Viral Hepatitis — MCQs
With which of the following types of viral hepatitis infection in pregnancy is maternal mortality the highest?
A 2 month old baby presented with acute icteric viral hepatitis. The mother is a known hepatitis B carrier. Mother's hepatitis B virus serological profile is MOST likely to be:
What is the treatment of choice for an 11-year-old child with hepatitis C infection?
Which of the following viruses is considered a defective virus that requires another virus for its replication?
Which viral infection is primarily associated with hemolysis?
Which of the following is true about Hepatitis A virus?
Which of the following markers in the blood is the most reliable indicator of recent hepatitis B infection?
What should you do next for a 35-year-old man who is positive for HBsAg and HBeAg, discovered incidentally during blood donation screening, with normal SGOT and SGPT laboratory values?
An elderly man who had been in several military conflicts during the early 1980s and received blood transfusions for injuries recently consulted his physician for a diagnosis of cryoglobulinemia and glomerulonephritis. Additional testing revealed that he was infected with a virus transmitted through blood. Which virus was involved in this infection?
Which component of HBV causes glomerulonephritis?
Viral Hepatitis Indian Medical PG Practice Questions and MCQs
Question 1: With which of the following types of viral hepatitis infection in pregnancy is maternal mortality the highest?
- A. Hepatitis-A
- B. Hepatitis-B
- C. Hepatitis-C
- D. Hepatitis-E (Correct Answer)
Explanation: ***Hepatitis E*** - While generally mild in the non-pregnant population, **Hepatitis E virus (HEV)** infection during pregnancy is associated with a significantly **higher risk of severe liver disease** and **fulminant hepatic failure**, leading to increased maternal and fetal mortality, especially in the third trimester. - The exact mechanisms are not fully understood, but hormonal and immunological changes during pregnancy are thought to contribute to a more severe course of HEV infection. *Hepatitis A* - **Hepatitis A virus (HAV)** infection typically causes an **acute, self-limiting liver disease** that is generally not more severe in pregnant women than in the general population. - While transmission to the fetus can occur, it is rare and usually does not result in significant maternal or fetal mortality. *Hepatitis B* - While **Hepatitis B virus (HBV)** infection can cause chronic liver disease, it does not typically lead to increased maternal mortality during pregnancy, especially if the mother is a chronic carrier without active disease flares. - The primary concern with HBV in pregnancy is the **high risk of vertical transmission** to the neonate, which can establish chronic infection in the infant. *Hepatitis C* - **Hepatitis C virus (HCV)** infection generally does not exacerbate during pregnancy and does not significantly increase maternal mortality. - The main perinatal issue with HCV is the **risk of perinatal transmission** to the infant, which is lower than HBV but still a concern for chronic infection in the child.
Question 2: A 2 month old baby presented with acute icteric viral hepatitis. The mother is a known hepatitis B carrier. Mother's hepatitis B virus serological profile is MOST likely to be:
- A. HBsAg and HBeAg positive (Correct Answer)
- B. HBsAg and HBe antibody positive
- C. HBsAg positive only
- D. HBV DNA positive
Explanation: ***HBsAg and HBeAg positive*** - A mother who is **HBsAg and HBeAg positive** has a high viral load and is highly infectious, making vertical transmission to her infant very likely, leading to acute icteric viral hepatitis in the newborn [1]. - **HBeAg positivity** indicates active viral replication, a key factor in efficient perinatal transmission of HBV [1]. *HBsAg and HBe antibody positive* - **HBe antibody positivity** indicates a lower viral load and less active viral replication, suggesting a lower risk of perinatal transmission than if HBeAg were positive [1]. - While the mother is a carrier (HBsAg positive), the presence of HBe antibody usually means the infection is in a less active, potentially chronic persistent phase, with reduced infectivity [1]. *HBsAg positive only* - A mother being **HBsAg positive only** (without HBeAg or antibody information) is insufficient to definitively determine the infectivity status or the likelihood of acute icteric hepatitis in the infant. - **HBsAg positivity** confirms carrier status but doesn't specify the level of viral replication or infectivity as precisely as HBeAg status [1]. *HBV DNA positive* - **HBV DNA positive** indicates the presence of viral genetic material, confirming active infection or replication, but it's a quantitative measure and doesn't replace the serological markers for assessing infectivity in the context of perinatal transmission [1]. - While strongly indicative of active infection, **HBV DNA positive** usually correlates with HBeAg positivity in highly infectious carriers, and HBeAg is the more specific serological marker for this high infectivity state [1].
Question 3: What is the treatment of choice for an 11-year-old child with hepatitis C infection?
- A. Direct-Acting Antivirals (DAAs) (Correct Answer)
- B. Gamma-globulin
- C. Corticosteroids
- D. Vaccine
Explanation: ***Direct-Acting Antivirals (DAAs)*** - **Direct-acting antivirals** are the current **standard of care** for hepatitis C infection in children due to their high efficacy, good safety profile, and ability to achieve sustained virologic response (SVR). - Several DAAs are approved and recommended for use in children as young as 3 years, with treatment regimens tailored to the **genotype** of the hepatitis C virus (HCV). *Gamma-globulin* - **Gamma-globulin** (immunoglobulin) is primarily used for **passive immunization** against certain infections or in conditions involving antibody deficiencies; it has no direct antiviral activity against chronic hepatitis C. - It would not be effective in eradicating the hepatitis C virus from an infected individual. *Corticosteroids* - **Corticosteroids** are potent **anti-inflammatory** and immunosuppressive agents, but they do not possess direct antiviral properties against HCV. - Using corticosteroids could potentially worsen the infection by **suppressing the immune response** needed to clear the virus, and they are generally contraindicated in active viral hepatitis. *Vaccine* - While there are effective **vaccines** for hepatitis A and hepatitis B, there is currently **no vaccine available** to prevent hepatitis C infection. - Research is ongoing, but a preventive vaccine for HCV has yet to be developed.
Question 4: Which of the following viruses is considered a defective virus that requires another virus for its replication?
- A. Hepatitis A virus (HAV)
- B. Hepatitis B virus (HBV)
- C. Hepatitis D virus (HDV) (Correct Answer)
- D. Hepatitis C virus (HCV)
Explanation: ***Hepatitis D virus (HDV)*** - **Hepatitis D virus (HDV)** is a unique RNA virus that is **defective** and requires the presence of **Hepatitis B virus (HBV)** and its surface antigen **(HBsAg)** for replication and assembly. - HDV infection can occur as **co-infection** (simultaneous HBV and HDV) or **superinfection** (HDV infection in an existing HBV carrier), often leading to **more severe liver disease**. - HDV is a **satellite virus** that cannot complete its life cycle independently. *Incorrect: Hepatitis A virus (HAV)* - **Hepatitis A virus (HAV)** is a **picornavirus** that causes acute hepatitis and **replicates independently** without the need for another helper virus. - It is transmitted via the **fecal-oral route** and does **not cause chronic infection**. *Incorrect: Hepatitis B virus (HBV)* - **Hepatitis B virus (HBV)** is a **hepadnavirus** that **replicates independently** and produces its own viral envelopes. - HBV is the **helper virus required for HDV replication**, but HBV itself does not require another virus to complete its life cycle. *Incorrect: Hepatitis C virus (HCV)* - **Hepatitis C virus (HCV)** is a **flavivirus** that can **replicate autonomously** and cause both acute and chronic hepatitis. - It does **not require a helper virus** for its replication, unlike HDV.
Question 5: Which viral infection is primarily associated with hemolysis?
- A. Hepatitis-C
- B. Epstein-Barr virus (Correct Answer)
- C. Hepatitis A virus
- D. Hepatitis B virus
Explanation: **Epstein-Barr virus** - **Epstein-Barr virus (EBV)** is strongly associated with **cold agglutinin disease**, an **autoimmune hemolytic anemia** where cold-reacting antibodies agglutinate and lyse red blood cells. [4] - Hemolysis in EBV infection can also occur due to direct viral effects on red blood cells or immune-mediated mechanisms beyond cold agglutinins. [1] *Hepatitis B virus* - Hepatitis B virus is primarily known for causing **liver inflammation** and **hepatocellular damage**, rather than direct or immune-mediated hemolysis. [2] - While chronic HBV infection can lead to complications such as cirrhosis or liver cancer, it is not a common cause of hemolytic anemia. *Hepatitis-C* - Hepatitis C virus is a common cause of **chronic liver disease**, leading to **fibrosis**, **cirrhosis**, and **hepatocellular carcinoma**. [3] - Although HCV is sometimes associated with mixed cryoglobulinemia, which can cause vasculitis and organ damage, it does not typically cause significant hemolysis. *Hepatitis A virus* - Hepatitis A virus causes **acute, self-limiting liver inflammation** and is primarily transmitted through the **fecal-oral route**. [2] - It does not typically cause sustained or severe hemolysis; any hemolytic events are rare and usually mild.
Question 6: Which of the following is true about Hepatitis A virus?
- A. Causes chronic hepatitis
- B. Helps HDV replication
- C. Causes cirrhosis
- D. Common cause of hepatitis in children (Correct Answer)
Explanation: ***Common cause of hepatitis in children*** - **Hepatitis A virus (HAV)** infection is often acquired in childhood, particularly in areas with poor sanitation, and many infections are **asymptomatic** or mild in children [1]. - Due to their developing immune systems and often exposure in daycare or school settings, children are a highly susceptible population for HAV transmission [1]. *Causes cirrhosis* - **HAV infection** is an **acute self-limiting illness** and typically does not lead to chronic liver disease or cirrhosis [1]. - **Cirrhosis** is primarily associated with chronic viral hepatitis (e.g., HBV, HCV), alcohol-related liver disease, or certain autoimmune conditions. *Helps HDV replication* - **Hepatitis D virus (HDV)** is a **defective virus** that requires the presence of **Hepatitis B virus (HBV)** surface antigen (HBsAg) for its replication and assembly [1]. - **HAV** has no role in the replication or pathogenesis of **HDV** [1]. *Causes chronic hepatitis* - **HAV infection** results in an **acute inflammatory response** in the liver that resolves spontaneously in most cases [1]. - Unlike **HBV** and **HCV**, **HAV** does not establish a persistent infection and, therefore, does not cause chronic hepatitis [1].
Question 7: Which of the following markers in the blood is the most reliable indicator of recent hepatitis B infection?
- A. anti-HBe
- B. HBsAg
- C. IgG anti - HBs
- D. IgM anti - HBc (Correct Answer)
Explanation: ***IgM anti - HBc*** - **IgM anti-HBc** (antibody to hepatitis B core antigen) is the most reliable marker for **recent or acute hepatitis B infection**. - It appears early in the infection and can be detected during the **window period** when HBsAg may have disappeared but anti-HBs has not yet appeared. *anti-HBe* - **Anti-HBe** (antibody to hepatitis B e-antigen) indicates **lower infectivity** and often suggests resolution of viral replication. - It usually appears after HBeAg disappears and is not a primary marker of recent infection. *HBsAg* - **HBsAg** (hepatitis B surface antigen) indicates active **hepatitis B infection** (acute or chronic), but does not differentiate recent from long-standing infection on its own. - While present in recent infection, IgM anti-HBc is more specific for **acute or recent onset**. *IgG anti - HBs* - **IgG anti-HBs** (antibody to hepatitis B surface antigen) indicates either **recovery from past infection** or **immunity due to vaccination**. - It does not signify recent infection; rather, it suggests long-term immunity.
Question 8: What should you do next for a 35-year-old man who is positive for HBsAg and HBeAg, discovered incidentally during blood donation screening, with normal SGOT and SGPT laboratory values?
- A. HBV-DNA estimation (Correct Answer)
- B. Observation
- C. Liver biopsy
- D. Interferon therapy
Explanation: ***HBV-DNA estimation*** - The presence of **HBsAg** and **HBeAg** indicates **active viral replication**, necessitating quantification of HBV-DNA to assess viral load [1]. - Normal SGOT and SGPT suggest compensated liver function, but **viral load** is crucial for staging the disease and guiding future management [1]. *Observation* - While liver enzymes are normal, the presence of **HBsAg** and **HBeAg** indicates active hepatitis B infection, which warrants further investigation, not just observation [1]. - Undiagnosed and untreated chronic hepatitis B can lead to serious complications such as **cirrhosis** and **hepatocellular carcinoma** [1]. *Liver biopsy* - **Liver biopsy** is an invasive procedure typically reserved for cases where histological assessment is required to confirm **fibrosis** or **inflammation severity**, or when there's discordance between viral markers and clinical presentation. - It's not the initial step for a patient with normal transaminases and clear serological markers of active infection; **HBV-DNA estimation** is generally performed first [1]. *Interferon therapy* - **Interferon therapy** is a treatment for chronic hepatitis B, but initiating treatment requires a comprehensive assessment including **HBV-DNA levels**, in addition to liver enzyme levels and evaluation of liver damage [2]. - It would be premature to consider treatment without a **viral load** measurement and a full workup to determine the phase of infection and the need for therapy [2].
Question 9: An elderly man who had been in several military conflicts during the early 1980s and received blood transfusions for injuries recently consulted his physician for a diagnosis of cryoglobulinemia and glomerulonephritis. Additional testing revealed that he was infected with a virus transmitted through blood. Which virus was involved in this infection?
- A. Hepatitis A Virus (HAV)
- B. Hepatitis B Virus (HBV)
- C. Hepatitis C Virus (HCV) (Correct Answer)
- D. Hepatitis D Virus (HDV)
Explanation: ***Hepatitis C Virus (HCV)*** - HCV infection is a common cause of **mixed cryoglobulinemia** and can lead to **glomerulonephritis**, particularly membranoproliferative glomerulonephritis. - Before widespread screening of the blood supply, HCV was a significant risk from **blood transfusions**, especially for individuals who received them in the early 1980s [1]. *Hepatitis A Virus (HAV)* - HAV is primarily transmitted via the **fecal-oral route** and does not typically cause chronic infection or lead to cryoglobulinemia or glomerulonephritis. - It causes **acute, self-limiting hepatitis** and is not associated with blood transfusions in the context described. *Hepatitis B Virus (HBV)* - While HBV can be transmitted through blood and can cause glomerulonephritis (e.g., membranous nephropathy), it is less commonly associated with **cryoglobulinemia** in comparison to HCV. - The constellation of cryoglobulinemia and glomerulonephritis, especially with a history of transfusions in the 1980s, points more strongly to HCV. *Hepatitis D Virus (HDV)* - HDV is a **defective virus** that requires co-infection with HBV to replicate. - While it can cause severe liver disease, it is not primarily associated with **cryoglobulinemia** or glomerulonephritis as a direct cause, but rather exacerbates HBV-related complications.
Question 10: Which component of HBV causes glomerulonephritis?
- A. Anti HBs Ag antibody
- B. HBc Ag
- C. Hbs Ag (Correct Answer)
- D. Hbe Ag
Explanation: ### HBs Ag - **Hepatitis B surface antigen (HBsAg)** is a viral protein that can form immune complexes with its corresponding antibody within the body [1]. - These **immune complexes** can deposit in the glomeruli of the kidneys, triggering an inflammatory response that leads to **glomerulonephritis**, particularly **membranous nephropathy** or **membranoproliferative glomerulonephritis**. *Anti HBs Ag antibody* - This antibody usually indicates **immunity** to HBV infection, either from vaccination or resolved infection [1]. - While it forms an immune complex with HBsAg, this typically leads to **clearance of the virus** and does not directly cause glomerulonephritis. *HBc Ag* - **Hepatitis B core antigen (HBcAg)** is located within the viral core and is not typically released into the bloodstream as a free antigen [1]. - Therefore, it is **unlikely to directly form immune complexes** in the circulation that could deposit in the kidney. *HBe Ag* - **Hepatitis B e antigen (HBeAg)** indicates active viral replication and high infectivity. - Although it can be detected in the serum, it is **less commonly implicated** in the direct formation of immune complexes leading to glomerulonephritis compared to HBsAg.
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