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Viral Hepatitis Flashcards

1
Q

Hepatitis A is more symptomatic / severe in

A. Adults
B. Children

A

Adults

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2
Q

Only hepatitis virus with a DNA genome

A

HBV

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3
Q

Is the most frequent indication for liver transplant

A

CLD from HCV

Chronic liver disease from HCV

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4
Q

Defective virus that requires helper function of HBV for replication and expression

A

HDV

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5
Q

Usually from contaminated water supply after monsoon flooding in endemic areas

A

HEV

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6
Q

Tx for HDV

A

Interferon

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7
Q

Tx for HAV and HEV

A

None

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8
Q

Tx for HBV

A 
Entecavir
Tenofovir
Adefovir
Interferon
PEG-IFN
Lamivudine
Telbivudine
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9
Q

HCV tx

A

PEG-IFN + Ribavirin
DAAs (direct acting antiviral agents):
Daclatasvir, Sofobuvir, Telaprevir, Boceprevir

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10
Q

Prophylaxis for HAV

A

Immunoglobulin

Inactivated vaccine

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11
Q

Prophylaxis HBV

A

HB-Ig

Recombinant vaccine

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12
Q

Prophylaxis for HCV

A

None

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13
Q

Prophylaxis for HDV

A

HBV recombinant vaccine

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14
Q

HEV prophylaxis

A

Vaccine

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15
Q

Prognosis

HAV

A

Excellent

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16
Q

Prognosis

HBV

A

Variable

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17
Q

Prognosis

HCV

A

Moderate

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18
Q

Prognosis

HDV

A

Variable

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19
Q

Prognosis

HEV

A

Good

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20
Q

Will not progress to chronicity

A

HAV, HEV

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21
Q

Commonly progresses to chronic hepatitis

A

HDV, HCV

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22
Q

Progression to chronicity HBV

A

Occasional, common if perinatal

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23
Q

Severity

HAV

A

Mild

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24
Q

Severity

HBV

A

Occasionally severe

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25
Q

Severity

HCV

A

Moderate

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26
Q

Severity

HDV

A

Occasionally severe

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27
Q

Severity

HEV

A

Mild

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28
Q

Predominant modes of transmission

HAV

A

Fecal-oral

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29
Q

Predominant modes of transmission

HBV

A

Percutaneous, perinatal, sexual

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30
Q

Predominant modes of transmission

HCV

A

Percutaneous

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31
Q

Predominant modes of transmission

HDV

A

Percutaneous, sexual

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32
Q

Predominant modes of transmission

HEV

A

Fecal-oral

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33
Q

Onset

HAV

A

Acute

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34
Q

Onset

HBV

A

Insidious or acute

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35
Q

Onset

HCV

A

Insidious

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36
Q

Onset

HDV

A

Insidious or acute

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37
Q

Onset

HEV

A

Acute

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38
Q

Prodromal symptoms

A 
Anorexia
Nausea and vomiting
Fatigue
Malaise
Arthralgias
Myalgias
Headache
Photophobia
Pharyngitis
Cough 
Coryza
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39
Q

Prodromal symptoms may precede onset of jaundice by

A

1-2 weeks

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40
Q

With the onset of jaundice the prodromal symptoms
A. Becomes severe
B. Diminish

A

Diminish

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41
Q

Complete clinical and biochemical recovery occurs after

A

1-2 months - hepatitis A and hepatitis E

3-4 months -after onset of jaundice hepatitis B and hepatitis C

42
Q

Among health adults, acute hepatitis B is self-limited in

43
Q

Among health adults, acute hepatitis C is self-limited in

44
Q

AST and ALT increase during this phase of acute viral hepatitis preceding the rise in bilirubin level

A

Prodromal phase

45
Q

Symptoms and signs of viral hepatitis

Phases

A

Prodromal
Jaundice
Recovery phase

46
Q

Peak levels of aminotransferases vary from

A

400-4000 IU or more

47
Q

Is hypoalbuminemia common in viral hepatitis

A

No.

it is uncommon in uncomplicated viral hepatitis

48
Q

Lab results requested for viral hepatitis

A 
Liver function test
AST, ALT
Bilirubin
PT prothrombin time
Alkaline phosphatase
Serum albumin

HBsAg
IgM Anti-HAV
IgM Anti-HBc
Anti-HCV

49
Q

(+) HBsAg
(-) IgM Anti-HAV
(+) IgM Anti-HBc
(-) Anti-HCV

A

Acute hepatitis B

50
Q

(+) HBsAg
(+) IgM Anti-HAV
(-) IgM Anti-HBc
(-) Anti-HCV

A

Acute hepatitis A superimposed on chronic hepatitis B

51
Q

(+) HBsAg
(+) IgM Anti-HAV
(+) IgM Anti-HBc
(-) Anti-HCV

A

Acute hepatitis A and B

52
Q

(-) HBsAg
(-) IgM Anti-HAV
(-) IgM Anti-HBc
(+) Anti-HCV

A

Hepatitis C

53
Q

HBsAg
(+) IgM Anti-HAV
IgM Anti-HBc
Anti-HCV

A

Acute hepatitis A

54
Q

Sequelae of acute viral hepatitis

A

Fulminant hepatitis

progression to chronic liver disease

55
Q

Most feared complication of viral hepatitis

A

Fulminant hepatitis

56
Q

Fulminant hepatitis is primarily seen in

A

Hepatitis A, B, D, E

57
Q

Fulminant hepatitis

Clinical manifestations

A

Signs and symptoms of encephalopathy that may evolve into deep coma

58
Q

Terminal events of fulminant hepatitis

A 
Brainstem compression
GI bleeding
Sepsis 
Respiratory failure
Cardiovascular collapse
Renal failure
59
Q

Massive hepatic necrosis

A

Fulminant hepatitis

60
Q

When will chronic hepatitis E occur

A

In immunocompromised patients

61
Q

Criteria to diagnose chronic hepatitis B

A

Persistence of HBeAg for >3 months or

HBsAg > 6 months

62
Q

For acute HCV infection, the likelihood of remaining chronically infected approaches ___%

63
Q 
(+) HBsAG
(-) Anti-HBS
(+) IgM Anti-HBc
(+) HBeAg
(-) Anti-HBe
A

Acute Hepatitis B , high-infectivity

64
Q 
(+) HBsAG
(-) Anti-HBS
(+) IgG Anti-HBc
(+) HBeAg
(-) Anti-HBe
A

Chronic Hepatitis B, high infectivity

65
Q 
(-) HBsAG
(-) Anti-HBS
(+) IgM Anti-HBc
(+/-) HBeAg
(+/-) Anti-HBe
A

Anti-HBC “window”

66
Q 
(-) HBsAG
(-) Anti-HBS
(+) IgG Anti-HBc
(-) HBeAg
(+/-) Anti-HBe
A

Hepatitis B in remote past

67
Q 
(-) HBsAG
(+) Anti-HBS
(+) IgG Anti-HBc
(-) HBeAg
(+/-) Anti-HBe
A

Recovery from Hepatitis B

68
Q 
(-) HBsAG
(+) Anti-HBS
(-) IgM Anti-HBc
(-) HBeAg
(-) Anti-HBe
A

Immunization with HBsAg

69
Q

Sequelae of Chronic Viral Hepatitis

A 
Liver cirrhosis
Hepatocellular carcinoma (Hepatitis B & C), esp if Hepatitis B is acquired perinatally
70
Q

Will treatment with antivirals decrease risk of HCC

A

Yes. But will not eliminate it

Surveillance for HCC should continue even after treatment

71
Q

HCC is mainly associated with

A

Hep B and C

72
Q

Factors that affect decision to treat and or Duration of treatment for Hepatitis B

A 
Clinical status (presence of cirrhosis, compensated vs decompensated, liver mass/ hepatocellular carcinoma)
Fam Hx of hepatocellular carcinoma
HBeAg status
HBV DNA titers
ALT levels
73
Q

Factors that affect decision to treat and or Duration of treatment for Hepatitis C

A

Detectable HCV RNA in serum
HCV genotype
Presence of significant fibrosis , cirrhosis

74
Q

Treatment for HBV (with doses)

A

High genetic barrier to resistance drugs

  1. Entecavir 0.5 mg PO OD, Tenofovir 300 mg PO OD)
  2. Pegylated Interferon once weekly SC injection
  3. Lamivudine 100 gm PO OD - first successful oral antiviral agent ; no longer recommended as first line except in short-term therapy such as cancer chemotherapy
75
Q

Treatment Hepatitis C (detailed)

A

DAAS: Daclatasvir, Sofobuvir, Telaprevir, Boceprevir, Dasabuvir, Ledipasvir
Pegylated Interferon + Ribavirin
a. Genotype 1 : 48 weeks
B. Genotype 2 : 24 weeks

76
Q

Most pronounced side effectof ribavirin is

77
Q

Diagnostic test for Acute Hep B infection

A

HBsAg

IGM Anti-HBc

78
Q

Chronic Hep B infection

A

HBsAg

IgG anti-HBc

79
Q

Markers of Hepatitis B replication

A

HBeAg

HBV DNA

80
Q

Hepatitis C

Diagnostic Test

A

Anti-HCV

HCV RNA

81
Q

Hepatitis D

Diagnostic test

A

HBsAg, anti-HDV

82
Q

HBV/HDV coinfection

Diagnostic test

A

IgM anti-HBc

IgM Anti-HDV

83
Q

HDV superinfection

A

IgG anti-HBc

IgM anti-HDV

84
Q

Hepatitis E infection

Diagnostics

85
Q

Diagnosis of Hepatitis A during acute illness and persists for several months

A

Anti-HAV (IgM)

Detected when aminotransferase activity is elevated and fecal HAV shedding is still occuring

86
Q

After acute illness fo HAV, remains detectable indefinitely

A

anti-HAV (IgG)

87
Q

Predominates during convalescence of HAV

Marker of IMMUNITY to reinfection

A

Anti-HAV (IgG)

88
Q

First virologic marker detectable in the serum within 1 -12 weeks after infection with HBV

89
Q

After HBsAg disappears, this becomes detectable and remains detectable indefinitely thereafter (protective antibody)

90
Q

The only serologic marker that appears after vaccination with HBV recombinant vaccine

91
Q

IgM anti-HBc predominates during the ____ months after acute infection

A

1st 6 months and anti-HBc window period

92
Q

Predominates the class of anti-HBc 6 months after acute infection

A

IgG anti-HBc

93
Q

An isolated reactive anti-HBc can be seen in

A

Gap or window period of acute Hepatitis B
Occult infection
Remote infection
False positive

94
Q

Appears concurrently with shortly after HBsAg

95
Q

Qualitative marker of HBV replication and relative infectivity

96
Q

Its diappearance may be a harbinger of clinical improvement and resolution of infection of Hepatitis B

97
Q

Its appearance coincides with a period of relatively lower infectivity

98
Q

More sensitive and quantitative indicator of HBV replication

99
Q

Diagnosis of hepatitis C

100
Q

Most sensitive test for HCV infection

Gold standard for diagnosis of HCV

101
Q

Testing for anti-HDV is useful in those with hepatitis B and severe/ fulminant disease

IM (25 decks)

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