Hepatits

Question 1

Which hepatitis are mostly co infections?

Answer 1

B and D

Question 2

Hepatitis E is worst in…. And found mainly in which part of the world?

Answer 2

Pregnancy

East asia

Question 3

Which hepatitis can be acquired perinatally?

Answer 3

B, C, D (sex, blood, mom)

Question 4

Which hepatitis can you acquire with consuming water or food?

Answer 4

A and E

Question 5

Which hepatitis rarely presents in acute form?

Answer 5

C

Question 6

Sx of hepatitis

Answer 6

Jaundice, fever, weight loss, fatigue, dark urine, hepatosplenomegaly, abdo pain

Question 7

What does the lab look like in viral hepatitis?

Answer 7

Increased direct bili, increased ALT>AST (viraL), increased alkaline phosphatase, aplastic anemia is a rare complication

Question 8

What test in hepatitis correlates with increased mortality?

Answer 8

Prothrombin time: 70-80% of the liver is dead if prothrombin time is up (all coag factors are made in liver except 8 and VWF)

Question 9

Best initial test for hepatitis A, C, D and E?

Answer 9

IgM antibody: acute infection

IgG antibody: resolution of infection

Question 10

Hepatitis C disease activity measured with

Answer 10

PCR RNA level : amount of active viral replication

If PCR rises it shows treatment failure

Question 11

Serologic pattern for hep B

Answer 11

Surface antigen: indicates presence of virus; + in acute or chronic infections, - in resolved infection
E antigen: degree of viral replication
Surface antibody if + could be vaccine, so look at core (vaccine gives no core), if core + then it means resolved, past infection if IgG, acute or chronic if IgM or IgG

Question 12

Serology hep B window period

Answer 12

Surface antigen, e antigen and surface antibody negatives

Core antigen positive IgM then IgG

Question 13

Which serologic marker becomes abnormal first in hep B?

Answer 13

Surface antigen

Question 14

Which serologic marker in hep B correlates directly with the amount of viral replication?

Answer 14

E antigen

Question 15

Which serologic marker in hepatitis B shows the infection is on the way to resolution?

Answer 15

Anti hep B e antibody

Question 16

The best serologic marker in hep B that indicates that a woman can transmit the disease to her baby is?

Answer 16

E antigen 90% chances!

Question 17

A carrier of hep B would have which serology?

Answer 17

Surface antigen + and that is it

Question 18

Which markers in hep B would indicate that you cannot transmit the infection

Answer 18

No surface antigen found

Question 19

Which is the best indication of the need for treatment in chronic hepatitis B?

Answer 19

E antigen

Question 20

What is the treatment for hep A?

Answer 20

Resolves spontaneously over weeks, almost always benign

Question 21

What is the treatment for hep E?

Answer 21

Resolves spontaneously over weeks, almost always benign

Question 22

What is the percentage of hep B that becomes chronic?

Answer 22

10%

Question 23

What is the treatment for acute hep B?

Answer 23

None

Question 24

What is the treatment for acute hep C?

Answer 24

Interferon, ribavirin and either telaprevir or boceprevir, decreases likelihood of developping chronic infection

Question 25

Chronic hepatitis B is dx when

Answer 25

Surface antigen is positive for longer than 6 months

Question 26

When to treat for chronic hep B?

Answer 26

Both surface antigen + (more than 6 months) and e antigen +

Question 27

What is the tx for hep B?

Answer 27

(one drug!)
Entecavir or adefovir or tenofovir or lamivudine or telbivudine or interferon (but has lots of adverse effects and no greater efficacy - flu like sx, plus it is injectable)

Question 28

Adverse effects of interferon?

Answer 28

Arthralgia, myalgia, leukopenia, thrombocytopenia, depression and flu like sx

Question 29

Goal of hep B therapy?

Answer 29

Convert e antigen in e antibody

Question 30

What test determines if you treat hep C?

Answer 30

PCR-RNA viral load elevated : treat with 3 drugs interferon ribavirin and either telaprevir or boceprevir

Question 31

What are side effects of ribavirin?

Answer 31

Anemia