American Board of Internal Medicine (ABIM) Certification Practice Exam

What surveillance protocol is advised for patients with persistent hepatocellular inflammation in HBV infection?

1. Annual liver biopsy

2. Every three months MRI

3. Ultrasound imaging every 6 months

4. Regular blood tests every month

The correct answer is: Ultrasound imaging every 6 months

In the context of patients with persistent hepatocellular inflammation due to Hepatitis B Virus (HBV) infection, the recommended surveillance protocol is to perform ultrasound imaging every six months. This approach effectively monitors for potential complications such as hepatocellular carcinoma (HCC), which can arise in patients with chronic liver disease or active viral hepatitis. Routine ultrasound imaging is favored because it is a non-invasive method that allows for the assessment of liver structure and can help in early detection of any hepatic lesions. The six-month interval is based on guidelines that aim to provide adequate monitoring without imposing unnecessary frequency or stress on the patient. Other options do not align with current practices. For instance, regular liver biopsies are more invasive and typically indicated only in specific situations rather than as a surveillance method. Frequent MRI scans, while detailed, may not be practical for regular surveillance due to cost and accessibility. Likewise, monthly blood tests, while they can provide information on liver function and HBV DNA levels, do not specifically monitor for HCC development, thus making ultrasound the most appropriate choice in this scenario.