Hepatology: metabolic dysfunction-associated steatotic 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 · Hepatology: metabolic dysfunction-associated steatotic liver disease

Sample item

A 50-year-old obese man with type 2 diabetes has fatty liver on ultrasound. Laboratory results show AST 60 U/L, ALT 64 U/L and platelet count 110 x 10^9/L. Using FIB-4 (age x AST divided by platelets x square root of ALT), what is the result and the best next step?

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

The answer and the reasoning

B. FIB-4 about 3.4 (high risk), so arrange transient elastography and hepatology review

FIB-4 = (50 x 60) / (110 x square root of 64) = 3000 / (110 x 8) = 3000 / 880, which is about 3.4. Values below 1.3 exclude advanced fibrosis, above 2.67 indicate a high risk, and in between need a second test. A high score calls for elastography and specialist assessment, with biopsy reserved for unresolved cases.

Option by option

  • A. FIB-4 about 1.9 (indeterminate), so no further testing is needed

    A value of 1.9 would be indeterminate, but the calculated value is 3.4, and even indeterminate scores need a second test.

  • B. FIB-4 about 3.4 (high risk), so arrange transient elastography and hepatology review (correct)

    The calculation gives 3.4, above the high-risk threshold of 2.67, so confirmatory non-invasive fibrosis assessment is needed.

  • C. FIB-4 about 0.9 (low risk), so reassure and advise lifestyle change only

    A value of 0.9 would be a calculation error and would wrongly lead to false reassurance.

  • D. FIB-4 about 3.4 (high risk), so liver biopsy is mandatory before any other test

    Liver biopsy is not mandatory first, because elastography is the recommended next non-invasive step.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is B, FIB-4 about 3.4 (high risk), so arrange transient elastography and hepatology review. FIB-4 = (50 x 60) / (110 x square root of 64) = 3000 / (110 x 8) = 3000 / 880, which is about 3.

Why is "FIB-4 about 1.9 (indeterminate), so no further testing is needed" not the answer?

A value of 1.9 would be indeterminate, but the calculated value is 3.4, and even indeterminate scores need a second test.

Why is "FIB-4 about 0.9 (low risk), so reassure and advise lifestyle change o…" not the answer?

A value of 0.9 would be a calculation error and would wrongly lead to false reassurance.

Why is "FIB-4 about 3.4 (high risk), so liver biopsy is mandatory before any…" not the answer?

Liver biopsy is not mandatory first, because elastography is the recommended next non-invasive step.

What concept does this question test?

It tests Hepatology: metabolic dysfunction-associated steatotic liver disease in General Medicine. 4. Values below 1.3 exclude advanced fibrosis, above 2.67 indicate a high risk, and in between need a second test. A high score calls for elastography and specialist assessment, with biopsy reserved for unresolved cases.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: metabolic dysfunction-associated steatotic 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.