A 24-year-old woman in New York City is admitted to the hospital because of jaundice. On workup, she is found to have HCV infection. The major risk factor for HCV infection in the United States is
(E) Working in health care occupations
Which of the following exposures poses a risk for hepatitis infection?
(A) A nurse sustains a needlestick while drawing up insulin to administer to an HBV-infected patient with diabetes.
(B) While cleaning the bathroom, a housekeeper’s intact skin has contact with feces.
(C) An operating room technician with chapped and abraded hands notices blood under his gloves after assisting in an operation on a patient with HCV infection.
(D) A child drinks out of the same cup as her mother, who has an HAV infection.
(E) A shopper eats a sandwich prepared by a worker with an asymptomatic HBV infection.
An epidemic of jaundice caused by HEV occurred in New Delhi. HEV is
(A) Found in rodents and pigs.
(B) A major cause of bloodborne hepatitis.
(C) The cause of a disease that resembles hepatitis C.
(D) Capable of establishing chronic infections.
(E) Associated with an increased risk of liver cancer.
HDV (delta agent) is found only in patients who have either acute or chronic infection with HBV. Which of the following is most correct?
(A) HDV is a defective mutant of HBV.
(B) HDV depends on HBV surface antigen for virion formation.
(C) HDV induces an immune response indistinguishable from that induced by HBV.
(D) HDV is related to HCV.
(E) HDV contains a circular DNA genome.
A 23-year-old woman is planning a 1-year trip through Europe, Egypt, and the Indian subcontinent and receives a vaccine for hepatitis A. The current hepatitis A vaccine is
(A) A live attenuated virus vaccine
(B) A recombinant DNA vaccine
(C) A formalin-inactivated virus vaccine
(D) An envelope glycoprotein subunit vaccine
(E) A chimeric poliovirus that expresses HAV neutralizing epitopes
The following statements about HCV infection and associated chronic liver disease in the United States are correct except
(A) HCV is responsible for 40% of chronic liver disease.
(B) Chronic infection develops in most (70–90%) HCV-infected persons.
(C) HCV-associated liver disease is the major cause for liver transplantation.
(D) HCV viremia occurs transiently during early stages of infection.
(E) HCV-infected patients are at high risk (5–20%) for liver cancer.
A middle-aged man complained of acute onset of fever, nausea, and pain in the right upper abdominal quadrant. There was jaundice, and dark urine had been observed several days earlier. A laboratory test was positive for HAV IgM antibody. The physician can tell the patient that
(A) He probably acquired the infection from a recent blood transfusion.
(B) He will probably develop chronic hepatitis.
(C) He will be at high risk of developing hepatocellular carcinoma.
(D) He will be resistant to infection with hepatitis E.
(E) He may transmit the infection to family members by person-to-person spread for up to 2 weeks.
Several different viruses can cause hepatitis. One of the following statements applies to all four viruses: HAV, HCV, HDV, and HEV.
(A) It contains a single-stranded RNA genome.
(B) It is transmitted primarily by the parenteral route.
(C) It is transmitted primarily by the fecal–oral route.
(D) It is associated with fulminant hepatitis.
(E) It undergoes sequence variation during chronic infection.
A 30-year-old student goes to the emergency room because of fever and anorexia for the past 3 days. She appears jaundiced. Her liver is enlarged and tender. A laboratory test shows elevated aminotransferases. She reports a history of having received hepatitis B vaccine 2 years ago but has not had hepatitis A vaccine. The results of her hepatitis serologic tests are as follows: HAV IgM-negative, HAV IgG-positive, HBsAg-negative, HBsAb-positive, HBcAb-negative, HCV Ab-positive. The most accurate conclusion is that she probably
(A) Has hepatitis A now, has not been infected with HBV, and had hepatitis C in the past.
(B) Has hepatitis A now and has been infected with both HBV and HCV in the past.
(C) Has been infected with HAV and HCV in the past and has hepatitis B now.
(D) Has been infected with HAV in the past, has not been infected with HBV, and has hepatitis C now.
(E) Has been infected with HAV and HCV in the past, has not been infected with HBV, and has hepatitis E now.
A 36-year-old nurse is found to be both HBsAg positive and HBeAg positive. The nurse most likely
(A) Has acute hepatitis and is infectious.
(B) Has both HBV and HEV infections.
(C) Has a chronic HBV infection.
(D) Has cleared a past HBV infection.
(E) Was previously immunized with HBV vaccine prepared from healthy HBsAg-positive carriers.
The following persons are at increased risk for HAV infection and should be routinely vaccinated except for which group?
(A) Persons traveling to or working in countries that have high levels of HAV infection
(B) Men who have sex with men
(C) Users of illegal drugs (both injecting and noninjecting)
(D) Persons who have an occupational risk for infection
(E) Persons who have a clotting factor disorder
(F) Susceptible persons who have chronic liver disease
(G) Teachers in elementary schools
There is global variation in the prevalence of HBV infection. Which of the following geographic areas has low endemicity (HBsAg prevalence of < 2%)?
Which of the following persons are not recommended to receive hepatitis B vaccine because they have a risk factor for HBV infection?
(A) Sexually active persons who are not in long-term, mutually monogamous relationships
(D) Persons who live in a household with a person who is HBsAg positive
(E) Persons seeking treatment for a sexually transmitted disease
Which of the following statements regarding HBIG is not true?
(A) HBIG provides temporary protection when administered in standard doses.
(B) HBIG typically is used instead of hepatitis B vaccine for postexposure immunoprophylaxis to prevent HBV infection.
(C) No evidence exists that HBV, HCV, or HIV have ever been transmitted by HBIG in the United States.
(D) MHBIG is not used as protection against HCV infection.
Each of the following statements concerning HAV is correct except
(A) The hepatitis A vaccine contains inactivated HAV as the immunogen.
(B) HAV commonly causes asymptomatic infection in children.
(C) The diagnosis of hepatitis A is usually made by isolating HAV in cell culture.
(D) γ-Globulin is used to prevent hepatitis A in exposed persons.
Which of the following serologic patterns is suggestive of a patient with chronic hepatitis B with a pre-core mutation?
(A) HBsAg positive, HBsAb negative, anti-HBc positive, HBeAg positive, HBV DNA positive
(B) HBsAg positive, HBsAb negative, anti-HBc positive, HBeAg positive, HBV DNA positive
(C) HBsAg positive, HBsAb positive, anti-HBc positive, HBeAg negative, HBV DNA positive
(D) HBsAg negative, HBsAb positive, anti-HBc positive, HBeAg negative, HBV DNA negative
A 35-year-old man addicted to intravenous drugs has been a carrier of HBsAg for 10 years. He suddenly develops acute fulminant hepatitis and dies within 10 days. Which of the following laboratory tests would contribute most to diagnosis?
(D) Anti-delta virus antibody
Each of the following statements concerning HCV and HDV is correct except
(B) HDV is transmitted primarily by the fecal–oral route.
(C) HDV is a defective virus that can replicate only in a cell that is also infected with HBV.
(D) People infected with HCV commonly become chronic carriers of HCV and are predisposed to hepatocellular carcinoma.
Which of the following statements about HBV is false?
(A) Replication involves reverse transcriptase.
(B) Infected persons may have large numbers of noninfectious viral particles circulating in their bloodstream.
(C) Infection can result in cirrhosis.
(D) Asymptomatic infections can last for years.
(E) In the United States, the incidence of infection has been steadily increasing over the past few years.
Treatment of hepatitis C can involve drugs of which of the following classes?
(A) Protease inhibitors, polymerase inhibitors, and interleukins
(B) Non-nucleoside polymerase inhibitors, protease inhibitors, and interferons
(C) Transcription inhibitors and interferons
(D) Protease inhibitors, polymerase inhibitors, and interferons
(E) Reverse transcriptase inhibitors and interferons