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Self-Assessment Questions

Infectious Diseases

Hepatitis: Review Questions

Varsha Moudgal, MD

Dr. Moudgal is an assistant professor of medicine, Wayne State University
School of Medicine, Detroit, MI; and the program director of the Infectious
Diseases Fellowship Program, St. Joseph Mercy Hospital, Ann Arbor, MI.

Choose the single best answer for each question.

1. A 33-year-old man presents to a travel clinic for evaluation prior to a planned trip to India in 2 weeks. He is travelling to a rural part of southern India and will live in a small village, eating native food. How should this patient be advised regarding vaccination for hepatitis A?
  1. Vaccination is not necessary
  2. The patient should receive 2 doses of inactivated hepatitis A vaccine prior to travel
  3. The patient can travel after 1 dose of hepatitis A vaccine
  4. The patient should receive the first dose of hepatitis A vaccine and a dose of immunoglobulin (IG)
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2. Hepatitis A vaccine is recommended in all of the following groups EXCEPT

  1. Children prior to 1 year of age
  2. Day care providers
  3. Food handlers
  4. Men who have sex with men
  5. Travelers to an endemic area
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3. A 45-year-old day care provider presents to her physician’s office with fever, nausea, malaise, and fatigue. On examination, she is icteric and has right upper quadrant tenderness and hepatomegaly. Serologic testing is positive for hepatitis A IgM antibody. The patient is responsible for the care of several toddlers. Following receipt of this information, the health care department should do which of the following?

  1. Administer IG to all previously unvaccinated staff and day care attendees
  2. Immediately administer ribavirin to staff and children who were in contact with the index patient
  3. Inform staff and parents that no further action is necessary except quarantining the affected employee
  4. Vaccinate all employees and recommend vaccination of all children attending the day care center
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4.  All of the following groups of people should be screened for the presence of hepatitis C virus (HCV) antibodies EXCEPT

  1. Intravenous (IV) drug users including those with a remote history of IV drug use
  2. Persons with HIV
  3. Persons with hemophilia who received clotting factor concentrates before 1987
  4. Persons who received blood or blood products after 1992
  5. Sexual partners of HCV-infected patients
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  5. All of the following statements regarding HCV are correct EXCEPT
  1. It is a positive, single-stranded RNA flavivirus
  2. It produces 12 trillion virions per day
  3. It replicates in hepatocytes
  4. HIV is more genetically diverse than HCV
  5. HCV enters the cell through the low-density lipoprotein and CD81 receptors
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6. All of the following statements regarding hepatitis G virus (HGV)/GB virus-C (GBV-C) are correct EXCEPT

  1. HGV/GBV-C is an RNA virus belonging to the Flaviviridae family
  2. HGV/GBV-C is spread predominantly through parenteral routes
  3. HIV-positive patients coinfected with HGV/GBV-C have improved survival as compared with patients with HIV alone
  4. Patients with HCV and a coexisting HGV/ GBV-C infection have a clinically more severe course of illness than those with HCV alone
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Questions 7 and 8 refer to the following case.

A 33-year-old man with a history of hypertension, diabetes mellitus, and HCV diagnosed 2 years ago presents to his primary care physician with a 2-week history of increasing fatigue and bilateral knee pain. On examination, he is afebrile with stable vital signs. There is no knee joint warmth or effusion; however, a small, raised, reddish-purple rash is noted on the lower extremities bilaterally. Laboratory studies reveal an elevated serum creatinine level (2.0 mg/dL) and a low serum complement level.

7. What is this patient’s most likely diagnosis?

  1. Acute hypersensitivity reaction
  2. Bilateral lower extremity cellulitis
  3. Essential mixed cryoglobulinemia (EMC)
  4. Insect bites
  5. Rocky Mountain spotted fever
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8. What is the next step in the treatment of this patient?

  1. Diphenhydramine and IV methylprednisolone
  2. Doxycycline
  3. IV cefazolin
  4. Pegylated interferon
  5. Topical corticosteroid
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