Hepatitis C MCQs With Answer

Hepatitis C MCQs With Answer provides B. Pharm students a focused, exam-oriented review of Hepatitis C virus (HCV) virology, diagnosis, pharmacotherapy and clinical management. This concise, keyword-rich introduction covers HCV epidemiology, genotypes, diagnostic assays (anti-HCV, HCV RNA), mechanisms of direct-acting antivirals (NS3/4A, NS5A, NS5B), resistance, drug interactions and monitoring parameters important for pharmacists. Emphasis is placed on treatment principles, adverse effects (ribavirin anemia, DAA interactions), special populations and prevention strategies. Each MCQ reinforces pharmacological concepts, therapeutic decision-making and laboratory interpretation relevant to B. Pharm curricula and clinical practice.

Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which of the following best describes the Hepatitis C virus (HCV) genome?

• Double-stranded DNA
• Single-stranded negative-sense RNA
• Single-stranded positive-sense RNA
• Double-stranded RNA

Correct Answer: Single-stranded positive-sense RNA

Q2. How many major HCV genotypes are commonly recognized worldwide?

• 2
• 4
• 6
• 10

Correct Answer: 6

Q3. What is the most common route of Hepatitis C transmission in current epidemiology?

• Fecal-oral contamination
• Respiratory droplets
• Parenteral exposure such as injection drug use
• Vertical transmission during all pregnancies

Correct Answer: Parenteral exposure such as injection drug use

Q4. Which of the following are structural proteins of HCV?

• NS3, NS5A, NS5B
• Core, E1, E2
• Polymerase and protease only
• Envelope protein only

Correct Answer: Core, E1, E2

Q5. Which HCV proteins are targeted by current direct-acting antivirals (DAAs)?

• NS1 and NS2
• NS3/4A protease, NS5A, NS5B polymerase
• Core protein only
• Host ribosomal proteins

Correct Answer: NS3/4A protease, NS5A, NS5B polymerase

Q6. The most reliable test to confirm active HCV infection is:

• Anti-HCV antibody ELISA
• ALT/AST liver enzymes
• HCV RNA by nucleic acid amplification (PCR)
• HCV antigen rapid test

Correct Answer: HCV RNA by nucleic acid amplification (PCR)

Q7. A positive anti-HCV (antibody) test indicates which of the following?

• Definitive cure of HCV
• Current or past exposure to HCV
• Immediate need for liver transplant
• Acute bacterial co-infection

Correct Answer: Current or past exposure to HCV

Q8. Sustained virologic response (SVR) is most commonly defined as undetectable HCV RNA at which timepoint after completing therapy?

• Week 1
• Week 4
• Week 12
• Week 52

Correct Answer: Week 12

Q9. Which of the following drugs is an example of an NS5B polymerase inhibitor?

• Ledipasvir
• Sofosbuvir
• Glecaprevir
• Pibrentasvir

Correct Answer: Sofosbuvir

Q10. Sofosbuvir’s antiviral mechanism is best described as:

• NS3 protease inhibition
• NS5A binding and methylation
• Nucleotide analog that inhibits NS5B RNA-dependent RNA polymerase
• Host immune checkpoint activation

Correct Answer: Nucleotide analog that inhibits NS5B RNA-dependent RNA polymerase

Q11. Which agent is a representative NS5A inhibitor commonly used in combination regimens?

• Ribavirin
• Ledipasvir
• Interferon-alpha
• Zidovudine

Correct Answer: Ledipasvir

Q12. An example of an HCV NS3/4A protease inhibitor is:

• Sofosbuvir
• Velpatasvir
• Glecaprevir
• Ribavirin

Correct Answer: Glecaprevir

Q13. Ribavirin’s antiviral activity is primarily attributed to:

• Protease inhibition
• Reverse transcriptase inhibition
• Guanosine analog causing viral mutagenesis
• NS5A inhibition

Correct Answer: Guanosine analog causing viral mutagenesis

Q14. A major psychiatric adverse effect associated with pegylated interferon therapy is:

• Hypertension
• Depression
• Hypoglycemia
• Renal failure

Correct Answer: Depression

Q15. Which antiviral is absolutely contraindicated during pregnancy due to teratogenicity?

• Sofosbuvir
• Ledipasvir
• Ribavirin
• Velpatasvir

Correct Answer: Ribavirin

Q16. Co-administration of sofosbuvir with which cardiac drug has been associated with severe bradycardia?

• Amlodipine
• Amiodarone
• Warfarin
• Metoprolol

Correct Answer: Amiodarone

Q17. Regarding renal impairment and DAAs, which statement is most accurate?

• Sofosbuvir requires caution or adjustment in severe renal impairment
• All DAAs are safe without dose modification in end-stage renal disease
• Renal function is irrelevant for DAA selection
• Only ribavirin needs renal dosing adjustments

Correct Answer: Sofosbuvir requires caution or adjustment in severe renal impairment

Q18. Which parameter is typically checked at week 4 of DAA therapy to assess early virologic response?

• Anti-HCV antibodies
• HCV RNA viral load
• Liver biopsy
• Serum albumin only

Correct Answer: HCV RNA viral load

Q19. The primary therapeutic goal in treating chronic Hepatitis C is to:

• Reduce ALT by 10%
• Achieve sustained virologic response (SVR), i.e., viral cure
• Prevent all future viral exposures
• Eradicate hepatitis B co-infection

Correct Answer: Achieve sustained virologic response (SVR), i.e., viral cure

Q20. Which statement about Hepatitis C vaccination is correct?

• A safe, effective vaccine is widely available
• Vaccination is only required for genotype 1
• No vaccine is currently available for HCV
• Vaccination cures chronic HCV infection

Correct Answer: No vaccine is currently available for HCV

Q21. An important extrahepatic manifestation of chronic HCV infection is:

• Mixed cryoglobulinemia
• Osteoporosis
• Type 1 diabetes exclusively
• Chronic bronchitis

Correct Answer: Mixed cryoglobulinemia

Q22. Which HCV genotype has been associated with hepatic steatosis and faster fibrosis progression?

• Genotype 1
• Genotype 2
• Genotype 3
• Genotype 5

Correct Answer: Genotype 3

Q23. Typical duration of most first-line DAA regimens for treatment-naïve patients without cirrhosis is:

• 1 week
• 4 weeks
• 8–12 weeks
• 48 weeks

Correct Answer: 8–12 weeks

Q24. The most commonly reported adverse effects of many DAA combinations include:

• Severe neutropenia and thrombocytopenia
• Fatigue and headache
• Acute pancreatitis
• Severe hypoglycemia

Correct Answer: Fatigue and headache

Q25. Resistance-associated substitutions (RAS) that compromise DAA efficacy are most commonly observed in which protein target?

• NS5A
• Core protein
• Host CYP enzymes
• Mitochondrial DNA

Correct Answer: NS5A

Q26. Baseline and on-treatment monitoring of which liver enzymes is standard practice in HCV management?

• Amylase and lipase
• ALT and AST
• Troponin
• Creatine kinase only

Correct Answer: ALT and AST

Q27. Which DAA combination is considered pan-genotypic and commonly used across genotypes?

• Sofosbuvir/velpatasvir
• Interferon/ribavirin
• Simeprevir alone
• Peginterferon monotherapy

Correct Answer: Sofosbuvir/velpatasvir

Q28. In patients co-infected with HIV, DAA selection requires special attention to:

• Only renal dosing, interactions are irrelevant
• Drug–drug interactions with antiretroviral therapy
• Stopping antiretroviral therapy during DAA use
• No differences compared to mono-infected patients

Correct Answer: Drug–drug interactions with antiretroviral therapy

Q29. After occupational needlestick exposure to HCV, the appropriate immediate action is:

• Start immediate antiviral prophylaxis with DAAs
• No follow-up is needed because HCV is noninfectious
• There is no proven PEP; conduct baseline and follow-up testing for HCV RNA/antibodies
• Administer hepatitis C vaccine

Correct Answer: There is no proven PEP; conduct baseline and follow-up testing for HCV RNA/antibodies

Q30. Chronic HCV infection is defined by persistence of HCV RNA for at least:

• 2 weeks
• 6 weeks
• 6 months
• 2 years

Correct Answer: 6 months

Q31. Which statement about acute Hepatitis C infection is true?

• Most acute HCV infections produce severe, obvious symptoms
• Most acute HCV infections are asymptomatic
• Acute HCV cannot progress to chronic infection
• Acute HCV is best diagnosed by liver biopsy only

Correct Answer: Most acute HCV infections are asymptomatic

Q32. Use of DAAs in liver transplant recipients requires attention to:

• Immunosuppressant drug interactions and level monitoring
• No special considerations; standard dosing always applies
• Absolute contraindication to all DAAs
• Use of ribavirin only

Correct Answer: Immunosuppressant drug interactions and level monitoring

Q33. NS5A inhibitors primarily interfere with which viral processes?

• Viral entry into hepatocytes
• Viral replication complex formation and virion assembly
• Host DNA replication
• Nucleotide salvage pathways

Correct Answer: Viral replication complex formation and virion assembly

Q34. Proton pump inhibitors can reduce absorption of which HCV drug class component?

• NS5B nucleotide analogs only
• NS5A inhibitors like ledipasvir
• NS3 protease inhibitors exclusively
• Ribavirin

Correct Answer: NS5A inhibitors like ledipasvir

Q35. Which noninvasive method has largely replaced liver biopsy for staging fibrosis in HCV patients?

• Ultrasound for steatosis only
• Transient elastography (FibroScan)
• Blood culture
• Chest X-ray

Correct Answer: Transient elastography (FibroScan)

Q36. Globally, the most prevalent HCV genotype is:

• Genotype 1
• Genotype 4
• Genotype 5
• Genotype 6

Correct Answer: Genotype 1

Q37. A key hematologic adverse effect associated with ribavirin therapy is:

• Hemolytic anemia
• Leukocytosis
• Thrombocytosis
• Pancytopenia only with DAAs

Correct Answer: Hemolytic anemia

Q38. Which laboratory parameter should be closely monitored during ribavirin therapy?

• Serum creatinine only
• Hemoglobin concentration
• Anti-HCV antibody titer
• Serum amylase

Correct Answer: Hemoglobin concentration

Q39. Which class of DAAs is generally contraindicated in patients with decompensated cirrhosis (Child-Pugh C)?

• NS5A inhibitors
• Nucleoside analog NS5B inhibitors
• NS3/4A protease inhibitors
• Immunomodulators only

Correct Answer: NS3/4A protease inhibitors

Q40. Metabolism of many HCV protease inhibitors involves which hepatic enzyme system?

• CYP3A4
• CYP2D6 exclusively
• Monoamine oxidase
• Renal esterase only

Correct Answer: CYP3A4

Q41. HCV replication relies on which viral enzyme synthesized from the NS5B gene?

• Reverse transcriptase
• RNA-dependent RNA polymerase
• DNA polymerase
• Protease

Correct Answer: RNA-dependent RNA polymerase

Q42. CDC recommends one-time HCV screening for which birth cohort in addition to risk-based screening?

• Born after 1997
• Born 1945–1965 (baby boomers)
• Only healthcare workers regardless of age
• Only people with prior transfusions after 2010

Correct Answer: Born 1945–1965 (baby boomers)

Q43. After achieving SVR, is reinfection with HCV possible?

• No, SVR confers lifelong sterilizing immunity
• Yes, reinfection is possible if exposed again
• Only possible within first week after SVR
• Reinfection can only occur with different genotypes outside humans

Correct Answer: Yes, reinfection is possible if exposed again

Q44. The combination glecaprevir/pibrentasvir contains which classes of DAAs?

• NS5B inhibitor + nucleoside analog
• NS3/4A protease inhibitor + NS5A inhibitor
• Interferon + ribavirin
• NS5A inhibitor + reverse transcriptase inhibitor

Correct Answer: NS3/4A protease inhibitor + NS5A inhibitor

Q45. Before initiating DAA therapy, screening for which co-infection is recommended due to risk of reactivation?

• Hepatitis A
• Hepatitis B (HBV)
• Influenza
• Malaria

Correct Answer: Hepatitis B (HBV)

Q46. Which of the following is NOT a class of direct-acting antivirals (DAAs) for HCV?

• NS3/4A protease inhibitors
• NS5A inhibitors
• NS5B polymerase inhibitors
• Reverse transcriptase inhibitors

Correct Answer: Reverse transcriptase inhibitors

Q47. Determination of HCV genotype for treatment planning is done primarily by which test?

• Anti-HCV ELISA
• HCV genotyping assay (sequence-based or line probe)
• Serum bilirubin measurement
• Complete blood count

Correct Answer: HCV genotyping assay (sequence-based or line probe)

Q48. Prior standard therapy for HCV that is now largely replaced by DAAs included:

• Pegylated interferon with ribavirin
• Sofosbuvir monotherapy only
• High-dose corticosteroids
• Zinc supplementation alone

Correct Answer: Pegylated interferon with ribavirin

Q49. Which factor most strongly predicts successful HCV cure with DAA regimens?

• Shorter duration of therapy regardless of adherence
• Strict adherence to the full DAA regimen
• Concurrent use of antibiotics
• Baseline ALT value only

Correct Answer: Strict adherence to the full DAA regimen

Q50. Which renal pathology is classically associated with chronic HCV infection as an extrahepatic manifestation?

• Membranoproliferative glomerulonephritis (MPGN)
• Minimal change disease only in children
• Acute tubular necrosis due to HCV
• Polycystic kidney disease

Correct Answer: Membranoproliferative glomerulonephritis (MPGN)

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