Gastroenterology: cholestatic liver disease: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology: cholestatic liver disease

Sample item

A 48-year-old woman has generalised itching and fatigue for 8 months. She has a raised alkaline phosphatase, normal bilirubin and ultrasound without bile duct dilatation. Antimitochondrial antibody is strongly positive. What is the first-line treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Ursodeoxycholic acid

Primary biliary cholangitis is an autoimmune destruction of small intrahepatic bile ducts, usually in middle-aged women, with cholestatic liver tests and positive antimitochondrial antibody (M2). Ursodeoxycholic acid slows progression, and obeticholic acid or fibrates are added if the response is poor. Cholestyramine relieves pruritus. Liver transplantation is for end-stage disease.

Option by option

  • A. Prednisolone alone

    Steroids alone are not effective and worsen bone loss in a disease prone to osteoporosis.

  • B. Ursodeoxycholic acid (correct)

    Correct. Ursodeoxycholic acid is the standard first-line disease-modifying therapy.

  • C. Endoscopic stenting of the bile duct

    Stenting treats obstructive biliary disease, which is excluded by normal ultrasound.

  • D. Methotrexate

    Methotrexate has no established role and is hepatotoxic.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Ursodeoxycholic acid. Primary biliary cholangitis is an autoimmune destruction of small intrahepatic bile ducts, usually in middle-aged women, with cholestatic liver tests and positive antimitochondrial antibody (M2).

Why is "Prednisolone alone" not the answer?

Steroids alone are not effective and worsen bone loss in a disease prone to osteoporosis.

Why is "Endoscopic stenting of the bile duct" not the answer?

Stenting treats obstructive biliary disease, which is excluded by normal ultrasound.

Why is "Methotrexate" not the answer?

Methotrexate has no established role and is hepatotoxic.

What concept does this question test?

It tests Gastroenterology: cholestatic liver disease in General Medicine. Ursodeoxycholic acid slows progression, and obeticholic acid or fibrates are added if the response is poor. Cholestyramine relieves pruritus. Liver transplantation is for end-stage disease.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology: cholestatic liver disease?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.