1.
A 17-year-old male presents complaining of tea-colored urine. Pertinent patient history includes a recent backpacking trip in Asia with his girlfriend, but is otherwise unremarkable. Hepatitis serology gives the following results:
HAV IgM positive
HBsAg negative
HBcAg IgM negative
HDV IgM negative
HCV IgM negative
What is the status of this patient?
A. 
B. 
C. 
D. 
E. 
2.
What is the most likely source of his infection?
A. 
B. 
Saliva from his infected, asymptomatic girlfriend
C. 
Vaginal secretions from his infected, asymptomatic girlfriend
D. 
3.
A 26-year-old woman presents complaining that her urine is dark and her stools pale. Patient history reveals that the patient has been to the Caribbean to see her long distance boyfriend. A serology panel reflects the following results:
HAV IgG positive
HBsAg positive
HBcAg IgM positive
HDV IgM negative
HCV IgM negative
What is the status of this patient?
A. 
B. 
C. 
D. 
E. 
4.
Which of these is not a potential risk for HBV transmission?
A. 
B. 
Needle sharing among intravenous drug users
C. 
Birth from an infected mother
D. 
E. 
Multiple blood product transfusions
5.
During hepatitis A infections, what is responsible for most of the liver damage?
A. 
B. 
Antibody-dependent cell cytotoxicity
C. 
CD4+ T lymphocyte-mediated cytotoxicity
D. 
E. 
CD8+ T lymphocyte-mediated cytotoxicity
6.
During acute hepatitis B infections, most liver cells are virally infected. Why do not most hepatitis B infected individuals die from acute liver failure?
A. 
CD8+ T lymphocytes clear the virus by destroying infected cells
B. 
NK cells clear the virus by destroying infected cells
C. 
Antibody-dependent cell cytotoxicity specifically destroys infected cells.
D. 
Hepatitis B virus replicates too slowly to induce significant liver damage.
E. 
CD8+ T lymphocytes clear the virus by purging viruses from infected cells in a non-cytolytic fashion.
7.
A 35-year-old intravenous drug abuser presents to a free clinic complaining of fatigue and loss of weight. Physical examination reveals slightly yellow-tinged sclerae. A hepatitis serology panel reflects the following:
HAV IgG positive
HBsAg negative
HBcAg IgM negative
HCV IgG positive
HDV IgM negative
Further testing reveals the following:
HIV-1 positive
HIV-1 viral load 103 RNA IU/mL
Which statement best applies to this patient?
A. 
HIV-1 co-infection will be of no consequence on the clinical outcome of patient.
B. 
Because the host immune response is strongly involved in the pathogenesis of viral hepatitis, liver damage will be limited in patient due to HIV-1-mediated immunosuppression.
C. 
Treatment of HIV-1 infection with reverse transcriptase inhibitors will also inhibit the viral reverse transcriptase responsible for transcribing the hepatitis viral RNA into gapped DNA, thereby also treating the hepatitis.
D. 
Patient could have avoided contracting a viral hepatitis altogether, had he received the vaccines currently available.
E. 
Patient will likely develop liver fibrosis more rapidly because of HIV-1 co-infection
8.
A 35-year-old intravenous drug abuser presents to a free clinic complaining that his urine is black. Following a physical examination, patient most likely suffers from hepatitis. A hepatitis serology panel shows the following results:
HAV IgG positive
HBsAg negative
HBcAg IgM negative
HBcAg IgG negative
HCV IgG positive
HDV IgM negative
HDV IgG negative
What would be the most prudent course of action in this case?
A. 
Initiate treatment for both hepatitis A and hepatitis C.
B. 
Initiate treatment for hepatitis C only
C. 
Initiate treatment for both hepatitis A and hepatitis C, and have a PCR run for the possible presence of HBV.
D. 
Initiate treatment for hepatitis C, and have an RT-PCR run for the possible presence of HBV
E. 
Initiate treatment for hepatitis C, and have a PCR run for the possible presence of HBV
9.
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 intravenous drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows elevated aminotransferase concentrations, but normal alkaline phosphatase levels.
The following graph depicts the progression of this patient’s disease:
Based on this graph, what is the most likely virus responsible for this patient’s disease?
A. 
B. 
C. 
D. 
10.
Is it an acute or chronic disease?
11.
What is the percentage of healthcare workers that get infected by the Hepatitis B virus following an accidental needlestick puncture containing blood from an HBeAg-positive patient?
A. 
B. 
C. 
D. 
E. 
12.
Using the graph below depicting the progression of a hepatitis A infection, around which week is the IgM titer most likely to peak?
A. 
B. 
C. 
D. 
E. 
13.
Using the graph below, determine the week at which anti-HAV IgGs are most likely to plateau?
A. 
B. 
C. 
D. 
E. 
14.
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 intravenous drug abuse. Physical examination reveals epigastric discomfort and yellow-tinged sclerae. Blood work shows elevated aminotransferase concentrations, but normal alkaline phosphatase levels. Which graph best exemplifies the case of a resolved, acute hepatitis B infection?
A. 
B. 
C. 
D. 
E. 
15.
Using the graph below depicting the progression of a hepatitis A infection, which week is most likely to correspond to the peak CTL response?
A. 
B. 
C. 
D. 
E. 
16.
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 months later, a second hepatitis serology panel is performed on the same patient:
Which graph best exemplifies the progression of this case?
A. 
B. 
C. 
D. 
17.
Which graph best exemplifies the progression of a hepatitis C virus infection?
A. 
B. 
C. 
D. 
18.
What proportion of infected individuals will present with symptoms in the first few months following HCV infection (and although all the answers are logically correct, choose the one that is most precise)?
A. 
B. 
C. 
D. 
E.