American Board of Internal Medicine (ABIM) Certification Practice Exam

After achieving SVR, how often should patients with cirrhosis be monitored for hepatocellular carcinoma?

1. Annually

2. Monthly

3. Twice yearly

4. Every two years

The correct answer is: Twice yearly

Monitoring patients with cirrhosis for hepatocellular carcinoma (HCC) after achieving sustained virologic response (SVR) is critical due to the persistent risk of liver cancer despite the resolution of viral hepatitis. Current guidelines recommend that patients with cirrhosis should undergo surveillance for HCC with imaging, typically ultrasound, every six months. This biannual monitoring allows for early detection of HCC, which can significantly improve outcomes due to the potential for curative treatments. The rationale for this frequency is based on evidence suggesting that the risk of HCC remains elevated even after successful treatment of the underlying viral infection. Cirrhosis itself is a significant risk factor, and regular monitoring is essential for identifying malignancy at an earlier and more treatable stage. The other frequency options, such as annual, monthly, or every two years, do not align with the recommended practice. Annual monitoring may lead to delays in diagnosis, while monthly monitoring may not be necessary and could result in overtreatment or unnecessary anxiety for patients. Monitoring every two years lacks sensitivity for early detection given that HCC can develop relatively fast in high-risk populations like those with cirrhosis. Thus, the twice-yearly schedule strikes an important balance between regular check-ups and