Hepatitis E MCQs With Answer

Hepatitis E MCQs With Answer is an essential review for B. Pharm students preparing for exams and clinical practice. This concise, Student-friendly post covers Hepatitis E virus (HEV) virology, transmission, clinical features, diagnosis, treatment options like ribavirin, prevention strategies, and vaccine status. Understanding HEV genotypes, risks in pregnancy, laboratory tests (IgM/IgG and RT‑PCR), and public health measures will strengthen your pharmacology and therapeutics knowledge. These focused MCQs emphasize practical points pharmacists must know for patient counseling, medication safety, and infection control. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary causative agent of Hepatitis E?

• Hepatitis E virus
• Hepatitis A virus
• Hepatitis B virus
• Non-A, non-B hepatitis agent

Correct Answer: Hepatitis E virus

Q2. To which viral family does Hepatitis E virus belong?

• Flaviviridae
• Hepeviridae
• Picornaviridae
• Hepadnaviridae

Correct Answer: Hepeviridae

Q3. What is the genomic structure of HEV?

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

Correct Answer: Single-stranded positive-sense RNA

Q4. What is the most common transmission route for Hepatitis E in endemic areas?

• Sexual transmission
• Fecal‑oral transmission via contaminated water
• Vector-borne transmission (mosquitoes)
• Airborne respiratory droplets

Correct Answer: Fecal‑oral transmission via contaminated water

Q5. What is the typical incubation period for HEV infection?

• 1–3 days
• 2–8 weeks (15–60 days)
• 6–12 months
• 10–14 days

Correct Answer: 2–8 weeks (15–60 days)

Q6. Which HEV genotypes commonly infect humans worldwide?

• Genotypes 5–8
• Genotypes 1–4
• Only genotype 1
• Only genotype 3

Correct Answer: Genotypes 1–4

Q7. Which HEV genotypes are most associated with zoonotic transmission?

• Genotype 1 and 2
• Genotype 3 and 4
• Genotype 5 only
• Genotype 2 and 6

Correct Answer: Genotype 3 and 4

Q8. Which group is at highest risk of fulminant hepatitis and death from HEV?

• Healthy young adult males
• Pregnant women, especially in the third trimester
• Children under 5 years only
• Elderly with hypertension

Correct Answer: Pregnant women, especially in the third trimester

Q9. Chronic HEV infection is most likely in which scenario?

• Immunocompetent adult infected with genotype 1
• Immunosuppressed patient (e.g., transplant recipient) infected with genotype 3
• Healthy child with genotype 2
• Pregnant woman with genotype 1

Correct Answer: Immunosuppressed patient (e.g., transplant recipient) infected with genotype 3

Q10. Which serological marker indicates acute HEV infection?

• Anti-HEV IgG
• Anti-HEV IgM
• HBeAg
• Anti-HBc IgM

Correct Answer: Anti-HEV IgM

Q11. Which marker suggests past HEV exposure and possible immunity?

• Anti-HEV IgM
• Anti-HEV IgG
• HEV RNA by RT-PCR
• HBe antibody

Correct Answer: Anti-HEV IgG

Q12. What is the molecular test of choice to detect acute HEV infection?

• ELISA for anti-HEV IgG only
• HEV RNA detection by RT‑PCR
• HCV RNA PCR
• Rapid antigen test for hepatitis A

Correct Answer: HEV RNA detection by RT‑PCR

Q13. Which clinical specimen often gives the highest yield for HEV RNA testing?

• Saliva only
• Stool (feces) or serum for RT‑PCR
• Hair follicles
• Sweat

Correct Answer: Stool (feces) or serum for RT‑PCR

Q14. Typical liver enzyme pattern in acute HEV is:

• Mild ALT and marked alkaline phosphatase elevation
• Marked elevation of ALT and AST with ALT higher than AST
• Normal transaminases with isolated hyperbilirubinemia
• Only GGT elevation

Correct Answer: Marked elevation of ALT and AST with ALT higher than AST

Q15. Which statement about HEV vaccination is correct?

• No HEV vaccine has ever been developed
• A recombinant HEV vaccine (Hecolin) is licensed in China for adults
• The HEV vaccine is universally available and WHO-recommended for all travelers
• Only inactivated whole-virus HEV vaccines exist globally

Correct Answer: A recombinant HEV vaccine (Hecolin) is licensed in China for adults

Q16. What is the first-line antiviral therapy recommended for chronic HEV in many clinical settings?

• Acyclovir
• Ribavirin
• Oseltamivir
• Sofosbuvir

Correct Answer: Ribavirin

Q17. Ribavirin therapy is contraindicated in which population due to teratogenicity?

• Children under 12
• Pregnant women
• Patients with diabetes
• Patients with CKD stage 1 only

Correct Answer: Pregnant women

Q18. Essential supportive measures for acute HEV management include:

• Immediate use of high-dose corticosteroids for all patients
• Hydration, rest, nutrition, and avoidance of hepatotoxic drugs
• Routine prophylactic antibiotics
• Immediate liver transplant for all cases

Correct Answer: Hydration, rest, nutrition, and avoidance of hepatotoxic drugs

Q19. Which open reading frame (ORF) encodes the HEV capsid protein?

• ORF1
• ORF2
• ORF3
• ORF4

Correct Answer: ORF2

Q20. Which HEV genotype is most commonly associated with large waterborne outbreaks in developing countries?

• Genotype 1
• Genotype 4
• Genotype 5
• Genotype 7

Correct Answer: Genotype 1

Q21. What animal is a major reservoir for zoonotic HEV transmission?

• Cats
• Pigs (swine)
• Birds
• Fish

Correct Answer: Pigs (swine)

Q22. Foodborne HEV outbreaks have been linked to consumption of:

• Undercooked pork or wild boar meat
• Pasteurized milk only
• Well-cooked poultry
• Bottled water exclusively

Correct Answer: Undercooked pork or wild boar meat

Q23. In immunocompetent individuals, HEV infection is usually:

• Chronic and progressive
• Self-limiting and acute
• Always asymptomatic lifelong carriage
• Causes immediate fulminant hepatic failure in all cases

Correct Answer: Self-limiting and acute

Q24. What is the approximate maternal mortality risk from HEV infection in pregnancy in some outbreaks?

• Less than 0.1%
• Up to 20% or higher, especially in the third trimester
• Exactly 50% in all cases
• No increased risk compared with nonpregnant adults

Correct Answer: Up to 20% or higher, especially in the third trimester

Q25. Can HEV be transmitted through blood transfusion?

• No, HEV is never transmitted via blood
• Yes, transfusion-transmitted HEV has been reported
• Only if blood is refrigerated for more than 7 days
• Only in neonates

Correct Answer: Yes, transfusion-transmitted HEV has been reported

Q26. Anti-HEV IgM antibodies typically appear and persist for how long?

• They never appear in HEV infection
• Appear around symptom onset and may persist for 3–6 months
• Appear only after 2 years
• Persist lifelong at high titres

Correct Answer: Appear around symptom onset and may persist for 3–6 months

Q27. Which extrahepatic manifestation has been associated with HEV infection?

• Guillain–Barré syndrome and other neurological disorders
• Chronic obstructive pulmonary disease
• Type 1 diabetes onset
• Osteoporosis

Correct Answer: Guillain–Barré syndrome and other neurological disorders

Q28. Which statement about HEV in food safety is correct?

• HEV is resistant to all cooking temperatures
• Proper cooking (thorough heat) inactivates HEV in meat
• Freezing reliably increases HEV infectivity
• Microwave heating at low power preserves HEV

Correct Answer: Proper cooking (thorough heat) inactivates HEV in meat

Q29. Chronic HEV infection is defined by persistence of HEV RNA for:

• Less than 2 weeks
• More than 3 months
• Exactly 24 hours
• Always lifelong from the first exposure

Correct Answer: More than 3 months

Q30. Where does HEV primarily replicate in the human body?

• Neurons
• Hepatocytes (liver cells)
• Cardiac myocytes
• Adipose tissue

Correct Answer: Hepatocytes (liver cells)

Q31. Which public health intervention is most effective in preventing HEV outbreaks?

• Improved sanitation and safe drinking water
• Mass influenza vaccination
• Eliminating dairy products
• Widespread antibiotic distribution

Correct Answer: Improved sanitation and safe drinking water

Q32. What is the primary role of HEV ORF3 protein?

• Encodes viral polymerase
• Encodes a small phosphoprotein involved in virion egress and host interactions
• Forms the viral envelope glycoprotein exclusively
• Is not expressed in human infections

Correct Answer: Encodes a small phosphoprotein involved in virion egress and host interactions

Q33. In immunosuppressed patients, serological tests for HEV may be unreliable; therefore which test is preferred?

• Liver biopsy only
• HEV RNA detection by RT‑PCR
• Urine culture
• Skin prick test

Correct Answer: HEV RNA detection by RT‑PCR

Q34. When is HEV screening of blood donors particularly considered?

• Never; HEV cannot be transmitted by blood
• In high-prevalence areas or when blood is destined for immunocompromised recipients
• Only for donors over 80 years old
• Only when donors report gastrointestinal symptoms

Correct Answer: In high-prevalence areas or when blood is destined for immunocompromised recipients

Q35. Which describes HEV particle morphology relevant to infectivity?

• Always enveloped in all body fluids
• Quasi-enveloped in blood but non-enveloped in feces
• Always non-enveloped in every matrix
• Contains a double lipid bilayer in stool

Correct Answer: Quasi-enveloped in blood but non-enveloped in feces

Q36. How should HEV infection in pregnancy be primarily managed?

• Start ribavirin immediately in all pregnant women
• Supportive care and close monitoring because ribavirin is contraindicated in pregnancy
• Immediate elective abortion in all cases
• Administer high-dose vitamin C as curative therapy

Correct Answer: Supportive care and close monitoring because ribavirin is contraindicated in pregnancy

Q37. A prolonged prothrombin time (PT) in HEV infection indicates:

• Coagulopathy and severe hepatic dysfunction
• Improved liver function
• Renal failure only
• Electrolyte imbalance unrelated to liver

Correct Answer: Coagulopathy and severe hepatic dysfunction

Q38. The HEV vaccine Hecolin is currently licensed for use in:

• All countries worldwide by WHO prequalification
• China for adults (recombinant vaccine)
• Only in veterinary use
• Children under 1 year exclusively

Correct Answer: China for adults (recombinant vaccine)

Q39. HEV superinfection in a patient with chronic hepatitis B or C most commonly results in:

• No change in clinical course
• Precipitation of acute-on-chronic liver failure and decompensation
• Immediate viral clearance of both viruses
• Improved hepatic synthetic function

Correct Answer: Precipitation of acute-on-chronic liver failure and decompensation

Q40. RT‑PCR assays for HEV commonly target which regions of the viral genome?

• Human mitochondrial DNA regions
• ORF2/ORF3 regions of HEV genome
• Only the 5S rRNA
• Hepatitis B surface antigen coding region

Correct Answer: ORF2/ORF3 regions of HEV genome

Q41. Which measure reduces zoonotic transmission of HEV from pigs to humans?

• Avoiding undercooked pork and improving pig farm hygiene
• Feeding pigs raw shellfish
• Encouraging consumption of raw pork liver dishes
• Stopping all vaccination programs in animals

Correct Answer: Avoiding undercooked pork and improving pig farm hygiene

Q42. How does HEV infection typically present in children?

• Severe fulminant hepatitis in most children
• Often asymptomatic or mild disease
• Always causes chronic hepatitis
• Causes congenital malformations

Correct Answer: Often asymptomatic or mild disease

Q43. Key travel advice to prevent HEV infection in endemic regions includes:

• Drink untreated river water to build immunity
• Avoid untreated water and uncooked foods; use bottled/boiled water
• Only eat ice made from local tap water
• Rely solely on hand sanitizers without food precautions

Correct Answer: Avoid untreated water and uncooked foods; use bottled/boiled water

Q44. Which antiviral has been used as a second-line option in some chronic HEV cases?

• Pegylated interferon in selected cases (e.g., some transplant recipients)
• Ampicillin
• Metronidazole
• Chloroquine

Correct Answer: Pegylated interferon in selected cases (e.g., some transplant recipients)

Q45. What biosafety level (BSL) is generally appropriate for routine laboratory work with HEV?

• BSL-1
• BSL-2
• BSL-4 only
• BSL-3 mandatory for all HEV tests

Correct Answer: BSL-2

Q46. What does HEV ORF1 encode?

• Structural capsid protein
• Nonstructural polyprotein including replicase and polymerase domains
• Host cell receptor
• Human cytokine analog

Correct Answer: Nonstructural polyprotein including replicase and polymerase domains

Q47. Which genotype has been most frequently implicated in severe pregnancy-associated HEV disease?

• Genotype 1
• Genotype 3 only in all cases
• Genotype 7 exclusively
• Genotype 5 only

Correct Answer: Genotype 1

Q48. Before anti-HEV antibodies appear, the most sensitive test to confirm early infection is:

• Liver enzyme levels only
• HEV RNA detection by RT‑PCR
• Chest X-ray
• Urine dipstick

Correct Answer: HEV RNA detection by RT‑PCR

Q49. How long is HEV typically shed in the stool after acute infection?

• Shedding does not occur in stool
• Several weeks, commonly 2–6 weeks
• Only a few hours
• Exactly 10 months in all patients

Correct Answer: Several weeks, commonly 2–6 weeks

Q50. Which is an important role for pharmacists regarding Hepatitis E?

• Counselling on prevention, advising about ribavirin teratogenicity, and providing vaccine information where applicable
• Performing liver transplants
• Prescribing ribavirin to pregnant women without consultation
• Replacing public health sanitation programs

Correct Answer: Counselling on prevention, advising about ribavirin teratogenicity, and providing vaccine information where applicable

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