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Chronic hepatitis B — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Chronic hepatitis BUSMLE Step 3

A 42-year-old man from Vietnam has positive hepatitis B surface antigen on repeat testing 8 months apart. ALT is elevated, HBV DNA is high, and ultrasound shows no hepatic mass. He drinks no alcohol and is HIV negative. Which of the following is the most appropriate next step in management?

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Correct answer: C — Refer for antiviral therapy evaluation and liver fibrosis assessment

Chronic hepatitis B with elevated ALT and high viral load requires staging and consideration of antiviral therapy.

Reference: AASLD hepatitis B guidance: https://www.aasld.org/