CE test on laboratory approach to acute and chronic hepatitis.

MLO and Northern Illinois University (NIU), DeKalb, IL, are cosponsors in offering continuing education units (CEUs) for this issue's article on LABORATORY APPROACH TO ACUTE AND CHRONIC HEPATITIS. CEUs or contact hours are granted by the College of Health and Human Sciences at NIU, which has been approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS P.A.C.E.[R] program (Provider No. 0001) and by the American Medical Technologists Institute for Education (Provider No. 121019; Registry No. 0061). Approval as a provider of continuing education programs has been granted by the state of Florida (Provider No. JP0000496), and for licensed clinical laboratory scientists and personnel in the state of California (Provider No. 351). Continuing education credits awarded for successful completion of this test are acceptable for the ASCP Board of Registry Continuing Competence Recognition Program. After reading the article on page 10, answer the following test questions and send your completed test form to NIU along with the nominal fee of $20. Readers who pass the test successfully (scoring 70 percent or higher) will receive a certificate for 1 contact hour of P.A.C.E.[R] credit. Participants should allow four to six weeks for receipt of certificates.

The fee for each continuing education test will be $20.

All feature articles published in MLO are peer-reviewed.

This test was prepared by Donna M. Falcone, MSM, CLS(NCA), MT(ASCP), Lab Consultant, Geneva, IL.

1. Over the past decade, there has been an increased recognition of which type of hepatitis in the United States?

a. Acute viral hepatitis

b. Chronic viral hepatitis

c. Alcoholic hepatitis

d. Nonalcoholic fatty liver disease

2. Cirrhosis is:

a. the 10th leading cause of death in the United States

b. a complication of chronic hepatitis

c. the result of fibrosis in the liver

d. all of the above

3. Acute hepatitis:

a. is an acute injury to the liver

b. is most commonly due to factors other than viral infection

c. is usually self-limiting, but can progress to chronic hepatitis

d. all of the above

4. In acute hepatitis due to toxins of shock:

a. AST and ALT increase slowly

b. prothrombin times are normal

c. AST and ALT increase rapidly, often to extremely high values

d. jaundice is very common

5. Hepatitis A virus (HAV):

a. is spread by the fecal-oral route

b. is diagnosed through the detection of total antibody to HAV

c. has a long incubation period

d. rarely causes jaundice

6. Hepatitis B Virus (HBV):

a. rarely causes acute viral hepatitis

b. is spread by the focal-oral route

c. can be transmitted through organ transplantation

d. has on incubation period of one to two weeks

7. Hepatitis C Virus (HCV):

a. has an incubation period of two to four weeks

b. is usually clinically silent

c. causes chronic infection in 50% to 80% of cases

d. all of the above

8. In alcoholic hepatitis:

a. AST and ALT enzymes are greatly increased

b. AST and ALT are minimally increased

c. there is no increase in neutrophil count

d. viral serologies are positive

9. Hepatitis presenting with rash, an increased eosinophil count, increased alkaline phosphatase and negative viral serologies is most likely:

a. acute viral hepatitis

b. alcoholic hepatitis

c. drug-induced hepatitis

d. none of the above

10. An acute hepatitis viral serology panel typically includes:

a. IgM HAV, IgM anti-HBc, HBsAg, and anti-HCV

b. total antibody to HAV

c. anti-HBs

d. all of the above

11. Chronic viral hepatitis:

a. is the most common form of chronic hepatitis

b. is often recognized when individuals are tested for blood donations or health and insurance exams

c. is often clinically unapparent

d. all of the above

12. In chronic hepatitis, 80% to 90% of cases are due to:

a. drugs

b. autoimmune hepatitis

c. chronic HBV and HCV infections and NASH

d. hemochromatosis 

13. The most common cause of chronic hepatitis in North America, Europe and Japan is:

a. HBV

b. HCV

c. NAFLD

d. drug reactions

14. Treatment for individuals infected with HCV:

a. includes the use of long-acting interferon and ribaviran

b. is not affected by which genotype of HCV is involved

c. is not available

d. is best accomplished through the use of lamivudine or adefovir dipivoxil

15. In a HBV patient treated with lamivudine, a mutation that is resistant to the drug may be indicated by:

a. a fall in liver enzymes

b. the return of HBV DNA 

c. the presence of HCV RNA

d. nothing--the development of mutants resistant to lamivudine is rare

16. The term used to describe the accumulation of fat in the liver is:

a. cirrhosis

b. hemochromatosis

c. nonalcoholic fatty liver disease (NAFLD)

d. jaundice

17. Nonalcoholic steatohepatitis (NASH):

a. is a severe form of NAFLD

b. occurs in about 10% of individuals with fatty liver

c. is often accompanied by increased lipids and glucose intolerance

d. all of the above

18. The findings of increased immunoglobulin levels, positive anti-nuclear antibody and positive anti-smooth muscle antibody in a chronic hepatitis patient indicate:

a. autoimmune hepatitis

b. HCV

c. HBV

d. hemochromatosis

19. If either anti-HCV or HBsAg is positive in a chronic hepatitis patient, active infection can be confirmed by:

a. liver biopsy

b. increased serum immunoglobulin levels

c. increased serum iron

d. positive HCV RNA of HBV DNA

20. Increased serum iron and ferritin, high transferrin and negative viral markers in a patient with chronic hepatitis indicate:

a. NASH

b. HBV

c. hemochromatosis

d. drug reaction