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nbme23/Block 2/Question#6 (39.5 difficulty score)
A 6-month-old girl is brought to the office ...
Hepatitis B🔍,📺

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submitted by chris07(57),
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hTe only noiceiftn no htat ilst hatt uyo olduw enev csener na rsteohewi hayhelt reiagpnpa didviulnia si eBHp. Teh soerth I owdul intkh uoy lony kecch fi eth iptante ahs a tnoprineseta ttha smeka uoy ctspuse h,met klei BEV fi they ahd nsgsi of n,omo or SRV fi ythe dah iporyatrers ptymo.mss At htta pt,nio 'ehreyt on logrne cnngeseir se,tts btu more iogsdtncia ne.os

gilbert  I got it right because I thought of the prevalance of HBV in China. +5  
yesa  Also, HBV forms chronic infection in children (HCV chronic in adults), so if she's not vaccinated for it, you screen for it first. All of the others you don't screen for even if they cause a latent infection (CMV...) +  

submitted by sympathetikey(1376),
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uykLc udt,icdoen tbu gokilno bka,c I ieebvel waht ythe erwe gngoi ofr si tahw esh uodhsl heav nebe ecdnativca ofr at 6 hmtnso fo age icn(es ethre are on neprpata osy.t)pmms

Hep B acnicev is lusyual evgni ta trhb,i 1 ot,mhn dna 6 mohtns of eag, so t'is rteytp nttpiamro tath she be intaeacvdc taignas ,it ulesns esh adeylra sah i,t in hhwci aesc she hdlsou eb etrdeat ot iodva .sosrrchii

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) +  
koko  Why does it have to be something with a vaccine? RSV Is extremely common in babies,shouldn’t screen for that? +  

submitted by usmle11a(77),
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the dchil is saytmaiotpmc csbeuae taiphites B is ylsotm siltne in tifanns ude to oorp ymphecotyl .setsym etrho eeisadss lwduo ropbybla ohsw rmeo smpsmtyo

submitted by goodkarmaonly(0),
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resDrsiod ocnomm in tsae Asai ccrdngioa to n:t iHlaaeGsioptj BVEB oiietnfnc - lsomyt eldagni to egrysannaophal h ApaCAl hlnesaTam oiairNmssteai edlkin ttnIisaeln eytp caitrsg CA

In hsit ieo,snqtu iscne eth ptaenit si sctmpyimatoa nda EVB snit clxyeat ee"dncers "ro,f tnew ihwt pHBe sa eht rnaesw

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

submitted by nukie404(8),
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To smu ti ,pu eenv fi you idn'td rmeziemo eth owehl tomiuiinmanz lt,abe sit' asey ot beermerm BVH notanimmizui is noed at br,hti m,1o om2 and m6o luhroyg. sAol ddead atth teh bayb is of sEta inasA nedec,t nad het ctaf hatt rtoeh ieitfcosnn no hte ilts ne'atr rcndseee for in the ifsrt lepac ni telkayignlohh-o ept,tains I itnkh tis' efas to dceude HVB aws eht asewnr rhee.

submitted by bilirrubin15(0),

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.

submitted by drzed(221),

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.

submitted by avicenna(2),

Good research to read over Hep-B being prevalent in china!