A 29-year-old man comes to the physician for a routine health maintenance examination. He feels well. He works as a nurse at a local hospital in the city. Three days ago, he had a needlestick injury from a patient whose serology is positive for hepatitis B. He completed the 3-dose regimen of the hepatitis B vaccine 2 years ago. His other immunizations are up-to-date. He appears healthy. Physical examination shows no abnormalities. He is concerned about his risk of being infected with hepatitis B following his needlestick injury. Serum studies show negative results for hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis C antibody. Which of the following is the most appropriate next step in management?
ARevaccinate with 3-dose regimen of hepatitis B vaccine
BRevaccinate with two doses of hepatitis B vaccine
CAdminister hepatitis B immunoglobulin
DAdminister hepatitis B immunoglobulin and 3-dose regimen of hepatitis B vaccine
EAdminister hepatitis B immunoglobulin and single dose hepatitis B vaccine
Two months after giving birth to a boy, a 27-year-old woman comes to the physician with her infant for a well-child examination. She was not seen by a physician during her pregnancy. Physical examination of the mother and the boy shows no abnormalities. Laboratory studies show elevated titers of hepatitis B surface antigen in both the mother and the boy. Which of the following statements regarding the infant's condition is most accurate?
AHepatitis B e antigen titer is likely undetectable
BChronic infection is unlikely
CLifetime risk of hepatocellular carcinoma is low
DSignificant elevation of transaminases is not expected
EThe viral replication rate is low
A 28-year-old man presents to the office with complaints of malaise, anorexia, and vomiting for the past 2 weeks. He also says that his urine is dark. The past medical history is unremarkable. The temperature is 36.8°C (98.2°F), the pulse is 72/min, the blood pressure is 118/63 mm Hg, and the respiratory rate is 15/min. The physical examination reveals a slightly enlarged, tender liver. No edema or spider angiomata are noted. Laboratory testing showed the following: HBsAg Positive IgM anti-HBc < 1:1,000 Anti-HBs Negative HBeAg Positive Anti-HBe Negative HBV DNA 2.65 × 10⁹ IU/L Alpha-fetoprotein 125 ng/mL What is the most likely cause of this patient's condition?
AAcute HBV infection
BPassive immunity
CAcute resolving infection
DResolved HBV infection (innate immunity)
EAcute exacerbation of chronic HBV infection
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