Q.

1
A 26-year-old Pakistani man presents with a history of
HBeAg positive hepatitis B infection. Two years ago he was
treated with peg-interferon alfa-2a 180 mcg SC weekly for 6
months. He was recently diagnosed with non-Hodgkin’s
lymphoma and will begin chemotherapy in the next several
weeks. He has been referred to you for further management.
His current HBV status: HBsAg positive, HBeAg negative,
HBe- Ab positive, HBsAb negative, hepatitis B DNA
undetectable, AST 12, ALT 28. What steps are required
regarding hepatitis B management?

A. Close monitoring of HBV DNA and LFTs while on

chemotherapy
B. No change in oncologic plan as the patient has cleared HBV
infection
C. Hepatitis B immune globulin
D. Peginterferon alfa-2a
E. Entecavir
Q.2
A 37-year-old Shikarpuri man presents for evaluation of
chronic hepatitis B infection. He is unaware of his parent’s
medical history but notes that a sister also has hepatitis B and
a maternal uncle died of liver cancer. He reports increased
fatigue but otherwise no other medical problems. He takes no
medications or herbal remedies. He smokes ½ pack per day
and drinks alcohol only twice a year during special occasions.
His physical examination is unremarkable and reveals normal
liver span, no splenomegaly, no shifting dullness, no
cutaneous stigmata of advanced liver disease. Laboratory
investigation reveals: total bilirubin 0.9 mg/dL, AST 25 U/L
(normal), ALT 30 U/L (normal), albumin 4.4 g/dL, HB- sAg
positive, HBeAg negative, HBeAb positive, HBV DNA 1,220
IU/mL, AFP 6.0 ng/mL. Liver ultrasound is unremarkable
without evidence of focal liver mass. What is the next best step
of management?

A. Repeat labs in 3 months

B. Liver biopsy
C. Initiate peg-interferon alfa-2a
D. Initiate entecavir
E. Initiate tenofovir
Q.3
A 34-year-old Pakistani-American man presents to your
office to consider treatment for chronic hepatitis B e-antigen
positive infection. He reports that his brother had success with
peginterferon treatment and would like to consider this option if
you believe he would be a good candidate. Which patient
profile is optimally suited for peg-interferon?

A. Patients with compensated disease, a low ALT level, and a

high HBV DNA
B. Patients with compensated disease, a high ALT level, and a
low HBV DNA
C. Patients with decompensated disease, a low ALT level, and
a high HBV DNA level
D. Patients with decompensated disease, a high ALT level,
and a low HBV DNA level
E. Pegylated interferon is not considered a first-line treatment
option.
Q.4
A 42-year-old Caucasian woman presents to you with a
history of chronic hepatitis B infection. She was treated “at
least 10 years ago” with pegylated interferon and was told that
her infection was “under control.” She is referred by her
oncologist due to a recently diagnosis of non-Hodgkin
lymphoma and will begin an anticipated 6 month course of
rituxan-based chemotherapy in a few weeks. You order
updated virologic labs which reveal the following: HB- sAg
positive, HBcAb positive, HBsAb negative, HBeAg negative,
HBeAb positive, hepatitis B virus (HBV) DNA 39,116 IU/mL,
AST 58 U/L, ALT 93 U/L, albumin 4.6 g/dL, INR 0.8. How
should you advise this patient regarding her infection?
A. Her HBV infection was cured by prior treatment and no
further steps are indicated
B. She will not require treatment but close monitoring of HBV
DNA and LFTs is warranted throughout her chemotherapy
course
C. She will only require treatment if her oncologist plans to
combine rituxan with corticosteroids for her chemotherapy
regimen
D. Initiate lamivudine prior to chemotherapy and for the full 6
month duration, then stop E. Initiate entecavir prior to
chemotherapy and continue.
E. Initiate entecavir prior to chemotherapy and continue
indefinitely.