Viral Hepatitis Prt 2
.JPG "Viral Hepatitis Prt 2 - Quiz")
Having covered all there is to viral hepatitis it is now time to see how much you understood. Take up this part two quiz and see if you can identify the causes, effect and how one comes to diagnosing a patient. All the best and ensure you go back to your nooks on what you get wrong.
Questions and Answers
- 1.
A 38-year-old woman screened for hepatitis presents the following serological status: HBsAg negative HBcAg IgG positive HBsAg IgG negative What is the most likely explanation for these results?
- A.
Vaccination
- B.
Resolved acute infection
- C.
Chronic infection with undetectable HBsAg
- D.
This is impossible
Correct Answer
C. Chronic infection with undetectable HBsAgExplanation
Nota: This patient has an occult infection. She has in fact been infected by the virus (as demonstrated by the presence of the HBcAg IgG), but has not been able to resolve the infection (as demonstrated by the absence of HBsAg IgG). The absence of detectable HBsAg means that the virus is either (1) not replicating, or barely replicating, so that HBsAg levels are under the detection limit of the ELISAs used in the lab, or that the HBsAg gene is mutated in such a way that it is undetectable by commercial ELISA tests. This is a rare occurrence, but it happens…Rate this question:
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- 2.
A 27-year-old female sex worker presents to a free clinic complaining of tea-colored urine and clay-colored stools. Patient history reveals a recent trip to Mexico and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. She admits to alcohol and injection drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows the following: Three years later, a new panel is performed on the same patient, with the following results: What is the status of this patient?
- A.
Acute HBV
- B.
Chronic HBV
- C.
Chronic, minimally replicating HBV
- D.
Chronic, HBeAg-negative mutant HBV
Correct Answer
C. Chronic, minimally replicating HBVExplanation
Nota: This patient is what is referred to as an inactive carrier.Rate this question:
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- 3.
How likely is it for this person to transmit the infection?
- A.
Unlikely
- B.
Likely
- C.
Highly likely
Correct Answer
A. UnlikelyExplanation
Nota: But this could change if the virus were to start replicating again…Rate this question:
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- 4.
A 27-year-old female sex worker presents to a free clinic complaining of tea-colored urine and clay-colored stools. Patient history reveals a recent trip to Mexico and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. She admits to alcohol and injection drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows the following: Three years later, a new panel is performed on the same patient, with the following results: What is the status of this patient?
- A.
Acute HBV
- B.
Chronic HBV
- C.
Chronic, minimally replicating HBV
- D.
Chronic, HBeAg-negative mutant HBV
Correct Answer
D. Chronic, HBeAg-negative mutant HBVExplanation
The patient is diagnosed with chronic, HBeAg-negative mutant HBV based on the laboratory results. The presence of HBsAg and anti-HBc IgG antibodies indicates chronic infection. The absence of HBeAg and presence of anti-HBe antibodies suggest a mutant strain of HBV that is not actively replicating. This is further supported by the low levels of HBV DNA in the serum. The patient's history of alcohol and injection drug abuse may have contributed to the development of chronic HBV.Rate this question:
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- 5.
A 27-year-old female sex worker presents to a free clinic complaining of tea-colored urine and clay-colored stools. Patient history reveals a recent trip to Mexico and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. She admits to alcohol and injection drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows the following: Three years later, a new panel is performed on the same patient, with the following results: What is the status of this patient?
- A.
Acute HBV
- B.
Chronic HBV
- C.
HBV-HDV co-infection
- D.
HBV-HDV super-infection
Correct Answer
D. HBV-HDV super-infectionExplanation
The patient is diagnosed with HBV-HDV super-infection. This is indicated by the presence of both HBsAg and anti-HDV IgM antibodies in the blood work. HDV (hepatitis D virus) can only infect individuals who are already infected with HBV (hepatitis B virus). Super-infection refers to the acquisition of HDV infection on top of an existing HBV infection. This is different from co-infection, where both viruses are acquired simultaneously. The patient's history of injection drug abuse and alcohol abuse may have put her at a higher risk for acquiring both HBV and HDV infections.Rate this question:
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- 6.
A 25-year-old pregnant woman (2nd trimester) presents with tea-colored urine and clay-colored stools. Patient history reveals a recent trip to India and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. Physical examination reveals yellow-tinged sclerae. Blood work shows the following: One month later, a new panel is performed on the same patient, with the following results: What is the most likely cause of this patient’s hepatitis?
- A.
HAV
- B.
HBV
- C.
HCV
- D.
HDV
- E.
HEV
Correct Answer
E. HEVExplanation
The most likely cause of this patient's hepatitis is HEV (Hepatitis E virus). This is suggested by the patient's recent trip to India, as Hepatitis E is endemic in this region. The patient's symptoms such as tea-colored urine, clay-colored stools, fatigue, nausea, and low-grade fever are consistent with hepatitis. Additionally, the yellow-tinged sclerae indicate jaundice, which is a common manifestation of hepatitis. The blood work showing elevated liver enzymes further supports the diagnosis of hepatitis.Rate this question:
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- 7.
What is the case fatality rate in this population of patient?
- A.
0-10%
- B.
10-20%
- C.
20-30%
- D.
30-40%
- E.
40-50%
Correct Answer
B. 10-20%Explanation
The case fatality rate in this population of patients is estimated to be between 10-20%. This means that out of the total number of patients in the population, approximately 10-20% will die from the disease.Rate this question:
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- 8.
A 31-year-old male sex worker presents to a free clinic complaining of tea-colored urine and clay-colored stools. Patient history reveals a recent trip to Mexico and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. He admits to alcohol and injection drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows the following: What is the status of this patient?
- A.
Acute HBV
- B.
Chronic HBV
- C.
Acute HCV
- D.
Chronic HCV
- E.
Acute HBV/Chronic HCV
- F.
Chronic HBV/Acute HCV
Correct Answer
E. Acute HBV/Chronic HCVExplanation
The patient's presentation of tea-colored urine, clay-colored stools, and yellow-tinged sclerae are indicative of liver dysfunction. The history of alcohol and injection drug abuse further supports liver disease. The blood work shows elevated liver enzymes (AST, ALT) and positive hepatitis B surface antigen (HBsAg) indicating acute hepatitis B infection. However, the patient also has positive anti-HCV antibodies, suggesting chronic hepatitis C infection. Therefore, the patient has both acute hepatitis B and chronic hepatitis C infections.Rate this question:
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- 9.
What would be the most likely serology profile of a person vaccinated for both HAV and HBV?
- A.
I
- B.
II
- C.
III
- D.
IV
- E.
V
- F.
VI
- G.
VII
- H.
VIII
Correct Answer
E. V -
- 10.
A 27-year-old female sex worker presents to a free clinic complaining of tea-colored urine and clay-colored stools. Patient history reveals a recent trip to Mexico and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. She admits to alcohol and injection drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows the following: Three years later, a new panel is performed on the same patient, with the following results: What is the status of this patient (choose the best answer)?
- A.
Resolved HBV infection
- B.
Resolved HDV infection
- C.
Resolved HBV-HDV co-infection
- D.
Resolved HBV-HDV super-infection
Correct Answer
C. Resolved HBV-HDV co-infectionExplanation
The patient's history of injection drug abuse, recent trip to Mexico, and symptoms such as tea-colored urine, clay-colored stools, fatigue, nausea, and low-grade fever suggest a possible hepatitis infection. The physical examination findings of epigastric discomfort and yellow-tinged sclerae further support this suspicion. The initial blood work shows positive HBsAg, positive anti-HDV IgG, and negative anti-HDV IgM, indicating a resolved HBV-HDV co-infection. Three years later, the new panel results show negative HBsAg, positive anti-HBs, and negative anti-HDV IgM, confirming the resolution of the HBV infection. Therefore, the best answer is Resolved HBV-HDV co-infection.Rate this question:
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- 11.
What important consideration must be made when treating an HIV-HBV co-infected individual with antivirals?
- A.
Need to wait until CD4 count drops to less than 200/mL
- B.
Care must be taken to choose a nucleoside analog that has a low probability of inducing resistance in HBV
- C.
IFN-a should be avoided
- D.
Care must be taken to choose a nucleoside analog that has a low probability of inducing resistance in HIV
Correct Answer
D. Care must be taken to choose a nucleoside analog that has a low probability of inducing resistance in HIVExplanation
When treating an HIV-HBV co-infected individual with antivirals, it is important to choose a nucleoside analog that has a low probability of inducing resistance in HIV. This is because the individual is co-infected with both HIV and HBV, and the antivirals used to treat HIV can also have an impact on HBV. Therefore, selecting an antiviral that is less likely to induce resistance in HIV is crucial to ensure effective treatment for both infections.Rate this question:
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- 12.
What conclusion(s) should be drawn from the following lab results? Three years later, a new panel is performed on the same patient, with the following results:
- A.
Resolved HBV infection
- B.
Current HDV infection
- C.
Resolved HBV-HDV co-infection
- D.
Resolved HBV-HDV super-infection
Correct Answer
A. Resolved HBV infectionExplanation
Note: Samples may have been mixed up since the HDV serology is not consistent with the HBV serologyRate this question:
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- 13.
A patient with the following lab results undergoes treatment with peg-IFN- and ribavirin: What is the most likely presentation of this patient?
- A.
Icteric
- B.
Asymptomatic
Correct Answer
B. AsymptomaticExplanation
The patient's lab results suggest that they are asymptomatic, meaning they do not have any noticeable symptoms of illness. The treatment with peg-IFN-α and ribavirin is likely being administered as a preventive measure or to address an underlying condition that has not yet caused symptoms.Rate this question:
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- 14.
What mechanism(s) contributed to the establishment of chronic disease?
- A.
Disruption of Jak/STAT-mediated IFN signaling
- B.
Induction of Treg-mediated immune tolerance
- C.
Disruption of RIG-1- and TLR3-mediated viral recognition
- D.
Capacity of the virus to cause little cytopathic effects
- E.
All of the Above
Correct Answer
E. All of the AboveExplanation
All of the mechanisms mentioned in the options - disruption of Jak/STAT-mediated IFN signaling, induction of Treg-mediated immune tolerance, disruption of RIG-1- and TLR3-mediated viral recognition, and the capacity of the virus to cause little cytopathic effects - can contribute to the establishment of chronic disease. These mechanisms can weaken the immune response, allowing the virus to persist and cause long-term damage, leading to the development of chronic diseases.Rate this question:
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- 15.
Which molecule expression is likely to be increased as a result of peg-IFN-a treatment?
- A.
PRB
- B.
IFN-y
- C.
Lactoferrin
- D.
Cathepsin H
- E.
Pkr
Correct Answer
E. PkrExplanation
Pkr is a likely molecule expression to be increased as a result of peg-IFN-a treatment.Rate this question:
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- 16.
Which HCV genotype and viral replication status is hardest to treat?
- A.
Genotype 1/RNA low
- B.
Genotype 1/RNA high
- C.
Genotype 2
- D.
Genotype 3
Correct Answer
B. Genotype 1/RNA highExplanation
Genotype 1 with high viral replication status is the hardest to treat. This is because high viral replication indicates a higher viral load in the body, making it more difficult for antiviral medications to effectively suppress the virus. Additionally, genotype 1 is known to be less responsive to treatment compared to other genotypes, further complicating the treatment process.Rate this question:
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- 17.
Which mechanisms are involved in the development of HCC?
- A.
Chronic inflammation
- B.
Oxygen radical production by immune cells
- C.
P53-mediated apoptosis
- D.
Oncogene activation by viral transactivator
- E.
ADCC
- F.
All of the Above
Correct Answer
F. All of the AboveExplanation
All of the mechanisms listed above are involved in the development of HCC. Chronic inflammation can lead to the production of oxygen radicals by immune cells, which can cause DNA damage and promote the development of cancer. p53-mediated apoptosis is a tumor suppressor mechanism that is often disrupted in HCC, allowing cancer cells to survive and proliferate. Oncogene activation by viral transactivators, such as hepatitis B or C viruses, can also contribute to the development of HCC. ADCC (antibody-dependent cell-mediated cytotoxicity) is a mechanism by which immune cells target and kill cancer cells, and its dysfunction can also play a role in HCC development.Rate this question:
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- 18.
Which HBV components are involved in the induction of tolerance and the establishment of chronic disease? Check ALL that apply
- A.
HBs
- B.
HBc
- C.
HBe
- D.
HBx
- E.
RT
Correct Answer(s)
A. HBs
C. HBeExplanation
HBs and HBe are involved in the induction of tolerance and the establishment of chronic disease in HBV infection. HBs refers to the hepatitis B surface antigen, which is responsible for the formation of the viral envelope and is involved in immune evasion. HBe refers to the hepatitis B e antigen, which is a marker of active viral replication and is associated with immune tolerance. HBc, HBx, and RT are not directly involved in the induction of tolerance and establishment of chronic disease in HBV infection.Rate this question:
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.JPG "A 27-year-old female sex worker presents to a free clinic complaining of tea-colored urine and clay-colored stools. Patient history reveals a recent trip to Mexico and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. She admits to alcohol and injection drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows the following:
Three years later, a new panel is performed on the same patient, with the following results:
What is the status of this patient?")
.JPG "A 27-year-old female sex worker presents to a free clinic complaining of tea-colored urine and clay-colored stools. Patient history reveals a recent trip to Mexico and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. She admits to alcohol and injection drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows the following:
Three years later, a new panel is performed on the same patient, with the following results:
What is the status of this patient?")
.JPG "A 25-year-old pregnant woman (2nd trimester) presents with tea-colored urine and clay-colored stools. Patient history reveals a recent trip to India and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. Physical examination reveals yellow-tinged sclerae. Blood work shows the following:
One month later, a new panel is performed on the same patient, with the following results:
What is the most likely cause of this patient’s hepatitis?")
.JPG "A 31-year-old male sex worker presents to a free clinic complaining of tea-colored urine and clay-colored stools. Patient history reveals a recent trip to Mexico and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. He admits to alcohol and injection drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows the following:
What is the status of this patient?")
.JPG "What would be the most likely serology profile of a person vaccinated for both HAV and HBV?")
.JPG "A 27-year-old female sex worker presents to a free clinic complaining of tea-colored urine and clay-colored stools. Patient history reveals a recent trip to Mexico and non-specific systemic symptoms such as fatigue, nausea, and low-grade fever. She admits to alcohol and injection drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows the following:
Three years later, a new panel is performed on the same patient, with the following results:
What is the status of this patient (choose the best answer)?")
.JPG "What conclusion(s) should be drawn from the following lab results?
Three years later, a new panel is performed on the same patient, with the following results:")
.JPG "A patient with the following lab results undergoes treatment with peg-IFN- and ribavirin:
What is the most likely presentation of this patient?")
Quiz Review Timeline +
Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.
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Current Version
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Mar 20, 2023Quiz Edited by
ProProfs Editorial Team -
Oct 17, 2012Quiz Created by
Chachelly
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