American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most appropriate management strategy for acute HBV infection?

1. Immediate liver transplant

2. Serial monitoring of liver enzymes

3. Antiviral therapy

4. Restrictive fluid intake

The correct answer is: Serial monitoring of liver enzymes

The most appropriate management strategy for acute hepatitis B virus (HBV) infection is serial monitoring of liver enzymes. In the case of acute HBV infection, many patients can achieve complete recovery without the need for specific antiviral therapy. Therefore, the primary goal in managing acute HBV infections typically involves monitoring the patient's liver function, as this allows healthcare providers to assess the progression of the liver disease and check for any potential complications, such as acute liver failure. Liver enzymes like ALT and AST can be elevated during an acute infection, and periodic assessments help in identifying the trends in these values and determining whether the patient is transitioning towards recovery or experiencing complications. This approach is supportive and allows for intervention if there is a significant decline in liver function. While antiviral therapy can be beneficial in cases of severe acute infection or in patients with coexisting conditions, it is not routinely indicated for all patients with acute HBV. Immediate liver transplantation is usually reserved for patients who develop acute liver failure, which is a rare outcome of HBV infection. Restrictive fluid intake is not a standard management strategy for acute HBV and does not address the underlying viral infection or its effects on the liver.