[MCQ] Acute viral hepatitis- Part 3

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Acute viral hepatitis- Part 3

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Congratulations - you have completed Acute viral hepatitis- Part 3. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

After infection with HBV, the first virologic marker detectable in serum is ?

A	HBsAg
B	HBeAg
C	HBcAg
D	HBxAg

Question 1 Explanation:

Upon HBV infection, the first virologic marker detectable in serum within 1-12 weeks, usually between 8-12 weeks is HBsAg.

Question 2

Of the following antibodies against HBV, which one is first to appear ?

A	Anti-HBc
B	Anti-HBs
C	Anti-HBe
D	None of the above

Question 3

Of the following antibodies against HBV, which one is detected last ?

A	Anti-HBc
B	Anti-HBs
C	Anti-HBe
D	None of the above

Question 3 Explanation:

Of the 3 antibodies against HBV, anti-HBc develops first, whereas anti-HBs antibody is detected last. Anti-HBc appears in serum within the first 1 - 2 weeks after appearance of HBsAg & preceding anti-HBs by weeks to months. Anti-HBs becomes detectable after HBsAg disappears in serum and remains detectable indefinitely thereafter

Question 4

Which of the following about HBsAg in acute HBV infection is false ?

A	Precedes rise in ALT
B	Precedes clinical symptoms
C	Detectable during entire icteric phase
D	Rarely persists beyond 3 months

Question 4 Explanation:

Circulating HBsAg precedes rise in serum aminotransferase levels & clinical symptoms by 2-6 weeks and remains detectable during the entire icteric phase of acute hepatitis B and beyond. HBsAg becomes undetectable 1-2 months after onset of jaundice & rarely persists beyond 6 months

Question 5

Which of the following about serology in acute HBV infection is false ?

A	Anti-HBs appears after HBsAg disappears
B	Anti-HBs remains detectable indefinitely
C	Anti-HBs precedes appearance of anti-HBc
D	HBeAg appears with HBsAg

Question 5 Explanation:

After HBsAg disappears, antibody to HBsAg (anti-HBs) becomes detectable in serum & remains detectable indefinitely. HBcAg naked core particles do not circulate in serum & therefore, HBcAg is not detectable routinely in serum of patients with HBV infection. Anti-HBc is readily demonstrable in serum, beginning within first 1-2 weeks after appearance of HBsAg & preceding detectable levels of anti-HBs by weeks to months. HBeAg appears concurrently with or shortly after HBsAg

Question 6

Which of the following is true during “gap” or “window” period in acute HBV infection ?

A	Absence of HBsAg
B	Absence of anti-HBs
C	Presence of IgM anti-HBc
D	All of the above

Question 6 Explanation:

At times a gap of several weeks or longer may separate disappearance of HBsAg & appearance of anti-HBs. During this “gap” or “window” period, anti-HBc may be the only serologic evidence of current or recent HBV infection & blood containing IgM anti-HBc in the absence of HBsAg & anti-HBs has been implicated in development of transfusion-associated hepatitis B. HBV DNA may be low or undetected

Question 7

Presence of which of the following represents hepatitis B infection in remote past ?

A	Anti-HBc
B	Anti-HBs
C	Anti-HBe
D	Any of the above

Question 7 Explanation:

Isolated anti-HBc represent hepatitis B infection in the remote past. IgM anti-HBc predominates during the first six months after acute infection, whereas IgG anti-HBc persists beyond six months. Generally, in persons who have recovered from hepatitis B, anti-HBs and anti-HBc persist indefinitely

Question 8

Isolated presence of which of the following suggests hepatitis B infection in remote past ?

A	HBsAg
B	Anti-HBs
C	IgM anti-HBc
D	IgG anti-HBc

Question 8 Explanation:

After HBV infection, anti-HBc may persist in circulation longer than anti-HBs. Isolated anti-HBc does not indicate active virus replication but indicates HBV infection in remote past.

Question 9

Recent and remote HBV infections can be distinguished by determination of ?

A	Anti-HBs
B	IgM anti-HBc
C	IgG anti-HBc
D	All of the above

Question 9 Explanation:

IgM anti-HBc predominates in first 6 months after acute infection, whereas IgG anti-HBc predominates beyond 6 months. In persons who have recovered from hepatitis B, anti-HBs & anti-HBc persist indefinitely.

Question 10

Which of the following genotype of HBV is frequent in India ?

A	A
B	B
C	C
D	Any of the above

Question 11

Which of the following is false about the serology in first stage of HBV patient ?

A	Presence of HBsAg
B	Presence of HBeAg
C	Presence of anti-HBs antibody
D	Presence of IgM anti-HBc antibody

Question 11 Explanation:

First stage of HBV infection is characterized by presence of HBsAg, HBeAg, and IgM class of antiHBc antibodies. In intermediate stage, patients lose HBeAg, develop anti-HBe antibodies & enter into clinical remission. Finally, loss of HBsAg & rise of the anti-HBs antibody indicate recovery from infection.

Question 12

Which of the following is false about expression of core protein and HBeAg ?

A	Core protein is translated from pregenomic mRNA, using the ATG codon at 1901 as initiation site
B	HBeAg is translated from precore mRNA, using ATG at 1814
C	G1896A nonsense mutation in precore region specifically prevents translation of HBeAg
D	None of the above

Question 12 Explanation:

Core protein is translated from pregenomic mRNA, using the ATG codon at 1901 as initiation site. HBeAg is translated from the precore mRNA, using ATG at 1814. G1896A nonsense mutation in the precore region specifically prevents translation of HBeAg

Question 13

HBeAg differs from HBcAg by a ?

A	Longer N-terminus and longer C-terminal tail
B	Shorter N-terminus and shorter C-terminal tail
C	Shorter N-terminus and longer C-terminal tail
D	Longer N-terminus and shorter C-terminal tail

Question 13 Explanation:

HBeAg differs from core protein (HBcAg) by a longer N-terminus and shorter C-terminal tail.

Question 14

Which of the following statements about HBV is false ?

A	HBeAg is not part of the virus particle
B	Anti-HBc antibody rises soon after infection
C	HBeAg expression is not essential for virus replication
D	None of the above

Question 15

HBeAg-negative chronic hepatitis B or e-CHB is characterised by all except ?

A	HBsAg-positive for at least 6 months
B	HBeAg-positive
C	Anti-HBe-positive
D	HBV DNA detectable in serum unamplified assays

Question 15 Explanation:

e-CHB or HBeAg-negative chronic hepatitis B patients are HBsAg-positive for at least 6 months, HBeAgnegative, anti-HBe-positive, with HBV DNA detectable in serum unamplified assays, and active liver disease (elevated AST or ALT, liver histology showing chronic hepatitis with or without cirrhosis

Question 16

Which of the following is expressed during periods of peak replication ?

A	HBeAg
B	Pre-S1 proteins
C	Pre-S2 proteins
D	All of the above

Question 16 Explanation:

HBeAg, appears concurrently with or shortly after HBsAg and its appearance coincides expression of pre-S1 and pre-S2 proteins marking high levels of virus replication and presence of circulating intact virions and detectable HBV DNA

Question 17

Which of the following is the qualitative marker of the replicative stage of HBV infection ?

A	HBsAg
B	HBcAg
C	HBeAg
D	HBxAg

Question 17 Explanation:

Replicative stage of HBV infection is the time of maximal infectivity & liver injury. HBeAg is a qualitative marker & HBV DNA a quantitative marker of replicative phase, during which all three forms of HBV circulate, including intact virions.

Question 18

Replicative phase of chronic HBV infection converts to relatively nonreplicative phase at a rate of ?

A	10 % per year
B	20 % per year
C	30 % per year
D	40 % per year

Question 18 Explanation:

Replicative phase of chronic HBV infection converts to a relatively nonreplicative phase at a rate of 10% per year accompanied by seroconversion from HBeAg-positive to anti-HBe-positive

Question 19

Seroconversion from HBeAg-positive to anti-HBe-positive is accompanied by which of the following ?

A	Acute elevation in aminotransferase activity
B	Hemoglobinuria
C	Anemia
D	All of the above

Question 19 Explanation:

Seroconversion from HBeAg-positive to anti-HBe-positive is accompanied by a transient, acute hepatitis-like elevation in aminotransferase activity, believed to reflect cell-mediated immune clearance of virus-infected hepatocytes

Question 20

Spontaneous reactivation of replicative HBV infection from nonreplicative phase is marked by which of the following ?

A	Re-expression of HBeAg
B	Re-expression of HBV DNA
C	Reappearance of IgM anti-HBc
D	All of the above

Question 20 Explanation:

Spontaneous reactivations i.e. nonreplicative HBV infection converting back to replicative infection is accompanied by re-expression of HBeAg and HBV DNA, IgM anti-HBc and exacerbations of liver injury

Question 21

HBV infections is self-limited if ?

A	HBeAg becomes undetectable after peak rise in ALT
B	HBeAg becomes undetectable before disappearance of HBsAg
C	Anti-HBe becomes detectable before disappearance of HBsAg
D	All of the above

Question 22

Which of the following about HBeAg in acute HBV infection is false ?

A	Appears with HBsAg
B	Appearance coincides with high viral replication
C	Undetectable after peak rise in ALT
D	Undetectable after disappearance of HBsAg

Question 22 Explanation:

HBeAg presence coincides with high levels of virus replication and reflects the presence of circulating intact virions and detectable HBV DNA. In self-limited HBV infections, HBeAg becomes undetectable shortly after peak elevations in aminotransferase activity, before the disappearance of HBsAg, and anti-HBe then becomes detectable, coinciding with a period of relatively lower infectivity.

Question 23

Which of the following about chronic HBV infection is false ?

A	HBsAg detectable > 6 months
B	IgG anti-HBc present
C	Anti-HBs low to absent
D	None of the above

Question 23 Explanation:

In chronic HBV infection, HBsAg remains detectable beyond 6 months, anti-HBc is primarily of the IgG class, and anti-HBs is either undetectable or detectable at low levels.

Question 24

Replicative chronic hepatitis B in the absence of HBeAg occurs in which of the following situations ?

A	Patients with core mutations
B	Patients with precore mutations
C	Patients with pre S1 mutations
D	Patients with pre S2 mutations

Question 24 Explanation:

Replicative chronic hepatitis B in the absence of HBeAg occurs in patients with precore mutations who cannot synthesize HBeAg

Question 25

HBeAg-negative chronic hepatitis with mutations in the precore region is now the most frequently encountered form of hepatitis B in which region of the world ?

A	North America
B	South America
C	Mediterranean countries
D	Southeast Asia

Question 25 Explanation:

HBeAg-negative chronic hepatitis with mutations in the precore region is now the most frequently encountered form of hepatitis B in Mediterranean countries and in Europe.

Question 26

Which of the following is false about severe chronic HBV infection due to precore region HBV mutant ?

A	Detectable HBV DNA
B	HBeAg negative
C	Anti-HBe positive
D	None of the above

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See all quizzes of Acute viral hepatitis at here:

1. After infection with HBV, the first virologic marker detectable
in serum is ?
A. HBsAg
B. HBeAg
C. HBcAg
D. HBxAg

2. Of the following antibodies against HBV, which one is first to
appear ?
A. Anti-HBc
B. Anti-HBs
C. Anti-HBe
D. None of the above
3. Of the following antibodies against HBV, which one is detected
last ?
A. Anti-HBc
B. Anti-HBs
C. Anti-HBe
D. None of the above

4. Which of the following about HBsAg in acute HBV infection is
false ?
A. Precedes rise in ALT
B. Precedes clinical symptoms
C. Detectable during entire icteric phase
D. Rarely persists beyond 3 months

5. Which of the following about serology in acute HBV infection
is false ?
A. Anti-HBs appears after HBsAg disappears
B. Anti-HBs remains detectable indefinitely
C. Anti-HBs precedes appearance of anti-HBc
D. HBeAg appears with HBsAg

6. Which of the following is true during “gap” or “window” period
in acute HBV infection ?
A. Absence of HBsAg
B. Absence of anti-HBs
C. Presence of IgM anti-HBc
D. All of the above

7. Presence of which of the following represents hepatitis B
infection in remote past ?
A. Anti-HBc
B. Anti-HBs
C. Anti-HBe
D. Any of the above

8. Isolated presence of which of the following suggests hepatitis
B infection in remote past ?
A. HBsAg
B. Anti-HBs
C. IgM anti-HBc
D. IgG anti-HBc

9. Recent and remote HBV infections can be distinguished by
determination of ?
A. Anti-HBs
B. IgM anti-HBc
C. IgG anti-HBc
D. All of the above

10. Which of the following genotype of HBV is frequent in India ?
A. A
B. B
C. C
D. Any of the above
11. Which of the following is false about the serology in first stage
of HBV patient ?
A. Presence of HBsAg
B. Presence of HBeAg
C. Presence of anti-HBs antibody
D. Presence of IgM anti-HBc antibody

12. Which of the following is false about expression of core protein
and HBeAg ?
A. Core protein is translated from pregenomic mRNA, using
the ATG codon at 1901 as initiation site
B. HBeAg is translated from precore mRNA, using ATG at 1814
C. G1896A nonsense mutation in precore region specifically
prevents translation of HBeAg
D. None of the above

13. HBeAg differs from HBcAg by a ?
A. Longer N-terminus and longer C-terminal tail
B. Shorter N-terminus and shorter C-terminal tail
C. Shorter N-terminus and longer C-terminal tail
D. Longer N-terminus and shorter C-terminal tail
.
14. Which of the following statements about HBV is false ?
A. HBeAg is not part of the virus particle
B. Anti-HBc antibody rises soon after infection
C. HBeAg expression is not essential for virus replication
D. None of the above
15. HBeAg-negative chronic hepatitis B or e-CHB is characterised
by all except ?
A. HBsAg-positive for at least 6 months
B. HBeAg-positive

16. Which of the following is expressed during periods of peak
replication ?
A. HBeAg
B. Pre-S1 proteins
C. Pre-S2 proteins
D. All of the above

17. Which of the following is the qualitative marker of the
replicative stage of HBV infection ?
A. HBsAg
B. HBcAg
C. HBeAg
D. HBxAg

18. Replicative phase of chronic HBV infection converts to
relatively nonreplicative phase at a rate of ?
Harrison’s 18th Ed. 2541
A. 10 % per year
B. 20 % per year
C. 30 % per year
D. 40 % per year

19.Seroconversion from HBeAg-positive to anti-HBe-positive is
accompanied by which of the following ?
A. Acute elevation in aminotransferase activity
B. Hemoglobinuria
C. Anemia
D. All of the above

20. Spontaneous reactivation of replicative HBV infection from
nonreplicative phase is marked by which of the following ?
A. Re-expression of HBeAg
B. Re-expression of HBV DNA
C. Reappearance of IgM anti-HBc
D. All of the above

21. HBV infections is self-limited if ?
A. HBeAg becomes undetectable after peak rise in ALT
B. HBeAg becomes undetectable before disappearance of HBsAg
C. Anti-HBe becomes detectable before disappearance of HBsAg
D. All of the above
22. Which of the following about HBeAg in acute HBV infection is
false ?
A. Appears with HBsAg
B. Appearance coincides with high viral replication
C. Undetectable after peak rise in ALT
D. Undetectable after disappearance of HBsAg

23. Which of the following about chronic HBV infection is false ?
A. HBsAg detectable > 6 months
B. IgG anti-HBc present
C. Anti-HBs low to absent
D. None of the above

24. Replicative chronic hepatitis B in the absence of HBeAg occurs
in which of the following situations ?
A. Patients with core mutations
B. Patients with precore mutations
C. Patients with pre S1 mutations
D. Patients with pre S2 mutations

25. HBeAg-negative chronic hepatitis with mutations in the precore
region is now the most frequently encountered form of hepatitis
B in which region of the world ?
A. North America
B. South America
C. Mediterranean countries
D. Southeast Asia

26. Which of the following is false about severe chronic HBV
infection due to precore region HBV mutant ?
A. Detectable HBV DNA
B. HBeAg negative
C. Anti-HBe positive
D. None of the above

Acute viral hepatitis

[MCQ] Acute viral hepatitis- Part 3

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Acute viral hepatitis- Part 3

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