Hepatology: autoimmune hepatitis: 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 · Hepatology: autoimmune hepatitis

Sample item

A 32-year-old woman has fatigue, arthralgia and amenorrhoea. ALT is 480 U/L, serum IgG is markedly raised, ANA is positive at 1:320 and anti-smooth muscle antibody is positive. Biopsy shows interface hepatitis with plasma cells. What is the appropriate treatment?

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

The answer and the reasoning

B. Prednisolone with azathioprine

Autoimmune hepatitis is a female-predominant disease with hypergammaglobulinaemia, ANA or anti-smooth muscle antibodies, and interface hepatitis with plasma cells on biopsy. Induction with prednisolone and maintenance with azathioprine, a steroid-sparing agent, gives remission in most patients. Treatment is generally long term.

Option by option

  • A. Peginterferon alfa

    Interferon can precipitate or worsen autoimmune hepatitis and is contraindicated.

  • B. Prednisolone with azathioprine (correct)

    Correct. Corticosteroid with azathioprine is standard therapy.

  • C. Ursodeoxycholic acid alone

    Ursodeoxycholic acid is for cholestatic disease such as primary biliary cholangitis and does not suppress this immune injury.

  • D. Entecavir

    Entecavir is an antiviral for hepatitis B, which is not present here.

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, Prednisolone with azathioprine. Autoimmune hepatitis is a female-predominant disease with hypergammaglobulinaemia, ANA or anti-smooth muscle antibodies, and interface hepatitis with plasma cells on biopsy.

Why is "Peginterferon alfa" not the answer?

Interferon can precipitate or worsen autoimmune hepatitis and is contraindicated.

Why is "Ursodeoxycholic acid alone" not the answer?

Ursodeoxycholic acid is for cholestatic disease such as primary biliary cholangitis and does not suppress this immune injury.

Why is "Entecavir" not the answer?

Entecavir is an antiviral for hepatitis B, which is not present here.

What concept does this question test?

It tests Hepatology: autoimmune hepatitis in General Medicine. Induction with prednisolone and maintenance with azathioprine, a steroid-sparing agent, gives remission in most patients. Treatment is generally long term.

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 Hepatology: autoimmune hepatitis?

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.