Health And Medicine- Viral Hepatitis Knowledge Test

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Health And Medicine- Viral Hepatitis Knowledge Test - Quiz

Viral Hepatitis is an inflammation of the liver due to viral infection. Hepatotropic viruses such as hepatitis A, B, C, D, and E are common causes. If you are studying medicine, you might know about this inflammation. Let's see how much knowledge do you have about this.


Questions and Answers
  • 1. 

    Which of the following statements about hepatitis A treatment is true?

    • A.

      There is no treatment specific for hepatitis A

    • B.

      Treatment should begin before symptom onset

    • C.

      IV antiviral therapy should be administered

    • D.

      Treatment can be discontinued once a patient has (+) IgG

    Correct Answer
    A. There is no treatment specific for hepatitis A
    Explanation
    There actually is NO specific treatment for hepatitis A. If a patient was not tolerating their symptoms, they would simply receive supportive care.

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  • 2. 

    Which of the following confers PASSIVE immunity?

    • A.

      Hepatitis A vaccine

    • B.

      IgG

    • C.

      Hepatitis B vaccine

    • D.

      Hepatitis C vaccine

    Correct Answer
    B. IgG
    Explanation
    Vaccines confer ACTIVE immunity, while directly giving a patient anti-bodies is known as passive immunity. There is no such thing as a hepatitis C vaccine.

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  • 3. 

    A patient is flying to Peru next week, but he is not sure if he has ever received a vaccine for hepatitis A. Which of the following should he receive (choose all that apply)?

    • A.

      Hepatitis A vaccine

    • B.

      IgG

    • C.

      IgM

    Correct Answer(s)
    A. Hepatitis A vaccine
    B. IgG
    Explanation
    Because the patient is traveling to a high endemic area (South America) in less than 2 weeks, they would receive BOTH the vaccine and IgG. IgM is not an antibody that is administered to patients.

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  • 4. 

    If a patient is positive for _____ Anti-HAV, this signifies that the patient currently has acute hepatitis A infection. (Answer is 3 letters)

    Correct Answer(s)
    IgM
    Explanation
    Remember that IgM comes first and indicates current infection in hepatitis A. IgG would only come after a patient has recovered.

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  • 5. 

    Which of the following patients would have positive IgG Anti-HBc? (Choose all that apply)

    • A.

      A 23-year old recovered from hepatitis A infection

    • B.

      A 54 year old who has recovered from hepatitis B infection

    • C.

      A 67 year old in phase 4 of hepatitis B infection

    • D.

      A 78 year old in acute hepatitis B infection

    Correct Answer(s)
    B. A 54 year old who has recovered from hepatitis B infection
    C. A 67 year old in phase 4 of hepatitis B infection
    Explanation
    Note that the question asked about Anti-HBc, which is specific to hepatitis B. In hepatitis B, the patient would only develop IgG after acute infection phase is done. So a patient who has recovered from HBV will have IgG Anti-HBc, and also a patient who has advanced to chronic illness will also have IgG Anti-HBc.

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  • 6. 

    In which TWO phases of hepatitis B is liver damage occurring?

    • A.

      Phase 1, 2

    • B.

      Phase 3, 5

    • C.

      Phase 2, 4

    • D.

      Phase 2, 3

    Correct Answer
    C. Phase 2, 4
    Explanation
    Phase 2 and 4 are the only two phases where liver damage is occurring. This is why treatment is given for both of these phases.

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  • 7. 

    For the following labs, which would be POSITIVE or ELEVATED in Phase 1 hepatitis B infection? (Choose all that apply)

    • A.

      HBeAg

    • B.

      HBsAg

    • C.

      IgG Anti-HBV

    • D.

      IgM Anti-HBV

    • E.

      Anti-HBe

    • F.

      Anti-HBs

    • G.

      HBV DNA

    • H.

      ALT

    Correct Answer(s)
    A. HBeAg
    B. HBsAg
    C. IgG Anti-HBV
    G. HBV DNA
    Explanation
    This is the "honeymoon" phase. So you are sick, replicating, but there is no liver damage.

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  • 8. 

    For the following labs, which would be POSITIVE or ELEVATED in Phase 2 hepatitis B infection? (Choose all that apply)

    • A.

      HBeAg

    • B.

      HBsAg

    • C.

      IgG Anti-HBV

    • D.

      IgM Anti-HBV

    • E.

      Anti-HBe

    • F.

      Anti-HBs

    • G.

      HBV DNA

    • H.

      ALT

    Correct Answer(s)
    A. HBeAg
    B. HBsAg
    C. IgG Anti-HBV
    G. HBV DNA
    H. ALT
    Explanation
    Phase 2 looks very similar to Phase 1 on lab work, EXCEPT you will now see elevated ALT. Remember that phase 2 sees liver damage.

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  • 9. 

    For the following labs, which would be POSITIVE or ELEVATED in Phase 3 hepatitis B infection? (Choose all that apply)

    • A.

      HBeAg

    • B.

      HBsAg

    • C.

      IgG Anti-HBV

    • D.

      IgM Anti-HBV

    • E.

      Anti-HBe

    • F.

      Anti-HBs

    • G.

      HBV DNA

    • H.

      ALT

    Correct Answer(s)
    B. HBsAg
    C. IgG Anti-HBV
    E. Anti-HBe
    Explanation
    Phase 3 has stopped replication (seroconversion of E antigen) and therefore stopped liver damage. These patients are still "sick" though, so there has not yet been seroconversion of S antigen.

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  • 10. 

    For the following labs, which would be POSITIVE or ELEVATED in Phase 4 hepatitis B infection? (Choose all that apply)

    • A.

      HBeAg

    • B.

      HBsAg

    • C.

      IgG Anti-HBV

    • D.

      IgM Anti-HBV

    • E.

      Anti-HBe

    • F.

      Anti-HBs

    • G.

      HBV DNA

    • H.

      ALT

    Correct Answer(s)
    B. HBsAg
    C. IgG Anti-HBV
    E. Anti-HBe
    G. HBV DNA
    H. ALT
    Explanation
    Phase 4 is the trickiest one. This is the variant of virus that no longer produces E antigen. But the virus is still very much there, replicating, and causing liver damage.

    Rate this question:

  • 11. 

    For the following labs, which would be POSITIVE or ELEVATED in Phase 5 hepatitis B infection? (Choose all that apply)

    • A.

      HBeAg

    • B.

      HBsAg

    • C.

      IgG Anti-HBV

    • D.

      IgM Anti-HBV

    • E.

      Anti-HBe

    • F.

      HBV DNA

    • G.

      ALT

    Correct Answer(s)
    C. IgG Anti-HBV
    E. Anti-HBe
    Explanation
    Not much here! This is the first and only phase where S Antigen is negative, which signifies functional cure. Notice that I did not give Anti-HBs as an option. That's because not everyone develops this antibody in phase 5, so Anti-HBs can be positive or negative in phase 5.

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  • 12. 

    Phase 1 Hepatitis B patients do not need to be treated, UNLESS _______________.

    • A.

      They are younger than 30

    • B.

      They are older than 30

    • C.

      They have elevated ALTs

    • D.

      They have extremely high levels of HBV DNA

    Correct Answer
    B. They are older than 30
    Explanation
    Most phase 1 patients do not need to treated. The exception is patients >30 years of age since they will very likely advance to phase 2 soon. Technically if a patient has elevated ALT, they are no longer in phase 1 (no liver damage) and are now in phase 2.

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  • 13. 

    Phase 3 and Phase 5 hepatitis B patients do NOT need to continue treatment, UNLESS ______________.

    • A.

      They are still HBsAg positive

    • B.

      They have had hepatitis B infection for more than 10 years

    • C.

      They are tolerating treatment very well

    • D.

      They already have cirrhosis with any detectable virus

    Correct Answer
    D. They already have cirrhosis with any detectable virus
    Explanation
    Phase 3 (remission) and phase 5 (functional cure) patients do not usually need to continue treatment. The exception is if they have already advanced to cirrhosis. In this case, these patients are still at risk for developing further complications of advanced liver disease. Plus, stopping a nucleoside analog can cause rebound hepatitis and the risk is worse in cirrhosis.

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  • 14. 

    Which of the following are considered first line for hepatitis B treatment? (Choose all that apply)

    • A.

      Pegylated Interferon

    • B.

      Lamivudine

    • C.

      Entecavir

    • D.

      Adefovir

    • E.

      Tenofovir

    • F.

      Telbivudine

    Correct Answer(s)
    A. Pegylated Interferon
    C. Entecavir
    E. Tenofovir
    Explanation
    Interferon, entecavir, and tenofovir are all considered first line in hepatitis B management. Treatment choice depends on outcomes desired, patient preference, cost, ADR profile, etc.

    Rate this question:

  • 15. 

    With which of the following drugs can you see an ALT flare?

    • A.

      Peg-interferon

    • B.

      Nucleoside analogues

    Correct Answer
    A. Peg-interferon
    Explanation
    An ALT flare can be see with interferon, which actually signifies a better chance at efficacy.

    Rate this question:

  • 16. 

    Which of the following drugs is more well tolerated?

    • A.

      Peg-interferon

    • B.

      Nucleoside analogues

    Correct Answer
    B. Nucleoside analogues
    Explanation
    NA's have significantly less ADRs compared to IFN.

    Rate this question:

  • 17. 

    Which of the following drugs is susceptible to resistance?

    • A.

      Peg-interferon

    • B.

      Nucleoside analogues

    Correct Answer
    B. Nucleoside analogues
    Explanation
    There is no such thing as resistance to IFN. Several NA's have high rates of resistance, however entecavir and tenofovir have the lowest risk.

    Rate this question:

  • 18. 

    Which of the following drugs is quicker at reducing HBV DNA and ALT?

    • A.

      Peg-interferon

    • B.

      Nucleoside analogues

    Correct Answer
    B. Nucleoside analogues
    Explanation
    NA's are more effective at lowering HBV DNA and ALT (Bronze medal) than IFN.

    Rate this question:

  • 19. 

    Which of the following is dosed as an injection once a week?

    • A.

      Peg-interferon

    • B.

      Nucleoside analogues

    Correct Answer
    A. Peg-interferon
    Explanation
    IFN is a SC injection once a week

    Rate this question:

  • 20. 

    Which of the following has the least risk for relapse?

    • A.

      Peg-interferon

    • B.

      Nucleoside analogues

    Correct Answer
    A. Peg-interferon
    Explanation
    This is one of the benefits of IFN over NA. If it works, the patient is at a lower chance of relapse compared to NA.

    Rate this question:

  • 21. 

    Which of the following is the most expensive?

    • A.

      Peg-interferon

    • B.

      Nucleoside analogues

    Correct Answer
    A. Peg-interferon
    Explanation
    This is one of the downsides to peg-IFN

    Rate this question:

  • 22. 

     
    • You have reached the end of the practice questions! Great job and thanks for taking the time to test your knowledge. 
      
    • As a *reward* for your work, I will be drawing a few random names to win a prize! If you win, you get to choose your prize, and all options are related to my "working during a pandemic" advice that I gave during the lecture. Keep in mind, the prize will be mailed to the Amazon lockers on campus. If you are not on campus, I can also send it to a different address that you supply.
     
    • If you'd like to enter your name in the drawing, please go to this google form to enter your info: https://forms.gle/YVLBQhDMuHCWLERN6
     
    • If you would like to pass on the prize (i.e. "this practice quiz was reward enough for me" or "I'd like to do a random act of kindness and let others have a better shot of winning a prize" or "I don't need more stuff", etc) then you are done!
    Please choose any of the following to get your score for this quiz.

    • A.

      I'm done with this quiz

    • B.

      I'm ready for my score

    Correct Answer
    A. I'm done with this quiz
  • 23. 

    The definition of sustained virologic response is to have undetectable HCV RNA _______ weeks after the end of treatment (enter a number)

    Correct Answer
    12
    Explanation
    SVR is when there is undetectable viral load 12 weeks after the end of treatment.

    Rate this question:

  • 24. 

    Which of the following medications is indicated in ALL six genotypes of hepatitis C infection? (Choose all that apply)

    • A.

      Ledipasvir and sofosbuvir 

    • B.

      Elbasvir and Grazoprevir

    • C.

      Glecaprevir/Pibrentasvir 

    • D.

      Velpatasvir and Sofosbuvir 

    • E.

      Sofosbuvir/Velpatasvir/Voxilaprevir

    Correct Answer(s)
    C. Glecaprevir/Pibrentasvir 
    D. Velpatasvir and Sofosbuvir 
    E. Sofosbuvir/Velpatasvir/Voxilaprevir
    Explanation
    Glecaprevir/Pibrentasvir, Velpatasvir and Sofosbuvir, and Sofosbuvir/Velpatasvir/Voxilaprevir are all indicated in all six genotypes of hepatitis C infection. These medications are direct-acting antivirals (DAAs) that target specific proteins involved in the replication of the hepatitis C virus. By targeting multiple genotypes, these medications provide a broad spectrum of coverage and are effective in treating hepatitis C regardless of the specific genotype of the virus present in the patient.

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  • 25. 

    Which genotypes are covered by ALL first line agents for hepatitis C infection? (Choose all that apply)

    • A.

      Genotype 1

    • B.

      Genotype 2

    • C.

      Genotype 3

    • D.

      Genotype 4

    • E.

      Genotype 5

    • F.

      Genotype 6

    Correct Answer(s)
    A. Genotype 1
    D. Genotype 4
    Explanation
    All first line agents for hepatitis C cover genotypes 1 and 4.

    Rate this question:

  • 26. 

    Which of the following describes the genotype indications for Harvoni?

    • A.

      1, 4

    • B.

      1, 2, 3, 4

    • C.

      1, 3, 4, 6

    • D.

      1, 4, 5, 6

    Correct Answer
    D. 1, 4, 5, 6
    Explanation
    The correct answer is 1, 4, 5, 6. This indicates that the genotype indications for Harvoni include genotypes 1, 4, 5, and 6. Genotype refers to the genetic makeup of an individual, specifically the combination of alleles for a particular gene. In the context of Harvoni, genotype indications refer to the specific genotypes of the hepatitis C virus that Harvoni is effective in treating.

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  • 27. 

    Which of the following describes the genotype indications for Zepatier?

    • A.

      1, 4

    • B.

      1, 2, 3, 4

    • C.

      1, 3, 4, 6

    • D.

      1, 4, 5, 6

    Correct Answer
    A. 1, 4
    Explanation
    The correct answer is 1, 4. This means that the genotype indications for Zepatier are indicated by the presence of genotypes 1 and 4.

    Rate this question:

  • 28. 

    Which is the only drug that is used in re-treatment for hepatitis C infection?

    • A.

      Epclusa

    • B.

      Vosevi

    • C.

      Mavyret

    • D.

      Harvoni

    • E.

      Zepatier

    Correct Answer
    B. Vosevi
    Explanation
    Vosevi is the only drug that is used in re-treatment for hepatitis C infection. This means that if a patient has previously been treated for hepatitis C but the infection returns, Vosevi is the drug that can be used again to treat the infection. The other options, Harvoni, Epclusa, Mavyret, and Zepatier, are not specifically indicated for re-treatment of hepatitis C.

    Rate this question:

  • 29. 

    Which of the following are safe to use with birth control containing ethinyl estradiol? (Choose all that apply)

    • A.

      Ledipasvir/sofosbuvir

    • B.

      Elbasvir and Grazoprevir 

    • C.

      Glecaprevir/Pibrentasvir 

    • D.

      Velpatasvir and Sofosbuvir 

    • E.

      Sofosbuvir/Velpatasvir/Voxilaprevir 

    Correct Answer(s)
    A. Ledipasvir/sofosbuvir
    B. Elbasvir and Grazoprevir 
    D. Velpatasvir and Sofosbuvir 
    Explanation
    The question asks which medications are safe to use with birth control containing ethinyl estradiol. The correct answer options are Ledipasvir/sofosbuvir, Elbasvir and Grazoprevir, and Velpatasvir and Sofosbuvir. These medications do not interact with ethinyl estradiol and can be safely used together. However, Glecaprevir/Pibrentasvir and Sofosbuvir/Velpatasvir/Voxilaprevir may interact with ethinyl estradiol and are not safe to use together.

    Rate this question:

  • 30. 

    Which of the following medications requires NO adjustment with any acid-reducing agent? (Choose all that apply)

    • A.

      Ledipasvir/sofosbuvir

    • B.

      Elbasvir and Grazoprevir 

    • C.

      Glecaprevir/Pibrentasvir 

    • D.

      Velpatasvir and Sofosbuvir 

    • E.

      Sofosbuvir/Velpatasvir/Voxilaprevir 

    Correct Answer
    B. Elbasvir and Grazoprevir 
    Explanation
    Elbasvir and Grazoprevir do not require any adjustment with acid-reducing agents.

    Rate this question:

  • 31. 

    Which of the following classes of medications will have minimal drug interactions with hepatitis C treatments?

    • A.

      Anti-histamines

    • B.

      Anti-hypertensives

    • C.

      Anti-convulsants

    • D.

      Anti-arrhythmics

    Correct Answer
    A. Anti-histamines
    Explanation
    Anti-histamines are the class of medications that will have minimal drug interactions with hepatitis C treatments. This is because anti-histamines primarily work on histamine receptors in the body and do not significantly interact with the liver enzymes that metabolize hepatitis C medications. On the other hand, anti-hypertensives, anti-convulsants, and anti-arrhythmics may have a higher likelihood of drug interactions with hepatitis C treatments due to their potential effects on liver enzymes or drug metabolism.

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  • 32. 

    Which drug requires two forms of contraception during treatment and 6 months after treatment?

    • A.

      Harvoni

    • B.

      Vosevi

    • C.

      Ribavirin

    • D.

      Viekira Pak

    Correct Answer
    C. Ribavirin
    Explanation
    Ribavirin requires two forms of contraception during treatment and 6 months after treatment. This is because Ribavirin can cause birth defects or death in an unborn baby. Therefore, it is crucial for both men and women who are taking Ribavirin to use two effective forms of contraception to prevent pregnancy during treatment and for 6 months after treatment to ensure the safety of the baby.

    Rate this question:

  • 33. 

     Which of the following must be monitored BEFORE treatment begins? (Choose all that apply)

    • A.

      Resistance Associated Substitutions

    • B.

      Genotype

    • C.

      CBC

    • D.

      Staging of liver fibrosis

    Correct Answer(s)
    A. Resistance Associated Substitutions
    B. Genotype
    C. CBC
    D. Staging of liver fibrosis
    Explanation
    All of these tests should be done before treatment begins

    Rate this question:

  • 34. 

    Which of the following drugs is contraindicated in CTP score of 7 or higher?

    • A.

      Mavyret

    • B.

      Harvoni

    • C.

      Ribavirin

    • D.

      Epclusa

    Correct Answer
    A. Mavyret
    Explanation
    Mavyret is glecaprevir and pibrentasvir. Remember that the "previr" drugs cannot be used in moderate to severe liver impairment.

    Rate this question:

  • 35. 

    A 63 year old patient was recently diagnosed with hepatitis C genotype 2 infection. She has completed all pre-treatment monitoring and is eligible to begin therapy today. This is her current medication list:  
    • Quetiapine 
    • Metformin
    • Levothyroxine
    Assuming she cannot change any of her current medications, which of the following is the best treatment option?

    • A.

      Harvoni

    • B.

      Mavyret

    • C.

      Epclusa

    • D.

      Zepatier

    Correct Answer
    C. Epclusa
    Explanation
    Harvoni and Zepatier do not cover genotype 2. Mavyret should not be used due to its potential interaction with quetiapine, which is an anti-psychotic. Epclusa can be used safely with anti-psychotic. There are no drug interactions with metformin or thyroid hormone.

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  • 36. 

    Which of the following medications should be taken with food

    • A.

      Epclusa

    • B.

      Zepatier

    • C.

      Harvoni

    • D.

      Mavyret

    Correct Answer
    D. Mavyret
    Explanation
    Mavyret should be taken with food because it contains a medication called glecaprevir, which is better absorbed when taken with a meal. Taking Mavyret with food helps to increase its effectiveness and ensures that the body can properly absorb the medication. This is why it is important to follow the instructions and take Mavyret with food.

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  • 37. 

    When taking hepatitis C treatment, ALT should be checked ____ weeks into treatment, and discontinued if it rises > _____ fold.

    • A.

      6, 3

    • B.

      4, 10

    • C.

      4, 3

    • D.

      6, 10

    Correct Answer
    B. 4, 10
    Explanation
    Check ALT at week 4 of treatment; Prompt d/c of therapy recommended 10-fold increase in ALT at any time during treatment

    Rate this question:

  • 38. 

    A 54 year old male patient would like to start hepatitis B treatment. The hepatologist wants your help in choosing the most appropriate drug. The patient has a PMH of CAD, DM, CKD, HTN, HL, and sleep apnea. He was diagnosed with hepatitis B when he was in the hospital 2 weeks ago for a myocardial infarction. His CrCl is 35 ml/min. He states he is open to both interferon and nucleoside analogs after hearing about the pros and cons of each.  Which of the following is the most appropriate choice for him?

    • A.

      Peg-interferon

    • B.

      Entecavir

    • C.

      Telbivudine

    • D.

      Lamivudine

    Correct Answer
    B. Entecavir
    Explanation
    IFN is contraindicated in severe cardiac disease since it can worsen ischemia. The patient had a very recent MI, so now would not be a good time to start IFN. While renal adjustments for CrCl

    Rate this question:

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