Preoperative assessment: liver function tests in cirrhosis: practice question

A Anaesthesia 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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Anaesthesia · Preoperative assessment: liver function tests in cirrhosis

Sample item

A man with alcoholic cirrhosis is listed for an elective inguinal hernia repair. Which investigation best reflects the synthetic function of his liver?

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

The answer and the reasoning

A. Prothrombin time (INR)

Clotting factors, apart from factor VIII, are made in the liver and factor VII has a short half-life, so the prothrombin time reflects synthetic function quickly. Transaminases show hepatocyte injury, while alkaline phosphatase and gamma-glutamyl transferase suggest cholestasis or enzyme induction.

Option by option

  • A. Prothrombin time (INR) (correct)

    Correct. The INR is prolonged when the liver cannot synthesise clotting factors.

  • B. Serum gamma-glutamyl transferase

    GGT rises with biliary disease and alcohol-related enzyme induction, not as a measure of synthesis.

  • C. Serum aspartate aminotransferase

    AST is released from damaged hepatocytes and reflects injury, not synthetic capacity.

  • D. Serum alkaline phosphatase

    Alkaline phosphatase rises mainly in cholestasis and bone disease.

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 Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Prothrombin time (INR). Clotting factors, apart from factor VIII, are made in the liver and factor VII has a short half-life, so the prothrombin time reflects synthetic function quickly.

Why is "Serum gamma-glutamyl transferase" not the answer?

GGT rises with biliary disease and alcohol-related enzyme induction, not as a measure of synthesis.

Why is "Serum aspartate aminotransferase" not the answer?

AST is released from damaged hepatocytes and reflects injury, not synthetic capacity.

Why is "Serum alkaline phosphatase" not the answer?

Alkaline phosphatase rises mainly in cholestasis and bone disease.

What concept does this question test?

It tests Preoperative assessment: liver function tests in cirrhosis in Anaesthesia. Transaminases show hepatocyte injury, while alkaline phosphatase and gamma-glutamyl transferase suggest cholestasis or enzyme induction.

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 Preoperative assessment: liver function tests in cirrhosis?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia 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.