Inestigations

Question 1

17 ketosteroids

Answer 1

Sex steroid metabolite, increased in adrenal rumours

Question 2

Hep A serology

Answer 2

Acute infection
Anti HAV igm
Blood pcr +

Past infection: anti-HAV igG
Vaccine response: same^

Question 3

Hep B serology

Answer 3

Acute infection: anti HBc igM +
HBs Ag +
Anti HBs
hbv Dna pcr

Past infection: anti HBs +
Anti HBc igG +

Chronic infection:
Core iGG 
HBs Ag +
Anti HBs
Pcr + or -

Vaccine response:
Anti HBs +
Anti HBc - (never exposed to core)

Question 4

Interrogation of hep B bloodwork

Answer 4

HbsAg: surface antigen + acute = exposure to hep B or presence of hep B

Core Ag (HBcAg) suggests present or past chronic infection

HbeAg: + in active/highly infectious phase of infection = active replication

HbeAb: + with Ag: lower infectivity as body response mounted, lower risk of infection –> no replicating virus but antibodies against it

HbcAb: + with acute, resolved or chronic infection, but NOT positive after immunization

HbsAb: + in resolved infection or after immunization

Question 5

Technetium-99 scan

Answer 5

Radio nucleotide splenic scan to assess function

Question 6

Csf in MS

Answer 6

Oligoclonal bands and IgG, incr protein and cell count