Hepatitis

Question 1

Name three modes of transmission of hep A

Answer 1

Fecal-oral
Contaminated food
Sexual contact

Question 2

Name two patient categories at risk of hep A infection

Answer 2

Travelers
MSM
IV drug users
Occupational risk exposures

Question 3

S+S of acute hepatitis

Answer 3

Preicteric phase
Fever
Malaise
N/V
Abdo pain
HSM

Icteric phase
↑ conjugated bilirubin
Pale stools
Dark urine
Jaundice

Question 4

Investigations for acute hepatitis A

Answer 4

Liver function tests
AST
ALT
ALP
Bilirrubin
PTT

Hepatitis A serology
(IgM + IgG)
Anti-HAV total test (viral load)

Question 5

Who gets post-exposure prophylaxis for hep A with immunoglobulins? (A)

Answer 5

Close contacts within 2 weeks after the exposure AND NOT IMMUNIZED

Children < 12 mo

Question 6

Who requires prophylaxis with hep A IG and vaccines combined? (2)

Answer 6

Immunocompromised
Chronic liver disease

Question 7

What is the general post-exposure prophylaxis for hep A?

Answer 7

Hep A vaccine (for those non-immunized)

Question 8

Name three fluids that can transmit hep B

Answer 8

Blood
Saliva
Semen

Question 9

Name three modes of transmission of hep B

Answer 9

Sexual contact
(Anal > vaginal > oral)

Vertical transmission (mother → baby)

Percutaneous → IVDU

Question 10

3 risk factors for hep B

Answer 10

Previous STIs
Household contact
Healthcare workers
IV drug users
Infant born to a mother with HBV
MSM

Question 11

2 main complications of chronic hep B infection

Answer 11

Cirrhosis
Hepatocellular carcinoma

Question 12

An adult patient wants to catch up on their immunizations. They never received the hep B vaccine. When should they receive the three doses?

Answer 12

0, 1 mo and 6 mo

Question 13

If a patient has a healthcare worker has an anti-HBS titre <10, what would be the next step?

Answer 13

Repeat 3 dose series and recheck in 1 - 2 mo

Question 14

If the second dose series of hep B vaccination reveals an anti-HBS still below 10, what is the next step?

Answer 14

No further immunization

Question 15

What are the 6 types of hep B serologies and what does each one mean?

Answer 15

HBSAg → acute or chronic indicator
Anti-HBs → immunity (immunization or contact with the virus)
Hep B core (Anti-HBC)
Anti-HBC IgM → infection in previous 6 mo
Anti-HBC IgG → distant infection
HBeAg → High level of replication
Anti-HBe → Low replication

Question 16

A 28-year-old healthcare worker has the following labs after a needlestick injury:
HBsAg negative, anti-HBs positive, anti-HBc negative.
What is the interpretation?

Answer 16

Immunity due to vaccination

Question 17

A 35-year-old man with fatigue and jaundice has labs showing:
HBsAg positive, anti-HBc IgM positive, anti-HBs negative.
What is the interpretation?

Answer 17

Acute hepatitis B infection

Question 18

A 50-year-old woman from an endemic area is asymptomatic. Labs show:
HBsAg positive, anti-HBc IgG positive, anti-HBs negative.
What is the interpretation?

Answer 18

Chronic hepatitis B infection

Question 19

A 42-year-old man has the following hepatitis B serology:
HBsAg negative, anti-HBs positive, anti-HBc positive.
What is the interpretation?

Answer 19

Resolved past hepatitis B infection (natural immunity)

Question 20

3 modes of transmission of hep C

Answer 20

Direct blood contact

IV drug use
Sharing cocaine snorting paraphernalia
Sharing sharp instruments or personal hygiene materials
Blood transfusions
Tattoos/body piercing
Hemodialysis

Question 21

4 risk factors of hep C infection

Answer 21

IV drug users
Chronic hemodialysis
Infant born to mother with HCV infection
Residents from endemic regions
Incarcerated people
People living with HIV
MSM

Question 22

T or F: 20% of hep C patients will spontaneously clear the virus

Answer 22

True (but 80% will evolve to chronic disease)

Question 23

As hep C is usually asymptomatic, list 3 clinical clues to screen for it

Answer 23

↑ ALT or AST
Drug use
Multiple transfusions
HBV/HIV infection
Signs of chronic liver disease
Unexplained renal impairment

Question 24

Which is the screening test for hep C

Answer 24

Anti-HCV

Question 25

If a patient has a negative HCV, but is high risk for the disease, what is the next step?

Answer 25

Order the HCV-RNA test (possibility of HCV deficiency with immunodeficiency)

Question 26

A patient has a positive anti-HCV and a negative HCV-RNA test. How do you interpret this?

Answer 26

Cleared previous infection (repeat it in 6 mo)

Question 27

If a patient has a positive anti-HCV and HCV-RNA, what is the next step?

Answer 27

Refer to I.D.

Question 28

Name three lifestyle counseling points for patients with chronic hep C

Answer 28

Limit alcohol intake Smoking cessation Healthy BMI Ensure Hep A and B immunity

Question 29

What is the goal of treatment of Hep C treatment?

Answer 29

Complete eradication or sustained virological response (undetectable HCV RNA 12 weeks after treatment completion)