Schoenwald - Hepatitis/Misc GI Infxns Flashcards
1
Q
hep A and E source
A
fecal/oral
2
Q
hep B -D source
A
blood/blood-derived body fluids
3
Q
hep B-D route of transmission
A
percutaneous
permucosal
4
Q
which strains of hepatitis cause chronic infxn
A
B-D
5
Q
which strains of hepatitis have vaccines
A
A
B
D
6
Q
hepatitis sx can range from
A
asymptomatic → symptomatic → fulminant → liver failure → death
7
Q
general sx associated w. hepatitis
A
n/v/abd pain
loa
f/d
clay colored stools
dark urine
jaundice
8
Q
common sx in smokers w. hepatitis
A
aversion to smoking
9
Q
what populations need vaccination against hep A (5)
A
drug users
homeless
men who have sex w. men
incarcerated
chronic liver dz
10
Q
one dose of hep A vaccine is __ effective,
2nd dose offers = __
A
95%
lifelong protection
11
Q
2 main sources of hep A spread
A
close personal contact → daycares, household, sex
contaminated food/water
12
Q
blood exposure spread of hep A is
A
rare
13
Q
2 vaccines for hep A
A
havris
twinrix
14
Q
havris is approved for __ and older
A
12 mo
15
Q
both kids and adults need __ doses of havris
A
2
16
Q
twinrix is a combo for hepatitis
A
A and B
17
Q
standard course for twinrix is __ shots
and accelerated course is __ shots
A
standard: 3
accelerated: 4
18
Q
who might you recommend the accelerated course of Twinrix for
A
travelers
19
Q
most easily transmitted of all blood borne pathogens
A
hep B
20
Q
tx for hep A
A
supportive
21
Q
types of hep B spread
A
high
moderate
low/not detectable
22
Q
high sources of hep B spread
A
blood serum
wound exudates
23
Q
moderate sources of hep B spread
A
semen
vaginal fluid
saliva
24
Q
low/not detectable sources of hep B spread
A
urine
feces
sweat
tears
breast milk
25
population w. highest rates of hep B
asian
26
populations at high risk for hep B
HCW
hemodialysis
all std clinic clients
multiple sex partners
prior STD
prison inmates
IVDU
developmental disability
MSM
27
testing markers for hep B
HBsAg
Anti-HBs
HBcAg
Anti-HBc
IgM anti-HBc
Total anti-HBc
28
HBsAg indicates
surface antigen → acute infxn
29
Anti-HBs indicates (3)
past infxn w. immunity to HBV
passive abs from HBIG
immune response from HB
30
HBcAg indicates
core antigen → *no commercial test available*
31
Anti-HBc indicates
abs to Anti-HBc → immune dt infxn
32
IgM anti-HBc indicates
IgM antibody → acute infxn
33
Total anti-HBc
IgG + IgM
34
hep B can lead to
cirrhosis
liver ca
→ in 25%
35
\_\_% of hep B bases clear on their own,
\_\_% become chronic
80
20
36
on chronic infxns __ will remain positive
HBsAg
37
hep B vaccines (3)
**engerix and recombivax**
heplisav
twinrix
38
enterix and recombivax require __ doses,
is approved for \_\_,
and offers lower protection in \_\_
3
newborn and above
older/immunocompromised
39
do pt's need to start over w. engerix and recombivax if they miss a dose
no!
40
heplisav requires __ doses
2
41
know how to interpret this chart
42
modes of transmission for hep B (3)
sexual
parenteral
perinatal
43
hep B is a integrates into host via
RNA
44
leading cause of HCC and liver transplant in US
hep C
45
incubation period for hep C
mc: 6-7 weeks
* up to 26 weeks*
46
exposures to hep C can include (6)
IVDU
tranfusion/transplant from infected donor
occupational exposure to blood → needle sticks
iatrogenic → unsafe injxns
birth to HCV mother
sex w. infected partner
47
mc presentation of hep C
asymptomatic
48
testing for hep C starts with \_\_
and is confirmed w. \_\_
hep C abs
PCR → detects viral load
49
hep C integrates into host via
DNA
50
hep B is a __ virus
hep C is a __ virus
RNA
DNA
51
for hep C: in US __ genotype is mc;
in asian countries __ genotypes are most common
1
4-6
52
\_\_% of hep C cases clear on their own,
\_\_% become chronic
20
80
53
is there a vaccine for hep C
no!
54
know how to interpret this chart
55
HCV abs reactive indicates \_\_,
confirm w.
HCV infxn
HCV RNA
56
HCV abs reactiv, HCV RNA detected indicates
current HCV infxn
57
HCV abs reactive
HCV RNA not detected indicates
no current HCV infxn
58
who is at increased risk for hep C and requires screening (5)
any hx IVDU (even once)
received clotting factors before 1987
received blood/organ donations before 7/92
chronic hemodialysis
e.o liver dz
59
who requires exposure management for hep C
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
is hep C more widespread than HIV?
yes! → 5x
61
t/f hep B is difficult to treat
T!
62
tx for hep B (3)
adefovir
entecavir
tenofivir
63
what tx is minimally effective and not used for hep C;
what tx are obsolete for hep C
rarely used: pegylated interferon
obsolete: protease inhibitors, polymerase inhibitors
64
what type of therapy has a 95% cure rate for hep C in non cirrhotic pt's
non interferon based, combination therapy
65
what are the 3 combo therapies for hep C
harvoni-sofosbovir/ledipasivir
epclusa-sofosbuvir/velpatasivir
mavyret (glecaprevir/pibrentasvir)
66
harvoni and epclusa tx lasts
12 weeks
67
mavyret tx lasts
8 weeks
68
black box warning for combo hep C therapy
could reactivate hep B infxn
69
what routine testing is done for hep C pt's on combo therapy
hep B surface antigen
hep B viral DNA
70
3 sx of infectious esophagitis
dysphagia
odynophagia
retrosternal CP
71
mc pathogen associated w. infectious esophagitis
**candida albicans**
*also CMV or herpes*
72
rf for infectious esophagitis
immunosuppression
DM
**HIV**
73
candida albicans infectious esophagitis is an __ defining illness
AIDS
74
dx for infectious esophagitis
endoscopy
75
tx for c albicans infectious esophagitis
diflucan
76
IV diflucan should only be used if pt has
odynophagia
severe dysphagia
77
tx for CMV infectious esophagitis
ganciclovir
78
what is the problem w. ganciclovir
lots of s.e
79
tx for HSV infectious esophagitis
Acyclovir
80
1 in 6 pt w. PUD have __ infection
h.pylori
81
h.pylori increases risk for __ by 20x
adenocarcinoma
82
bacterial classification of h.pylori
gram negative rod
83
h. pylori is also associated w.
MALT cell lymphoma
*high cure rates*
84
dx for h.pylori (4)
stool Ag
urea breath test
endoscopy
abs test
85
what is the problem w. the abs test for h.pylori
it will be (+) if pt has any hx of infxn → can't be used for recurring infxn
86
pharm for h. pylori (2)
PPI
PLUS
clarithromycin AND amoxicillin
→ **PrevPac (combo of all 3)**
87
besides pharm, another important aspect of h.pylori tx
smoking cessation
88
what do you think when you see LLQ pain, bloody stools, **fever**
diverticulitis
89
tx for diverticulitis
metronidazole
PLUS
cipro
90
what do you think when you see flaccid, descending paralysis
botulism
91
symptoms associated w. botulism (lots)
dysphagia
dry mouth
dysarthria
fatigue
UE weakness/LE weakness
constipation
dyspnea
vomiting
dizziness
92
pe exam findings of botulism
ophthalmoplegia
ptosis
decreased gag reflex
facial weakness w. normal mental status
93
wound botulism is associated w.
IVDU
94
clostridium botulism is a gram __ bacteria
that produces \_\_
(+)
## Footnote
**spores**
95
botulism __ produce a toxin
that prevents \_\_
spores
release of Ach at NMJ
96
botulism has __ onset
after \_\_
rapid
eating contaminated foods
97
tx for botulism (3)
ICU admit!
induce vomiting
**antitoxin**
98
2 parameters for botulism antitoxin
culture proven
very high likelihood of infxn
99
what tx is controversial for botulism
abx (penicilins) → *killing bacteria may release more toxin*
