A 48-year-old woman presents with an elevated ALT found on an insurance screening examination. Her hepatitis C antibody test is positive. She denies any risk factors for hepatitis C. What should you do?

Correct Answer: D

Rationale: This woman has a positive antibody test in the setting of an elevated ALT. She denies any risk factors for hepatitis C, so it is imperative to rule out a false positive test. Hepatitis C RNA is a highly specific test to confirm the diagnosis. Because ALT levels do not predict severity of disease, there is no need to follow enzyme levels. All hepatitis C patients should be referred for consideration of therapy with interferon and ribavirin, not prednisone.

Correct Answer: B

Rationale: PPIs reduce gastric acid production by inhibiting the proton pump in parietal cells, promoting ulcer healing by decreasing acid-related damage.

Correct Answer: C

Rationale: Black, tarry stools (melena) result from digested blood due to upper GI bleeding, a common sign of a bleeding peptic ulcer.

Correct Answer: A

Rationale: Misoprostol, a prostaglandin analog, protects the stomach lining by increasing mucus and bicarbonate secretion.

Correct Answer: B

Rationale: Giving antacids 1-3 hours after meals maximizes their acid-neutralizing effect when acid levels peak post-digestion.