Primary Care Lab Values Cheat Sheet

Patients with severe chronic kidney disease and a history of gastrointestinal bleeding have strict contraindications to systemic therapies. Intra-articular corticosteroids offer targeted relief without systemic toxicity. Both naproxen and celecoxib are NSAIDs that will worsen renal impairment and increase bleeding risk. Duloxetine is contraindicated in patients with an eGFR below 30 mL/min/1.73 m2 due to decreased clearance and increased toxicity.

For adults who are overweight or obese and undergo screening for type 2 diabetes, guidelines recommend repeating the screening at least every three years if the initial results are normal. This patient's hemoglobin A1c is 5.2%, which is well within the normal range. Repeating the test in six months, one year, or two years is unnecessary and increases healthcare costs without clinical benefit, assuming his risk profile and clinical status remain stable. Routine clinical monitoring should continue, but formal screening is safely deferred for three years.

A positive anti-HCV antibody indicates prior exposure to the hepatitis C virus but cannot differentiate between an active chronic infection and a past resolved infection. Therefore, ordering a quantitative HCV RNA test is the essential next step to confirm current viral replication. Option A is incorrect because normal transaminases do not rule out active hepatitis C; many patients with chronic infection maintain normal liver enzymes. Option B is premature and overly invasive before confirming active viremia and considering non-invasive fibrosis staging. Option D is incorrect because direct-acting antiviral therapy should never be initiated based solely on an antibody test without confirming the presence of viral RNA.