Clinical biochemistry: liver enzymes: 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.

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Biochemistry · Clinical biochemistry: liver enzymes

Sample item

A 45-year-old man with chronic heavy alcohol use has AST 180 U/L, ALT 70 U/L, a raised GGT and an MCV of 106 fL. What is the most likely cause of the aminotransferase pattern?

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

The answer and the reasoning

C. Alcoholic liver injury, with AST to ALT ratio above 2

An AST to ALT ratio above 2, with AST rarely above 300 U/L, suggests alcoholic liver disease. Alcohol depletes hepatic pyridoxal phosphate, which is needed more by ALT, and mitochondrial injury releases AST. A raised GGT and macrocytosis support heavy alcohol use.

Option by option

  • A. Ischaemic hepatitis, with transaminases in the thousands

    Ischaemic hepatitis produces very high values in the thousands after hypotension.

  • B. Acute viral hepatitis, with ALT much higher than AST

    Acute viral hepatitis typically gives ALT higher than AST, often in the hundreds to thousands.

  • C. Alcoholic liver injury, with AST to ALT ratio above 2 (correct)

    Correct. A ratio above 2 with raised GGT and macrocytosis is typical of alcoholic hepatitis.

  • D. Biliary obstruction, with alkaline phosphatase markedly elevated and normal transaminases

    Biliary obstruction gives a predominantly cholestatic pattern and not this transaminase rise.

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.

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Questions about this Biochemistry question

What is the answer to this Biochemistry question?

The best answer is C, Alcoholic liver injury, with AST to ALT ratio above 2. An AST to ALT ratio above 2, with AST rarely above 300 U/L, suggests alcoholic liver disease.

Why is "Ischaemic hepatitis, with transaminases in the thousands" not the answer?

Ischaemic hepatitis produces very high values in the thousands after hypotension.

Why is "Acute viral hepatitis, with ALT much higher than AST" not the answer?

Acute viral hepatitis typically gives ALT higher than AST, often in the hundreds to thousands.

Why is "Biliary obstruction, with alkaline phosphatase markedly elevated and…" not the answer?

Biliary obstruction gives a predominantly cholestatic pattern and not this transaminase rise.

What concept does this question test?

It tests Clinical biochemistry: liver enzymes in Biochemistry. Alcohol depletes hepatic pyridoxal phosphate, which is needed more by ALT, and mitochondrial injury releases AST. A raised GGT and macrocytosis support heavy alcohol use.

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 biochemistry: liver enzymes?

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.