-HBc

A

Answer: A

27
Q

IgM anti-HAV - negative
HBsAg - positive
IgM anti-HBc - positive
anti-HCV - negative

Diagnosis?
A.Acute hepatitis A and acute hepatitis B
B. Acute hepatitis B
C. Acute hepatitis C

A

B. Acute hep b.

28
Q

What are steps that should be taken when a person is infected with Hep B via sexual contact & may have Hep A or C?

A
  1. The case of acute hepatitis B should be reported to the local health department.
  2. The patient should be advised to inform his sex and household contacts that they might have been exposed to HBV and that they should see a health care professional for medical evaluation.
  3. The patient should be tested for total anti-HAV to determine if he is a candidate for hepatitis A vaccination.
29
Q

What vaccine should MSM have?

A

Hep A vaccine

30
Q

T/F MSM have higher risk of Hep C than gen pop.

A

False. Same risk.

31
Q

If you are having an acute Hep B infection, should you receive the Hep B vaccine?

A

N0

32
Q

SEx contact is HbsAg pos. what should be done?

A

The patient is likely to have chronic HBV infection
The patient should tell his sex and household contacts about his HBV infection status.
The patient should be evaluated for chronic liver disease.
The case should be reported to the health department.
All of the above

33
Q

What’s the deal with Hep C virus?

A 
RNA virus (single-stranded)
one serotype
enveloped
34
Q 
What do the following mean?
AntiHCV (-)
HCV RNA (-)
A

absence of Hep C

35
Q 
What do the following mean?
AntiHCV (+)
HCV RNA (+)
A

acute or chronic HCV

36
Q 
What do the following mean?
AntiHCV (+)
HCV RNA (-)
A

resolution of HCV

37
Q 
What do the following mean?
AntiHCV (-)
HCV RNA (+)
A

new infection or chronic if pt is immunocompromised

38
Q

What is the natural hx of HCV?

A

Exposed & 15% resolve
Chronic HCV, some progress to cirrhosis & some eventually to end stage liver disease or hepatocellular carcinoma. At that point, in time you will need a liver transplant or it could be lethal.

39
Q

A 25 year old Asian male had been feeling very tired, was jaundiced and had vague “flu-like” symptoms. He went to see his primary care physician who did a history and physical and ordered blood tests that included serology for acute viral hepatitis.

What serological test is most appropriate?

  1. HBsAg, IgM anti HAV, IgM anti HBc and anti HCV
  2. IgM anti HAV
  3. IgM anti HBc
A

Answer: A.

40
Q

HBsAg - negative
IgM anti-HBc - negative
IgM anti-HAV - negative
Anti-HCV - positive by enzyme immunoassay (EIA)
- positive by recombinant immunoblot assay (RIBA)
ALT -1500 IU (upper limit of normal - 45 IU)
Diagnosis?

A

Acute Hep C

ALT levels crazy high in this case, v. chronic.

41
Q

What are some steps to take for patients with + Hep C tests?

A
  1. An interview to identify risk factors
  2. Counseling for prevention of transmission
    3 Follow up to evaluate outcome of infection
42
Q

A 43-year-old man, recently infected with hepatitis C virus, donates blood during the window period of the infection. The blood is screened for antibodies to HCV and other blood-borne agents. What is the clinical significance of the time period during which the screening was performed?

A

A. Anti-HCV antibodies would not be demonstrable

Block X-Week 4-M (4 decks)

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