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NBME 23 Answers

nbme23/Block 2/Question#6

A 6-month-old girl is brought to the office for a ...

Hepatitis B

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 +7  upvote downvote
submitted by chris07(30),

The only infection on that list that you would even screen an otherwise healthy appearing individual is HepB. The others I would think you only check if the patient has a presentation that makes you suspect them, like EBV if they had signs of mono, or RSV if they had respiratory symptoms. At that point, they're no longer screening tests, but more diagnostic ones.

gilbert  I got it right because I thought of the prevalance of HBV in China. +3  

Lucky deduction, but looking back, I believe what they were going for is what she should have been vaccinated for at 6 months of age (since there are no apparent symptoms).

Hep B vaccine is usually given at birth, 1 month, and 6 months of age, so it's pretty important that she be vaccinated against it, unless she already has it, in which case she should be treated to avoid cirrhosis.

ls3076  how can we actually be expected to know vaccination schedules... there must be some other reason the answer is correct +2  

Disorders common in east Asia according to Goljan: Hepatitis B EBV infection - mostly leading to nasopharyngeal CA Alpha Thalassemia Nitrosamine linked Intestinal type gastric CA

In this question, since the patient is asymptomatic and EBV isnt exactly "screened for", went with HepB as the answer

ls3076  i think asymptomatic is really the key here -- good catch +1  

 +1  upvote downvote
submitted by usmle11a(36),

the child is asymptomatic because hepatitis B is mostly silent in infants due to poor lymphocyte system. other diseases would probably show more symptoms

 +1  upvote downvote
submitted by nukie404(6),

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(44),

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.