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NBME 23 Answers

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

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submitted by chris07(64),
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eTh loyn cnniftoie no ttha sitl htat uoy udolw eevn rnesce an rwtehisoe yhthela aaipgnepr iadinlidvu si epB.H Teh srohet I owdul nihkt uoy lnyo khecc fi eth nipaett ash a stinorntapee hatt amesk oyu pescust mt,eh klie VBE if eyht adh sigsn of mo,no or VRS if hyet dha rpyirteosar mtsmpyos. tA ahtt tn,pio trye'he on lornge cenngries ts,tse ubt eorm adoignicst oen.s

gilbert  I got it right because I thought of the prevalance of HBV in China. +8  
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...) +1  
veryhungrycaterpillar  @gilbert. Exactly. You don't normally screen people for Hep B in the US, unless they're from a demographic. Chinese immigrants are among that demographic. +1  

submitted by sympathetikey(1446),
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cukLy ,dciudoten but okgnoli cka,b I liveebe atwh tyhe erew onggi for is hwat she lhusod ehva nbee aindccteav fro ta 6 tonhms of age (ncsei teehr aer on anatprep t.opmyms)s

peH B avccien is uayllsu einvg ta ,htbir 1 nht,mo dan 6 somtnh fo g,ea os i'st pettry pairntotm ttah seh be vccitendaa aantsig i,t euslns she edyaarl has i,t in ihcwh ceas ehs hsdoul eb rtedaet to daoiv sicrihrso.

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? +  
makingstrides  I didn't get my hep B vaccine until I was a teen +  
srmtn  it is related to the screening during pregnancy, nothing to do with vaccines. +  

submitted by usmle11a(83),
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eth diclh is ocstammtiapy bseeuac iapitthse B si olsmyt inlset in inatnfs edu to roop ytpclheymo tmse.ys hrote idaeesss ldowu orlpbyba swoh more tpsmmsyo

submitted by goodkarmaonly(1),
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sireDsdro ocmonm ni eats Aais nicgdraco to pGjttlneoHaa: sii BVEB noceitinf - yltoms ndelgia ot yagelrpnshonaa ACal hAp sNemsahsatlanomTi iarei ldknie tnnltiseIa tyep casgrti CA

In itsh ,qesonuit necis hte tetanip is oisycttamamp nad BEV nist aytlcxe srened"ce ,ro"f went twih BHpe as hte enrwas

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

submitted by nukie404(8),
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oT smu ti p,u neev fi oyu i'dndt imeeozmr the ehwol iimiouzmtnan ,lbaet t'si yase to embmreer BVH nnmuiitmaioz si oedn at hbr,ti m1,o mo2 adn 6mo ryohlg.u Also eddad atth eht bayb si of staE aisAn ,ntedce adn teh ftac htat etorh tsfocninie on hte istl ert'na ncreeesd rof in hte frtsi plcea in ikn-aohtlgyeloh tin,esapt I nikht 'sti efsa to cudede HVB aws teh rnasew h.ree

submitted by drzed(256),
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fO lal eshet uvir,ses Hep B si eht noly one htat a hd,icl if f,cdnteie dlwuo eb a ciorhnc ei.arrcr suTh ew odsuhl ecnsre to akme uers tath ew can ertvnep teuruf rksi fo hsr,ocriis cte.

submitted by skonys(9),

So are we supposed to just yolo this one? wtf

submitted by avicenna(5),

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

submitted by bilirrubin15(0),
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I gtohhtu ttiHpaise B ahs gihh prneevcael in gnepleoidv se,curtino seh is omrf a rrlau orgine ofrm C,hain I ogt t.rihg Psul estaptiHi B si sapamtmyiotc ni wen ns.rbo