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NBME 23 Answers

nbme23/Block 2/Question#6 (32.7 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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Teh ylon enctinfoi no htat list taht ouy loduw neve neercs an ohetwiesr ahyehtl ipgnaearp liniadidvu is .HBep Teh hesrot I ludow khint uoy ylno ceckh if teh nettiap has a nnaetoeisrtp tath aesmk yuo ustcspe e,mth keli BVE if yeht dah sings fo ono,m or VRS if tehy adh iorretapsry smypm.tos At atht o,tipn yt'ereh no elnorg ngesreinc te,sst tub erom toanisidgc se.on

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

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cuykL ddec,tnoui tub gilknoo k,cab I eleiebv twha eyth ewre gnigo fro si hatw hes olhdsu heva ebne aitaccvned for at 6 snthom of ega sni(ce eethr are no ptenarpa smt)os.mpy

Hpe B iavccen si lluuays givne ta birh,t 1 ,ntohm dna 6 onhmts fo gea, so 'ist repytt anripottm that seh be tndcaiavce ganstai ti, eslsnu hes yaelrad hsa it, ni whhci aesc esh uldhso eb etteard to odavi rssi.ircho

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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Ddsreiors nmomoc in sate aAsi dngoccari ot :teGplnoiaaist Hj BVEB ntcfnieoi - yltsmo dnaeilg to slaphnognraeya hAlapCA mTshseiasrNi maatlnaeoi keindl tneistlIan ptey ctirsag CA

nI iths ,snutqeio inesc het aeptnti si pstymioctama adn VBE nist ectlaxy "dncsreee "o,rf etnw ihtw peBH as the ewansr

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

 +1  upvote downvote
submitted by usmle11a(65),
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teh dlhic si aimtpcstmoya ebcseua tiepshati B is mostly nesilt in atnfnsi ued ot oopr hyteolpycm .mseyts ehtor sdessaie wuldo prolbyba owhs emro pmosytms

 +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.