Hepatology: chronic hepatitis B antiviral therapy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Hepatology: chronic hepatitis B antiviral therapy

Sample item

A patient with chronic hepatitis B, compensated cirrhosis, a high HBV DNA level and raised ALT needs antiviral treatment. Which drug is a preferred option?

AAcyclovirBTenofovirCRibavirinDLamivudine monotherapy

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Tenofovir

Tenofovir and entecavir are preferred nucleos(t)ide analogues because of high potency and a high barrier to resistance. Lamivudine has a low barrier and causes frequent resistance. Ribavirin is used for hepatitis C and acyclovir for herpes viruses.

Option by option

A. Acyclovir
Acyclovir has no activity against hepatitis B virus.
B. Tenofovir (correct)
Correct. Tenofovir is potent with minimal resistance.
C. Ribavirin
Ribavirin does not treat hepatitis B.
D. Lamivudine monotherapy
Lamivudine selects resistant mutants quickly and is not preferred.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Tenofovir. Tenofovir and entecavir are preferred nucleos(t)ide analogues because of high potency and a high barrier to resistance.

Why is "Acyclovir" not the answer?

Acyclovir has no activity against hepatitis B virus.

Why is "Ribavirin" not the answer?

Ribavirin does not treat hepatitis B.

Why is "Lamivudine monotherapy" not the answer?

Lamivudine selects resistant mutants quickly and is not preferred.

What concept does this question test?

It tests Hepatology: chronic hepatitis B antiviral therapy in General Medicine. Lamivudine has a low barrier and causes frequent resistance. Ribavirin is used for hepatitis C and acyclovir for herpes viruses.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatology: chronic hepatitis B antiviral therapy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.