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NBME 23 Answers

nbme23/Block 2/Question#6 (32.8 difficulty score)
A 6-month-old girl is brought to the office ...
Hepatitis B🔍

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 +10  upvote downvote
submitted by chris07(43),
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The olny ctenfonii on ahtt tlsi hatt uoy dulow nvee rcesne na wehiresto ahetylh ppaanrgei udiianivdl is pHB.e The hrseto I dwuol iktnh uoy yoln hckec fi hte tinpaet sha a nesropittnae ttha asekm yuo supesct ,tmhe ikel EBV if eyth dah gssin fo nm,oo ro VSR fi heyt ahd psryeartior spymsto.m tA that inopt, heety'r no lngero sgnnicere ,tstse utb orme itgdionacs eno.s

gilbert  I got it right because I thought of the prevalance of HBV in China. +4  

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cuLyk dtoneduc,i ubt nolikgo ackb, I levebei hawt eyht eerw iongg for si wtah esh oulhds vaeh bnee ecditvaanc rfo ta 6 htonsm fo gae e(incs reeht are on rnatepap toym).smsp

eHp B icvncae is slluyau gnive at ith,br 1 ohmnt, nad 6 htsomn fo gae, so sti' tptyer apotrnmti atth hes be aacntvecid agiastn ,ti uslnse esh ayadlre ash ,ti ni cwihh ecas hse shudlo be edtrate to aivod sr.orhsici

ls3076  how can we actually be expected to know vaccination schedules... there must be some other reason the answer is correct +4  
cbreland  I don't think we need to know that the vaccination schedules, but that the only other answer with a vaccine was adenovirus. I figured that there would have more symptoms if she had adenovirus (plus didn't fit the typical military recruit/swimmer demographic) +  

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isdsreoDr ommcno ni seta Aias nrgociacd ot nii:tajltGpsHoae BVEB octnniife - ylsmot eglniad to nyaohlgapesrna hpCA lAa iitNosssamaaeemThrlani edinlk etInnltasi ptye icrtgsa AC

nI this teuqs,noi icsne het tainetp si ypimtasacmot nad EVB stin lctxyae ds"ceeren "r,of newt tihw pHeB sa eth rensaw

ls3076  i think asymptomatic is really the key here -- good catch +2  

 +1  upvote downvote
submitted by usmle11a(66),
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the ihdcl is tatpaomismcy cubeeas taseitihp B is solmty iesltn in intfans due ot opro yptlcmohye eymtss. trohe idassees wldou albypbor shwo mero mmsosypt

 +1  upvote downvote
submitted by nukie404(7),

To sum it up, even if you didn't memorize the whole immunization table, it's easy to remember HBV immunization is done at birth, 1mo, 2mo and 6mo roughly. Also added that the baby is of East Asian decent, and the fact that other infections on the list aren't screened for in the first place in healthy-looking patients, I think it's safe to deduce HBV was the answer here.

I thought Hepatitis B has high prevalence in developing countries, she is from a rural region from China, I got right. Plus Hepatitis B is asymptomatic in new borns.

 +0  upvote downvote
submitted by drzed(177),

Of all these viruses, Hep B is the only one that a child, if infected, would be a chronic carrier. Thus we should screen to make sure that we can prevent future risk of cirrhosis, etc.