Clinical enzymology: transaminases: practice question

A Biochemistry 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.

Try it

Biochemistry · Clinical enzymology: transaminases

Sample item

A 45-year-old man with long-term heavy alcohol use has jaundice and tender hepatomegaly. AST is 220 IU/L and ALT 90 IU/L. Which interpretation is best?

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

The answer and the reasoning

B. Alcoholic hepatitis, with AST to ALT ratio above 2

In alcoholic liver disease the AST to ALT ratio is typically more than 2, with enzyme values usually below 300 IU/L. Pyridoxal phosphate depletion lowers hepatic ALT activity, and mitochondrial injury releases AST. In viral hepatitis and fatty liver ALT is usually higher than AST.

Option by option

  • A. Non-alcoholic fatty liver disease, which characteristically gives ALT higher than AST

    Fatty liver typically has ALT higher than AST.

  • B. Alcoholic hepatitis, with AST to ALT ratio above 2 (correct)

    Correct. A ratio above 2 with modest elevations fits alcoholic hepatitis.

  • C. Extrahepatic biliary obstruction, which characteristically gives AST and ALT persistently in the thousands

    Biliary obstruction primarily raises ALP and GGT; transaminases are usually modest or only transiently high.

  • D. Acute viral hepatitis, which characteristically gives ALT higher than AST

    Viral hepatitis gives ALT higher than AST and often very high values.

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 Biochemistry questions

Questions about this Biochemistry question

What is the answer to this Biochemistry question?

The best answer is B, Alcoholic hepatitis, with AST to ALT ratio above 2. In alcoholic liver disease the AST to ALT ratio is typically more than 2, with enzyme values usually below 300 IU/L.

Why is "Non-alcoholic fatty liver disease, which characteristically gives ALT…" not the answer?

Fatty liver typically has ALT higher than AST.

Why is "Extrahepatic biliary obstruction, which characteristically gives AST…" not the answer?

Biliary obstruction primarily raises ALP and GGT; transaminases are usually modest or only transiently high.

Why is "Acute viral hepatitis, which characteristically gives ALT higher than…" not the answer?

Viral hepatitis gives ALT higher than AST and often very high values.

What concept does this question test?

It tests Clinical enzymology: transaminases in Biochemistry. Pyridoxal phosphate depletion lowers hepatic ALT activity, and mitochondrial injury releases AST. In viral hepatitis and fatty liver ALT is usually higher than AST.

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 Clinical enzymology: transaminases?

Build one table of enzyme deficiency, disease, inheritance and key finding, then revise it by spaced recall. Then use the flashcards and the other Biochemistry 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.