Hepatitis E and Hepatitis D

Hepatitis E and Hepatitis D

Q. 1

Non-parenteral hepatitis is :

 A

Hepatitis E

 B

Hep B

 C

Hep C

 D

Hep D

Q. 1

Non-parenteral hepatitis is :

 A

Hepatitis E

 B

Hep B

 C

Hep C

 D

Hep D

Ans. A

Explanation:

Answer is A (Hepatitis E)

Hepatitis B, C and D are essentially spread by parenteral routes.

Hepatitis A & E are non parenteral hepatitis.


Q. 2

Which of the following Hepatitis has worst prognosis

 A

HBV Infection

 B

HDV Infection

 C

HBV – HDV Coinfection

 D

HDV super- infection on HBV

Q. 2

Which of the following Hepatitis has worst prognosis

 A

HBV Infection

 B

HDV Infection

 C

HBV – HDV Coinfection

 D

HDV super- infection on HBV

Ans. D

Explanation:

Answer is D (HDV super-infection on HBV):

HDV superinfection of a person with chronic Hepatitis B (HBV) has the worst prognosis with high likelihood of fulminant hepatitis and death.

Among patients ill enough to be hospitalized for acute hepatitis B infection the case finality rate is 1%. Patients with simultaneous acute hepatitis B and hepatitis D do not necessarily experience a higher mortality rate than do patients with acute hepatis B alone, however in several recent outbreaks of acute simultaneous HBV and HDV infection amongst injection drug users the case fatality rate has been – 5%. In the case of HDV super infection of a person with chronic hepatitis B, the likelihood offuhninant hepatitis and death is increased substantially. In out breaks of severe HDV super infection in isolated populations with a high hepatitis B carrier state the mortality has been recorded in excess of 20% – Harrison’s 1e/2552

Prognosis in HBV Infection

Acute HBV infection simultaneous HBV– HDV confection << HDV super-infection on HBV infection (Best prognosis)  (worst prognosis)


Q. 3

True regarding hepatitis E virus is:

 A

Seen in Post transfusion cases

 B

Associated with increased mortality in pregnant female

 C

Associated with hepatitis B virus

 D

All

Q. 3

True regarding hepatitis E virus is:

 A

Seen in Post transfusion cases

 B

Associated with increased mortality in pregnant female

 C

Associated with hepatitis B virus

 D

All

Ans. B

Explanation:

Answer is B (Associated with increased mortality in pregnant women)

Hepatitis E is associated with increased mortality in pregnant women and is acquired by fecooral route.

Hepatitis E is not associated with transfusion with Hepatitis B virus infection.

Most common virus associated with transfusion associated hepatitis is HCV

Hepatitis E is associated with increased mortality in pregnant females

A unique feature of Hepatitis E virus is the clinical severity and high case fatality rate of 20-40% in pregnant women, especially in the last trimester of pregnancy.

Hepatitis D is associated with Hepatitis B infection and not Hepatitis E


Q. 4

The most common route of spread in hepatitis E is:

 A

Blood transfusion

 B

Feco-oral

 C

Intercourse

 D

IV injection

Q. 4

The most common route of spread in hepatitis E is:

 A

Blood transfusion

 B

Feco-oral

 C

Intercourse

 D

IV injection

Ans. B

Explanation:

Answer is B (Feco-oral)

Hepatitis E is synonymous with Enterically transmitted non-A non-B Hepatitis.

The infection caused by hepatitis E is essentially a water borne disease- Water or Food supplies, contaminated with feces in which the virus is excreted, have been implicated in major outbreaks reported in all parts of the world


Q. 5

Which hepatitis virus has worst prognosis in pregnancy :

 A

HBV

 B

HCV

 C

HEV

 D

HAV

Q. 5

Which hepatitis virus has worst prognosis in pregnancy :

 A

HBV

 B

HCV

 C

HEV

 D

HAV

Ans. C

Explanation:

Answer is C (HEV)


Q. 6

Most common type of hepatitis responsible for epidemics in India is :

 A

Hepatitis A

 B

Hepatitis B

 C

Hepatitis C

 D

Hepatitis E

Q. 6

Most common type of hepatitis responsible for epidemics in India is :

 A

Hepatitis A

 B

Hepatitis B

 C

Hepatitis C

 D

Hepatitis E

Ans. D

Explanation:

Answer is D (Hepatitis E)

Epidemics are almost exclusively caused by enterically transmitted NONA NON B Hepatitis virus – i.e. Hepatitis E. – Park

Sporadic cases :

Most common cause of sporadic cases in adults is – Hepatitis E Q

Most common cause of sporadic cases in children is – Hepatitis A. Q


Q. 7

Most common cause of acute sporadic hepatitis in India is

 A

Hepatitis E

 B

Hepatitis B

 C

Hepatitis C

 D

Hepatitis D

Q. 7

Most common cause of acute sporadic hepatitis in India is

 A

Hepatitis E

 B

Hepatitis B

 C

Hepatitis C

 D

Hepatitis D

Ans. A

Explanation:

Answer is A (Hepatitis E)

The most common cause of acute sporadic hepatitis amongst adults in India is Hepatitis E.

‘In India HEV infection is the most common cause of acute sporadic hepatitis and account s far upto 70% of such cases amongst adults’ – Zokin & Boyer’s Hepatology

`Hepatitis E is the second leading cause of acute clinical hepatitis in adults in North African and the middle east (after Hepatitis B) and is the most common cause in Nepal, India and throughout central & south east Asia. – Schiff – Diseases of the Liver

`Hepatitis E is the most common cause of a sporadic and epidemic Hepatitis amongst adults in Asia (India) and the second most common cause amongst adults (after HBV) in the middle east and north Africa’

De Sweet’s Medical Disorder in Obstetric Practice

Hepatitis E (HEV)

  • Most common cause of sporadic Hepatitis amongst adults in India°
  • Most common cause of epidemic Hepatitis amongst adults in India°
  • Most common cause of Fulminant Hepatitis amongst pregnanat women°
  • Most common route of aquisition /transmission is ,fecoral route°

Q. 8

In an epidemic of hepatitis E, infection in which of the following carries a poor prognosis:           

March 2012

 A

Malnourished male

 B

Pregnant women

 C

Anaemic male

 D

Postmenopausal women

Q. 8

In an epidemic of hepatitis E, infection in which of the following carries a poor prognosis:           

March 2012

 A

Malnourished male

 B

Pregnant women

 C

Anaemic male

 D

Postmenopausal women

Ans. B

Explanation:

Ans: B i.e. Pregnant women

Hepatitis E differs from hepatitis A in that infection during pregnancy is associated with the development of acute liver failure, which has a high mortality rates


Q. 9

True about hepatitis E are all except:

September 2005, 2010

 A

Transmitted by faeco-oral route

 B

Majority of patients develops chronic infection

 C

Caused by non-enveloped, positive-sense, single stranded RNA genomic ,HAV like virus

 D

Fulminant hepatitis occurs more frequently in pregnancy

Q. 9

True about hepatitis E are all except:

September 2005, 2010

 A

Transmitted by faeco-oral route

 B

Majority of patients develops chronic infection

 C

Caused by non-enveloped, positive-sense, single stranded RNA genomic ,HAV like virus

 D

Fulminant hepatitis occurs more frequently in pregnancy

Ans. B

Explanation:

Ans. B: Majority of patients develops chronic infection

HEV is transmitted via the faecal-oral route.

It is caused by non-enveloped, positive-sense, single-stranded RNA genomic, HAV like virus.

Hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks. In general, hepatitis E is a self-limiting viral infection followed by recovery. Prolonged viraemia or faecal shedding are unusual and chronic infection does not occur.

Occasionally, a fulminant form of hepatitis develops, with overall patient population mortality rates ranging between 0.5 – 4.0%. Fulminant hepatitis occurs more frequently in pregnancy and regularly induces a mortality rate of 20% among pregnant women in the 3rd trimester.

Since cases of hepatitis E are not clinically distinguishable from other types of acute viral hepatitis, diagnosis is made by blood tests which detect elevated antibody levels of specific antibodies to hepatitis E in the body or by reverse transcriptase polymerase chain reaction (RT-PCR). Unfortunately, such tests are not widely available.


Q. 10

Pregnant lady presents with fulminant hepatitis. Most Common Cause:           

March 2005, September 2010

 A

Hepatitis D

 B

Hepatitis E

 C

Hepatitis B

 D

Hepatitis A

Q. 10

Pregnant lady presents with fulminant hepatitis. Most Common Cause:           

March 2005, September 2010

 A

Hepatitis D

 B

Hepatitis E

 C

Hepatitis B

 D

Hepatitis A

Ans. B

Explanation:

Ans. B: Hepatitis E

In general, hepatitis E is a self-limiting viral infection followed by recovery. Prolonged viraemia or faecal shedding are unusual.

Fulminant hepatitis occurs more frequently in pregnancy and regularly induces a mortality rate of 20% among pregnant women in the 3rd trimester. Perinatal transmission is uncommon.

Fulminant hepatitis is uncommon with hepatitis-C and rare with hepatitis-A.


Q. 11

Defective hepatitis virus is ‑

 A

HAV

 B

HBV

 C

HCV

 D

HDV

Q. 11

Defective hepatitis virus is ‑

 A

HAV

 B

HBV

 C

HCV

 D

HDV

Ans. D

Explanation:

Ans. is ‘d’ i.e., HDV

Hepatitis D (HDV) or Delta virus

  • It is defective RNA virus dependent on the helper function of HBV for its replication and expression.
  • It contains single stranded RNA (ssRNA) – Defective RNA.
  • It has no independent existence and can survive and replicate only as long as HBV infection persists in the host.
  • It resembles some plant viruses, such as viroids or satellite viruses.
  • It has been classified in genus Deltavirus.
  • Delta core of HDV is encapsidated by an outer envelope of HBs Ag, so it require cooperative function of HBV.
  • Intracellular replication of HDV RNA can occur without HBV but liver injury requires the presence of HBV.
  • HDV can cause two types of infection.

Q. 12

Hepatitis E usually affects ‑

 A

Children

 B

Adults

 C

Old age

 D

Toddlers

Q. 12

Hepatitis E usually affects ‑

 A

Children

 B

Adults

 C

Old age

 D

Toddlers

Ans. B

Explanation:

Ans. is `b’ i.e., Adults


Q. 13

Most common hepatitis virus in India 

 A

HAV

 B

HBV

 C

HCV

 D

HEV

Q. 13

Most common hepatitis virus in India 

 A

HAV

 B

HBV

 C

HCV

 D

HEV

Ans. D

Explanation:

Ans. is ‘d’ i.e., HEV 

  • Hepatitis A virus (HAV) and hepatitis E virus (HEV), both enterically transmitted, are highly endemic in India, HEV has been responsible for most of these epidemics.
  • In India, HEV infection is responsible for 30-70% of cases of acute sporadic hepatitis and is the major cause of acute liver failure.
  • Among children, HAV is the predominant cause of acute hepatitis, and dual infection with HAV and HEV have been more frequently reported among children with ALF.


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