Hepatitis D MCQs With Answer

Hepatitis D MCQs With Answer is a focused review designed for B. Pharm students to master the virology, pathogenesis, diagnosis, clinical patterns, and pharmacologic management of Hepatitis D (HDV). This introduction covers key SEO phrases like Hepatitis D, HDV, delta virus, HBV co-infection, interferon therapy, bulevirtide, and prevention by HBV vaccination. The MCQs emphasize mechanisms (HDV dependence on HBsAg), laboratory diagnosis (anti-HDV, HDV RNA), therapeutic options and emerging drugs, and clinical implications for pharmacy practice. Clear, exam-oriented questions help reinforce critical concepts needed for safe medication use and patient counseling. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which of the following best describes the hepatitis D virus (HDV)?

• Enveloped single-stranded DNA virus independent of other viruses
• Enveloped single-stranded RNA virus that requires hepatitis B surface antigen for assembly
• Non-enveloped double-stranded RNA virus transmitted by Aedes mosquitoes
• Retrovirus that integrates into the host genome causing chronic infection

Correct Answer: Enveloped single-stranded RNA virus that requires hepatitis B surface antigen for assembly

Q2. The genome of HDV is best described as:

• Positive-sense linear single-stranded RNA with poly-A tail
• Negative-sense segmented RNA similar to influenza
• Single-stranded circular negative-sense RNA that forms rod-like structure
• Double-stranded circular DNA with reverse transcriptase

Correct Answer: Single-stranded circular negative-sense RNA that forms rod-like structure

Q3. HDV requires which hepatitis virus for its life cycle and packaging?

• Hepatitis A virus (HAV)
• Hepatitis B virus (HBV)
• Hepatitis C virus (HCV)
• Hepatitis E virus (HEV)

Correct Answer: Hepatitis B virus (HBV)

Q4. Which of the following clinical scenarios indicates HDV superinfection?

• Simultaneous acute infection with HBV and HDV occurring at the same time
• Acute HDV infection in a person previously immune to HBV
• Acute HDV infection occurring in a chronic HBV carrier
• Transmission of HDV without HBV exposure

Correct Answer: Acute HDV infection occurring in a chronic HBV carrier

Q5. Compared to HBV alone, HDV infection is associated with which clinical outcome?

• Milder, self-limited hepatitis with low risk of chronicity
• Higher rates of fulminant hepatitis and more rapid progression to cirrhosis
• No change in disease severity or progression
• Protection against hepatocellular carcinoma development

Correct Answer: Higher rates of fulminant hepatitis and more rapid progression to cirrhosis

Q6. The most reliable laboratory test to confirm active HDV replication is:

• Anti-HDV IgG antibody ELISA
• Anti-HDV IgM antibody ELISA
• Serum HDV RNA PCR
• HBsAg quantification

Correct Answer: Serum HDV RNA PCR

Q7. Which serologic marker indicates recent acute HDV infection?

• Anti-HDV IgG only
• Anti-HDV IgM
• HBsAg clearance
• Anti-HBc IgG

Correct Answer: Anti-HDV IgM

Q8. Prevention of HDV infection at the population level is most effectively achieved by:

• Universal hepatitis A vaccination
• Active vaccination against HBV
• Administration of interferon to all newborns
• Mass antiviral therapy with lamivudine

Correct Answer: Active vaccination against HBV

Q9. Which antiviral agent has demonstrated the most consistent efficacy for chronic HDV treatment historically?

Correct Answer: Pegylated interferon-alpha (pegIFN-α)

Q10. Bulevirtide (Myrcludex B) acts against HDV by which mechanism?

• Reverse transcriptase inhibition
• Inhibition of sodium taurocholate co-transporting polypeptide (NTCP) entry receptor
• Protease inhibition in viral polyprotein processing
• Inhibition of viral RNA-dependent RNA polymerase

Correct Answer: Inhibition of sodium taurocholate co-transporting polypeptide (NTCP) entry receptor

Q11. Which statement about coinfection with HBV and HDV is true?

• Coinfection always leads to chronic HDV infection
• Coinfection often results in severe acute hepatitis but lower chronicity than superinfection
• Coinfection prevents HBV replication completely
• Coinfection is asymptomatic in all patients

Correct Answer: Coinfection often results in severe acute hepatitis but lower chronicity than superinfection

Q12. A B. Pharm student counseling on interferon therapy for HDV should warn patients about which common adverse effect?

• Severe nephrotoxicity without warning signs
• Flu-like symptoms, depression, and cytopenias
• Immediate hypersensitivity with anaphylaxis in most patients
• Complete hair loss in all treated patients

Correct Answer: Flu-like symptoms, depression, and cytopenias

Q13. Which of the following laboratory patterns favors HDV superinfection in a chronic HBV carrier?

• New ALT elevation with anti-HDV IgM positive and rising HDV RNA
• Isolated anti-HBc IgG without ALT change
• Decrease in ALT with HBsAg clearance
• Positive anti-HAV IgM

Correct Answer: New ALT elevation with anti-HDV IgM positive and rising HDV RNA

Q14. Which statement about HDV genotypes is correct?

• There is only one HDV genotype worldwide
• Different genotypes (1–8) influence disease severity and geographic distribution
• HDV genotypes determine resistance to nucleoside analogues
• Genotyping is irrelevant for prognosis or epidemiology

Correct Answer: Different genotypes (1–8) influence disease severity and geographic distribution

Q15. The role of nucleos(t)ide analogues (e.g., tenofovir) in HDV management is:

• Highly effective at clearing HDV RNA when used alone
• Useful for suppressing HBV replication but have limited effect on HDV replication
• Contraindicated in HDV infection
• First-line monotherapy for chronic HDV

Correct Answer: Useful for suppressing HBV replication but have limited effect on HDV replication

Q16. Which investigational agent is a prenylation inhibitor evaluated for HDV treatment?

• Ribavirin
• Lonafarnib
• Sofosbuvir
• Interleukin-2

Correct Answer: Lonafarnib

Q17. Which is the primary route of HDV transmission?

• Fecal-oral transmission through contaminated food
• Respiratory droplets
• Parenteral and percutaneous routes, including IV drug use and blood transfusion
• Vector-borne via ticks

Correct Answer: Parenteral and percutaneous routes, including IV drug use and blood transfusion

Q18. In which population is HDV prevalence highest globally?

• Regions with low HBV endemicity like North America
• Populations with high HBV prevalence such as parts of Africa, Mediterranean, and Amazon Basin
• Areas with strict blood-screening programs only
• Only rural areas of East Asia

Correct Answer: Populations with high HBV prevalence such as parts of Africa, Mediterranean, and Amazon Basin

Q19. For diagnosing HDV infection, which combination of tests is most informative?

• ALT, AST only
• Anti-HDV antibodies (IgM/IgG) plus HDV RNA PCR
• HBsAg alone
• Complete blood count only

Correct Answer: Anti-HDV antibodies (IgM/IgG) plus HDV RNA PCR

Q20. A pharmacist advising a pregnant patient with chronic HBV about HDV risk should say:

• HDV cannot infect pregnant women
• HBV vaccination in newborns prevents HDV because HDV requires HBV
• Pregnancy cures HBV and thus prevents HDV
• Lamivudine is the recommended prophylaxis against HDV in pregnancy

Correct Answer: HBV vaccination in newborns prevents HDV because HDV requires HBV

Q21. Which histological feature is commonly seen in HDV-associated liver disease?

• Steatosis without inflammation
• Marked necroinflammation and rapid progression to cirrhosis
• Only fatty change with minimal fibrosis
• Characteristic Mallory bodies only

Correct Answer: Marked necroinflammation and rapid progression to cirrhosis

Q22. Which of the following is NOT a recommended monitoring parameter during pegylated interferon therapy for HDV?

• Complete blood count with differential
• Thyroid function tests
• Serum HDV RNA and liver enzymes
• Routine measurement of HDV envelope proteins in serum

Correct Answer: Routine measurement of HDV envelope proteins in serum

Q23. The presence of HBsAg is necessary for HDV because:

• HBsAg provides the viral polymerase for HDV replication
• HBsAg supplies the envelope proteins required for HDV particle assembly and infectivity
• HBsAg integrates into HDV genome to enable replication
• HBsAg neutralizes host immunity enabling HDV persistence

Correct Answer: HBsAg supplies the envelope proteins required for HDV particle assembly and infectivity

Q24. Which patient scenario most strongly suggests testing for HDV?

• Patient with isolated anti-HBs positivity and normal ALT
• Chronic HBV carrier with unexplained ALT elevation or worsening liver disease
• Patient vaccinated against HBV
• Patient with acute HAV infection

Correct Answer: Chronic HBV carrier with unexplained ALT elevation or worsening liver disease

Q25. Which of the following statements about HDV RNA testing is correct?

• HDV RNA is irrelevant for disease activity assessment
• Quantitative HDV RNA helps assess viral replication and response to therapy
• HDV RNA can be reliably detected by standard HBsAg assays
• HDV RNA is only useful in vaccine response monitoring

Correct Answer: Quantitative HDV RNA helps assess viral replication and response to therapy

Q26. Which of the following best describes the recommended duration of pegIFN-α therapy for chronic HDV in many guidelines?

• Single dose only
• Typically 48 weeks, sometimes extended based on response
• No duration; treat indefinitely
• Only 2 weeks of therapy

Correct Answer: Typically 48 weeks, sometimes extended based on response

Q27. Which pharmacologic effect is associated with lonafarnib when used for HDV?

• NTCP receptor blockade preventing viral entry
• Inhibition of farnesyltransferase preventing virion assembly
• Reverse transcriptase inhibition similar to tenofovir
• Direct protease cleavage of delta antigen

Correct Answer: Inhibition of farnesyltransferase preventing virion assembly

Q28. Which clinical sign should prompt urgent evaluation for fulminant hepatitis in an HDV-infected patient?

• Mild fatigue without jaundice
• Rapid onset jaundice with coagulopathy and encephalopathy
• Isolated pruritus with normal LFTs
• Chronic low-grade fever only

Correct Answer: Rapid onset jaundice with coagulopathy and encephalopathy

Q29. Which is true about HDV antibodies in chronic infection?

• Anti-HDV IgG usually disappears quickly after infection
• Anti-HDV IgG may persist and indicate past or ongoing infection
• Anti-HDV antibodies neutralize HBV infection completely
• Antibody testing is unnecessary if HBsAg is present

Correct Answer: Anti-HDV IgG may persist and indicate past or ongoing infection

Q30. Which public health strategy is most cost-effective for preventing HDV in high endemic regions?

• Mass administration of interferon to entire population
• Universal infant HBV immunization and perinatal prophylaxis
• Providing lonafarnib to all adults
• Quarantining individuals with anti-HDV IgG

Correct Answer: Universal infant HBV immunization and perinatal prophylaxis

Q31. Which drug interaction concern is most relevant when combining pegIFN-α with other therapies?

• Severe CYP3A4 induction reducing interferon levels
• Potential additive myelosuppression and neuropsychiatric effects
• Interferon lowers blood glucose by direct insulin release
• Interferon causes immediate renal failure with tenofovir

Correct Answer: Potential additive myelosuppression and neuropsychiatric effects

Q32. In clinical trials combining bulevirtide with pegIFN-α for HDV, expected benefit is:

• No antiviral effect compared to placebo
• Potential additive antiviral activity with improved HDV RNA decline
• Complete elimination of HBV and HDV in all patients
• Increase in HDV replication due to drug interaction

Correct Answer: Potential additive antiviral activity with improved HDV RNA decline

Q33. A B. Pharm student should know that HBV vaccination prevents HDV because:

• Vaccination induces anti-HDV antibodies directly
• Vaccination prevents HBsAg expression necessary for HDV assembly
• Vaccine contains HDV antigen that confers immunity
• HBV vaccine is an antiviral that clears existing HDV

Correct Answer: Vaccination prevents HBsAg expression necessary for HDV assembly

Q34. Which clinical laboratory feature is most consistent with acute HDV superinfection?

• Normal ALT and AST with elevated bilirubin only
• Marked ALT/AST elevation, positive anti-HDV IgM, and rising HDV RNA
• Isolated thrombocytopenia without liver enzyme changes
• Low alkaline phosphatase with normal transaminases

Correct Answer: Marked ALT/AST elevation, positive anti-HDV IgM, and rising HDV RNA

Q35. Which of the following is a known extrahepatic manifestation sometimes associated with HDV or HBV coinfection?

• Polyarteritis nodosa and immune-complex mediated vasculitis
• Chronic obstructive pulmonary disease
• Type 1 diabetes caused directly by HDV
• Hairy cell leukemia always present

Correct Answer: Polyarteritis nodosa and immune-complex mediated vasculitis

Q36. Which factor predicts poorer response to interferon therapy in chronic HDV?

• Low baseline HDV RNA
• Mild histologic activity on biopsy
• High baseline HDV RNA and advanced fibrosis
• Short duration of infection only

Correct Answer: High baseline HDV RNA and advanced fibrosis

Q37. For a patient with chronic HBV-HDV coinfection, what is the rationale for treating HBV with nucleos(t)ide analogues?

• They directly inhibit HDV replication
• Suppressing HBV can reduce HBsAg levels and indirectly affect HDV
• They are used to vaccinate against HDV
• They are contraindicated in coinfected patients

Correct Answer: Suppressing HBV can reduce HBsAg levels and indirectly affect HDV

Q38. Which of the following is the most appropriate screening recommendation for HDV among HBV-infected patients?

• Only test symptomatic patients with no history of HBV
• Test all HBsAg-positive individuals for anti-HDV, especially if elevated ALT or risk factors
• No testing is required due to rarity
• Only test if patient is vaccinated for HBV

Correct Answer: Test all HBsAg-positive individuals for anti-HDV, especially if elevated ALT or risk factors

Q39. Which laboratory value is most useful to monitor treatment response in HDV therapy?

• Serum creatinine only
• Quantitative HDV RNA and liver enzymes
• Urinalysis for protein
• Anti-HDV IgG titers only

Correct Answer: Quantitative HDV RNA and liver enzymes

Q40. Which statement about HDV vaccination is correct?

• There is a licensed vaccine specifically for HDV
• No specific HDV vaccine exists; HBV vaccination prevents HDV indirectly
• HDV vaccine is given as a booster to HBsAg-positive individuals
• HDV vaccination is effective post-exposure in chronic HBV patients

Correct Answer: No specific HDV vaccine exists; HBV vaccination prevents HDV indirectly

Q41. A likely pharmacologic reason for limited efficacy of nucleos(t)ide analogues against HDV is:

• HDV uses a DNA polymerase identical to HBV
• HDV replication employs host RNA polymerases and delta antigen-dependent mechanisms not targeted by these drugs
• They cannot reach the liver due to poor bioavailability
• They are rapidly degraded by HDV proteases

Correct Answer: HDV replication employs host RNA polymerases and delta antigen-dependent mechanisms not targeted by these drugs

Q42. Which monitoring is essential when initiating lonafarnib for HDV in a clinical trial?

• No monitoring required
• Monitor for gastrointestinal adverse effects and drug interactions due to CYP3A involvement
• Only monitor thyroid function tests
• Only weekly liver biopsy

Correct Answer: Monitor for gastrointestinal adverse effects and drug interactions due to CYP3A involvement

Q43. Which marker indicates active HBV replication and is relevant when assessing HDV coinfection?

• Anti-HBs
• HBV DNA and HBeAg presence
• Anti-HBc IgM only
• Anti-HAV IgG

Correct Answer: HBV DNA and HBeAg presence

Q44. Which clinical approach is recommended for an HBsAg-positive patient found to be anti-HDV positive but HDV RNA negative?

• No follow-up required since HDV RNA is negative
• Periodic monitoring for reactivation with ALT and HDV RNA testing as needed
• Immediate liver transplant
• Start lifelong interferon regardless of clinical status

Correct Answer: Periodic monitoring for reactivation with ALT and HDV RNA testing as needed

Q45. Which of the following is an approved indication for bulevirtide in some regions?

• Treatment of chronic HBV monoinfection only
• Treatment of chronic HDV infection in adults with compensated liver disease
• Universal prophylaxis for newborns against HDV
• Cure of chronic hepatitis C

Correct Answer: Treatment of chronic HDV infection in adults with compensated liver disease

Q46. In counseling a patient starting pegIFN-α therapy, which laboratory baseline assessment is critical?

• Baseline psychiatric evaluation and CBC including neutrophil count
• No baseline tests are necessary
• Only blood glucose is needed
• Baseline serum HDV antigen test only

Correct Answer: Baseline psychiatric evaluation and CBC including neutrophil count

Q47. Reinfection with HDV after recovery is prevented primarily by:

• Long-term lamivudine therapy
• Immunity conferred by HBV vaccination and clearance of HBsAg
• Frequent interferon retreatment
• Oral ribavirin prophylaxis

Correct Answer: Immunity conferred by HBV vaccination and clearance of HBsAg

Q48. Which statement about HDV-related hepatocellular carcinoma (HCC) risk is correct?

• HDV infection completely eliminates HCC risk
• HDV co-infection increases liver disease progression, indirectly raising HCC risk
• HCC occurs only in HDV monoinfection without HBV
• HDV prevents HBV-mediated oncogenesis

Correct Answer: HDV co-infection increases liver disease progression, indirectly raising HCC risk

Q49. For pharmacology students, which adverse effect is characteristic of pegylated interferon therapy and may require dose modification?

• Severe neutropenia and thrombocytopenia
• Hypertension resistant to all medications
• Permanent blindness in most patients
• Immediate kidney failure in all treated individuals

Correct Answer: Severe neutropenia and thrombocytopenia

Q50. Which practical counseling point should pharmacists provide to HDV patients regarding prevention of transmission?

• No precautions are necessary since HDV is not transmissible
• Avoid sharing needles, practice safe sex, and ensure household contacts receive HBV vaccination
• Only food precautions are needed to prevent spread
• Transmission occurs via casual contact like hugging, so isolation is required

Correct Answer: Avoid sharing needles, practice safe sex, and ensure household contacts receive HBV vaccination

G S Sachin

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