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A. MLA Map Infections > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

If a patient presents with jaundice, all of the following investigations should be performed EXCEPT which one?

1 - Viral Serology – hepatitis A, B, C, and E, EBV, CMV, HIV
2 - Antibodies (AMA, SMA, LKM1, immunoglobulins (for PBC and autoimmune hepatitis)
3 - Ferritin and transferrin saturations (Haemochromatosis)
4 - Caeruloplasmin and copper (for Wilson’s Disease)
5 - Alpha 1 antitrypsin levels (for alpha 1 antitrypsin deficiency)
6 - Alphafetoprotein (AFP) to exclude HCC
7 - Brain natriuretic peptide 32 (BNP)

A

7 - Brain natriuretic peptide 32 (BNP)

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2
Q

Which of the following is NOT a cause of hepatitis?

1 - drugs such as paracetamol
2 - alcohol
3 - viruses
4 - autoimmune disease
5 - heart failure

A

5 - heart failure

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3
Q

Patients with hepatitis can present with all of the following EXCEPT which one?

1 - nausea and vomiting
2 - fevers
3 - enlarged appendix
4 - joint pain and muscle aches
5 - jaundice
6 - abdominal pain
7 - itchy skin
8 - pale stools and dark urine

A

3 - enlarged appendix

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4
Q

Patients with hepatitis can present with pale stools. This is because a specific molecule is missing that makes our stool brown. What is the name of this missing compound?

1 - urobilligen
2 - stercobilin
3 - stercobilinogen
4 - heme

A

2 - stercobilin
- liver is unable to synthesis bile
- stercobilin is a breadkdown product of bile in the GIT
- stercobilin makes stool brown

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5
Q

Patients with hepatitis can present with dark urine. This is because a specific molecule is missing that makes our stool brown. What is the name of this missing compound?

1 - urobilligen
2 - stercobilin
3 - stercobilinogen
4 - heme

A

1 - urobilligen
- reabsorbed from GIT and some sent to kidneys
- urobilligen converted to urobilin, which gives urine its yellow colour
- if liver isn’t functioning, all urobilinogen is sent to the kidney making urine darker

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6
Q

What is the difference between acute and chronic hepatitis?

A
  • acute = <6 months
  • chronic = >6 months
  • chronic means inflammation perseveres
  • inflammation leads to scarring, fibrosis and cirrhosis
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7
Q

What common drug can cause acute hepatitis?

1 - Naloxone
2 - Acetaminophen
3 - NSAIDs
4 - Ramipril

A

2 - Acetaminophen
- more commonly known as paracetamol

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8
Q

There are a number of virus that can cause acute hepatitis, including A, B, C, D and E. Which 2 of these cause only acute hepatitis?

A
  • hepatitis A and E
  • spread in food, dirty water and through faecal matter
  • common in travellers
  • REMEMBER A+E are vowels so its in the bowels
  • E can also be transmitted via blood products
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9
Q

Hepatitis causes by viruses A and E can both be transmitted through faecal matter and and contaminated food and water, and is common in travellers. Which antibody is high in active acute hepatitis caused by A and E viruses?

1 - IgG
2 - IgA
3 - IgM
4 - IgE
5 - IgD

A

3 - IgM
- IgM is the first antibody secreted by the adaptive immune system in response to a foreign antigen.

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10
Q

Hepatitis causes by viruses A and E can both be transmitted through faecal matter and and contaminated food and water, and is common in travellers. Which antibody is high in patients in recovery or vaccinated in acute hepatitis caused by A and E viruses?

1 - IgG
2 - IgA
3 - IgM
4 - IgE
5 - IgD

A

1 - IgG
- levels are high either due to vaccination, or the patient is producing IgG to fight the virus

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11
Q

Hepatitis causes by viruses A and E can both be transmitted through faecal matter and and contaminated food and water, and is common in travellers. Although viruses A and E are very similar, which of these can be very dangerous in pregnancy?

A
  • E
  • no vaccine available and can cause acute liver failure
  • middle aged men are most commonly affected
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12
Q

When looking at hepatitis A and E, do they both cause acute and chronic hepatitis?

A
  • no
  • E can cause acute and chronic hepatitis
  • immunosuppressed are at particular risk
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13
Q

There are a number of virus that can cause acute hepatitis, including A, B, C, D and E. Which 2 of these can cause acute and chronic hepatitis?

A
  • hepatits B and C
  • transmitted through bodily fluids and circulation
  • generally spread by blood-to-blood contact associated with injection drug use, poorly sterilized medical equipment, needlestick injuries in healthcare, and transfusions
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14
Q

All of the following are modes of transmission for hepatitis B and C, EXCEPT which one?

1 - contaminated water
2 - unprotected sex
3 - needle sharing
4 - childbirth

A

1 - contaminated water
- essentially viruses B and C are transmitted in the blood

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15
Q

All of the following are modes of transmission for hepatitis B and C, EXCEPT which one?

1 - contaminated water
2 - unprotected sex
3 - needle sharing
4 - childbirth

A

1 - contaminated water
- essentially viruses B and C are transmitted in the blood

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16
Q

In hepatitis C, which diagnosis approach has the highest sensitivity and specificity?

1 - presence of IgG antibodies
2 - recombinant immunoblot assay
3 - hepatitis C RNA on PCR
4 - presence of IgM antibodies

A

3 - hepatitis C RNA on PCR
- if RNA PCR remains constant = chronic
- if RNA PCR reduces = patient improvement

17
Q

There are 3 methods for diagnosing hepatitis B (HBV). Which of the following is NOT one of the 3?

1 - HBV surface antigen (HBsAg = HBV surface antigen)
2 - HBV RNA PCR
3 - core HBV antigen (HBcAg = HBV core antigen)
4 - E antigen produced by infected cells

A

2 - HBV RNA PCR

  • E antigen tells us that the bacteria is active and replicating
18
Q

There are 3 methods for diagnosing hepatitis B (HBV):

  • HBV surface antigen (HBsAg = HBV surface antigen)
  • core HBV antigen (HBcAg = HBV core antigen)
  • E antigen produced by infected cells

Which of these diagnoses tests will be high in a patient with an active HBV?

A
  • all 3 will be high
  • IgM will be produced against the core antigens
  • IgG will be produced against the surface antigen
19
Q

There are 3 methods for diagnosing hepatitis B (HBV):

  • HBV surface antigen (HBsAg = HBV surface antigen)
  • core HBV antigen (HBcAg = HBV core antigen)
  • E antigen produced by infected cells

Following the active HBV, there is a phase called the window, where the host immune cells and virus are not winning. What can be detected here to identify this phase?

1 - IgG antibodies against the HBaAg
2 - IgM antibodies against the HBaAg
3 - IgG antibodies against the HBcAg
4 - IgM antibodies against the HBcAg

A

4 - IgM antibodies against the HBcAg

  • window phase can last weeks to months
20
Q

Which 2 hepatitis viruses have a vaccination?

1 - A
2 - B
3 - C
4 - D
5 - E

A

1 - A
2 - B

21
Q

In order for hepatitis D to infect a patient, which virus do patients already need to be infected with?

1 - A
2 - B
3 - C
4 - D

A

2 - B

  • B and E acquired together = coinfection
  • B and then E = superinfection and is more severe
22
Q

In order for hepatitis D to infect a patient, the patient needs to already be infected with hepatitis B. Which antibodies signifies an active infection?

1 - IgG
2 - IgA
3 - IgM
4 - IgE
5 - IgD

A

3 - IgM
- first antibody to be mobilised

23
Q

If the ALT is really high but other liver enzymes are not affected, what can this be indicative of?

1 - alcoholic hepatitis
2 - drug or viral hepatitis
3 - autoimmune hepatitis
4 - all of the above

A

2 - drug or viral hepatitis
- drug is typically paracetamol

24
Q

Hepatitis A is common in developing countries and south east Asia. What is the incidence (new rates of disease in a given time frame) of hepatitis A?

1 - 100,00 per year
2 - 1 million per year
3 - 3 million per year
4 - 10 million per year

A

3 - 3 million per year
- faecal oral route, contaminated water and food

25
Q

Hepatitis A (HVA) does not always cause symptoms immediately. What is the typically incubation period of HVA?

1 - 1-2 days
2 - 1 week
3 - 2-6 weeks
4 - 8-10 weeks

A
  • incubation of between 2-6 weeks
26
Q

Hepatitis A now has a vaccine. However, if a patient is not vaccinated, how are they typically treated?

1 - supportive with fluids
2 - antibiotics
3 - antivirals
4 - steroids

A

1 - supportive with fluids

27
Q

Hepatitis E (HVE) does not always cause symptoms immediately. What is the typically incubation period of HVA?

1 - 1-2 days
2 - 1 week
3 - 2-9 weeks
4 - 8-10 weeks

A

3 - 2-9 weeks

28
Q

How is hepatitis E diagnosed?

1 - antibodies IgM and IgG
2 - HBV surface antigen (HBsAg = HBV surface antigen)
3 - core HBV antigen (HBcAg = HBV core antigen)
4 - E antigen produced by infected cells

A

1 - antibodies IgM and IgG
- HEV = hepatic E virus

29
Q

Hepatitis B is most common in Sub-Saharan Africa and South East Asia. How many people does it affect?

1 - 350 million
2 - 200 million
3 - 100 million
4 - 25 million

A

1 - 350 million

30
Q

In patients with hepatitis B and they have a high viral load and have become fibrotic, what would their treatment be?

A
  • lifelong antivirals
  • offer vaccinations
31
Q

Hepatitis D requires patient who are already infected with hepatitis B. Where is HVD most common?

1 - Eastern Europe
2 - Brazil
3 - North Africa
4 - all of the above

A

4 - all of the above

32
Q

Where is hepatitis C common?

1 - Egypt
2 - Pakistan
3 - China
4 - all of the above

A

4 - all of the above

33
Q

What is the prevalence (number of patients diagnosed with HVC) of hepatitis C?

1 - 500 million
2 - 300 million
3 - 170 million
4 - 50 million

A

3 - 170 million

34
Q

What is the incidence (new cases each year) of hepatitis C?

1 - 3-4 million
2 - 1-2 million
3 - 500,000
4 - 100,000

A

1 - 3-4 million

35
Q

Which of the following is NOT a method in which hepatitis C transmitted?

1 - contaminated water
2 - unprotected sex
3 - needle sharing
4 - intravenous drug use

A

1 - contaminated water

36
Q

Do all patients with hepatitis C present with symptoms?

A
  • no most are asymptomatic
  • fatigue is common and jaundice can occur
  • 85% of those acutely infected develop chronic infection
37
Q

If a patient with hepatitis C is not treated, what % progress to cirrhosis over 1-20 years?

1 - 0.3%
2 - 3%
3 - 30%
4 - 80%

A

3 - 30%
- this develops another 30% every 20-30 years

38
Q

If a patient with hepatitis C is effectively treated, what is the curing rate?

1 - 98-99%
2 - 70-80%
3 - 30-50%
4 - 5-25%

A

1 - 98-99%

39
Q

Which hepatitis virus is most commonly associated with liver cancer?

1 - A
2 - B
3 - C
4 - D
5 - E

A

2 - B

  • hepatitis B can also cause liver cirrhosis

A. MLA Map Infections (24 decks)

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