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446- ID and transplant > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

which hepatitis virus is DNA genome

A

B

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2
Q

hep ___ causes chronic hepatitis in 10%, whiel hep ___ causes it in 70%

A

B, C

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3
Q

hepatitis A is _______ (enveloped/ nonenv), _____ (RNA?DNA) virus

A

nonenveloped
RNA

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4
Q

Hep A transmission is through

A

fecal oral
ingestion of contaminated food or water

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5
Q

immune response by ________ likely cause of hepatocyte damage in Hep A

A

cytotoxic T cells

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6
Q

which of the following is false regarding hep A
1. children are often asymptomatic
2. virus replicates outside of hepatocytes, causing generalized inflammation
3. serology of negative anti-HAV IgM and + AntiHAV-IgG = immunity from past infection or vaccine
4. all of the above are true

A

2

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7
Q

what does + anti HAV IgM and IgG mean

A

acute or recent HAV infection

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8
Q

list 3 ways to prevent hep A infection

A

Hand washing + contact precautions
Sanitation, Avoid drinking contaminated water
Boil food/ beverages that may be contaminated
Hep A vaccination, Immunoglobulin

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9
Q

hep A is generally
1. self limiting
2. requires hospitalization
3. requires immunization if recent infection
4. none of the above

A

1

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10
Q

hep B is a ___ (RNA/ DNA) virus that is ___ (enveloped/ nonenveloped)

A

DNA
enveloped

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11
Q

HBsAG is on the

A

outer surface

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12
Q

HBcAG and HBeAG is the

A

inner core

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13
Q

labs expected to see in No current/ previous HBV infxn
No immunity

A

negative to HBsAG, antiHBs, antiHBc

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14
Q

labs expected to see in HBV immunity due to vaccination

A

neg HBsAG, antiHBc
+ antiHBs

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15
Q

labs expected to see in chronic HBV infection

A

+HBsAG, - antiHBs, + antiHBc

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16
Q

T or F: hep B is curable

A

F

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17
Q

how to prevent Hep B

A

vaccination
passive immunity in post exposure individuals
barrier protection + avoid sharing products which may have blood

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18
Q

hep C disproportionately affects

A

indigenous
IJDUs
immigrants
homeless or incarcerated
born 1946-1965

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19
Q

list 3 ways hep C can be transmitted

A

Sharing drug injection equipment
Unsterile tattooing or body piercing
Unsterile medical or dental procedures (where skin is pierced)
Blood produce transfusion in Canada before 1992
Parent to child transmission during pregnancy or childbirth (do not need to avoid pregnancy or breastfeeding)
Sexual transmission (even trace blood)
Reusing someone’s personal items with blood on them (ex- razors, nail clippers, toothbrushes)

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20
Q

rank the following from lowest to highest risk of transmission by needlestick: HIV, HCV, HBV

A

HIV < HCV <HBV

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21
Q

initial clinical presentation of hep C is usually ______

A

asymptomatic

22
Q

HCV is detectable within ____ and ____ increases

A

1-2wks
ALT

23
Q

hep C sx

A

Fatigue, weakness
Anorexia, abdominal pain
Jaundice, dark urine

24
Q

describe prognosis of untx hep C infection

A

15-40% resolution
60-80% chronic HCV → 20% cirrhosis @ 20yrs (death/ transplant) → 1-4% hepatocellular carcinoma @ 30 yrs (death/ transplant)

25
Q

what is a way to prevent hep C transmission by up to 80%

A

Access to opioid agonist tx + needle and syringe programs (NSP) can reduce HCV by up to 80%

26
Q

T or F: dried hep C blood is not contagious

A

F- is contagious,. should clean with bleach

27
Q

list 3 populations we should test for HCV

A

Current/ hx IJDU
Born or had medical/ dental tx in HCV endemic countries
Received healthcare where there is a lack of universal precautions
Received blood transfusions, products, or organ transplant in Canada before 1992>18mths born to mothers with HCV
Hx incarceration
Hx needle stick injury
Persistently elevated ALT
Other RF: high risk sexual behavior, homelessness, IN drug use, tattooing, body piercing, sharing personal care items with someone who is HCV infxn

28
Q

hep C virus should be tested ____ after exposure for ____

A

3mths
RNA

29
Q

if antibodies for HCV are positive, that indicates

A

acute, chronic, or past infxn

30
Q

if a PCR HCV RNA is +, what happens

A

confirm using RNA
if RNA - = HCV cleared (past infxn)
if RNA + = current infxn

31
Q

pros of POCT hep C

A

Easy to perform (capillary blood - finger prick)
Results in 20min
V good sensitivity and spec (96-100%, 99-100%)
Easy to adapt to diff practice models/settings
Low barrier for testing

32
Q

cons of POCT hep C

A

Requires confirmation (HCV RNA)
Results not on netcare
Pt may be at risk of HIV or other STIs
Cost of testing

33
Q

pros of dried blood spot hep C test

A

Easy to perform (capillary blood - finger prick)
V good sensitivity and spec
Can detect HCV RNA
Can test for multiple infections (HIV, HBV, syphilis, etc)
Low barrier for testing

34
Q

cons of hep C blood spot test

A

Not widely available at public health labs
Results not immediate

35
Q

T or F: hep C is a notifiable disease in alberta

A

T

36
Q

what are some counselling tips for adults with HCV infection

A

reduce/ avoid alcohol
Smoking cessation (to ↓ risk hepatocellular carcinoma)
Hep A and B vaccines (if nonimmune)
Maintain healthy weight and diet
avoid/ limit hepatotoxic agents/ drugs

37
Q

list 10 labs to order in HCV infection

A

anti-hep A
IgG antibody
hep B surface antigen
anti-Hbc antibody
anti-HBs antibody
AST
ALT
CBC
creatinine

38
Q

if FIB-4 >3.25 =

A

refer to specialist

39
Q

tx for hep C is recommended for

A

all pts with chronic HCV infection

40
Q

who do not need hep C tx

A

those with severe comorb + short life expectancy unrelated to HCV

41
Q

in adults with HCV without cirrhosis and have not received previous hep C tx
1. should receive full hep C tx
2. should receive simplified tx
3. do not need tx- will clear themselves
4. 2 or 3

A

2

42
Q

the goal of hep B tx is to achieve SVR- absence of detectable HCV ________________ at least _____ after completion of tx

A

absence of detectable HCV RNA
12 wks

43
Q

____ is a marker for cure of HCV infection

A

SVR

44
Q

T or F: for a pt to have eradicated the infection, they must be rid of both HCV antibodies and RNA in serum and tissue

A

F- will still have HCV antibodies

45
Q

3 oral tx classes for hep B

A

NS3/4A protease inhibitor (-previr)
NS5B polymerase inhibitors (-buvir)
NS5A inhibitors (-asvir)

46
Q

NS3A4 protease inhibitor ends with

A

-previr

47
Q

NS5B polymerase inhibitors end with

A

-buvir

48
Q

NS5A inhibitors end with

A

-asvir

49
Q

most intx with hep B tx are

A

CYP3A4 metabolism
hepatic/ intestinal transporters

50
Q

describe monitoring for hep B after tx

A

week 12 after end of tx = do SVR
HCV RNA, AST, ALT

446- ID and transplant (18 decks)

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