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Clin Med II - Exam 3 > Schoenwald - Hepatitis/Misc GI Infxns > Flashcards

Schoenwald - Hepatitis/Misc GI Infxns Flashcards

1
Q

hep A and E source

A

fecal/oral

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2
Q

hep B -D source

A

blood/blood-derived body fluids

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3
Q

hep B-D route of transmission

A

percutaneous

permucosal

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4
Q

which strains of hepatitis cause chronic infxn

A

B-D

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5
Q

which strains of hepatitis have vaccines

A

A

B

D

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6
Q

hepatitis sx can range from

A

asymptomatic → symptomatic → fulminant → liver failure → death

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7
Q

general sx associated w. hepatitis

A

n/v/abd pain

loa

f/d

clay colored stools

dark urine

jaundice

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8
Q

common sx in smokers w. hepatitis

A

aversion to smoking

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9
Q

what populations need vaccination against hep A (5)

A

drug users

homeless

men who have sex w. men

incarcerated

chronic liver dz

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10
Q

one dose of hep A vaccine is __ effective,

2nd dose offers = __

A

95%

lifelong protection

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11
Q

2 main sources of hep A spread

A

close personal contact → daycares, household, sex

contaminated food/water

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12
Q

blood exposure spread of hep A is

A

rare

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13
Q

2 vaccines for hep A

A

havris

twinrix

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14
Q

havris is approved for __ and older

A

12 mo

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15
Q

both kids and adults need __ doses of havris

A

2

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16
Q

twinrix is a combo for hepatitis

A

A and B

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17
Q

standard course for twinrix is __ shots

and accelerated course is __ shots

A

standard: 3
accelerated: 4

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18
Q

who might you recommend the accelerated course of Twinrix for

A

travelers

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19
Q

most easily transmitted of all blood borne pathogens

A

hep B

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20
Q

tx for hep A

A

supportive

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21
Q

types of hep B spread

A

high

moderate

low/not detectable

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22
Q

high sources of hep B spread

A

blood serum

wound exudates

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23
Q

moderate sources of hep B spread

A

semen

vaginal fluid

saliva

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24
Q

low/not detectable sources of hep B spread

A

urine

feces

sweat

tears

breast milk

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25
Q

population w. highest rates of hep B

A

asian

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26
Q

populations at high risk for hep B

A

HCW

hemodialysis

all std clinic clients

multiple sex partners

prior STD

prison inmates

IVDU

developmental disability

MSM

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27
Q

testing markers for hep B

A

HBsAg

Anti-HBs

HBcAg

Anti-HBc

IgM anti-HBc

Total anti-HBc

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28
Q

HBsAg indicates

A

surface antigen → acute infxn

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29
Q

Anti-HBs indicates (3)

A

past infxn w. immunity to HBV

passive abs from HBIG

immune response from HB

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30
Q

HBcAg indicates

A

core antigen → no commercial test available

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31
Q

Anti-HBc indicates

A

abs to Anti-HBc → immune dt infxn

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32
Q

IgM anti-HBc indicates

A

IgM antibody → acute infxn

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33
Q

Total anti-HBc

A

IgG + IgM

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34
Q

hep B can lead to

A

cirrhosis

liver ca

→ in 25%

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35
Q

__% of hep B bases clear on their own,

__% become chronic

A

80

20

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36
Q

on chronic infxns __ will remain positive

A

HBsAg

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37
Q

hep B vaccines (3)

A

engerix and recombivax

heplisav

twinrix

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38
Q

enterix and recombivax require __ doses,

is approved for __,

and offers lower protection in __

A

3

newborn and above

older/immunocompromised

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39
Q

do pt’s need to start over w. engerix and recombivax if they miss a dose

A

no!

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40
Q

heplisav requires __ doses

A

2

41
Q

know how to interpret this chart

A
42
Q

modes of transmission for hep B (3)

A

sexual

parenteral

perinatal

43
Q

hep B is a integrates into host via

A

RNA

44
Q

leading cause of HCC and liver transplant in US

A

hep C

45
Q

incubation period for hep C

A

mc: 6-7 weeks
* up to 26 weeks*

46
Q

exposures to hep C can include (6)

A

IVDU

tranfusion/transplant from infected donor

occupational exposure to blood → needle sticks

iatrogenic → unsafe injxns

birth to HCV mother

sex w. infected partner

47
Q

mc presentation of hep C

A

asymptomatic

48
Q

testing for hep C starts with __

and is confirmed w. __

A

hep C abs

PCR → detects viral load

49
Q

hep C integrates into host via

A

DNA

50
Q

hep B is a __ virus

hep C is a __ virus

A

RNA

DNA

51
Q

for hep C: in US __ genotype is mc;

in asian countries __ genotypes are most common

A

1

4-6

52
Q

__% of hep C cases clear on their own,

__% become chronic

A

20

80

53
Q

is there a vaccine for hep C

A

no!

54
Q

know how to interpret this chart

A
55
Q

HCV abs reactive indicates __,

confirm w.

A

HCV infxn

HCV RNA

56
Q

HCV abs reactiv, HCV RNA detected indicates

A

current HCV infxn

57
Q

HCV abs reactive

HCV RNA not detected indicates

A

no current HCV infxn

58
Q

who is at increased risk for hep C and requires screening (5)

A

any hx IVDU (even once)

received clotting factors before 1987

received blood/organ donations before 7/92

chronic hemodialysis

e.o liver dz

59
Q

who requires exposure management for hep C

A

healthcare. emergency, public safety workers post needle stick/mucosal exposures

children born to HCV (+) mom

anyone born from 1945-1965 → 5x more likely to be infected

60
Q

is hep C more widespread than HIV?

A

yes! → 5x

61
Q

t/f hep B is difficult to treat

A

T!

62
Q

tx for hep B (3)

A

adefovir

entecavir

tenofivir

63
Q

what tx is minimally effective and not used for hep C;

what tx are obsolete for hep C

A

rarely used: pegylated interferon

obsolete: protease inhibitors, polymerase inhibitors

64
Q

what type of therapy has a 95% cure rate for hep C in non cirrhotic pt’s

A

non interferon based, combination therapy

65
Q

what are the 3 combo therapies for hep C

A

harvoni-sofosbovir/ledipasivir

epclusa-sofosbuvir/velpatasivir

mavyret (glecaprevir/pibrentasvir)

66
Q

harvoni and epclusa tx lasts

A

12 weeks

67
Q

mavyret tx lasts

A

8 weeks

68
Q

black box warning for combo hep C therapy

A

could reactivate hep B infxn

69
Q

what routine testing is done for hep C pt’s on combo therapy

A

hep B surface antigen

hep B viral DNA

70
Q

3 sx of infectious esophagitis

A

dysphagia

odynophagia

retrosternal CP

71
Q

mc pathogen associated w. infectious esophagitis

A

candida albicans

also CMV or herpes

72
Q

rf for infectious esophagitis

A

immunosuppression

DM

HIV

73
Q

candida albicans infectious esophagitis is an __ defining illness

A

AIDS

74
Q

dx for infectious esophagitis

A

endoscopy

75
Q

tx for c albicans infectious esophagitis

A

diflucan

76
Q

IV diflucan should only be used if pt has

A

odynophagia

severe dysphagia

77
Q

tx for CMV infectious esophagitis

A

ganciclovir

78
Q

what is the problem w. ganciclovir

A

lots of s.e

79
Q

tx for HSV infectious esophagitis

A

Acyclovir

80
Q

1 in 6 pt w. PUD have __ infection

A

h.pylori

81
Q

h.pylori increases risk for __ by 20x

A

adenocarcinoma

82
Q

bacterial classification of h.pylori

A

gram negative rod

83
Q

h. pylori is also associated w.

A

MALT cell lymphoma

high cure rates

84
Q

dx for h.pylori (4)

A

stool Ag

urea breath test

endoscopy

abs test

85
Q

what is the problem w. the abs test for h.pylori

A

it will be (+) if pt has any hx of infxn → can’t be used for recurring infxn

86
Q

pharm for h. pylori (2)

A

PPI

PLUS

clarithromycin AND amoxicillin

→ PrevPac (combo of all 3)

87
Q

besides pharm, another important aspect of h.pylori tx

A

smoking cessation

88
Q

what do you think when you see LLQ pain, bloody stools, fever

A

diverticulitis

89
Q

tx for diverticulitis

A

metronidazole

PLUS

cipro

90
Q

what do you think when you see flaccid, descending paralysis

A

botulism

91
Q

symptoms associated w. botulism (lots)

A

dysphagia

dry mouth

dysarthria

fatigue

UE weakness/LE weakness

constipation

dyspnea

vomiting

dizziness

92
Q

pe exam findings of botulism

A

ophthalmoplegia

ptosis

decreased gag reflex

facial weakness w. normal mental status

93
Q

wound botulism is associated w.

A

IVDU

94
Q

clostridium botulism is a gram __ bacteria

that produces __

A

(+)

spores

95
Q

botulism __ produce a toxin

that prevents __

A

spores

release of Ach at NMJ

96
Q

botulism has __ onset

after __

A

rapid

eating contaminated foods

97
Q

tx for botulism (3)

A

ICU admit!

induce vomiting

antitoxin

98
Q

2 parameters for botulism antitoxin

A

culture proven

very high likelihood of infxn

99
Q

what tx is controversial for botulism

A

abx (penicilins) → killing bacteria may release more toxin

Clin Med II - Exam 3 (14 decks)

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