Viral Hepatitis

Question 1

How can you use the ratio between ALT/AST to tell the difference between viral and toxic hepatitis?

Answer 1

• viral hepatitis = ALT > AST

- toxic hepatitis = AST > ALT

Question 2

Choose the best answer for the following serologic profile

HBsAg -
Anti-HBc IgM -
Total Anti-HBc antibodies +
Anti-HBs antibodies +

a. incubation
b. acute hepatitis
c. convalescence
d. recovery

Answer 2

d. recovery

Question 3

What is the difference between subfulminant and fulminant hepatic failure?

Answer 3

• subfulminant = encephalopathy > 8 weeks

- fulminant = encephalopathy < 8 weeks

Question 4

T/F: Hepatitis A never evolves to chronic hepatitis?

Answer 4

True

Question 5

What are the 2 current treatment options for Hep C?

Answer 5

• Glecaprevir/Pibrentasvir for 8 weeks

- Sofosbuvir/Velpatasvir for 12 weeks

Question 6

What 2 types of hepatitis are caused by fecal-oral transmission?

Answer 6

• A and E

Question 7

How can you tell the difference between Hep D/B coinfection vs. superinfection?

Answer 7

• Coinfection = HBcIgM +

- Superinfection = no HBcIgM present

Question 8

If you have hepatitis B you are at an increased risk for what type of cancer?

Answer 8

• hepatocellular carcinoma

Question 9

In this phase of acute viral hepatitis, the patient has jaundice, dark urine, and light stool. He also has pruritus, weight loss, fatigue. His ALT/AST are now >10x ULN.

a. pre-icteric phase
b. icteric phase
c. incubation period
d. convalescent period

Answer 9

b. icteric phase

Question 10

What drug therapy is used for infants of infected Hep B mothers to reduce vertical transmission?

Answer 10

• Hep B Ig + vaccine (within 12h of birth)

Question 11

What is the vaccination protocol for Hep B in children?

Answer 11

• 1st dose = at birth
• 2nd dose = 1-2 mo
• 3rd dose = 6-18 mo

Question 12

What type of viral hepatitis is an enveloped DNA virus?

Answer 12

• B

Question 13

What drug therapy can be used for prevention of Hep B if a patient has had exposure within 48 hrs?

Answer 13

• Hep B immunoglobulin

Question 14

What is the incubation period for Hepatitis B?

Answer 14

• 30-150 day

Question 15

75% of cases of Hepatitis C occur in this population.

Answer 15

• Baby boomers

Question 16

What is the primary form of transmission of hepatitis B?

Answer 16

• Body fluids

Question 17

At what level of bilirubin will you see jaundice?

Answer 17

> 2.5 mg/dL

Question 18

In this phase of acute viral hepatitis, the virus is detectable in the blood but the patient is asymptomatic.

a. pre-icteric phase
b. icteric phase
c. incubation period
d. convalescent period

Answer 18

c. incubation period

Question 19

What was the classic regimen for Hep C and why is it no longer used?

Answer 19

• Interferon + Ribavirin

- no longer used d/t interferon having multiple side effects

Question 20

What serology values confirms an acute Hep C infection?

Answer 20

(-) Anti-HCV antibodies

(+) HCV RNA

Question 21

What type of viral hepatitis is associated with GBS?

Answer 21

• E

Question 22

NAC is indicated for acetaminophen blood levels are how high?

Answer 22

> 200

Question 23

What is the first line treatment for Hep B? (2 options)

Answer 23

Entecavir or Tenofovir

Question 24

Choose the best answer for the following serologic profile

HBsAg +
Anti-HBc IgM +/-
Total Anti-HBc antibodies +/-
Anti-HBs antibodies -

a. incubation
b. acute hepatitis
c. convalescence
d. recovery

Answer 24

a. incubation

Question 25

In this phase of acute viral hepatitis, the patient begins to have non-specific symptoms. Viral titers peak and ALT/AST rise. a. pre-icteric phase b. icteric phase c. incubation period d. convalescent period

Answer 25

a. pre-icteric phase

Question 26

Chronic hepatitis is characterized as greater than how many months?

Answer 26

> 6 months *ALT/AST may remain elevated

Question 27

What is the protocol for Hep C prevention during a needle stick?

Answer 27

- no empiric treatment | - check HCV RNA & AST/ALT at 0, 2 weeks, 4 months, 6 months

Question 28

Hep D can only replicate with coexisting what?

Answer 28

Hep B infection

Question 29

What serology study indicates the patient has been vaccinated for Hep B?

Answer 29

- HBsAb + | - everything else negative

Question 30

What hepatitis C genotype is most common in the U.S.?

Answer 30

- genotype 1

Question 31

# Choose the best answer for the following serologic profile HBsAg - Anti-HBc IgM + Total Anti-HBc antibodies + Anti-HBs antibodies - a. incubation b. acute hepatitis c. convalescence d. recovery

Answer 31

c. convalescence

Question 32

In this phase of acute viral hepatitis, symptoms gradually resolve and antibody levels rise. a. pre-icteric phase b. icteric phase c. incubation period d. convalescent period

Answer 32

d. convalescent period

Question 33

What lab study is ordered to obtain a quantitative marker of Hep B viral replication?

Answer 33

- HBV DNA (viral load) | * also used to monitor treatment of chronic HBV infection

Question 34

What is the goal of Hep C treatment?

Answer 34

- to achieve a sustained virologic response | * this means Hep C not detectable in blood

Question 35

Which of the detectable antigens indicate a chronic Hep B infection?

Answer 35

- Hepatitis B envelope antigen (HBeAg)

Question 36

Currently, what is the most common cause of Hepatitis C?

Answer 36

- IVDU

Question 37

What is the treatment for Hepatitis A?

Answer 37

- supportive, usually self-limited

Question 38

What hepatitis E genotypes are strictly human?

Answer 38

- 1 & 2

Question 39

Where in the lifecycle of Hep C do most drugs work?

Answer 39

- they interfere with translation and replication of RNA in the cytoplasm

Question 40

# Choose the best answer for the following serologic profile HBsAg + Anti-HBc IgM + Total Anti-HBc antibodies + Anti-HBs antibodies - a. incubation b. acute hepatitis c. convalescence d. recovery

Answer 40

b. acute hepatitis

Question 41

Which of the detectable antigens indicate an acute Hep B infection?

Answer 41

- Hepatitis B surface antigen (HBsAg)