 Welcome back to our MedSmarter question of the week where we're taking a smarter approach to preparing future physicians. Before we get started, if you'll take just a quick minute and click that like button and also subscribe and turn the bell on so that you'll be notified when we post new videos. Let's jump right into that question and as always we start with the last sentence of the vignette and then read the rest. Which of the following is the most appropriate conclusion? A hepatitis panel is ordered for a 25 year old woman as part of a routine workup for abdominal pain. Results of the serologic testing are negative for the Hep B envelope antigen and the Hep B surface antigen, but positive for the Hep B surface antibody and IgG Hep B core antibody. Which of the following is the most appropriate conclusion? Alright, so we need to go back and remember that chart of what rises and falls when for Hep B patients when they are in the acute phase, when they're in the recovery phase, when they're in the window phase and that will tell us what we're dealing with. So let's look at these answer choices. Take a minute, read each answer choice, come up with your answer, write it in the comment box below. Alright, so we're looking for patients that have negative envelope, negative surface antigen, but positive surface antibody and core antibody. I do remember that the surface antigen is one of the first things that goes up. So if they have a negative surface antigen that tells me they're not in an acute infection. So let's look and see if there are any of those options here. Alright, C is the acute phase, so we know acute phase is out. I also saw when I was reading through this, A was never infected. Well, I know that they've been infected because they have the antibodies. So I'll take A out. So that leaves us someone that's completely recovered in the window phase or never been exposed. If they've never been exposed, they wouldn't have antibodies again. So E is out. So are we in the window phase or are we in the completely recovered phase? This is where we need to determine between the IgG core antibody and the IgM core antibody. The IgM core antibody comes up first and disappears while the IgG comes up later. So IgM would be present in the window period whereas IgG would be present in the acute phase. Well, we have IgG here, so therefore we are in the completely recovered, not in D. So that means B is going to be my final answer. And B is the final answer. So he's been exposed to Hep B and he's completely recovered because of the Hep B surface antibody and the IgG core antibody. They don't have the antigen from the surface of the Hep B virus, which would indicate a carrier state. But she does have the surface antibody, meaning she's been exposed to it and has recovered. And the recovery is indicated by the IgG core antibody. So let's take a look here at the chart just so we can see where we're at. So with this patient we said that they had the anti-core antibody, which is here. This is the purple. And they had the anti-surface IgG antibody, which is going to be this green line here, which tells us that for both of those to be present they've got to be in that recovery phase. You can have the anti-core antibody present in the window phase as well, but it would be an IgM core antibody, not an IgG. If we were in the acute infection phase, that's where we would see the envelope antigen and the surface antigen present, but we don't see either of that to be able to diagnose an acute phase of the infection. If you found this material helpful for your studying, please like and consider subscribing to the channel. Also, share this video so that more people can benefit from it like you have.