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1 | |
A 49-year-old man comes to your office, requesting testing for hepatitis C. He recently attended his 25-year college reunion, where he heard from a mutual acquaintance that an old friend was seriously ill with cirrhosis due to hepatitis C. The patient became very concerned because he had "partied" with this friend during a brief period of experimentation with injection drugs while in college. The patient is otherwise healthy and denies any symptoms except for occasional fatigue after a long day at work. Physical examination of the patient is unremarkable. There are no stigmata of chronic liver disease.
Which of the following is the most appropriate course of action? |
| | A) | Check a quantitative HCV PCR ("viral load"). |
| | B) | Order a recombinant immunoblot assay (RIBA). |
| | C) | Order an HCV antibody test (enzyme immunoassay). |
| | D) | Order a qualitative HCV PCR. |
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2 | |
The patient returns several weeks later to discuss his test results. His HCV antibody test is positive. A liver panel obtained that day shows an ALT of 48 IU/L (normal range, 0-20) and an AST of 39 IU/L (0-31). His albumin and total bilirubin are within normal limits. He is extremely anxious about his liver, as he has been in contact with his old college friend and learned that his friend is now on the waiting list for a liver transplant.
You now recommend: |
| | A) | Liver-spleen scan to assess for evidence of cirrhosis. |
| | B) | Reassure the patient that his mild liver test abnormalities rule out cirrhosis. |
| | C) | Percutaneous liver biopsy. |
| | D) | Abdominal ultrasound with Doppler to assess for evidence of cirrhosis. |
| | E) | Abdominal CT to assess for evidence of cirrhosis. |
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3 | |
The patient agrees to a liver biopsy, which is scheduled for the following week. Nonetheless, he is still very concerned about his situation and asks what you think the chances are that he already has cirrhosis.
Regarding the development of progressive liver disease in hepatitis C, all of the following are true EXCEPT: |
| | A) | Approximately 20% of patients with chronic HCV infection will develop serious liver disease. |
| | B) | Heavy alcohol use is a risk factor for development of serious liver disease. |
| | C) | Acquisition of HCV infection after the age of 40 is associated with increased risk of developing serious liver disease. |
| | D) | HVC genotype impacts on the probability of developing end-stage liver disease. |
| | E) | Males are more likely than females to develop serious liver disease. |
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4 | |
The patient is concerned that he may transmit the virus to his wife or children. They are tested and are found to be negative for HCV antibody. He is relieved but asks for advice to prevent infecting them.
You tell him all of the following EXCEPT: |
| | A) | No change in sexual practices is recommended for couples in a long-term monogamous relationship in which one partner is HCV+ and the other HCV-. |
| | B) | The use of condoms is recommended for couples in a long-term monogamous relationship in which one partner is HCV+ and the other HCV-. |
| | C) | Hepatitis C is not spread by hugging, sneezing, or sharing a drinking glass. |
| | D) | Household members of persons infected with HCV should not share items that might be contaminated with small amounts of blood, such as razors or nail clippers. |
| | E) | Parenteral exposure to infected blood is a major route of transmission of hepatitis C. |
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5 | |
The patient's liver biopsy shows mild to moderate inflammatory activity and portal and periportal fibrosis (Stage 2). He is relieved to find out that he does not have cirrhosis, but remains very concerned about his hepatitis and wants to do everything possible to "get rid of" the hepatitis C. He asks about treatment for his HCV.
You tell him which of the following? |
| | A) | Combination therapy with interferon and ribavirin results in sustained virologic responses (SVR) in 40-70% of patients treated. |
| | B) | Failure to attain a 2-log10 drop in the quantitative HCV PCR in the first 12 weeks of antiviral treatment is a predictor of treatment failure. |
| | C) | Combination therapy with interferon and ribavirin can cause numerous side effects, including cytopenias, flu-like symptoms, worsening of autoimmune conditions, depression, and hemolytic anemia. |
| | D) | The HCV genotype is a strong predictor of response to treatment. |
| | E) | All of the above. |
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