Hepatology: severe alcoholic 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.

Try it

General Medicine · Hepatology: severe alcoholic hepatitis

Sample item

A 45-year-old man with heavy alcohol use has jaundice and tender hepatomegaly. Bilirubin is 8 mg/dL, prothrombin time is 24 s (control 14 s), AST 160 U/L and ALT 70 U/L. He has no infection or renal failure. What is his Maddrey discriminant function and the recommended management?

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

The answer and the reasoning

A. 54; severe disease, so start prednisolone

Discriminant function = 4.6 x (PT patient minus PT control) + bilirubin in mg/dL = 4.6 x 10 + 8 = 54. A value of 32 or more indicates severe alcoholic hepatitis. Prednisolone 40 mg daily for 28 days improves short-term survival if there is no infection, bleeding or renal failure, and response is assessed with the Lille score at day 7.

Option by option

  • A. 54; severe disease, so start prednisolone (correct)

    Correct. The score of 54 exceeds 32 and steroids are indicated in the absence of contraindications.

  • B. 54; steroids are contraindicated because of ongoing alcohol use

    Alcohol use is the cause of the disease and is not a contraindication to steroids; infection and bleeding are.

  • C. 54; give pentoxifylline because it improves survival over steroids

    Pentoxifylline did not improve survival in the large STOPAH trial and is not preferred over prednisolone.

  • D. 22; below 32, so give supportive care and abstinence only

    A score of 22 is arithmetically wrong and would wrongly deny treatment to a severe case.

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 A, 54; severe disease, so start prednisolone. Discriminant function = 4.

Why is "54; steroids are contraindicated because of ongoing alcohol use" not the answer?

Alcohol use is the cause of the disease and is not a contraindication to steroids; infection and bleeding are.

Why is "54; give pentoxifylline because it improves survival over steroids" not the answer?

Pentoxifylline did not improve survival in the large STOPAH trial and is not preferred over prednisolone.

Why is "22; below 32, so give supportive care and abstinence only" not the answer?

A score of 22 is arithmetically wrong and would wrongly deny treatment to a severe case.

What concept does this question test?

It tests Hepatology: severe alcoholic hepatitis in General Medicine. 6 x (PT patient minus PT control) + bilirubin in mg/dL = 4.6 x 10 + 8 = 54. A value of 32 or more indicates severe alcoholic hepatitis. Prednisolone 40 mg daily for 28 days improves short-term survival if there is no infection, bleeding or renal failure, and response is assessed with the Lille score at day 7.

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: severe alcoholic 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.