Course: Microbiology Topic: Hepatitis Virus, Hepatitis, Hepatitis A, Hepatitis C, Hepatitis B, Hepatitis D, Hepatitis B Virus, Hepatitis E, Hepatitis B, D, Hepatitis B, C, D

Question 1

Select the single best answer to the numbered question.

Which of the following are FALSE regarding hepatitis C virus:


A. may be transmitted in utero or at the time of birth from an infected mother.
B. may cause a chronic infection.
C. is an enveloped RNA virus.
D. is routinely assayed for in blood transfused in the U.S.
E. is a member of the paramyxovirus family.
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Question 2

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Which of the following statements about the structure of hepatitis B virus is FALSE?


A. Virus proteins on the HBV envelope are known as surface antigens (HBsAg).
B. Hepatitis B virus nucleocapsid contains the core antigen (HBcAg).
C. Hepatitis B virus e antigen is a derivative of the core antigen.
D. A serum positive for HBcAg is almost always positive for the DNA polymerase.
E. The 20 nm particles present in blood in great abundance are the infectious HepB virions.
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Question 3

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Hepatitis D virus:


A. is included in the current hepatitis B vaccine.
B. uses the HBV capsid and therefore can be diagnosed only by nucleotide sequence data.
C. contains a circular ss RNA as its genome.
D. infection always leads to chronic hepatitis.
E. is not preventable.
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Question 4

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RNA viruses cause all the diseases listed below EXCEPT:


A. dengue.
B. SARS.
C. Ebola.
D. Hepatitis B.
E. mumps.
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Question 5

Select the single best answer to the numbered question.

A DNA virus that has an RNA genomic intermediate:


A. hepatitis B virus.
B. rotavirus.
C. herpes simplex virus.
D. retrovirus.
E. papillomaviruses.
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Question 6

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All of the following statements about hepatitis B virus are true, EXCEPT:


A. All hepatitis B virus carriers have antibodies to HBcAg.
B. Hepatitis B carriers with circulating HBeAg are more likely to suffer liver damage.
C. Passive immunization with hepatitis B immune globulin will prevent active disease.
D. Active immunization with cloned HBcAg appears to be very effective in preventing disease.
E. HBeAg is a truncated form of HBcAg.
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Question 7

Select the best answer(s) to the numbered question. In some cases, more than one answer may be correct. Dont be afraid to try all the answers. Perhaps the reason an answer is wrong is not the reason you suspected.

Which of the following statements is/are true for hepatitis B in the United States?


A. It is estimated that there are 300,000 new cases each year.
B. Six to ten percent of these will become chronic carriers.
C. 6,000 to 8,000 new HBV infections occur in health-care workers annually.
D. There are about one million HBV carriers in the U. S.
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Question 8

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All the following statements about viral hepatitis are true, EXCEPT:


A. Hepatitis A and hepatitis E are transmitted primarily via the fecal-oral route.
B. An effective, killed vaccine is available for hepatitis C.
C. Hepatitis A virus produces acute but not chronic hepatitis.
D. Hepatitis D can only affect persons co-infected with hepatitis B.
E. Hepatitis B is no longer an important cause of post-transfusion hepatitis.
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Question 9

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Which of the following is a widely-used vaccine that is a laboratory-prepared single protein (subunit) vaccine in which the viral antigen is expressed in yeast cells?


A. Respiratory syncytial virus vaccine
B. Hepatitis B vaccine
C. Sabin polio vaccine
D. Rubella vaccine
E. Salk polio vaccine
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Question 10

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Which of the following statements about hepatitis B virus pathogenesis is FALSE?


A. Chronic infection by HBV is probably due to an inadequate immune response to the primary infection.
B. The basic pathology of HBV is hepatocellular damage and formation of intravascular immune complexes.
C. HBV kills hepatocytes by interfering with the synthesis of proteins and mRNA.
D. HBV DNA may become integrated into the host cell genome.
E. HBV DNA is replicated by reverse transcription in the cytoplasm of an infected cell.
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Question 11

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Chronic infection by HBV:


A. occurs in over 90% of acute infections.
B. results in continuous production of infectious virus.
C. occurs with reduced frequency when HBV is acquired as a perinatal infection.
D. never resolves spontaneously.
E. all of the above.
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Question 12

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Hepatitus delta virus (HDV):


A. encapsidates its genome using the hepatitis B virus core protein.
B. uses the hepatitis B virus RNA dependent DNA polymerase for genome replication.
C. encapsidates its genome using the hepatitis B virus surface protein.
D. establishes a chronic infection in the absence of hepatitis B virus.
E. provides an essential helper function for hepatitis B virus replication.
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Question 13

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Which of the following is true concerning hepatitis C virus?


A. Majority of people infected develop chronic infection.
B. Virus is spread by the fecal-oral route and causes explosive epidemics.
C. Initial clinical symptoms are usually more severe than with hepatitis B virus.
D. Effective subunit vaccine is now available.
E. Virus is easy to grow in cell culture.
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Question 14

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The most severe infections with hepatitis A are seen in which of the following?


A. Infants
B. Children
C. Adults
D. Pregnant women
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Question 15

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Viral RNA is detected by RT-PCR techniques in blood of patient several years after the initial infection with this virus.


A. Hantavirus
B. Hepatitis B virus
C. Hepatitis C virus
D. Hepatitis delta virus
E. Hepatitis E virus
F. Rotavirus
G. Norwalk virus
H. Measles virus
I. Herpes simplex virus
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Question 16

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Your patient develops clinical symptoms characteristic of hepatitis shortly after returning from a trip to several Asian countries. The most likely infecting agent is:


A. Hantavirus
B. Hepatitis B virus
C. Hepatitis C virus
D. Delta hepatitis virus
E. Hepatitis E virus
F. Rota virus
G. Norwalk virus
H. Measles virus
I. Hepes simplex virus
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Question 17

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Which virus is most likely to be involved in hepatocellular carcinoma (HCC)?


A. Papillomavirus
B. HTLV-1
C. Hepatitis B Virus
D. Epstein-Barr Virus
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Question 18

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To establish a persistent infection, a virus must evade the immune system. How is this accomplished by HBV?


A. Latent infection in nerve cells
B. Latent infection in lymph nodes, particularly adenoids, and down-modulation of MHC.
C. Latency in macrophages and non-activated T-cells.
D. Latent infection in hepatocytes and production of excess viral proteins as decoys.
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Question 19

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Hepatitis B Virus, a dsDNA virus, contains a complete minus strand and a plus strand which is often only 50-80% complete. When in the virus life cycle are the missing regions in the plus-strand synthesized?


A. Within the Dane particle prior to infection of a new host cell.
B. As soon as the virion uncoats in a new host cell.
C. As soon as the virion is transported into the host cell nucleus.
D. Within the Golgi during acquisition of the virion’s envelope.
E. Immediately after reverse transcriptase synthesizes a minus-sense DNA strand from the RNA template.
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Question 20

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An enterprising young medical student has offered to do all of the blood draws for his patients while he is on service. That afternoon, while drawing blood from a chronic HCV patient, he accidentally sticks himself with the needle he used to draw the lab sample. What is his chance of becoming infected from this single needle stick?


A. 90%
B. 50%
C. 20%
D. 3%
E. 0.1%
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Question 21

Select the single best answer to the numbered question.

Which of these hepatitis viruses replicates it’s genome in the nucleus of the host hepatocyte?


A. HAV
B. HBV
C. HCV
D. HDV
E. HEV
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Question 22

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Who is at least risk for HCV infection?


A. 35 y/o female who abuses IV drugs
B. 38 y/o male who has unprotected intercourse with multiple partners
C. 30 y/o hemophiliac
D. 15 y/o hemophiliac
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Question 23

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A patient of your’s who you have recently informed is among the 85% of acute HCV infections who progress to persistent infection ask you what long term health problems their HCV status will cause


A. Cirrhosis
B. Liver Failure
C. Hepatocellular carcinoma
D. type II Diabetes
E. A,B,and C
F. all of the above
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Question 24

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How does the clinical course of Hepatitis A in children differ from the clinical course in adults?


A. 80-95% of children have jaundice on clinical exam
B. Adults are unlikely to have a complete resolution of their infection.
C. 80-95% of children progress to chronic disease
D. Adults are more likely than children to have a subclinical infection
E. 80-95% of children have a subclinical infection
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Question 25

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An unruly college student has gone on summertime adventure to China. He comes to your clinic as soon as he returns from Shanghai with a three week history of worsening nausea, vomiting, and jaundice. During his trip, he toured the countryside, enjoyed the many seafood and vegetable dishes locally available, had multiple sexual partners, and occasionally used IV drugs. Which of these activities would put him at risk for Hepatitis A?


A. touring the countryside
B. seafood and vegetable dishes
C. multiple sexual partners
D. IV drug use
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Question 26

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A 55y/o patient with known chronic HBV infection presents to the hospital with acutely worsening symptoms of hepatitis (jaundice, right sided tenderness, nausea, vomiting, fatigue). You suspect you know what has caused this patient’s acute change. What one serologic marker would you choose to use?


A. anti-HAV IgM
B. HBeAg
C. Anti-HCV
D. delta antigen
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Question 27

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In a patient with acute HBV infection, coinfection with HDV results in:


A. decreased severity of disease
B. no change in the severity of HBV infection
C. increased rate of fulminant hepatitis
D. increased rate of fulminant hepatitis but decreased rate of progression to chronic, carrier status
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Question 28

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Hepatitis D requires coinfection with Hepatitis B in order to infect a host’s hepatocytes. What part of Hepatitis B virus’s infectious machinery does Hepatitis D require?


A. HDV uses HBV’s S-glycoprotein in it’s membrane to facilitate cell entry
B. HDV incorporates HbcAg into it’s icosohedral capsid
C. HDV pathogenicity is facilitated by HBV’s Australia Antigen (HBsAg particles)
D. HDV’s gene’s are activated by HBV’s protein X
E. HDV requires HBV’s gene for DNA polymerase in order to replicate.
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Question 29

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A 20 y/o male hemophiliac presents to your emergency room complaining of 3 month progressive fatigue, nausea, and fever. On physical exam you note right-sided tenderness and a significantly enlarged liver. Given his history of multiple blood transfusions in the past, you are concerned for hepatitis. What serologies would you send for?


A. HBsAg, HBeAg, Anti-HBc IgM
B. HBsAg, HBeAg, Anti-HBcAg IgM, HCV RNA, anti-HDV
C. HBsAg, HBeAg, Anti-HBcAg IgM, HCV RNA
D. HBsAg, HBeAg, Anti-HBcAg IgM, anti-HDV
E. HCV RNA, anti-HDV
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Question 30

Select the single best answer to the numbered question.

Which of these viruses can cause hepatitis?


A. CMV
B. HAV
C. EBV
D. HSV
E. yellow fever
F. b and c
G. all of the above
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Question 31

Select the single best answer to the numbered question.

Once the HBV capsid has been created with the host cell, what are the genomic contents within the viral capsid?


A. +ssRNA
B. -ssRNA
C. dsRNA
D. dsDNA
E. minus-strand DNA
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Question 32

Select the single best answer to the numbered question.

A nurse working at UVA is tested for hepatitis and is found to be anti-HBsAg positive and e-antigen positive. Choose the correct statement:


A. As per hospital regulation, she has been vaccinated to HBV
B. She likely has chronic HBV and coinfection with HDV
C. She is infected and has active hepatits
D. She is a chronic HBV carrier
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Question 33

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How should we treat a pregnant, chronic HBV infected mother and her baby in order to minimize vertical transmission?


A. Treat the mother with lamivudine and HB immune globulin during her pregnancy.
B. Vaccinate the neonate within two days postpartum
C. Vaccinate the neonate within two days postpartum and treat with lamivudine
D. Vaccinate the neonate within two days postpartum and also treat with HB immune globulin promptly after birth.
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Question 34

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Adult patients who are infected with HBV have a __ % chance of clearing an infection without sequelae while newborns who are infected with HBV have a __ % chance of clearing the infection without sequelae.


A. 5% and 95% respectively
B. 50% and 50% respectively
C. 95% and 5% respectively
D. both 95%
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Question 35

Select the single best answer to the numbered question.

What is the only positive marker for HBV during the "window phase"? (there are two correct answers)


A. Anti-HBcAg
B. HBcAg
C. Anti-HBsAg
D. HBsAg
E. Anti-HBeAg
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Question 36

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What entry-site does Hepatitis B virus use to infect a host?


A. respiratory epithelial srufaces
B. gastrointestinal epithelial surfaces
C. direct, parenteral transmission
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Question 37

Select the single best answer to the numbered question.

What is a neonate's risk of chronic Hepatitis B infection if his/her mother had chronic HBV infection while pregnant?


A. 20%
B. 50%
C. 90%
D. 99%
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Question 38

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You are seeing patients in a physicians outpatient practice as a third year medical student. On glancing at the chart of your next patient, you notice that she had an acute HBV infection 4 years ago which was confirmed by serologies. If she has completely cleared the infection, what would her hepatitis B serology panel look like today?


A. (-) Anti-HBs,(+) HBsAg, (+) Anti-HBc, (-) Anti-HBe, (+) HBeAg
B. (+) Anti-HBs,(-) HBsAg, (+) Anti-HBc, (-) Anti-HBe, (-) HBeAg
C. (+) Anti-HBs,(-) HBsAg, (-) Anti-HBc, (-) Anti-HBe, (-) HBeAg
D. (-) Anti-HBs,(+) HBsAg, (+) Anti-HBc, (-) Anti-HBe, (+) HBeAg
E. (-) Anti-HBs,(+) HBsAg, (-) Anti-HBc, (-) Anti-HBe, (-) HBeAg
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Question 39

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A 28 y/o IV drug user returns to your clinic two months after initially presenting to you with a several week history of worsening fever, fatigue, lack of appetite, and a change in the color of his skin and eyes. Today his symptoms are resolved. Two months ago, you made the diagnosis of acute hepatitis B infection based on the history and positive HBsAG and HBeAg serum titers with negative Anti-HBsAg levels. If you were to retest tihs individual today, two months after his initial presention, what serologic markers would be positive?


A. Anti-HBsAg
B. HBsAg
C. Anti-HBeAg
D. HBeAg
E. Anti-HBcAg
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Question 40

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A 28 y/o male IV drug user presents to your clinic complaining of a two month history of worsening fever, fatigue, and lack of appetite. He also describes pain in his right side and a change in the color of his skin and eyes. What serum markers would be elevated in the acute phases of this illness?


A. Anti-HBeAg
B. HBeAg
C. Anti-HBsAg
D. HBsAg
E. A & B
F. B&D
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