Liver Function Testing-- Hepatitis

Front 1

1. What is the mechanism of injury in acute viral hepatitis?

Back 1

a. Direct cytotoxicity
b. Immune response
c. Combination of the two

Front 2

2. What is the mechanism of injury in chronic viral hepatitis?

Back 2

a. Immune response more important

Front 3

3. What are the symptoms of acute viral hepatitis?

Back 3

a. Fever, malaise, nausea, vomiting
b. Anorexia
c. Jaundice, scleral icterus
d. RUQ pain
e. Hepatomegaly
f. Arthritis

Front 4

4. What are the lab indications of liver pathology?

Back 4

a. Elevated ALT and AST
b. Elevated bilirubin-- conjugated
c. Elevated ALP

Front 5

a. What is the incubation period of Hep A?

Back 5

i. 30 days

Front 6

b. What are the complications of Hep A?

Back 6

i. Fulminant hepatitis
ii. Cholestatic hepatitis
iii. Relapsing hepatitis

Front 7

c. What immunoglobulin is present in the acute phase of Hep A infection?

Back 7

i. IgM

Front 8

d. Who should get a Hep A vaccination?

Back 8

i. Children older than 1
ii. Working in endemic areas
iii. Traveling to endemic areas

Front 9

e. How should get Hep A immune globulin pre-exposure?

Back 9

i. Travelers to intermediate and high HAV-endemic regions

Front 10

f. What is the window for post-exposure use of HAV immune globulin?

Back 10

i. 14 days

Front 11

a. What is the incubation period of Hep B?

Back 11

i. 60-90 days

Front 12

b. What is the presentation of chronic persistent HBV hepatitis?

Back 12

i. Asymptomatic

Front 13

c. What is the presentation of chronic active HBV hepatitis?

Back 13

i. Symptomatic exacerbations of hepatitis

Front 14

d. What are the manifestations of Hep B disease?

Back 14

i. Chronic persistent hepatitis
ii. Chronic active hepatitis
iii. Cirrhosis
iv. Hepatocellular carcinoma

Front 15

e. During what period is HBsAg present in someone recovering from HBV?

Back 15

i. 4-24 weeks

Front 16

f. When do anti-HBs antibodies show up in someone recovering from HBV?

Back 16

i. 32 weeks

Front 17

g. During what period is IgM anti-HBc present in someone recovering from HBV?

Back 17

i. 4-32 weeks

Front 18

h. When is the “window period” of an HBV infection?

Back 18

i. 24-32 weeks
ii. Between HBsAG cessation and anti HBs appearance

Front 19

i. What is the serological proof that someone is “cured” of HBV?

Back 19

i. Antibodies to both core and surface of HBV

Front 20

j. When is HBeAg present in someone recovering from HBV?

Back 20

i. 4-12 weeks

Front 21

k. When does total anti-HBc appear in someone recovering from HBV?

Back 21

i. 4 weeks
ii. Continues permanently

Front 22

l. During what period is IgM anti-HBc present in progression to chronic HBV infection?

Back 22

i. 6-36 weeks

Front 23

a. During what period I HBsAg present in progression to chronic HBV infection?

Back 23

i. Permanently

Front 24

n. What % of infant cases of HBV go chronic?

Back 24

i. 90%

Front 25

o. Where is HBV most highly concentrated?

Back 25

i. Blood
ii. Serum
iii. Wound exudates

Front 26

p. Where is HBV found moderately concentrated?

Back 26

i. Semen
ii. Vaginal fluid
iii. Saliva

Front 27

q. Where is HBV low/not detectable

Back 27

i. Urine
ii. Feces
iii. Sweat
iv. Tears
v. Breastmilk

Front 28

r. How is HBV transmitted?

Back 28

i. Sexually
ii. Parenterally
iii. Perinatally

Front 29

s. What is the goal of HBV treatment?

Back 29

i. Remission of liver disease

Front 30

a. How does INFα work?

Back 30

i. Suppresses replication
ii. Induces remission

Front 31

b. How is INFα administered?

Back 31

i. Subcutaneous injections
ii. 6-12 months

Front 32

c. What is the MOA of nucleosides? What are some examples?

Back 32

i. Make virus unable to replicate-- does not prevent all viral replication
ii. Lamivudine, adefovir, entecavir, telbivudine

Front 33

d. What is a drawback of nucleosides?

Back 33

i. Resistance can be developed very quickly

Front 34

a. When should children get the HBV vaccine?

Back 34

i. 1st dose at birth
ii. 2nd dose at 1-2 months of age
iii. 3rd dose at 6-18 months of age

Front 35

b. When should adults get the HBV vaccination?

Back 35

i. 1st dose whenever
ii. 2nd dose 4 weeks after the first
iii. 3rd dose 5 months after the second

Front 36

a. What is the incubation period of HCV?

Back 36

i. 6-7 weeks

Front 37

b. What are the risk factors for transmission of HCV?

Back 37

i. Transfusion or transplant
ii. Injected drug use
iii. Hemodialysis
iv. Needles/sharps injury
v. Sexual/household exposure
vi. Multiple sex partners
vii. Vertical transmission

Front 38

c. What is the use of the HCV antibody?

Back 38

i. Dx HCV
ii. Not useful in acute phase

Front 39

d. What is the use of HCV antigen?

Back 39

i. Dx acute phase of HCV
ii. Measure response to therapy

Front 40

e. What is the use of HCV-RNA?

Back 40

i. Dx acute phase of HCV
ii. Measure response to therapy

Front 41

f. What is the goal of HCV treatment?

Back 41

i. Prevent complications and death
ii. Sustained virological response at 24 weeks

Front 42

g. Who should you NOT treat for HCV?

Back 42

i. Major uncontrolled depressive illness
ii. Solid organ transplant
iii. Autoimmune hepatitis
iv. Untreated thyroid disease
v. Pregnant or unwilling to comply with contraception
vi. Other major medical issue
vii. Age less than 2 years

Front 43

h. What medications are used to treat HCV?

Back 43

i. INFα and ribavirin

Front 44

i. What determines the dosing of ribavirin?

Back 44

i. Weight

Front 45

j. How long should INFα and ribavirin be given to treat genotype I of HCV?

Back 45

i. 1-48 weeks

Front 46

k. How long should INFα and ribavirin be given to treat genotypes II and III of HCV?

Back 46

i. 24 weeks

Front 47

l. What is a rapid virological response?

Back 47

i. Undetectable HCV RNA at week 4 of treatment

Front 48

m. What is an early virological response?

Back 48

i. A 2 log reduction or complete absence of serum HCV RNA at week 12 of therapy compared with baseline level

Front 49

a. Who is most at risk for autoimmune hepatitis?

Back 49

i. Middle-aged or teenage women
ii. Non-drinker
iii. No viral hepatitis

Front 50

b. What are the symptoms of autoimmune hepatitis?

Back 50

i. Fatigue
ii. Arthralgias/myalgias
iii. Oligomenorrhea
iv. Jaundice

Front 51

c. What are the lab markers for autoimmune hepatitis?

Back 51

i. AST/ALT increase
ii. Gamma globulins
iii. Positive ANA and SMA

Front 52

d. How can you treat autoimmune hepatitis?

Back 52

i. Corticosteroids

Front 53

a. What is the dx determinant of primary biliary cirrhosis?

Back 53

i. Isolated elevation of ALP
ii. POSITIVE AMA

Front 54

b. For what are you at risk if you have primary biliary cirrhosis?

Back 54

i. Hepatocellular carcinoma

Front 55

a. How can you dx primary sclerosing cholangitis/

Back 55

i. Elevated ALP
ii. Negative for AMA
iii. Closely linked to UC