Hepatitis B/C US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Hepatitis B/C. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Hepatitis B/C US Medical PG Question 1: A 29-year-old man comes to the physician for a routine health maintenance examination. He feels well. He works as a nurse at a local hospital in the city. Three days ago, he had a needlestick injury from a patient whose serology is positive for hepatitis B. He completed the 3-dose regimen of the hepatitis B vaccine 2 years ago. His other immunizations are up-to-date. He appears healthy. Physical examination shows no abnormalities. He is concerned about his risk of being infected with hepatitis B following his needlestick injury. Serum studies show negative results for hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis C antibody. Which of the following is the most appropriate next step in management?
- A. Revaccinate with 3-dose regimen of hepatitis B vaccine
- B. Revaccinate with two doses of hepatitis B vaccine
- C. Administer hepatitis B immunoglobulin
- D. Administer hepatitis B immunoglobulin and 3-dose regimen of hepatitis B vaccine (Correct Answer)
- E. Administer hepatitis B immunoglobulin and single dose hepatitis B vaccine
Hepatitis B/C Explanation: ***Administer hepatitis B immunoglobulin and 3-dose regimen of hepatitis B vaccine***
- This patient had prior vaccination but current serology shows **negative HBsAb**, indicating **non-response** to the vaccine (failure to develop protective antibodies).
- Given exposure to a hepatitis B positive patient, immediate post-exposure prophylaxis with **HBIG** is crucial for passive immunity and immediate protection.
- A **complete 3-dose revaccination series** should be initiated simultaneously, as per **CDC/ACIP guidelines** for vaccine non-responders with occupational exposure [1].
- This provides both immediate passive protection (HBIG) and attempts to establish active immunity through revaccination [1].
*Revaccinate with 3-dose regimen of hepatitis B vaccine*
- While revaccination is necessary due to the non-response, starting a 3-dose regimen alone without **HBIG** would leave the patient vulnerable during the initial period before vaccine response develops.
- After high-risk exposure in a non-responder, both passive (HBIG) and active (vaccine) immunity are required.
*Revaccinate with two doses of hepatitis B vaccine*
- A 2-dose regimen is insufficient; the standard revaccination schedule for non-responders is **3 doses** at 0, 1, and 6 months [1].
- Additionally, this option lacks **HBIG** for immediate protection after the high-risk exposure.
*Administer hepatitis B immunoglobulin*
- **HBIG** alone provides immediate passive immunity, which is crucial given the recent exposure and the patient's non-immune status.
- However, offering only HBIG without initiating active immunization (vaccine series) would leave the patient unprotected once the passive immunity wanes (approximately 3-6 months).
- This approach fails to address the need for long-term protection through revaccination.
*Administer hepatitis B immunoglobulin and single dose hepatitis B vaccine*
- While HBIG is appropriate for immediate protection, giving only a **single dose** of vaccine is inadequate.
- Standard post-exposure management for vaccine non-responders requires initiating a **complete 3-dose revaccination series**, not just one dose [1].
- A single dose would not provide adequate long-term protection for this non-responder.
Hepatitis B/C US Medical PG Question 2: A 59-year-old woman comes to the physician for a routine health maintenance examination. She feels well. She has systemic lupus erythematosus and hypertension. She does not drink alcohol. Her current medications include lisinopril and hydroxychloroquine. She appears malnourished. Her vital signs are within normal limits. Examination shows a soft, nontender abdomen. There is no ascites or hepatosplenomegaly. Serum studies show:
Total bilirubin 1.2 mg/dL
Alkaline phosphatase 60 U/L
Alanine aminotransferase 456 U/L
Aspartate aminotransferase 145 U/L
Hepatitis A IgM antibody negative
Hepatitis A IgG antibody positive
Hepatitis B surface antigen positive
Hepatitis B surface antibody negative
Hepatitis B envelope antigen positive
Hepatitis B envelope antibody negative
Hepatitis B core antigen IgM antibody negative
Hepatitis B core antigen IgG antibody positive
Hepatitis C antibody negative
Which of the following is the most appropriate treatment for this patient?
- A. Pegylated interferon alpha therapy
- B. Tenofovir therapy (Correct Answer)
- C. Referral to a liver transplantation center
- D. Reassurance and follow-up
- E. Lamivudine therapy
Hepatitis B/C Explanation: ***Tenofovir therapy***
- This patient has **chronic hepatitis B** with evidence of **active viral replication** (positive HBsAg, HBeAg, and elevated liver enzymes), indicating a need for antiviral treatment.
- **Tenofovir** is a highly effective and well-tolerated oral antiviral agent for chronic hepatitis B, suitable for initial therapy.
*Pegylated interferon alpha therapy*
- While an option for chronic hepatitis B, **pegylated interferon alpha** has more significant side effects and is generally avoided in patients with **systemic lupus erythematosus (SLE)** due to the risk of exacerbating the autoimmune condition.
- It also requires subcutaneous injections and has a lower rate of HBeAg seroconversion compared to nucleos(t)ide analogs in many patient populations.
*Referral to a liver transplantation center*
- This patient currently shows **elevated liver enzymes** but no immediate signs of **decompensated liver disease** (e.g., ascites, encephalopathy, variceal bleeding) or severe liver failure that would warrant urgent transplantation.
- Treatment with antiviral medication is the first step to prevent progression to end-stage liver disease.
*Reassurance and follow-up*
- The patient has **elevated transaminases** and markers of **active viral replication** (positive HBeAg), indicating ongoing liver injury and potential progression to cirrhosis.
- Simply observing the patient without treatment would be inappropriate and could lead to irreversible liver damage.
*Lamivudine therapy*
- **Lamivudine** is an older nucleos(t)ide analog for hepatitis B that has a significantly **higher rate of drug resistance** compared to newer agents like tenofovir.
- It is generally not recommended as a first-line treatment due to its resistance profile.
Hepatitis B/C US Medical PG Question 3: A 32-year-old woman comes to the physician because of a 3-month history of fatigue and myalgia. Over the past month, she has had intermittent episodes of nausea. She has a history of intravenous drug use, but she has not used illicit drugs for the past five years. She has smoked one pack of cigarettes daily for 14 years and drinks one alcoholic beverage daily. She takes no medications. Her last visit to a physician was 4 years ago. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. Physical examination shows jaundice and hepatosplenomegaly. There are also blisters and erosions on the dorsum of both hands. The remainder of the examination shows no abnormalities. Laboratory studies show:
Hemoglobin 12 g/dL
Leukocyte count 8,300/mm3
Platelet count 250,000/mm3
Serum
Glucose 170 mg/dL
Albumin 3.0 g/dL
Total bilirubin 2.2 mg/dL
Alkaline phosphatase 80 U/L
AST 92 U/L
ALT 76 U/L
Hepatitis B surface antigen negative
Hepatitis B surface antibody positive
Hepatitis B core antibody positive
Hepatitis C antibody positive
Which of the following is the most appropriate next step in diagnosis?
- A. PCR for viral DNA
- B. Western blot for HIV
- C. Serology for anti-HAV IgM
- D. PCR for viral RNA (Correct Answer)
- E. Liver biopsy
Hepatitis B/C Explanation: ***Correct: PCR for viral RNA***
- The patient has high suspicion for **chronic hepatitis C infection** due to a history of intravenous drug use, the presence of **fatigue**, **myalgia**, **jaundice**, hepatosplenomegaly, and **elevated liver enzymes (AST and ALT)**
- The **blisters and erosions on the dorsum of both hands** are highly suggestive of **porphyria cutanea tarda (PCT)**, a well-established complication of chronic hepatitis C caused by hepatic uroporphyrinogen decarboxylase deficiency
- The positive **Hepatitis C antibody** indicates exposure to HCV, but does not distinguish between acute, chronic, or resolved infection
- **PCR for viral RNA (HCV RNA)** is required to confirm **active viral replication** and diagnose current hepatitis C infection, which is crucial for treatment decisions
- The elevated glucose (170 mg/dL) may also represent hepatogenous diabetes related to chronic liver disease
*Incorrect: PCR for viral DNA*
- This test is primarily used for diagnosing active infections caused by **DNA viruses**, such as **hepatitis B** (HBV DNA) or cytomegalovirus
- The patient's hepatitis B serology indicates **past infection with immunity** (HBsAg negative, HBsAb positive, HBcAb positive), so HBV DNA testing is not indicated
- The clinical picture points toward HCV (an RNA virus), not a DNA virus
*Incorrect: Western blot for HIV*
- While the patient has a history of intravenous drug use (a risk factor for HIV), initial HIV screening is done with a **fourth-generation antigen/antibody combination assay**, not Western blot
- **Western blot** is a confirmatory test used only when initial HIV screening tests are reactive
- HIV testing may be appropriate given her risk factors, but it does not address the most pressing concern of active hepatitis C infection with complications (PCT)
*Incorrect: Serology for anti-HAV IgM*
- **Anti-HAV IgM** indicates **acute hepatitis A infection**, typically transmitted via the fecal-oral route
- The patient's symptoms, risk factors (IV drug use), positive HCV antibody, and characteristic skin findings (PCT) are not consistent with hepatitis A as the primary diagnosis
- Hepatitis A would not explain the chronic nature of symptoms or the skin manifestations
*Incorrect: Liver biopsy*
- **Liver biopsy** is an invasive procedure used to assess the **extent of liver damage**, inflammation, and fibrosis/cirrhosis after diagnosis of liver disease has been established
- It is not the most appropriate initial step to confirm **active viral replication**; PCR for HCV RNA should be performed first to establish that there is ongoing infection
- Once active HCV is confirmed, non-invasive methods (e.g., FibroScan, serum markers) are often preferred over biopsy for staging liver fibrosis
Hepatitis B/C US Medical PG Question 4: A 26-year-old woman who is a medical student is undergoing evaluation after sticking herself with a needle while drawing blood from a patient. The patient’s medical history is unknown. A blood sample from the medical student is drawn and processed, and the results are presented below:
Anti-HAV IgM negative
Anti-HAV IgG positive
HBsAg negative
HBeAg negative
Anti-HBs negative
Anti-HBc IgG negative
Anti-HBc IgM negative
Anti-HBe negative
Anti-HCV negative
What is true about the student’s laboratory findings?
- A. She has not been vaccinated against the hepatitis B virus. (Correct Answer)
- B. She recovered from a hepatitis B virus infection.
- C. She is infected with the hepatitis D virus.
- D. She can transmit the hepatitis A virus.
- E. She is an asymptomatic carrier of the hepatitis B virus.
Hepatitis B/C Explanation: ***She has not been vaccinated against the hepatitis B virus.***
- A **negative Anti-HBs** indicates a lack of protective antibodies developed either through vaccination or past infection.
- A **negative Anti-HBc IgG** and **IgM** further confirms no prior exposure to the hepatitis B core antigen, which would be present with natural infection.
*She recovered from a hepatitis B virus infection.*
- Recovery from HBV infection would typically show **positive Anti-HBs** and **positive Anti-HBc IgG**, neither of which are present here.
- The absence of **Anti-HBc antibodies** rules out past natural infection, whether resolved or chronic.
*She is infected with the hepatitis D virus.*
- Hepatitis D virus (HDV) infection only occurs in the presence of an active **Hepatitis B virus (HBV) infection**.
- The student's **HBsAg negative** status indicates no active HBV infection, thereby ruling out HDV.
*She can transmit the hepatitis A virus.*
- **Anti-HAV IgG positive** indicates prior exposure to HAV or vaccination, leading to immunity.
- **Anti-HAV IgM negative** suggests no acute HAV infection, meaning she is not currently infectious.
*She is an asymptomatic carrier of the hepatitis B virus.*
- An asymptomatic carrier of HBV would have **positive HBsAg** and likely **positive Anti-HBc IgG**, but both are negative in this case.
- The absence of **HBsAg** definitively rules out an active carrier state.
Hepatitis B/C US Medical PG Question 5: An investigator is studying the rate of multiplication of hepatitis C virus in hepatocytes. The viral genomic material is isolated, enzymatically cleaved into smaller fragments and then separated on a formaldehyde agarose gel membrane. Targeted probes are then applied to the gel and visualized under x-ray. Which of the following is the most likely structure being identified by this test?
- A. Lipid-linked oligosaccharides
- B. Transcription factors
- C. Polypeptides
- D. Ribonucleic acids (Correct Answer)
- E. Deoxyribonucleic acids
Hepatitis B/C Explanation: ***Ribonucleic acids***
- The description of isolating "viral genomic material," which is then "enzymatically cleaved" and run on a "formaldehyde agarose gel," followed by the application of "targeted probes" and X-ray visualization, perfectly matches the technique of **Northern blotting**.
- Northern blotting is used to detect and quantify specific **RNA sequences**, which is consistent with the hepatitis C virus being an RNA virus.
*Lipid-linked oligosaccharides*
- These molecules are involved in protein glycosylation and are typically analyzed using techniques like **mass spectrometry** or **chromatography**, not Northern blotting.
- They are not nucleic acid material, which is implied by "viral genomic material" and enzymatic cleavage steps.
*Transcription factors*
- **Transcription factors** are proteins that regulate gene expression and would typically be identified using techniques like **Western blotting** (for protein detection) or Electrophoretic Mobility Shift Assay (EMSA) for DNA binding.
- They are not directly "genomic material" that would be cleaved and run on an agarose gel in this manner.
*Polypeptides*
- **Polypeptides** are chains of amino acids, i.e., proteins, which are normally detected using **Western blotting** after separation on an SDS-PAGE gel.
- The use of "formaldehyde agarose gel" and "enzymatic cleavage" points specifically to nucleic acid analysis, not protein analysis.
*Deoxyribonucleic acids*
- While DNA is genomic material and is often analyzed similarly, the use of a **formaldehyde agarose gel** is characteristic of RNA electrophoresis because formaldehyde prevents RNA from forming secondary structures.
- Furthermore, hepatitis C is a **single-stranded RNA virus**, meaning its genome is RNA, not DNA.
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