Hepatitis Viruses — MCQs
A 5 year old boy is detected to be HBsAg positive on two separate occasions during a screening program for hepatitis B. He is otherwise asymptomatic. Child was given three doses of recombinant hepatitis B vaccine at the age of 1 year. His mother was treated for chronic hepatitis B infection around the same time. The next relevant step for further investigating the child would be to –
Which of the following viruses is considered a defective virus that requires another virus for its replication?
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?
Which of the following is the preferred treatment after birth for a baby of an HBsAg-positive mother?
Chronic viral hepatitis is seen with all of the following viruses, except?
A dentist suffered from Hepatitis B infection 3 months back. His liver function tests are normal, but HBsAg remains positive and he is not allowed by the medical board to do surgical practice. He is:
Which one of the following is the correct sequence of appearance for the Hepatitis B virus serological markers?
All are transmitted by blood except -
Which gene of the hepatitis B virus has the longest coding sequence?
Hepatitis Viruses Indian Medical PG Practice Questions and MCQs
Question 1: A 5 year old boy is detected to be HBsAg positive on two separate occasions during a screening program for hepatitis B. He is otherwise asymptomatic. Child was given three doses of recombinant hepatitis B vaccine at the age of 1 year. His mother was treated for chronic hepatitis B infection around the same time. The next relevant step for further investigating the child would be to –
- A. Repeat another course of Hepatitis B vaccine
- B. Repeat HBsAg
- C. Obtain HBeAg and anti-HBe levels (Correct Answer)
- D. Obtain anti HBs levels
Explanation: **Obtain HBeAg and anti–HBe levels** - Given the child is **HBsAg positive** on two separate occasions and has a mother with **chronic hepatitis B**, evaluating **HBeAg** and **anti-HBe levels** is crucial to determine if the child is in a high replicative immune tolerant phase or an immune clearance phase. - This information helps differentiate between persistent infection, risk of vertical transmission, and guides subsequent management, including the potential for antiviral therapy and monitoring requirements. *Repeat another course of Hepatitis B vaccine* - Repeating the vaccine is not indicated as the child is already **HBsAg positive**, indicating an active infection or carrier state, not a need for further immunization. - Vaccination aims to prevent infection, but in this case, the child is already confirmed to be infected. *Repeat HBsAg* - The question states the child was detected to be **HBsAg positive on two separate occasions**, making another repeat unnecessary for confirmation of infection. - The next step should aim to characterize the infection rather than re-confirm its presence. *Obtain anti HBs levels* - **Anti-HBs antibodies** indicate immunity from vaccination or resolved infection. Since the child is **HBsAg positive**, indicating active infection, anti-HBs levels would likely be negative or low and would not provide critical information about the current stage of infection. - The focus should be on characterizing the active infection, not assessing protective immunity.
Question 2: 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 3: 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 4: 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 5: Which of the following is the preferred treatment after birth for a baby of an HBsAg-positive mother?
- A. HepB immunoglobulin only
- B. HepB immunoglobulin + HepB immunization (Correct Answer)
- C. Only HepB immunization
- D. No active treatment required
Explanation: ***HepB immunoglobulin + HepB immunization*** - This combination provides both **passive immunity** (immunoglobulin) and **active immunity** (immunization) to the newborn. - Administration within **12 hours of birth** is crucial to prevent perinatal transmission of hepatitis B from an HBsAg-positive mother. *HepB immunoglobulin only* - Provides only **temporary passive immunity** and does not induce long-lasting protection against hepatitis B. - While it offers immediate protection, it eventually wanes, leaving the infant susceptible without active immunization. *Only HepB immunization* - Induces **active immunity**, but it takes time to develop, leaving a window of vulnerability postpartum. - It would not provide immediate protection against the high risk of transmission from an HBsAg-positive mother. *No active treatment required* - This approach is incorrect and dangerous as infants of HBsAg-positive mothers are at a **very high risk of acquiring chronic hepatitis B infection**. - Without intervention, there is a **70-90% chance of developing chronic hepatitis B**, which can lead to serious liver disease later in life.
Question 6: Chronic viral hepatitis is seen with all of the following viruses, except?
- A. HEV (Correct Answer)
- B. HCV
- C. HBV
- D. HDV
Explanation: ***HEV*** - While HEV can cause acute hepatitis, it **rarely progresses to chronic infection** in immunocompetent individuals. - Chronic HEV infection is primarily seen in **immunocompromised patients**, such as organ transplant recipients. *HCV* - **Hepatitis C virus** is well-known for its high propensity to establish chronic infection, with about 75-85% of acutely infected individuals developing **chronic hepatitis** [1]. - Chronic HCV infection can lead to **cirrhosis**, liver failure, and hepatocellular carcinoma [1]. *HBV* - **Hepatitis B virus** is a major cause of chronic hepatitis worldwide, especially when acquired perinatally or in early childhood [1]. - Approximately 5-10% of immunocompetent adults who acquire acute HBV infection progress to **chronic hepatitis** [1]. *HDV* - **Hepatitis D virus** is a defective virus that requires co-infection with HBV to replicate; therefore, chronic HDV infection only occurs in individuals with chronic HBV. - Co-infection or superinfection with HDV often **accelerates the progression of liver disease** to cirrhosis and liver failure.
Question 7: A dentist suffered from Hepatitis B infection 3 months back. His liver function tests are normal, but HBsAg remains positive and he is not allowed by the medical board to do surgical practice. He is:
- A. Inactive carrier
- B. Healthy carrier (Correct Answer)
- C. Convalescent carrier
- D. Paradoxical carrier
Explanation: ***Healthy carrier*** - A **healthy carrier** is an asymptomatic individual who harbors and can transmit the infectious agent while appearing clinically well with **normal liver function tests**. - The dentist has **recovered clinically** (normal LFTs) but remains **HBsAg positive at 3 months**, making him infectious and capable of transmitting hepatitis B to patients during exposure-prone procedures. - This is the **appropriate classification** for someone who is asymptomatic with persistent HBsAg beyond the acute phase but before the 6-month mark that defines chronic infection. - The **practice restriction** is justified because healthy carriers pose a **transmission risk** in surgical and dental procedures involving blood exposure. *Inactive carrier* - An **inactive carrier** (or inactive chronic HBsAg carrier) is a more specific term for individuals with **chronic HBV infection** (HBsAg positive >6 months) who have minimal viral replication, normal ALT, and low/undetectable HBV DNA. - At **3 months post-infection**, chronic carrier state cannot yet be definitively diagnosed as chronicity requires **persistence beyond 6 months**. - While this patient may eventually become an inactive carrier, at 3 months the broader term "healthy carrier" is more appropriate. *Convalescent carrier* - A **convalescent carrier** harbors and sheds pathogens during the **immediate recovery phase** of acute illness, typically for **days to a few weeks**. - At **3 months post-infection**, the patient is well beyond the convalescent period and has entered a **persistent carrier state** rather than active convalescence. - This term is too time-limited to accurately describe someone with **persistent HBsAg at 3 months**. *Paradoxical carrier* - The term **paradoxical carrier** is **not a recognized classification** in hepatitis B epidemiology or standard infectious disease carrier state terminology. - It does not appear in authoritative texts on **viral hepatitis** or carrier state definitions.
Question 8: Which one of the following is the correct sequence of appearance for the Hepatitis B virus serological markers?
- A. Anti-HBe, HBsAg, Anti-HBc
- B. HBeAg, Anti-HBe, Anti-HBc, HBsAg
- C. HBsAg, HBeAg, Anti-HBc, Anti-HBe (Correct Answer)
- D. Anti-HBc, HBsAg, Anti-HBe
Explanation: ***HBsAg, HBeAg, Anti-HBc, Anti-HBe*** - **HBsAg** (Hepatitis B surface antigen) is the first marker to appear in acute infection, indicating active viral replication. - **HBeAg** (Hepatitis B e-antigen) appears shortly after HBsAg, correlating with high viral replication and infectivity. **Anti-HBc** (antibody to hepatitis B core antigen) is the next to appear, often during the window period. **Anti-HBe** (antibody to hepatitis B e-antigen) signals reduced viral replication and decreased infectivity, typically following the disappearance of HBeAg. *Anti-HBe, HBsAg, Anti-HBc* - This sequence is incorrect because **Anti-HBe** appears much later in the infection, typically after clearance of HBeAg, indicating reduced viral replication. - **HBsAg** is the earliest indicator of active infection, not appearing after Anti-HBe. *HBeAg, Anti-HBe, Anti-HBc, HBsAg* - This sequence is incorrect as **HBeAg** and **Anti-HBe** do not typically appear before **HBsAg**, which is the initial marker of viral presence. - The appearance of **Anti-HBe** before **HBsAg** is also not consistent with the natural history of Hepatitis B infection. *Anti-HBc, HBsAg, Anti-HBe* - This sequence is incorrect because **Anti-HBc** usually appears earlier than Anti-HBe, and while it can be detected relatively early, **HBsAg** is the first antigen to be detectable. - The appearance of **Anti-HBe** is a sign of decreasing viral activity and generally appears later than both HBsAg and Anti-HBc.
Question 9: All are transmitted by blood except -
- A. Parvovirus B-19
- B. Cytomegalovirus
- C. Hepatitis G
- D. Epstein-Barr virus (Correct Answer)
Explanation: **Epstein-Barr virus** - While Epstein-Barr virus can be detected in blood, its primary mode of transmission is through **saliva** (e.g., kissing, sharing utensils), leading to infectious mononucleosis. - **Blood transfusion transmission** of EBV is rare and not considered a major route of spread in otherwise healthy individuals. *Parvovirus B-19* - **Parvovirus B-19** is well-known to be transmitted via **blood products** and can cause transient aplastic crisis, especially in patients with chronic hemolytic anemias. - It can also be transmitted via **respiratory droplets** and vertically from mother to fetus. *Cytomegalovirus* - **Cytomegalovirus (CMV)** is frequently transmitted through **blood transfusions**, especially to immunocompromised patients. - It can also be transmitted through other bodily fluids, organ transplantation, and congenitally. *Hepatitis G* - **Hepatitis G virus (HGV)**, now renamed **GB virus C (GBV-C)**, is primarily transmitted through **blood** and blood products. - It is often found as a co-infection with hepatitis C virus but its pathogenicity remains controversial.
Question 10: Which gene of the hepatitis B virus has the longest coding sequence?
- A. P gene (Correct Answer)
- B. X gene
- C. S gene
- D. C gene
Explanation: ***P gene*** - The **P gene** (polymerase gene) encodes the viral **reverse transcriptase**, which is crucial for replicating the HBV genome. - This enzyme is very large and complex, requiring the **longest coding sequence** to accommodate all its functional domains. *X gene* - The **X gene** encodes the **HBx protein**, which is a transcriptional transactivator and plays a role in hepatocarcinogenesis. - It has a relatively **short coding sequence** compared to the P gene. *S gene* - The **S gene** encodes the **surface antigens (HBsAg)**, which are involved in viral entry and immune evasion. - It has a **shorter coding sequence** than the P gene, as it primarily codes for structural proteins. *C gene* - The **C gene** encodes the **core protein (HBcAg)**, which forms the viral nucleocapsid, and the **HBeAg**. - Its coding sequence is also **shorter** than that of the P gene, reflecting its role in structural and regulatory functions.
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