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Case 7 Answers

Gerry Gettings arrives for his yearly checkup. You see in his chart that about 8 months ago he had a serology positive case of hepatitis due to HBV. His hepatitis symptoms resolved in about 3 weeks and he mentions feeling fine now. See Gerry's History for vaccinations. Gerry's vital signs were all within normal range. Examination of all other systems appeared normal. You suggest that Gerry have some routine blood tests (e.g., cholesteral tests, glucose, Chem 7 panel).

Knowing Gerry's recent infection which of the following would help you determine how his liver is functioning?

    1. Alanine aminotransferase and aspartate aminotransferase- liver function tests*
    2. Blood urea nitrogen and creatinine- kidney function tests
    3. Blood carbon dioxide- lung and heart function
    4. Troponins and creatinine phosphokinase- heart function
    5. Amylase- pancreas and gallbladder
     

His liver enzymes were mildly elevated. To be on the safe side you ordered a hepatitis panel (see table below).

Test

Result

HBsAg

Negative

Anti-HBs

Positive

IgM for HBc

Negative

IgG for HBc

Positive

Which of the following best describes Gerry's current condition?

  1. Acute HBV infection- He was acutely ill with HBV 8 months ago (Case 2). He should have immunity to another HBV infection or have chronic HBV.
  2. Window period of HBV infection- would have negative HBsAg and Anti-HBs and positive for IgM for HBc.
  3. Convalescent HBV infection*
  4. Chronic HBV infection- HBsAg would be positive and Anti-HBs would still be negative.

If Gerry's tests were the following then which of the following best describes his current condition?

Test

Result

HBsAg

Positive

Anti-HBs

Negative

IgM for HBc

Negative

IgG for HBc

Positive
  1. Acute HBV infection
  2. Window period of HBV infection
  3. Convalescent HBV infection
  4. Chronic HBV infection- No Anti-HBs is made to get the HBsAg out of the bloodstream. People that make Anti-HBs will eliminate HBV from the liver. In some people it takes up to 6 months to start making detectable amounts of Anti-HBs. So those with HBsAg still in their bloodstream for 6 months or longer have CHRONIC HBV.*

Which of the following would have shown that Gerry's previous HBV vaccinations before and during medical school were protective (Gerry's History)?

  1. positive- HBsAg, positive-Anti-HBs, and positive-Anti-HBc- Only HBsAg is in the vaccine so only Anti-HBs would be positive.
  2. negative- HBsAg, positive-Anti-HBs, and positive-Anti-HBc- Only HBsAg is in the vaccine so only Anti-HBs would be positive.
  3. negative- HBsAg, negative-Anti-HBs, and positive-Anti-HBc- Only HBsAg is in the vaccine so only Anti-HBs would be positive.
  4. negative- HBsAg, positive-Anti-HBs, and negative-Anti-HBc*
  5. negative- HBsAg, negative-Anti-HBs, and negative-Anti-HBc- HBsAg is in the vaccine so if he was immune then Anti-HBs would be positive.

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Site Last Revised 11/12/13
Neal Chamberlain, PhD. A. T. Still University of Health Sciences/Kirksville College of Osteopathic Medicine.

Take Care and Think Microbiologically!