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AMC MCQ - Key points > Hepatology > Flashcards

Hepatology Flashcards

1
Q

Describe the mode of transmission of HAV and HEV.

A

Feco-oral transmission (food transmitted).

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2
Q

Describe the mode of transmission of HBV and HCV.

A

Blood derived transmission.

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3
Q

What is the recommended action for a patient with positive anti-HBs and negative all other HBV serology?

A

Vaccination.

A patient with positive anti-HBs (hepatitis B surface antibody) and negative for all other HBV (hepatitis B virus) serologies typically indicates immunity to hepatitis B. This immunity can be due to:

  1. Vaccination: The patient has been vaccinated against hepatitis B and developed immunity.
  2. Resolved Infection: The patient had a past HBV infection that has been resolved, leaving them with immunity.
  • Positive anti-HBs: Indicates immunity to hepatitis B, either from vaccination or past resolved infection.
  • Negative HBsAg (hepatitis B surface antigen): No current HBV infection.
  • Negative anti-HBc (hepatitis B core antibody): No past infection if this result is from a vaccination.
  • Negative IgM anti-HBc: No recent acute infection.
  • No further action is typically needed for hepatitis B unless there are clinical reasons to suspect exposure or infection. The patient is considered protected against HBV.
  • Routine follow-up is not required unless the patient’s clinical situation changes.

In summary, a positive anti-HBs with negative other HBV serologies usually means the patient is immune to hepatitis B, most likely due to vaccination, and no further action is required.

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4
Q

What does the first marker that appears in the blood indicate in HBV infection?

A

Surface antigen.

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5
Q

What marker is detected only by liver biopsy in HBV infection?

A

Hbc-Ag.

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6
Q

What marker in HBV infection indicates high infectivity?

A

e-Antigen.

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7
Q

How should follow-up be conducted in HBV infection?

A

PCR.

Arrange regular monitoring
However, the minimum recommended interval for this monitoring is yearly, including clinical review, liver function tests (lFTs) and HBV DNA viral load (annual HBV DNA testing is funded by Medicare for all HBsAg positive patients).
https://www.racgp.org.au › …PDF
Chronic hepatitis B - RACGP

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8
Q

What is the treatment approach for acute cases of HBV infection?

A

No specific treatment.

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9
Q

Define chronic hepatitis B.

A

More than 6 months with positive serology for HBV.

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10
Q

What are the treatment options for chronic HBV infection?

A

Lamivudine and interferon.

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11
Q

What is the recommended post-exposure prophylaxis for HBV in individuals with a history of previous vaccination?

A

Reassure.

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12
Q

What is the first act that someone does in post-exposure prophylaxis for HBV in individuals with a history of vaccination?

A

Wash hands.

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13
Q

What is the first step in post-exposure prophylaxis for HBV in individuals without a history of vaccination?

A

Check immune status.

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14
Q

What should be done if an individual is negative for antibodies in post-exposure prophylaxis for HBV?

A

Administer vaccine and IVIG.

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15
Q

What should be done if there is no option to check immune status in post-exposure prophylaxis for HBV?

A

Administer vaccine and IVIG.

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16
Q

What is the immediate action for a baby born to an HBV-infected mother?

A

Administer vaccine and IVIG immediately.

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17
Q

What is the chronicity rate of hepatitis B in adults?

A

10-15%.

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18
Q

What is the chronicity rate of hepatitis B in newborns?

A

Over 75%.

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19
Q

What are the main side effects of interferon in hepatitis B treatment?

A

Depression and fatigue.

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20
Q

What should be done if depression occurs during interferon treatment for hepatitis B?

A

Stop interferon.

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21
Q

What is the first step in post-exposure prophylaxis for Hepatitis C?

A

Check baseline immune status.

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22
Q

What is the second step in post-exposure prophylaxis for Hepatitis C?

A

Serial labs for 6 months.

Post-treatment monitoring
Screening for HCC with ultrasonography is recommended at baseline for all patients with cirrhosis. These patients require serial ultrasonography (every six months) even after achieving SVR as the risk of HCC, although reduced, is not eliminated. Patients with cirrhosis should be referred to a specialised hepatology centre for ongoing cirrhosis management and monitoring, even if SVR is achieved. Endoscopies might be required to rule out oesophageal varices, along with bone mineral density testing to assess for osteoporosis.

People who do not have cirrhosis and who have normal LFT results after SVR (alanine aminotransferase ≤30 U/L in males, ≤19 U/L in females) do not require further follow-up.

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23
Q

What should be done if an individual is positive for HCV antibodies in post-exposure prophylaxis for Hepatitis C?

A

Proceed to HCV RNA testing.

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24
Q

What is the treatment approach for hepatitis C?

A

Hepatitis C virus infection is curable, and viral eradication will prevent the long term liver complications of HCV infection. For the past decade, the standard-of-care treatment for CHC infection has been dual therapy with pegylated-interferon-alphaαand ribavirin (peg-IFN+RBV).
https://www.racgp.org.au › july
Hepatitis C – an update - RACGP

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25
Q

Describe the counseling questions for patients with HCV infection regarding vaginal delivery, lactation, and sex.

A

Patients with HCV infection can have vaginal delivery, breastfeed, and engage in sexual activity, but it is preferred to use condoms.

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26
Q

What is the best way to avoid hepatitis C transmission according to the content?

A

Avoid sharing razors is emphasized as an important measure to prevent hepatitis C transmission.

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27
Q

What is the recommended approach to prevent neonatal infection of hepatitis C?

A

To prevent neonatal infection, it is advised to avoid the use of scalp electrodes during delivery.

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28
Q

When should screening for hepatitis C be done in neonates according to the content?

A

Screening for hepatitis C in neonates should be performed at 18 months using antibody testing.

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29
Q

Describe the diagnosis and key lab findings of a patient returning from Thailand with fever, jaundice, RUQ abdominal pain, increased ALT and AST, and normal alkaline phosphatase.

A

The diagnosis is Hepatitis A Virus (HAV) infection.

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30
Q

What is the diagnosis and key lab findings of a patient with fever, jaundice, RUQ abdominal pain, increased ALT and AST, and marked increase in alkaline phosphatase after returning from Thailand?

A

The diagnosis is acute cholangitis.

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31
Q

What is the diagnosis of a patient with fever, RUQ abdominal pain, increased WBCs, and normal ALT, AST, and alkaline phosphatase after returning from Thailand?

A

The diagnosis is acute cholecystitis.

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32
Q

Describe the prophylaxis against HAV infection mentioned in the content.

A

Prophylaxis against HAV infection involves receiving the inactivated vaccine ‘4 Ws before travel’.

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33
Q

What is the most effective measure to control a Hepatitis A Virus (HAV) epidemic at a school according to the content?

A

Controlling the food source and vaccination are the most effective measures to control a HAV epidemic at school.

34
Q

What is the recommended investigation of choice for a patient with liver cirrhosis and ascites who develops abdominal pain and fever?

A

Paracentesis with analysis of ascitic fluid for increased white blood cells and more than 250 neutrophils is the investigation of choice.

35
Q

What is the treatment of choice for spontaneous bacterial peritonitis (SBP) in a patient with liver cirrhosis and ascites?

A

The treatment of choice for SBP is intravenous cefotaxime.

36
Q

Describe the prevention of recurrence in a patient with liver cirrhosis and ascites according to the content.

A

The prevention of recurrence involves using trimethoprim-sulfamethoxazole (TMP-SMX).

37
Q

What is the most accurate test for primary biliary cirrhosis according to the content?

A

The most accurate test for primary biliary cirrhosis is the presence of antimitochondrial antibodies (AMA).

38
Q

What is the definitive treatment for primary biliary cirrhosis as mentioned in the content?

A

The definitive treatment for primary biliary cirrhosis is a liver transplant.

39
Q

Describe the diagnosis of a patient with cirrhosis, choreiform movement, and personality changes according to the content.

A

The diagnosis is Wilson’s disease.

40
Q

What are the best initial tests for Wilson’s disease as per the content?

A

The best initial tests include checking ceruloplasmin levels and performing a slit lamp examination of the eyes for Kayser-Fleischer rings.

41
Q

What is the most accurate test for Wilson’s disease according to the content?

A

The most accurate test for Wilson’s disease is a liver biopsy.

42
Q

What is the treatment of choice for Wilson’s disease as mentioned in the content?

A

The treatment of choice for Wilson’s disease is penicillamine.

43
Q

What is the best initial test for hemochromatosis according to the content?

A

The best initial test for hemochromatosis is measuring transferrin levels or ferritin levels, with a preference for transferrin levels if both are available.

44
Q

Describe the screening process for hemochromatosis in the normal population.

A

1st step: Check serum ferritin or transferrin levels. 2nd step: If either is high, proceed with gene analysis.

45
Q

What is the recommended first step in screening for hemochromatosis in individuals with a first-degree relative with the condition?

A

Screen for HFE gene mutation.

46
Q

When should children be tested for hemochromatosis?

A

If both parents are carriers of the gene.

47
Q

Define the treatment for hemochromatosis.

A

Phlebotomy.

48
Q

What is the most accurate test for hemochromatosis?

A

Liver biopsy.

49
Q

What is the diagnosis for a patient with hemochromatosis known to have cirrhosis presenting with fever and abdominal pain?

A

Spontaneous bacterial peritonitis (SBP).

50
Q

Describe the diagnosis for a patient with obesity, diabetes, and hyperlipidemia who develops hepatomegaly.

A

Non-alcoholic steatohepatitis (NASH).

51
Q

What is the diagnosis for a young non-smoker with emphysema and liver cirrhosis?

A

Alpha-1 antitrypsin deficiency.

52
Q

What should be done if a young non-smoker with pan-acinar emphysema is identified?

A

Survey their liver.

53
Q

How can hepatic encephalopathy in a patient with cirrhosis be managed if ammonia levels are elevated?

A

Administer lactulose and enema.

54
Q

What is the most common cause of liver cirrhosis in Australia?

A

Alcoholic liver disease.

55
Q

What is the treatment for emphysematous cholecystitis?

A

Intravenous fluids, antibiotics, and emergent surgery.

56
Q

What is the most common virus causing chronic liver disease in adults?

A

Hepatitis C virus (HCV).

57
Q

What is the most common virus causing chronic liver disease in children?

A

Hepatitis B virus (HBV).

58
Q

What is the most common virus causing liver cancer?

A

Hepatitis B virus (HBV).

59
Q

What is the most common virus transmitted after needle abrasion?

A

Hepatitis B virus (HBV).

60
Q

What is the most common virus transmitted by food?

A

Hepatitis A virus (HAV).

61
Q

Describe the virus that can be lethal to pregnant women.

A

Hepatitis E virus (HEV).

62
Q

Describe the virus associated with hepatitis B.

A

Hepatitis B virus (HBV)

63
Q

What is the most common route of HBV transmission in perinatal cases?

A

Perinatal transmission

The most common route of hepatitis B virus (HBV) transmission in Australia is through sexual contact. Other significant routes include perinatal transmission (from mother to child during birth) and sharing needles among intravenous drug users.

For more detailed information, you can refer to the RACGP guidelines on HBV transmission and management.

64
Q

What is the best investigation for chronic hepatitis?

A

Liver biopsy

65
Q

What is the most common cause for the need of liver transplantation?

A

Cirrhosis

66
Q

What is the most common disease causing the need for liver transplant in Australia?

A

Alcoholic liver disease

67
Q

If a patient on the transplant list states they cannot stop drinking, what might be the most common reason for not giving them a liver?

A

Patient’s inability to stop drinking

68
Q

Is there a vaccine available for HBV?

A

Yes, vaccine available

69
Q

Is there a vaccine available for HCV?

A

No, vaccine not available

70
Q

What is the most common virus causing Hepatic cancer?

A

Hepatitis B virus (HBV)

71
Q

What is the most common toxin causing hepatic cancer?

A

Aflatoxin

72
Q

What is the most common cause of hepatic cancer overall?

A

Cirrhosis

73
Q

What is the first step in managing variceal bleeding?

A

Resuscitation with normal saline

74
Q

What type of blood is typically used if blood is needed for variceal bleeding?

A

Packed red blood cells (O- RH- low hemolysis)

75
Q

What is the first step to control bleeding in variceal bleeding?

A

Sengstaken tube placement

76
Q

What is the definitive treatment for variceal bleeding?

A

Band ligation

77
Q

What is the next step if band ligation fails in variceal bleeding?

A

Transjugular intrahepatic portosystemic shunt (TIPS)

78
Q

Describe the presentation of a patient with pain in the right upper quadrant, fever, jaundice, and an air-fluid level in the biliary tree.

A

Cholecystitis caused by Clostridium

79
Q

What is the next step in management for a patient with cholecystitis symptoms?

A

Intravenous fluids and antibiotics

80
Q

What is the definitive treatment for cholecystitis?

A

Surgery

AMC MCQ - Key points (49 decks)

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