skip to main content

Hepatitis B screening — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardAmbulatory Medicine / Primary CareHepatitis B screeningUSMLE Step 3

A pregnant patient at 28 weeks has chronic hepatitis B, HBeAg positivity, HBV DNA 3.8 million IU/mL, normal bilirubin, and no cirrhosis. Which plan best reduces perinatal transmission?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Start third-trimester tenofovir; give neonatal HBV vaccine and HBIG at birth

The best answer is “Start third-trimester tenofovir; give neonatal HBV vaccine and HBIG at birth”. High maternal viral load warrants third-trimester tenofovir in addition to immediate neonatal vaccine and HBIG. Delivery route is not the primary preventive intervention, interferon is unsuitable in pregnancy, and delaying neonatal prophylaxis increases transmission. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: AASLD, Reproductive Health and Liver Disease Guidance: https://www.aasld.org/practice-guidelines/reproductive-health-and-liver-disease