Viral hepatitis — MRCP Part 1 flashcards

Question 1

Which serological marker confirms ACUTE hepatitis A infection?

Accepted Answer

IgM anti-HAV. — IgG anti-HAV indicates past infection or vaccination. Hepatitis A is a faeco-oral picornavirus with no chronic or carrier state.

Question 2

A kidney transplant recipient on tacrolimus has a persistently raised ALT. He often eats undercooked pork sausages. HEV RNA remains positive after 3 months. Which antiviral is used for chronic hepatitis E?

Accepted Answer

Ribavirin (for about 3 months), alongside reducing immunosuppression where possible. — HEV is usually self-limiting, but immunosuppressed patients can develop chronic infection and cirrhosis.

Question 3

Which serological result defines CHRONIC hepatitis B infection?

Accepted Answer

HBsAg positive for more than 6 months. — HBsAg is the hallmark of active infection. In recovery it disappears and anti-HBs appears.

Question 4

During the 'window period' of acute hepatitis B, which marker may be the only positive one?

Accepted Answer

IgM anti-HBc. — HBsAg has cleared but anti-HBs has not yet appeared, so only core antibody shows the infection.

Question 5

Hepatitis B serology: vaccinated only = ______; past infection now cleared = anti-HBc positive, HBsAg negative (usually with anti-HBs).

Accepted Answer

anti-HBs positive, anti-HBc negative — The vaccine contains only surface antigen, so vaccinated people never make anti-HBc.

Question 6

Hepatitis B serology: vaccinated only = anti-HBs positive, anti-HBc negative; past infection now cleared = ______ (usually with anti-HBs).

Accepted Answer

anti-HBc positive, HBsAg negative — The vaccine contains only surface antigen, so vaccinated people never make anti-HBc.

Question 7

Under NICE guidance, what is first-line antiviral treatment for an adult with chronic hepatitis B and COMPENSATED liver disease?

Accepted Answer

A 48-week course of peginterferon alfa-2a. — A finite course can achieve lasting HBeAg seroconversion. Second line: tenofovir disoproxil if HBeAg-positive; entecavir or tenofovir disoproxil if HBeAg-negative.

Question 8

What is first-line antiviral treatment for chronic hepatitis B with DECOMPENSATED liver disease?

Accepted Answer

Entecavir (tenofovir disoproxil if there is lamivudine resistance). — Peginterferon must NOT be given in decompensated disease because it can precipitate liver failure.

Question 9

NICE CG165: pregnant women with hepatitis B are offered ______ if HBV DNA is above 10⁷ IU/mL in the third trimester.

Accepted Answer

tenofovir disoproxil — This reduces transmission to the baby, alongside vaccine and immunoglobulin at birth.

Question 10

NICE CG165: pregnant women with hepatitis B are offered tenofovir disoproxil if HBV DNA is above ______ in the third trimester.

Accepted Answer

10⁷ IU/mL — This reduces transmission to the baby, alongside vaccine and immunoglobulin at birth.

Question 11

What is the main renal adverse effect of tenofovir disoproxil?

Accepted Answer

Nephrotoxicity – proximal tubular damage (Fanconi-type syndrome) – so renal function and phosphate are monitored. — Tenofovir is cleared by the proximal tubule. It can also reduce bone mineral density.

Question 12

After a full hepatitis B vaccine course, a healthcare worker's anti-HBs is below 10 mIU/mL. What is done?

Accepted Answer

Treat as a non-responder: repeat the full vaccine course and recheck; if still a non-responder, give HBIG after any exposure. — Anti-HBs of 100 or more indicates a good response; 10–99 is a suboptimal response needing a booster dose.

Question 13

Hepatitis C: screen with ______, then confirm active infection with HCV RNA (PCR).

Accepted Answer

anti-HCV antibody — Antibody stays positive after clearance or cure, so RNA is needed to show current infection. Test RNA directly if immunocompromised or acute infection is suspected.

Question 14

Hepatitis C: screen with anti-HCV antibody, then confirm active infection with ______.

Accepted Answer

HCV RNA (PCR) — Antibody stays positive after clearance or cure, so RNA is needed to show current infection. Test RNA directly if immunocompromised or acute infection is suspected.

Question 15

What is the modern treatment for chronic hepatitis C, and how is cure defined?

Accepted Answer

A pangenotypic direct-acting antiviral combination (e.g. sofosbuvir/velpatasvir for 12 weeks or glecaprevir/pibrentasvir for 8 weeks); cure = SVR12, undetectable HCV RNA 12 weeks after finishing. — DAAs cure about 95% of patients; interferon and ribavirin are now rarely used.

Question 16

Sofosbuvir is a nucleotide inhibitor of the HCV ______; velpatasvir and ledipasvir inhibit NS5A.

Accepted Answer

NS5B RNA-dependent RNA polymerase — Combining drugs that hit different viral proteins prevents resistance. NS3/4A protease inhibitors (e.g. grazoprevir, glecaprevir) are a third class.

Question 17

Sofosbuvir is a nucleotide inhibitor of the HCV NS5B RNA-dependent RNA polymerase; velpatasvir and ledipasvir inhibit ______.

Accepted Answer

NS5A — Combining drugs that hit different viral proteins prevents resistance. NS3/4A protease inhibitors (e.g. grazoprevir, glecaprevir) are a third class.

Question 18

Which antiarrhythmic must not be combined with sofosbuvir-containing regimens, and why?

Accepted Answer

Amiodarone – risk of severe, sometimes fatal, bradycardia and heart block. — The mechanism is not fully understood. If unavoidable, it needs specialist advice and close cardiac monitoring.

Question 19

Which renal lesion is classically associated with hepatitis C infection?

Accepted Answer

Membranoproliferative glomerulonephritis (often with mixed cryoglobulinaemia). — Immune complexes and cryoglobulins deposit in glomeruli. Other extrahepatic links: porphyria cutanea tarda, lichen planus, Sjögren's, insulin resistance.

Viral hepatitis flashcards

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