Liver Function Tests — MCQs
Discriminant score is used for management of?
A patient with a history of alcohol dependence syndrome presents with sudden and unintentional weight loss. What is the most likely diagnosis?
In a child with acute liver failure, the most important abnormal serum biochemical test that indicates poor prognosis is?
Biomarker of alcoholic hepatitis:
Which of the following statements about alcoholic hepatitis is false?
A 35-year-old woman presents with jaundice, dark urine, and pruritus. Liver function tests reveal elevated alkaline phosphatase and conjugated bilirubin. What is the most likely diagnosis?
Which of the following biochemical markers is NOT elevated in a child presenting with jaundice, icterus, pruritus, and clay-colored stools?
Hay's sulfur test is used to detect which of the following?
A 67-year-old male smoker presents with haemoptysis and cough. Bronchoscopic biopsy revealed an undifferentiated tumour. The immunohistochemical marker that can be most helpful is:
Match List-I with List-II and select the correct answer using the code given below the Lists:
Liver Function Tests Indian Medical PG Practice Questions and MCQs
Question 1: Discriminant score is used for management of?
- A. Viral hepatitis
- B. Alcoholic hepatitis (Correct Answer)
- C. Variceal bleeding
- D. Weight loss
Explanation: ***Alcoholic hepatitis*** - The **Maddrey Discriminant Function (MDF) score** is a widely used tool specifically for assessing the severity of alcoholic hepatitis [1]. - scores greater than or equal to 32 indicate **severe alcoholic hepatitis** and guide the decision for corticosteroid therapy. *Viral hepatitis* - Management of viral hepatitis (e.g., Hepatitis B or C) typically involves antiviral medications, and severity assessment relies on viral load, liver biopsy, and clinical features, not the **discriminant score**. - While liver function tests are important, specific discriminant scores are not the primary tool for guiding treatment decisions in **viral hepatitis**. *Variceal bleeding* - Prognostic scores for variceal bleeding include the **Child-Pugh score** and **MELD score**, which assess liver function and predict mortality in cirrhosis, but not the **discriminant score**. - Management focuses on endoscopic interventions and medications to prevent re-bleeding, not on a discriminant score. *Weight loss* - Weight loss is a symptom, not a diagnosis requiring a specific discriminant score for management. - Its management involves identifying and addressing the **underlying cause**, which can be diverse and does not typically involve such a score.
Question 2: A patient with a history of alcohol dependence syndrome presents with sudden and unintentional weight loss. What is the most likely diagnosis?
- A. Hepatic adenoma
- B. Cholangiocarcinoma
- C. Hepatocellular carcinoma (Correct Answer)
- D. Alcoholic hepatitis
Explanation: ***Hepatocellular carcinoma*** - The **alpha-fetoprotein (AFP)** level of **600 ng/mL** is significantly elevated, suggesting a diagnosis of hepatocellular carcinoma, especially in a patient with a history of **alcohol dependence syndrome** [1]. - The **AST/ALT ratio of 0.5** indicates significant liver damage, commonly seen in chronic liver disease leading to **hepatocellular cancer**. *Alcoholic hepatitis* - Typically presents with **elevated AST and ALT**, usually with a ratio >2:1, which is not the case here [2]. - May cause weight loss, as alcoholic patients often lose weight due to self-neglect and poor dietary intake, but the **elevated AFP** is not characteristic of merely alcoholic hepatitis [3]. *Cholangiocarcinoma* - This type of cancer primarily presents with **biliary obstruction** symptoms, such as jaundice, which is not indicated here given **normal bilirubin levels**. - Does not typically lead to such high levels of **AFP**, making it less likely with the provided lab results. *Hepatic adenoma* - More commonly associated with **oral contraceptive use** or anabolic steroid use, not primarily alcohol dependence. - AFP levels are usually normal or only mildly elevated in hepatic adenoma, making this option less viable with an **AFP level of 600 ng/mL**.
Question 3: In a child with acute liver failure, the most important abnormal serum biochemical test that indicates poor prognosis is?
- A. Reversal of serum albumin-globulin ratio
- B. Increasing transaminase
- C. Increasing prothrombin time (Correct Answer)
- D. Increasing bilirubin
Explanation: ***Increasing prothrombin time*** - An **increasing prothrombin time (PT)** in acute liver failure indicates severe hepatic dysfunction, as the liver synthesizes **coagulation factors I, II, V, VII, X, and XI**. - A prolonged PT reflects a significant **loss of hepatic synthetic function**, which is a key predictor of poor prognosis and the need for liver transplantation. *Reversal of serum albumin-globulin ratio* - This typically indicates **chronic liver disease** or other conditions causing **hypoalbuminemia**, rather than the acute deterioration seen in acute liver failure. - While albumin levels can be low in acute liver failure, the **immediate prognostic marker** is related to synthetic function of rapidly turned over proteins. *Increasing transaminase* - Elevated **transaminases (ALT, AST)** indicate ongoing **hepatocellular injury** and are diagnostic of acute liver failure, but they do not correlate well with prognosis after the initial phase. - Very high transaminase levels can even normalize as the liver tissue is destroyed, but this doesn't mean improved function, hence it is not the most important prognostic indicator. *Increasing bilirubin* - Rising **bilirubin** signifies impaired liver excretory function and is a marker of liver failure, contributing to jaundice. - However, it is not as strong a prognostic indicator as PT because PT reflects the **synthetic capacity of the liver**, which is crucial for survival.
Question 4: Biomarker of alcoholic hepatitis:
- A. ALP
- B. GGT
- C. LDH
- D. AST (Correct Answer)
Explanation: ***Correct Option: AST (Aspartate Aminotransferase)*** - **Classic finding in alcoholic hepatitis**: AST:ALT ratio typically **>2:1** (often 2-3:1) - AST elevation is usually **moderate** (rarely >300 U/L) due to **pyridoxine (Vitamin B6) deficiency** in chronic alcoholics, which impairs ALT more than AST - **Mitochondrial AST** is released due to hepatocyte mitochondrial damage from alcohol toxicity - The AST predominance with relatively lower ALT is a **characteristic pattern** distinguishing alcoholic from non-alcoholic hepatitis *Incorrect Option: GGT (Gamma-Glutamyl Transferase)* - While **highly sensitive** for chronic alcohol consumption and often markedly elevated in alcoholic liver disease - **Not specific** for alcoholic hepatitis; elevated in various cholestatic and hepatobiliary conditions - Better marker for **screening alcohol abuse** and **monitoring abstinence** rather than diagnosing hepatitis *Incorrect Option: ALP (Alkaline Phosphatase)* - May be **mildly elevated** in alcoholic hepatitis, especially if cholestatic features present - **Less specific** and not a characteristic biomarker - More prominent in **cholestatic liver diseases** and bone disorders *Incorrect Option: LDH (Lactate Dehydrogenase)* - **Non-specific marker** of cellular injury, can be elevated in alcoholic hepatitis - Lacks specificity as it's elevated in numerous conditions (hemolysis, myocardial infarction, malignancy) - **Not diagnostically useful** for alcoholic hepatitis specifically
Question 5: Which of the following statements about alcoholic hepatitis is false?
- A. Gamma glutamyl transferase is raised
- B. Alkaline phosphatase is raised
- C. SGOT is raised > SGPT
- D. SGPT is raised > SGOT (Correct Answer)
Explanation: ***SGPT is raised > SGOT*** - In **alcoholic hepatitis**, the ratio of **AST (SGOT)** to **ALT (SGPT)** is typically **2:1 or higher**, meaning SGOT is usually significantly higher than SGPT. - This is because alcohol depletes **pyridoxal phosphate**, a cofactor for ALT, leading to relatively lower ALT levels. *Gamma glutamyl transferase is raised* - **Gamma-glutamyl transferase (GGT)** is frequently elevated in **alcoholic liver disease**, including alcoholic hepatitis [1]. - It serves as a sensitive marker for **biliary tract injury** and **alcohol consumption** [1]. *SGOT is raised > SGPT* - This statement is **true** for alcoholic hepatitis, as the **AST (SGOT)** to **ALT (SGPT)** ratio is typically **2:1 or greater**. - The disproportionately high AST is a characteristic feature reflecting the **mitochondrial damage** caused by alcohol within hepatocytes [2]. *Alkaline phosphatase is raised* - **Alkaline phosphatase (ALP)** can be elevated in alcoholic hepatitis, although usually to a lesser extent than in obstructive jaundice [1]. - Its elevation often reflects superimposed **cholestasis** or **biliary inflammation** [1].
Question 6: A 35-year-old woman presents with jaundice, dark urine, and pruritus. Liver function tests reveal elevated alkaline phosphatase and conjugated bilirubin. What is the most likely diagnosis?
- A. Chronic hepatitis B infection
- B. Primary biliary cholangitis (Correct Answer)
- C. Autoimmune hepatitis
- D. Acute viral hepatitis
Explanation: ***Primary biliary cholangitis*** - The combination of **jaundice**, **dark urine**, and **pruritus** along with **elevated alkaline phosphatase** and **conjugated bilirubin** points towards a cholestatic liver disease [3]. - **Primary biliary cholangitis (PBC)** is an autoimmune disease characterized by the progressive destruction of small bile ducts, leading to cholestasis, and is more common in women [4]. *Chronic hepatitis B infection* - While it can cause jaundice and elevated bilirubin, **chronic hepatitis B** primarily leads to hepatocellular damage, which would typically present with significantly elevated aminotransferases (AST/ALT) rather than predominantly elevated alkaline phosphatase [2]. - Pruritus is less common and often indicative of significant cholestasis, which is not the primary pathology in uncomplicated chronic hepatitis B. *Autoimmune hepatitis* - This condition is characterized by immune-mediated hepatocellular inflammation, leading to elevated **aminotransferases (AST/ALT)** [1]. - While jaundice can occur, **alkaline phosphatase** elevation and significant pruritus are not the predominant features, unlike in cholestatic disorders. *Acute viral hepatitis* - **Acute viral hepatitis** typically presents with elevated aminotransferases (AST/ALT) that are often much higher than alkaline phosphatase, indicating hepatocellular injury [2]. - While jaundice and dark urine are common, the prominent **pruritus** and isolated severe elevation of alkaline phosphatase make a primary cholestatic disorder more likely [3].
Question 7: Which of the following biochemical markers is NOT elevated in a child presenting with jaundice, icterus, pruritus, and clay-colored stools?
- A. Gamma glutamyl transpeptidase
- B. Alkaline phosphatase
- C. 5' nucleotidase
- D. Glutamate dehydrogenase (Correct Answer)
Explanation: ***Glutamate dehydrogenase*** - **Glutamate dehydrogenase (GLDH)** is an enzyme primarily found in the mitochondria of hepatocytes and is a marker of **hepatocellular necrosis**. - In a presentation dominated by **cholestasis** (jaundice, pruritus, clay-colored stools), GLDH is typically not elevated; rather, enzymes indicative of bile duct obstruction would be. *Alkaline phosphatase* - **Alkaline phosphatase (ALP)** is an enzyme found in the bile duct epithelium and is significantly elevated in **cholestatic conditions**, such as bile duct obstruction. - Its presence in high levels is a strong indicator of an issue with bile flow. *Gamma glutamyl transpeptidase* - **Gamma-glutamyl transpeptidase (GGT)** is a microsomal enzyme found in liver cells and bile duct epithelium, with very high sensitivity for **cholestatic liver disease**. - Its elevation along with ALP helps confirm a cholestatic pattern of liver injury. *5' nucleotidase* - **5' nucleotidase (5'-NT)** is an enzyme found in the cell membranes of hepatocytes and bile duct cells. - It is considered a more **specific marker for cholestasis** than ALP, as it is not elevated in bone diseases or pregnancy.
Question 8: Hay's sulfur test is used to detect which of the following?
- A. Bile salts in urine (Correct Answer)
- B. Reducing sugar in urine
- C. Ketone bodies in urine
- D. Urobilinogen in urine
Explanation: ***Bile salts in urine*** - Hay's sulfur test is a classic qualitative test used to detect the presence of **bile salts** in a urine sample. - Bile salts reduce the **surface tension** of urine, causing sulfur powder to sink when sprinkled on the surface. *Reducing sugar in urine* - Reducing sugars (like glucose) are typically detected using tests such as **Benedict's test** or glucose oxidase strips, not Hay's sulfur test. - These tests rely on color changes due to the **reduction of copper ions** or enzymatic reactions, respectively. *Ketone bodies in urine* - Ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are detected using tests like the **Rothera's test** or dipsticks, which react with acetoacetate. - These reactions produce color changes in the presence of ketones, unrelated to surface tension. *Urobilinogen in urine* - Urobilinogen in urine is commonly detected using **Ehrlich's reagent** (e.g., in a dipstick test) which forms a red color. - Elevated urobilinogen indicates issues with liver function or hemolysis, and its detection does not involve surface tension.
Question 9: A 67-year-old male smoker presents with haemoptysis and cough. Bronchoscopic biopsy revealed an undifferentiated tumour. The immunohistochemical marker that can be most helpful is:
- A. Cytokeratin (Correct Answer)
- B. Vimentin
- C. GGT
- D. Calretinin
Explanation: ***Cytokeratin*** - **Cytokeratin** is a **intermediate filament protein** found in epithelial cells and is a key marker for carcinomas, which are the most common type of lung cancer [1]. - Given the patient's history (smoker, haemoptysis) and an undifferentiated tumor, a **carcinoma** is highly probable, making cytokeratin the most helpful marker for classification [2]. *Vimentin* - **Vimentin** is an intermediate filament protein typically expressed in **mesenchymal cells** (e.g., sarcomas, lymphomas, melanoma). - Its presence would suggest a non-epithelial tumor, which is less likely in this clinical context of a lung mass in a smoker. *GGT* - **Gamma-glutamyl transpeptidase (GGT)** is an enzyme primarily used as a marker for **liver function** and bile duct obstruction. - It is not a tumor marker and has no role in the immunohistochemical diagnosis of an undifferentiated lung tumor. *Calretinin* - **Calretinin** is a nuclear and cytoplasmic protein that is a useful marker for **mesothelioma** and some other neuroendocrine tumors. - While mesothelioma can occur in the lung, it is less common than carcinoma, and calretinin would only be considered if mesothelioma was specifically suspected. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 334-337. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 720-721.
Question 10: Match List-I with List-II and select the correct answer using the code given below the Lists:
- A. A→1 B→3 C→2 D→4 (Correct Answer)
- B. A→1 B→2 C→3 D→4
- C. A→3 B→2 C→4 D→1
- D. A→4 B→3 C→2 D→1
Explanation: ***A→1 B→3 C→2 D→4*** - Caroli's disease is characterized by **dilatation of intrahepatic bile ducts**, predisposing to **bile stasis**, stone formation, and recurrent **biliary sepsis** with associated abdominal pain. - Budd-Chiari Syndrome is defined by **hepatic venous outflow obstruction**, leading to symptoms like **ascites**, hepatomegaly, and abdominal pain. - Polycystic Liver Disease involves the presence of **multiple cysts in the liver**, which can cause **hepatomegaly** and **pain** due to the size and mass effect of the cysts. - Primary sclerosing cholangitis (PSC) is a **cholestatic liver disease** causing inflammation and fibrosis of the bile ducts, leading to **abnormal liver function tests** (elevated alkaline phosphatase and bilirubin) and often presenting with **jaundice**. *A→1 B→2 C→3 D→4* - This option incorrectly matches Budd-Chiari Syndrome with Hepatomegaly, Pain and Polycystic Liver Disease with Ascites. - The hallmark of Budd-Chiari is venous outflow obstruction leading to **ascites**, while **hepatomegaly and pain** are more characteristic symptoms of Polycystic Liver Disease due to the expanding cysts. *A→3 B→2 C→4 D→1* - This option incorrectly associates Caroli's disease with ascites and Primary Sclerosing Cholangitis with Abdominal pain, Biliary sepsis. - Caroli's disease is primarily characterized by **biliary complications** like cholangitis, not ascites, and ascites is a key feature of Budd-Chiari, not Polycystic Liver Disease. *A→4 B→3 C→2 D→1* - This option incorrectly links Caroli's disease with Abnormal LFT/jaundice generally and Primary Sclerosing Cholangitis with Abdominal pain, Biliary sepsis. - While Caroli's can cause abnormal LFTs and jaundice secondarily to cholangitis, its primary specific presentation involves **recurrent infection (biliary sepsis)**. Primary Sclerosing Cholangitis directly causes **abnormal LFTs and jaundice** due to cholestasis, but it is not commonly associated with abdominal pain and biliary sepsis.
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