Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MKSAP: 55-year-old man with hepatitis C virus (HCV)

mksap
Conditions
March 12, 2016
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 55-year-old man is evaluated in follow-up after a recent routine screening for antibody to hepatitis C virus (HCV) was positive. His medical history is unremarkable; he has not used illicit drugs or had any history of blood transfusions. He currently feels well and takes no medications.

Vital signs and physical examination are normal.

Laboratory studies reveal a positive HCV antibody test, but HCV RNA testing is negative. The serum alanine aminotransferase level is normal.

Which of the following is the most appropriate diagnostic test to perform next?

A: Perform liver ultrasound
B: Perform serial alanine aminotransferase monitoring
C: Repeat HCV antibody testing
D: Repeat HCV RNA testing
E: No further testing

MKSAP Answer and Critique

The correct answer is E: No further testing.

Patients who are hepatitis C virus (HCV) antibody positive but HCV RNA negative do not have HCV infection and require no further testing. Repeating HCV RNA testing can be considered if there are risk factors for recent HCV infection or if there is other clinical evidence of liver disease, but neither of these is present in this patient. A 2013 guideline from the U.S. Preventive Services Task Force recommended screening for hepatitis C once in all persons born between 1945 and 1965, as well as targeted screening of persons with risk factors such as illicit drug use, receipt of blood products, hemodialysis, and multiple sex partners. Screening is accomplished by testing for antibody to HCV (anti-HCV). If antibody testing is positive, the next step is to perform HCV RNA testing, which is often done by “reflex” testing in many laboratories. The test results are interpreted in the following ways: Positive anti-HCV with negative HCV RNA indicates either false-positive anti-HCV or cleared infection, and positive anti-HCV with positive HCV RNA indicates active infection. Rarely, in instances of acute HCV infection or in an immunosuppressed patient, HCV RNA may be positive despite a negative anti-HCV.

Liver ultrasound and serial alanine aminotransferase monitoring are not necessary in the absence of clinical evidence of liver disease.

Key Point

  • Patients with a positive antibody to hepatitis C virus (HCV) but negative HCV RNA do not have HCV infection, and no further testing is required.

This content is excerpted from MKSAP 17 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

Wait lists at the VA may be a sign of things to come

March 11, 2016 Kevin 12
…
Next

How to do a no hands-on physical in 3 minutes (or less)

March 12, 2016 Kevin 71
…

Tagged as: Gastroenterology

Post navigation

< Previous Post
Wait lists at the VA may be a sign of things to come
Next Post >
How to do a no hands-on physical in 3 minutes (or less)

ADVERTISEMENT

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

Related Posts

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 35-year-old woman with constipation

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 60-year-old woman with persistent constipation

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 45-year-old woman with type 2 diabetes mellitus

    mksap
  • Is misinformation deadlier than the virus?

    Michele Luckenbaugh
  • The breakthroughs and failures of medicine

    Shannon Casey, PA-C
  • A call for cost transparency

    Mukul Mehra, MD

More in Conditions

  • Why regular exercise is the best prescription for lifelong health

    George F. Smith, MD
  • When the weight won’t budge: the hidden physiology of grief, stress, and set point

    Sarah White, APRN
  • Why peer support can save lives in high-pressure medical careers

    Maire Daugharty, MD
  • Addressing menstrual health inequities in adolescents

    Callia Georgoulis
  • Healing beyond the surface: Why proper chronic wound care matters

    Alvin May, MD
  • Why specialist pain clinics and addiction treatment services require strong primary care

    Olumuyiwa Bamgbade, MD
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Eric Topol explores the science of super-agers and healthy aging [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why more doctors are leaving clinical practice and how it helps health care

      Arlen Meyers, MD, MBA | Physician
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why regular exercise is the best prescription for lifelong health

      George F. Smith, MD | Conditions
    • When the weight won’t budge: the hidden physiology of grief, stress, and set point

      Sarah White, APRN | Conditions
    • Why starting with why can transform your medical practice

      Neil Baum, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Eric Topol explores the science of super-agers and healthy aging [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why more doctors are leaving clinical practice and how it helps health care

      Arlen Meyers, MD, MBA | Physician
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why regular exercise is the best prescription for lifelong health

      George F. Smith, MD | Conditions
    • When the weight won’t budge: the hidden physiology of grief, stress, and set point

      Sarah White, APRN | Conditions
    • Why starting with why can transform your medical practice

      Neil Baum, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...