ROSH Gastrointestinal Practice Exam

What is the most appropriate next step in management for a previously healthy young man with no risk factors for hepatitis C?

1. Administration of hepatitis C vaccine

2. Referral to gastroenterology

3. Screening with hepatitis C antibody test

4. Screening with hepatitis C RNA test

The correct answer is: Screening with hepatitis C antibody test

In the scenario where a previously healthy young man has no known risk factors for hepatitis C, screening with a hepatitis C antibody test is the most appropriate next step in management. The U.S. Preventive Services Task Force recommends one-time screening for hepatitis C virus (HCV) infection in adults aged 18 to 79 years, regardless of risk factors, to identify cases of the infection that may go unnoticed, as hepatitis C can be asymptomatic in its early stages. The hepatitis C antibody test is a simple blood test that can indicate if someone has been exposed to the virus. If the test is positive, further testing with hepatitis C RNA can determine if there is an active infection. The rationale behind this recommendation is the silent nature of many cases of hepatitis C, which can lead to chronic liver disease, making early detection and management crucial. Other options such as administering a vaccine or referral to gastroenterology are not relevant since there is currently no vaccine for hepatitis C and a gastroenterology referral is typically reserved for individuals who have already been diagnosed or are showing symptoms associated with liver disease. Screening with hepatitis C RNA is not the first step since that would be done after a positive antibody test to confirm active infection.