Mastering Hepatitis B MCQs With Answer is essential for B. Pharm students preparing for exams and clinical practice. This focused set covers HBV virology, serology markers like HBsAg and anti-HBc, clinical phases, complications (cirrhosis, HCC), vaccination, post‑exposure prophylaxis, and antiviral pharmacotherapy including nucleos(t)ide analogues and interferons. Expect questions on diagnosis, interpretation of serological profiles, mechanism of drugs, resistance mutations (e.g., YMDD), maternal‑neonatal prevention, and monitoring strategies such as HBV DNA and ALT. Clear explanations of real‑world scenarios and drug safety considerations will sharpen your clinical reasoning and exam readiness. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. Which of the following best describes the genome of hepatitis B virus (HBV)?
- Single-stranded RNA
- Double-stranded linear DNA
- Partially double-stranded circular DNA
- Double-stranded circular RNA
Correct Answer: Partially double-stranded circular DNA
Q2. The infectious particle of HBV is commonly referred to as which of the following?
- Dane particle
- Koilocyte
- Prion
- Virion simplex
Correct Answer: Dane particle
Q3. Presence of HBsAg in serum for more than 6 months indicates which condition?
- Acute HBV infection
- Resolved HBV infection
- Chronic HBV infection
- Window period of HBV
Correct Answer: Chronic HBV infection
Q4. Which serologic marker is most indicative of high infectivity and active viral replication?
- Anti-HBs
- Anti-HBc IgG
- HBeAg
- HBsAg
Correct Answer: HBeAg
Q5. Detection of anti-HBc IgM in patient serum primarily suggests which stage?
- Past resolved infection
- Acute or recent HBV infection
- Immunity after vaccination
- Chronic inactive carrier state
Correct Answer: Acute or recent HBV infection
Q6. Which combination is characteristic of the serologic “window period” in acute HBV?
- HBsAg positive, anti-HBs positive
- HBsAg negative, anti-HBc IgM positive
- HBsAg positive, HBeAg positive
- Anti-HBs positive, anti-HBc IgG positive
Correct Answer: HBsAg negative, anti-HBc IgM positive
Q7. The HBV vaccine primarily contains which viral component?
- Inactivated whole virus
- Recombinant HBsAg protein
- Live attenuated HBV
- HBcAg core protein
Correct Answer: Recombinant HBsAg protein
Q8. Standard adult HBV vaccine schedule is usually given at which intervals?
- 0, 1, and 6 months
- 0, 2, and 4 weeks
- At birth only
- Every year for three years
Correct Answer: 0, 1, and 6 months
Q9. Post‑exposure prophylaxis for a newborn of an HBsAg‑positive mother includes which of the following within 12 hours of birth?
- HBV vaccine alone
- Hepatitis B immune globulin (HBIG) alone
- HBV vaccine plus HBIG
- No treatment unless infection occurs
Correct Answer: HBV vaccine plus HBIG
Q10. Which antiviral is a nucleoside analogue associated with the YMDD resistance mutation?
- Interferon alpha
- Lamivudine
- Tenofovir
- Ribavirin
Correct Answer: Lamivudine
Q11. Tenofovir’s major safety concern that requires monitoring is which of the following?
- Hepatotoxicity only
- Renal toxicity and bone mineral density loss
- Severe neutropenia
- Cardiotoxicity
Correct Answer: Renal toxicity and bone mineral density loss
Q12. Pegylated interferon differs from conventional interferon primarily because it:
- Is administered orally
- Has longer half‑life and less frequent dosing
- Directly inhibits DNA polymerase
- Is effective only in HBV genotype C
Correct Answer: Has longer half‑life and less frequent dosing
Q13. The intrahepatic viral reservoir responsible for HBV persistence is called:
- Linear cDNA
- cccDNA (covalently closed circular DNA)
- Pregenomic RNA
- HBV integron
Correct Answer: cccDNA (covalently closed circular DNA)
Q14. Which HBV genotype is generally associated with better response to interferon therapy?
- Genotype A
- Genotype D
- Genotype C
- Genotype F
Correct Answer: Genotype A
Q15. Which test is most sensitive for monitoring active viral replication and response to therapy?
- ALT level
- HBsAg quantitative assay
- HBV DNA by PCR
- Anti-HBs titer
Correct Answer: HBV DNA by PCR
Q16. A patient with HBsAg positive, HBeAg negative, high HBV DNA, and elevated ALT is most likely in which phase?
- Immune tolerant phase
- Inactive carrier phase
- Immune active (HBeAg‑negative chronic hepatitis)
- Window period
Correct Answer: Immune active (HBeAg‑negative chronic hepatitis)
Q17. Which laboratory marker indicates protective immunity after vaccination?
- Anti-HBc IgG
- Anti-HBs ≥10 mIU/mL
- HBsAg positive
- HBeAg positive
Correct Answer: Anti-HBs ≥10 mIU/mL
Q18. HDV (hepatitis D virus) infection requires which of the following for replication and assembly?
- HCV envelope proteins
- HBV surface antigen (HBsAg)
- HIV reverse transcriptase
- Influenza viral proteins
Correct Answer: HBV surface antigen (HBsAg)
Q19. Which of the following is TRUE regarding lamivudine in HBV therapy?
- High genetic barrier to resistance
- Frequent development of resistance via YMDD mutation
- Contraindicated in pregnancy
- Causes severe nephrotoxicity at therapeutic doses
Correct Answer: Frequent development of resistance via YMDD mutation
Q20. Entecavir is best described as which class of antiviral?
- Interferon analog
- Guanylate analogue nucleoside reverse transcriptase inhibitor
- Protease inhibitor
- Integrase inhibitor
Correct Answer: Guanylate analogue nucleoside reverse transcriptase inhibitor
Q21. Which of the following clinical outcomes is a long‑term complication of chronic HBV infection?
- Acute pancreatitis
- Hepatocellular carcinoma
- Chronic kidney disease from direct viral invasion
- Multiple sclerosis
Correct Answer: Hepatocellular carcinoma
Q22. Primary prevention of HBV in healthcare workers mainly relies on which measure?
- Annual HBV DNA testing
- Pre-exposure vaccination with HBV vaccine
- Universal antibiotic prophylaxis
- Wearing N95 masks only
Correct Answer: Pre-exposure vaccination with HBV vaccine
Q23. A patient with isolated anti-HBc (total) positive, HBsAg negative, anti-HBs negative could represent which scenario?
- Vaccinated individual
- False positive or past resolved infection with waning anti-HBs
- Acute window period always
- Current high-level viremia
Correct Answer: False positive or past resolved infection with waning anti-HBs
Q24. Which antiviral has the highest barrier to resistance and is recommended as first-line therapy for many patients?
- Lamivudine
- Adefovir
- Tenofovir
- Ribavirin
Correct Answer: Tenofovir
Q25. In pregnant women with high HBV DNA, which intervention during late pregnancy reduces mother-to-child transmission?
- Start lamivudine in first trimester
- Administer tenofovir during the third trimester
- Delay vaccination of newborn
- Give HBIG to the mother before delivery
Correct Answer: Administer tenofovir during the third trimester
Q26. Which adjuvant is commonly used in recombinant hepatitis B vaccines to enhance immunogenicity?
- Aluminium salts (alum)
- Complete Freund’s adjuvant
- Monophosphoryl lipid A only
- Squalene alone
Correct Answer: Aluminium salts (alum)
Q27. Which marker is most useful to assess loss of replicative HBV activity during therapy?
- HBeAg seroconversion to anti-HBe
- Anti-HBc IgG titers
- HBsAg qualitative presence
- AST decrease alone
Correct Answer: HBeAg seroconversion to anti-HBe
Q28. Which statement about HBV cccDNA is correct?
- It is easily eliminated by current antivirals
- It serves as a template for viral mRNA and is difficult to eradicate
- It is only present during acute infection
- It is identical to the host mitochondrial DNA
Correct Answer: It serves as a template for viral mRNA and is difficult to eradicate
Q29. For a needle‑stick from an HBsAg‑positive source to an unvaccinated healthcare worker, the recommended prophylaxis is:
- No action needed
- HBIG only
- HBV vaccine series plus HBIG immediately
- Antiviral therapy for 6 months
Correct Answer: HBV vaccine series plus HBIG immediately
Q30. Which of the following best describes the mechanism of interferon-alpha in HBV treatment?
- Direct viral DNA chain termination
- Immunomodulatory and antiviral effects enhancing host response
- Inhibition of host ribosomes
- Blockade of viral entry receptors
Correct Answer: Immunomodulatory and antiviral effects enhancing host response
Q31. A decrease in HBV DNA with persistent HBsAg indicates which of the following?
- Complete viral eradication
- Partial virological response or suppression
- Vaccination response
- Laboratory error only
Correct Answer: Partial virological response or suppression
Q32. Which of the following is a contraindication to receiving the hepatitis B vaccine?
- Pregnancy
- History of severe allergic reaction to yeast
- Chronic renal disease
- Prior resolved HBV infection
Correct Answer: History of severe allergic reaction to yeast
Q33. Which antiviral is associated with mitochondrial toxicity and lactic acidosis risk in some nucleoside analogues (less so with modern agents)?
- Adefovir
- Stavudine (d4T) in HIV context
- Entecavir
- Tenofovir
Correct Answer: Stavudine (d4T) in HIV context
Q34. Reactivation of HBV can occur in patients undergoing which therapy?
- Short course antibiotics
- Immunosuppressive therapy like rituximab
- Topical antifungals
- Local radiation to limb only
Correct Answer: Immunosuppressive therapy like rituximab
Q35. Which diagnostic method directly quantifies circulating HBV DNA copies?
- ELISA for HBsAg
- Polymerase chain reaction (PCR)
- Liver function tests only
- Rapid antigen card test
Correct Answer: Polymerase chain reaction (PCR)
Q36. A patient with chronic HBV and decompensated cirrhosis requires which approach to antiviral therapy?
- Immediate discontinuation of all antivirals
- Start or continue potent nucleos(t)ide analogues with high barrier to resistance
- Interferon therapy as first-line
- Only supportive care, antivirals contraindicated
Correct Answer: Start or continue potent nucleos(t)ide analogues with high barrier to resistance
Q37. Which is the most appropriate follow-up test to assess functional immunity after completing HBV vaccination?
- HBV DNA PCR
- Anti-HBs quantitative measurement
- HBeAg testing
- Anti-HBc IgM
Correct Answer: Anti-HBs quantitative measurement
Q38. In HBV therapy, primary nonresponse to a nucleos(t)ide analogue means:
- Rapid viral suppression within 4 weeks
- Less than 1 log10 reduction in HBV DNA after 3 months of therapy
- Development of YMDD mutation immediately
- Seroconversion of HBsAg
Correct Answer: Less than 1 log10 reduction in HBV DNA after 3 months of therapy
Q39. Hepatitis B immune globulin (HBIG) provides what type of protection?
- Active long-term immunity
- Immediate passive short-term immunity
- Cell-mediated immunity induction
- Vaccine adjuvant effect
Correct Answer: Immediate passive short-term immunity
Q40. Which of the following best explains why current antivirals rarely cure HBV infection?
- Antivirals cannot enter hepatocytes
- Persistence of intrahepatic cccDNA and possible integration into host genome
- Virus replicates only in erythrocytes
- Antivirals are all inactive in the liver environment
Correct Answer: Persistence of intrahepatic cccDNA and possible integration into host genome
Q41. Combination therapy of interferon with nucleos(t)ide analogues is generally recommended because:
- It is standard for all HBV patients
- It may increase rates of seroconversion and prevent resistance in select cases
- It guarantees eradication of cccDNA
- It eliminates need for monitoring
Correct Answer: It may increase rates of seroconversion and prevent resistance in select cases
Q42. HBV transmission routes include all EXCEPT which one?
- Perinatal transmission
- Sexual contact
- Contaminated blood transfusion
- Ingestion of contaminated food
Correct Answer: Ingestion of contaminated food
Q43. Which of the following is a marker of past natural infection rather than vaccination?
- Anti-HBs positive only
- Anti-HBc total positive
- HBsAg positive
- HBeAg positive
Correct Answer: Anti-HBc total positive
Q44. A patient with chronic HBV on entecavir therapy shows rising HBV DNA and ALT after initial response; the most likely cause is:
- Nonadherence, antiviral resistance, or reinfection
- Complete spontaneous cure
- Vaccination effect
- Laboratory contamination only
Correct Answer: Nonadherence, antiviral resistance, or reinfection
Q45. Which procedure is the least useful for routine assessment of fibrosis in chronic HBV?
- Liver biopsy
- Transient elastography (FibroScan)
- Serum fibrosis markers (APRI, FIB-4)
- Complete blood count alone
Correct Answer: Complete blood count alone
Q46. Which of the following best describes serologic evidence of recovery from past HBV infection?
- HBsAg positive, anti-HBs negative
- HBsAg negative, anti-HBs positive, anti-HBc positive
- HBeAg positive only
- Anti-HBc IgM positive only
Correct Answer: HBsAg negative, anti-HBs positive, anti-HBc positive
Q47. Which population should receive birth dose of hepatitis B vaccine within 24 hours?
- Only infants of HBsAg-positive mothers
- All newborns regardless of maternal status
- Only preterm infants
- Only infants whose mothers are anti-HBs positive
Correct Answer: All newborns regardless of maternal status
Q48. The primary mechanism of resistance to HBV nucleoside analogues involves:
- Host immune suppression
- Mutations in the viral polymerase gene affecting drug binding
- Overexpression of host P-glycoprotein
- Increased hepatic blood flow
Correct Answer: Mutations in the viral polymerase gene affecting drug binding
Q49. Which clinical feature suggests progression to fulminant hepatic failure in acute HBV?
- Mild ALT elevation only
- Jaundice with coagulopathy and hepatic encephalopathy
- Isolated anti-HBs positivity
- Asymptomatic carrier state
Correct Answer: Jaundice with coagulopathy and hepatic encephalopathy
Q50. For chronic HBV patients co-infected with HIV, treatment choice should consider which of the following?
- Use of antiretrovirals that are also active against HBV, like tenofovir and lamivudine or emtricitabine
- Avoid tenofovir due to drug interactions with HIV therapy
- Only use interferon regardless of HIV status
- Delay HBV therapy until HIV is cured
Correct Answer: Use of antiretrovirals that are also active against HBV, like tenofovir and lamivudine or emtricitabine
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com