Hepatobiliary Quiz—8 (2013)

Abstract

1.Regarding the epidemiology of hepatitis E virus (HEV) the following are TRUE EXCEPT:1.Large scale water borne epidemics in high-endemicity regions are usually due to genotype 1 and 22.Genotypes 3 and 4 mainly cause zoonotic disease with only occasional clinical infection in humans3.Infection is more common in young healthy individuals in low-endemicity regions4.Person to person spread is a common mode for transmission of HEV5.In India, human infection is predominantly by genotype 1 and animal infection by genotype 42.Regarding chronic HEV infection the following are TRUE:1.Reducing dose of immunosuppressants often leads to clearance of HEV infection2.Pegylated interferon and ribavirin have been unsuccessful in treatment of chronic HEV infection in organ transplant recipients3.Treatment of patients positive for HEV RNA prior to organ transplant is not useful4.HEV infection in transplant recipients can cause severe neurological manifestations5.HEV infection is a cause of renal dysfunction after kidney and liver transplantation3.Regarding immunosuppressive regimens used after liver transplantation the following are TRUE:1.Combination of sirolimus with calcineurin inhibitors (CNI) is a good renal sparing regimen2.Low dose CNI with mycophenolate is a good regimen for patients with renal dysfunction3.Tacrolimus has been proven to cause less hepatitis C recurrence than cyclosporine4.Steroid boluses are associated with severe recurrence of hepatitis C5.Immunosuppression therapy should be reduced in patients with post transplant lymphoproliferative disorder4.Regarding renal failure in patients with cirrhosis the following are TRUE EXCEPT:1.Hepatorenal syndrome (HRS) is the most common cause of renal dysfunction in cirrhosis2.Urinary neutrophil gelatinase-associated lipocalin may help differentiate causes of renal failure in cirrhosis3.Treatment of pre-renal azotemia is diuretic withdrawal and volume expansion with albumin4.Terlipressin with albumin reverses renal failure in almost all patients with HRS5.Treatment of HRS with vasopressors and albumin does not decrease mortality5.Regarding hepatitis B virus (HBV) associated polyarteritis nodosa (PAN) the following are TRUE:1.PAN is due to type III immunity (immune complex) formation2.HBV associated PAN is more severe than PAN without virus infection3.Treatment of HBV associated PAN is with prolonged immunosuppression similar to PAN without virus infection4.Plasma exchange is not useful in HBV associated PAN5.Interferon can be used for treatment of HBV with PAN6.Regarding hepatitis C virus (HCV) and cryoglobulinemic vasculitis the following are TRUE:1.Presence of cryoglobulins in serum is a common finding in HCV infected individuals2.Symptoms of cryoglobulinemia are common in HCV infected individuals3.HCV related cryoglobulinemia is usually of type 14.Symptomatic cryoglobulinemia is an indication for anti-HCV therapy5.Immunosuppression is not useful for HCV associated cryoglobulinemia7.Regarding HEV infection in pregnancy the following are TRUE EXCEPT:1.Pregnant women are more likely to have HEV as cause of acute viral hepatitis (AVH) in both sporadic and epidemic settings2.HEV infection is more severe in pregnancy and more likely to cause acute liver failure3.Among patients with acute liver failure, HEV infection and pregnancy are poor prognostic variables4.Viral load and duration of viremia are similar in pregnant and non-pregnant patients5.Poor outcomes in pregnancy are believed to be secondary to immunosuppressive effects of progesterone8.Regarding management of esophageal varices in patients of cirrhosis who have never bled the following are TRUE:1.Probability of first bleed depends upon the size of the largest esophageal varix2.Non-selective β blockers (NSBB) are useful to prevent development of varices3.Endoscopic band ligation (EBL) is an accepted modality for primary prophylaxis of variceal bleed in patients with small esophageal varices4.Endoscopic band ligation (EBL) is an accepted modality for primary prophylaxis of variceal bleed in patients with large esophageal varices5.Carvedilol may be effective in patients who do not respond to propranolol9.Regarding microRNAs (miRs) in liver disease the following are TRUE:1.miR are only found intra-cellularly2.miR-122 is a liver specific miR3.Miravirsen has antiviral activity for HCV4.miR-122 has antiviral activity for HBV5.miR-29 is pro-fibrogenic10.Regarding acute on chronic liver failure (ACLF) due to AVH the following are TRUE EXCEPT:1.AVH is the most common acute precipitating event of ACLF in Asia2.HBV flare is more likely a cause of ACLF than AVH in HBV related cirrhosis3.Hepatitis A virus (HAV) is a more common cause of ACLF than HEV in Asia4.HAV related ACLF has worse outcome than HEV related ACLF5.Ribavirin is a potential therapy for HEV related ACLF