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STEP 2 GI > Mehlman viral hepatitis 11-15 (2) > Flashcards

Mehlman viral hepatitis 11-15 (2) Flashcards

1
Q

what three can ALSO cause chronic hepatitis?

A

B, C, D

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1
Q

what two can cause only acute hepatitis?

A

A ir E

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2
Q

Hepatocellular damage is caused by what mechanism?

A

2) HY point is that hepatocellular damage from hepatitis is due to T-cell-mediated apoptosis, not direct viral cytopathicity. Same goes for general hepatic inflammation. Choose T cell response, not direct viral effect.

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3
Q

what ALT/AST in hepatitis?

A

Hepatitis in general classically has ALT > AST, where #s can be in the hundreds to thousands, but I’ve seen plenty of variability on NBME Qs, which is why I don’t consider this a foundational point.

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4
Q

what most common acute hepatitis in USA as an answer?

A

Hepatitis A virus. The answer for acute hepatitis in the United States most of the time.

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5
Q

Hepatitis A. what hint regarding travel might be said in Q?

A

patient recently traveled to Mexico

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6
Q

Hepatitis A. what transmision?

A

fecal-oral

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7
Q

Hepatitis A. what Ig shows acute?

A

IgM against HepA means acute infection.

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8
Q

Hepatitis A. what Ig means that infection is cleared?

A

IgG against HepA means patient has cleared infection (because there is no chronic HepA).

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9
Q

Hepatitis A. what indication for vaccine in usmle?

A
  • USMLE wants you to know HepA vaccine is indicated for IV drug users and MSM.

There’s a 2CK NBME Q where they just mention otherwise healthy MSM, and answer is Hep A vaccination.

MSM - mex sex men

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10
Q

Hepatitis B. mandatory stuff for usmle is serology.

A

.

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11
Q

Hepatitis B. its most common hepatitis infection worldwide.

A

.

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12
Q

Hepatitis B. Usmle likes CHINA for HBV.
Probably due to high number of unvaccinated people.

what about USA?

A

HCV most common in usa.

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13
Q

Hepatitis B. transmission?

A

Parenteral
Transmitted vertically from mother to neonate, sex, iv drugs, blood exposure.
Presents in all blood fluids including breast milk.

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14
Q

Hepatitis B. can be acute and chronic.

A

.

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15
Q

Hepatitis B. Patient currently has HepB?

A

Positive surface ANTIGEN

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16
Q

Hepatitis B. Patient is immune to HepB?

A

positive surface antibody

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17
Q

Hepatitis B. Patient has HepB now or did in the past.?

A

positive core antibody

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18
Q

Hepatitis B. If positive core antibody IgM?

A

patient has acute infection

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19
Q

Hepatitis B. If positive core antibody IgG?

A

patient has chronic HepB, OR cleared HepB.

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20
Q

Hepatitis B. Vaccinated against HepB.?2

A

(+) Surface antibody / (-) Core antibody = immune

21
Q

Hepatitis B. History of HepB / cleared it.? 2

A

(+) Surface antibody / (+) Core antibody = immune

22
Q

Hepatitis B. Not immune / Susceptible
–> need to vaccinate.? 2

A

(-) Surface antibody / (-) Core antibody = no immune

23
Q

Hepatitis B. window period? 3

A

(-) Surface antigen / (-) Surface antibody / (+) Core antibody IgM

24
Q

Hepatitis B. when vaccination? for peds

A

Vaccination against HepB is at birth, 2 months, and 6 months (no longer at 4 months)

25
Q

Hepatitis B. when to give HepB IVIG to neonate?

A

Only give HepB IVIG to neonate if mom is confirmed (+).

A 2CK NBME Q gives mother’s status as
unknown when child is born –> answer = “Give HepB vaccine now + only give IVIG if mother is positive.”

26
Q

Hepatitis B. Patient has Hx of completed HepB vaccination, but has titers that show susceptibility –> what answer, ie what to do?

A

the answer is just “give more vaccine.” Sometimes people’s immunity wanes.

27
Q

Hepatitis B. window period. cia pora sakiniu.

A

Once a susceptible patient is exposed to HepB and the immune system attempts to clear it, sometimes Surface antigen will decline to the point that it is no longer detectible. But at the same time, the Surface antibody might not be high enough / at detectable levels yet.

This is called the “window period,” where both Surface antigen and antibody are negative, so it can appear as though the patient doesn’t have an infection.

28
Q

Hepatitis B. window period. so if surface antigen and antibody is negative, so what is positive?

A

However, Core antibody IgM will be (+)

29
Q

Hepatitis B. 2 key facts about window period?

A

1) you know the double-negative Surface antibody/antigen combo is seen in the
window period,
and
2) that Core antibody IgM is most reliable during the window period.

30
Q

HBV. USMLE dont give a fuck about HepB pharma. Waste of time.
The only that we need to know is interferon-a can be used for HepB.

A

.

31
Q

Hepatitis C virus. damage mechanism?

A

Hepatocellular damage is due to T cells / death is due to T-cell-mediated apoptosis, not direct viral cytopathicity.

very fucking HY for usmle

32
Q

Hepatitis C virus. transmission?

A

Parenteral.

33
Q

Hepatitis C virus. can be acute and chronic.

A

.

34
Q

Hepatitis C virus. transmitted exclusively through what way?

A

Transmitted almost exclusively from IV drugs/blood exposure. Not present in breastmilk and non-sanguineous body fluids (in contrast to HepB).

35
Q

Hepatitis C virus. NOT PRESENT IN BREAST MILK or other fluids - just hepB

A

.

36
Q

Hepatitis C virus.

In contrast to HepB, HepC is not considered sexually transmitted. Large longitudinal study of couples with one HepC(+) partner showed sexual transmission almost nil (possibly due to menses exposure). If you’re forced to choose on NBME, however, still inform that abstinence or barrier contraception minimizes risk.

A

.

37
Q

Hepatitis C virus. why NO VACCINE?

A

No vaccine due to ­­ high antigenic variation (i.e., >7 genotypes and 80 subtypes of HepC exist).

38
Q

Hepatitis C virus. what serology shows acute infection?

A

IgM against HepC means acute infection

39
Q

Hepatitis C virus. what serology shows chronic infection?

A

IgG against HepC means usually means chronic HepC.

40
Q

Hepatitis C virus. many drugs can be used for Tx, but usmle dont give a fuck. just be aware of pegylated interferon-a.

A

.

41
Q

Hepatitis C virus. what one drug to know for Tx?

A

just be aware of pegylated interferon-a.

42
Q

Hepatitis D. what important fact regarding presence?

A

Requires hepatitis B in order to infect.

43
Q

Hepatitis D + HBV.
2 scenarios?

A

Can be due to co-infection (happening at the same time) or superinfection (occurs later in someone who already has HepB).

44
Q

Hepatitis D. if usmle asks how to prevent HDV?

A
  • If USMLE asks how to prevent HepD infection, answer = vaccination against hepatitis B. There is no vaccine against HepD.
45
Q

Hepatitis D. what about vaccine?

A

no vaccine agains HDV.

46
Q

Hepatitis D virus.

  • Apparently HepB antigen forms the envelope for HepD (i.e., forms a circle around HepD).
    neikirtau sito pasakymo, bet prie vakciniu buvo pamineta. tipo kad norint isvengti D viruso –> reikia skiepyti nuo HBV.
A
47
Q

HEV. causes what hepatitis and in what population?

A

Causes fulminant hepatitis / incr. (2 arrows)­­ risk of death in pregnant women.

48
Q

HEV. what kind of hepatitis?

A

only acute, no chronic

49
Q

HEV. in what area?

A

Seen more in Asia, e.g., Tibet.

But if USMLE says Mexico + pregnant woman + fast death from hepatitis, you still have to use your head and know that’s HepE over HepA.

STEP 2 GI (17 decks)

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