Hepatitis B/C Practice Questions

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?

Accepted Answer

Administer hepatitis B immunoglobulin and 3-dose regimen of hepatitis B vaccine

Answer

Revaccinate with 3-dose regimen of hepatitis B vaccine

Answer

Revaccinate with two doses of hepatitis B vaccine

Answer

Administer hepatitis B immunoglobulin

Answer

Administer hepatitis B immunoglobulin and single dose hepatitis B vaccine

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?

Accepted Answer

Tenofovir therapy

Answer

Pegylated interferon alpha therapy

Answer

Referral to a liver transplantation center

Answer

Reassurance and follow-up

Answer

Lamivudine therapy

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?

Accepted Answer

PCR for viral RNA

Answer

PCR for viral DNA

Answer

Western blot for HIV

Answer

Serology for anti-HAV IgM

Answer

Liver biopsy

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?

Accepted Answer

She has not been vaccinated against the hepatitis B virus.

Answer

She recovered from a hepatitis B virus infection.

Answer

She is infected with the hepatitis D virus.

Answer

She can transmit the hepatitis A virus.

Answer

She is an asymptomatic carrier of the hepatitis B virus.

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?

Accepted Answer

Ribonucleic acids

Answer

Lipid-linked oligosaccharides

Answer

Transcription factors

Answer

Polypeptides

Answer

Deoxyribonucleic acids

Question 6

A 52-year-old man presents to his physician after his routine screening revealed that he has elevated liver enzymes. He complains of occasional headaches during the past year, but otherwise feels well. The patient reports that he was involved in a serious car accident in the 1980s. He does not smoke or drink alcohol. He has no history of illicit intravenous drug use. He does not currently take any medications and has no known allergies. His father had a history of alcoholism and died of liver cancer. The patient appears thin. His temperature is 37.8°C (100°F), pulse is 100/min, and blood pressure is 110/70 mm Hg. The physical examination reveals no abnormalities. The laboratory test results show the following:
Complete blood count
Hemoglobin 14 g/dL
Leukocyte count 10,000/mm3
Platelet count 146,000/mm3
Comprehensive metabolic profile
Glucose 150 mg/dL
Albumin 3.2 g/dL
Total bilirubin 1.5 mg/dL
Alkaline phosphatase 75 IU/L
AST 95 IU/L
ALT 73 IU/L
Other lab tests
HIV negative
Hepatitis B surface antigen negative
Hepatitis C antibody positive
HCV RNA positive
HCV genotype 1
A liver biopsy is performed and shows mononuclear infiltrates localized to portal tracts that reveal periportal hepatocyte necrosis. Which of the following is the most appropriate next step in management?

Accepted Answer

Sofosbuvir and ledipasvir therapy

Answer

Peginterferon alpha therapy

Answer

Interferon and ribavirin therapy

Answer

Tenofovir and entecavir therapy

Answer

Tenofovir and velpatasvir therapy

Question 7

A 42-year-old male with a history significant for IV drug use comes to the emergency department complaining of persistent fatigue and malaise for the past three weeks. On physical exam, you observe a lethargic male with icteric sclera and hepatomegaly. AST and ALT are elevated at 600 and 750, respectively. HCV RNA is positive. Albumin is 3.8 g/dL and PT is 12. A liver biopsy shows significant inflammation with bridging fibrosis. What is the current first-line treatment?

Accepted Answer

Sofosbuvir/Velpatasvir

Answer

Glecaprevir/Pibrentasvir

Answer

Sofosbuvir/Ledipasvir

Answer

Ribavirin monotherapy

Answer

Interferon monotherapy

Question 8

A 35-year-old man with no known past medical history presents to his physician because he is applying for a job as a healthcare worker, which requires screening for the hepatitis B virus (HBV). The patient states that he is in good health and denies any symptoms. His vital signs and physical exam are unremarkable. Labs are drawn, and the patient's HBV serology shows the following:

HBsAg: positive
anti-HBsAg antibody: negative
anti-HBcAg IgM: negative
anti-HBcAg IgG: positive
HBeAg: negative
anti-HBeAg antibody: positive

Which of the following best describes this patient's results?

Accepted Answer

Chronically infected, low infectivity

Answer

Immune due to previous infection

Answer

Immune due to previous vaccination

Answer

Acutely infected

Answer

Chronically infected, high infectivity

Question 9

A 3-month-old girl is brought to the emergency department because of a 2-day history of progressive difficulty breathing and a dry cough. Five weeks ago, she was diagnosed with diffuse hemangiomas involving the intrathoracic cavity and started treatment with prednisolone. She appears uncomfortable and in moderate respiratory distress. Her temperature is 38°C (100.4°F), pulse is 150/min, respirations are 50/min, and blood pressure is 88/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 87%. Oral examination shows a white plaque covering the tongue that bleeds when scraped. Chest examination shows subcostal and intercostal retractions. Scattered fine crackles and rhonchi are heard throughout both lung fields. Laboratory studies show a leukocyte count of 21,000/mm3 and an increased serum beta-D-glucan concentration. An x-ray of the chest shows symmetrical, diffuse interstitial infiltrates. Which of the following is most likely to confirm the diagnosis?

Accepted Answer

Bronchoalveolar lavage

Answer

Tuberculin skin test

Answer

Urine antigen test

Answer

CT scan of the chest

Answer

DNA test for CFTR mutation

Question 10

Two viruses, X and Y, infect the same cell and begin to reproduce within the cell. As a result of the co-infection, some viruses are produced where the genome of Y is surrounded by the nucleocapsid of X and vice versa with the genome of X and nucleocapsid of Y. When the virus containing genome X surrounded by the nucleocapsid of Y infects another cell, what is the most likely outcome?

Accepted Answer

Virions containing genome X and nucleocapsid X will be produced

Answer

Virions containing genome Y and nucleocapsid Y will be produced

Answer

No virions will be produced

Answer

Virions containing genome X and nucleocapsid Y will be produced

Answer

Virions containing genome Y and nucleocapsid X will be produced

Hepatitis B/C

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HBV structure and replication

HBV serological markers

Acute hepatitis B

Chronic hepatitis B phases

HBV treatment indications and options

HBV vaccination and prevention

HCV structure and genotypes

HCV diagnostic testing

Natural history of HCV infection

Direct-acting antivirals for HCV

HCV resistance and treatment failure

HBV/HCV co-infection

HCC screening in viral hepatitis

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