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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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heT yoln finoietcn no tath ilst htat ouy udolw nvee enecsr an sehoritwe hetaylh rapnieapg luviddniai si .eBpH Teh ohetrs I lduow knthi uoy ylon ccehk fi hte teanpti ash a netaetnsirop ttah ekasm uoy scspeut ,tmeh ielk BEV if thye ahd isngs fo on,mo ro RVS fi etyh dah eaosrrpytri ptmos.ysm tA atth poi,tn rehyte' on lrenog gecrsinen ,stste but eomr adgticosin so.en

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

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kucyL tduioe,cnd tub golonik kcab, I ebevile wath heyt wree ggoin ofr is hatw hes sdlohu aveh eenb tcvaniaecd for at 6 stmohn fo ega (nicse erthe rae no eapanptr os).ymptsm

epH B ecaivcn si usylula ievgn ta hbi,rt 1 tno,hm adn 6 snmoht fo ,age so sti' trpeyt pmrtnitao hatt she be acitcdaenv atnsaig ,it ulssne ehs ydleraa ahs ,ti ni cihwh ecsa esh ouhsld be etdarte ot doavi riroih.scs

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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rsiorDsde mmncoo in aset saAi igdaocncr ot GsneojaHtilapi t: VB EB nncioteif - oytlsm alingde ot snhpaalenoargy h AAplCa ihamarmiai asNnstsTolee ldkein ilInnasett peyt irasctg CA

In sith it,eoquns icesn eth eptntai si apisamcomtyt nda VEB nist caxyetl "srceened r"f,o wten iwht pHeB sa teh nesarw

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

 +1  upvote downvote
submitted by usmle11a(66),
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eht ldich is tpaaioystcmm ceeusba aptthiesi B si toslym ietsln in atnfisn due ot oorp thpcymleyo .ssetym ehtro ediaesss dulwo ybbparlo hwso mero mptmssoy

 +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.