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Which Hepatitis viruses can be transmitted enterally?
A and E
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Which Hepatitis viruses can be transmitted parenterally?
B, C, and D
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Which Hepatitis viruses exist in a chronic carrier state?
B, C, and D
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Which Hepatitis viruses do not exist in a chronic carrier state?
A and E
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What modes of transmission are possible for HAV?
- Orofecal
- Sexual
- Rarely by blood
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What modes of transmission are possible for HBV?
- Possibly Orofecal
- Sexual
- Blood
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What modes of transmission are possible for HCV?
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What modes of transmission are possible for HDV?
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What modes of transmission are possible for HEV?
Orofecal
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Which Hepatitis viruses cause cirrhosis and hepatocellular carcinoma?
- B
- C
- D (with HBV co-infection)
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Which type of Hepatitis virus is DNA based?
HBV
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What are the risk factors for contracting HAV?
- Travel to regions at risk
- Infected sexual partners
- Household members or caregivers of infected persons
- Homosexuals
- Users of certain illegal drugs (non-injection included)
- Clotting factor disorders
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What are the risk factors for contracting HBV?
- Travel to regions at risk
- Infected sexual partners
- Multiple sex partners
- Household members and caregivers of infected persons
- Homosexuals
- Injection drug users
- Hemodialysis patients
- Persons with STDs
- Infants born to infected mothers
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What are the risk factors for contracting HCV?
- Current or former injection drug users
- Recipients of clotting factor concentrates before 1987
- Recipients of donated organs or blood transfusions before July 1992
- Long-term dialysis patients
- Persons with known exposure to HCV (needlesticks, blood or organ recipients)
- HIV infected persons
- Infants born to infected mothers
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What are the types of acute Hepatitis?
- Asymptomatic
- Symptomatic
- Fulminant
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What is the characteristic associated with asymptomatic hepatitis?
- marked only by a rise in liver function tests and detection of serological markers
- 10-30 times more likely than symptomatic infection
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What are the phases and characteristics of symptomatic hepatitis?
- Incubation period: no symptoms
- Pericteric phase: nonspecific, influenza-like sx for 2-3wks (malaise, conjugated bilirubin increases, may see dark urine)
- Icteric phase: Jaundice in the sclera, pale stools, pruritis for 7-30d
- Convalescent phase: fatigue and weakness for up to 6 months
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What are the characteristics of fulminant hepatitis?
- Severe liver failure that develops within 8wks of sx onset
- Characterized by liver cell destruction leading to coagulopathy and hepatic encephalopathy
- Rare
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What are the characteristics of chronic hepatitis?
- Protracted hepatocellular necrosis and inflamation
- Fibrosis often present
- Lasts longer than 6mo
- Cirrhosis, portal HTN, and/or hepatocellular carcinoma possible
- Result of cytolytic T-cell response to infected hepatocytes rather than direct viral injury to cells
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What plays a key role in the transmission of HAV?
asymptomatic children
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How is HAV primarily transmittted?
contaminated food and water
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Why is HAV so easily transmitted?
Viremia and fecal shedding occur before the sx begin
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What is the supportive care for HAV?
- Bed rest until sx resolve
- Anti-nausea meds (not chlorpromazine)
- Correct fluid imbalances
- Pain control (use APAP, not narcotics or hypnotics)
- Manage pruritis (cholestyramine)
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What are the pharmacological therapies for HAV?
- Pre-exposure: HAV immunoglobulin
- Post-exposure: HAV immunoglobulin (also to contacts)
- Steroids (prednisone) in the iteric phase may decrease bilirubin, alleviate itching, and minimize fatigue
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Which racial groups are at higher rick for HBV?
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How is diagnosis made for HBV?
based on serologic markers of infection in a clinical setting consistent with acute infection
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What is the presence of HBc indicative of?
Replicating HBV
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If serologic testing is positive for anti-HBc and anti-HBs, how was immunity acquired?
immunity due to natural infection
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If serologic testing is positive for anti-HBs only, how was immunity acquired?
through vaccination
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If serologic testing is positive for HBsAg, anti-HBc and IGM anti-HBc, what type of infection is present?
Acute HBV infection
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If serologic testing is positive for HBsAg and anti-HBc, what type of infection is present?
Chronic HBV infection
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What are the phases of chronic HBV infection?
- Immune tolerant: active replication in the liver, but little or no evidence of disease
- Immune active: symptomatic w/ flares of hepatitis and ALT. cirrhosis and carcinoma
- Inactive carrier: anti-HBe present, HBV DNA present but undetectable
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What is the treatment for chronic HBV?
- Interferon-α2b 30-35 million IU TIW SC(only for compensated disease)
- Peginterferon-α2a 180μg/wk SC x 48wks (only for compensated disease)
- Lamivudine 100mg/d PO
- Adefovir 10mg/d PO
- Entecavir 0.5mg/d PO
- Tenofovir 300mg/d PO
- Telbivudine 600mg/d PO
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What is the most common blood borne pathogen?
HCV
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What is decompenstated liver disease?
- ascites
- hepatic encephalopathy
- hemorrage d/t portal HTN
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What is the treatment for acute HCV?
- Interferon-α2b 3million IU TIW SC
- Peginterferon-α2a 180μg/wk SC x 48wks
- Peginterferon-α2b 1.0μg/kg/wk x 52wks
- Any of the above + Ribavirin 800mg/d PO for genotypes 2and 3
- Any of the above + Ribavirin 1000-1200mg/d PO for genotypes 1 and 4
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What are the SE of PEGinterferon?
- Depression
- Insomnia
- Irritability
- Anxiety
- Flu-like sx
- Neutropenia
- Alopecia
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What are the SE of interferon-α2b?
- Bone marrow suppression
- Depression
- Flu-like sx
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What are the SE of Lamivudine?
- Lacitc acidosis
- Severe hepatomegaly w/steatosis
- Malaise
- Fatigue
- GI upset
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What are the SE of Adefovir?
- Lactic acidosis
- Severe hepatomegaly w/steatosis
- Hepatitis
- Nephrotoxicity
- HA
- GI upset
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What are the SE of Entecavir?
- Lactic acidosis
- Severe hepatomegaly w/steatosis
- HA
- Fatigue
- Dizziness
- Nausea
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What are the SE of Tenofovir?
- Lactic acidosis
- Severe hepatomegaly w/steatosis
- Nepthrotoxicity
- Nausea
- Decrease in bone mineral density
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What are the SE of Telbivudine?
- Lactic acidosis
- Severe hepatomegaly w/steatosis
- Myopathy
- Peripheral neuropathy
- Fatigue
- HA
- Flu-like sx
- GI upset
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What are the SE of ribavirin?
Hemolytic anemia
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