TDM Examination sample case B
Get familiar with the multiple-choice and short-menu question types you will see on the TDM Examination.
A 25-year-old man presents to your clinic for counselling regarding his recently diagnosed chronic hepatitis B infection. He will be seen by a hepatologist in a few weeks.
Which of the following key recommendations should be discussed today to prevent the transmission of hepatitis B virus? Select 3.
Given the patient’s diagnosis, which one of the following vaccines is most important to administer? Select 1.
Treatment is initiated for chronic hepatitis B infection. Which of the following are the goals of treatment? Select 2.
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Hepatitis B virus spreads efficiently through sexual contact and blood exposure; therefore, counselling should focus on reducing these specific routes of spread. Using condoms consistently lowers exposure to infectious bodily fluids. Blood donation is contraindicated because of the risk for transmission of hepatitis B virus. Sharing needles is contraindicated as this targets the highest-risk blood-to-blood mechanism. Hepatitis B vaccination is important for susceptible household contacts, sexual contacts, or both. However, in this case, the patient already has chronic hepatitis B infection, so vaccination is not a key personal prevention step. Consistent handwashing and covering all wounds with a dressing are general hygiene measures that do not address the main transmission pathways in typical community settings. Travel out of country is unrelated to hepatitis B virus transmission. Avoiding tattoos or piercings may reduce exposure to contaminated instruments, and using safer regulated service settings mitigates risk; however, these are not key considerations in this vignette. Sexual activity avoidance is unnecessary because safer sex practices can effectively reduce risk.
Lok ASF. Hepatitis B virus infection: Overview of management. UpToDate. Updated September 10, 2024. Accessed January 21, 2026.
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With chronic hepatitis B infection, hepatitis A vaccine is the most important to administer because hepatitis A superinfection can precipitate severe acute hepatitis and even liver failure in someone with underlying chronic liver disease. Vaccinating against hepatitis A prevents a potentially serious additional viral hepatitis that worsens hepatitis and decompensation risk. Hepatitis B vaccination is not useful once chronic infection is established. Tetanus, diphtheria, acellular pertussis vaccination; meningococcal vaccination; pneumococcal vaccination; or combinations thereof may be indicated based on routine schedules, risk factors, or comorbidities. However, these vaccinations do not specifically address a major foreseeable complication uniquely heightened by chronic hepatitis B infection in the same way hepatitis A vaccination does.
Lok ASF. Hepatitis B virus infection: Overview of management. UpToDate. Updated September 10, 2024. Accessed January 21, 2026.
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The primary goals of treating chronic hepatitis B are to suppress viral replication, prevent progression to cirrhosis and hepatocellular carcinoma, and reduce transmission. These goals help guide decisions about antiviral therapy, monitoring, and vaccination of contacts. Reducing co-infection with HIV is not a treatment goal for hepatitis B; it requires separate prevention strategies. Reducing symptoms of hepatitis B infection is often not a primary goal because many patients are asymptomatic, and symptom burden does not reliably track viral activity. Although antiviral therapy for chronic hepatitis B can lead to normalization of liver enzymes, it is not the central therapeutic endpoint. Likewise, normalizing the creatinine level or preventing immunosuppression are not primary goals of hepatitis B treatment.
Lok ASF. Hepatitis B virus: Overview of management. UpToDate. Updated September 10, 2024. Accessed January 21, 2026.