American Board of Internal Medicine (ABIM) Certification Practice Exam

What symptom is indicative of persistent inflammatory activity in HBV infection?

1. Normal ALT levels

2. Stable HBV DNA levels

3. Elevated ALT levels

4. Decreased liver size

The correct answer is: Elevated ALT levels

Elevated ALT levels are indicative of persistent inflammatory activity in hepatitis B virus (HBV) infection. Alanine aminotransferase (ALT) is an enzyme found in the liver, and its levels in the blood are commonly used as a marker for liver inflammation and damage. When there is ongoing infection and inflammation due to HBV, liver cells are damaged, leading to the release of ALT into the bloodstream, resulting in elevated levels. In the context of HBV, elevated ALT levels suggest that active liver inflammation is occurring, which can be associated with ongoing viral replication. Monitoring ALT levels is crucial for assessing the state of the infection and determining the appropriate management strategies. The other options do not indicate persistent inflammatory activity. For instance, normal ALT levels would suggest an absence of significant inflammation or liver damage at that time. Stable HBV DNA levels do not necessarily correlate with inflammation on their own, as stable levels could represent either active infection without significant liver damage or a chronic infection with quiescent liver disease. Lastly, decreased liver size is not a reflection of inflammatory activity; rather, it could indicate advanced liver scarring (cirrhosis), which may actually be accompanied by lower ALT levels in late-stage liver disease due to loss of hepatocytes