Medical disorders in pregnancy: acute fatty liver: practice question

A OBG 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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OBG · Medical disorders in pregnancy: acute fatty liver

Sample item

A woman at 36 weeks presents with nausea, jaundice, hypoglycaemia, raised ammonia and prolonged prothrombin time with only mildly raised transaminases. What is the diagnosis and management?

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

The answer and the reasoning

D. Acute fatty liver of pregnancy; stabilise and deliver promptly

Acute fatty liver of pregnancy is a microvesicular steatosis disorder linked with fetal long-chain 3-hydroxyacyl CoA dehydrogenase deficiency. It needs prompt delivery, glucose and correction of coagulopathy. Hypoglycaemia and coagulopathy distinguish it from HELLP and cholestasis.

Option by option

  • A. Viral hepatitis A; discharge

    Hepatitis A would show very high transaminases and no hypoglycaemia in the same pattern.

  • B. HELLP syndrome; wait for term

    HELLP has haemolysis and low platelets with hypertension and does not warrant waiting.

  • C. Intrahepatic cholestasis; ursodeoxycholic acid only

    Cholestasis causes pruritus with raised bile acids without liver failure.

  • D. Acute fatty liver of pregnancy; stabilise and deliver promptly (correct)

    Correct. Liver failure features with mild enzyme rise point to AFLP and call for delivery.

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 OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Acute fatty liver of pregnancy; stabilise and deliver promptly. Acute fatty liver of pregnancy is a microvesicular steatosis disorder linked with fetal long-chain 3-hydroxyacyl CoA dehydrogenase deficiency.

Why is "Viral hepatitis A; discharge" not the answer?

Hepatitis A would show very high transaminases and no hypoglycaemia in the same pattern.

Why is "HELLP syndrome; wait for term" not the answer?

HELLP has haemolysis and low platelets with hypertension and does not warrant waiting.

Why is "Intrahepatic cholestasis; ursodeoxycholic acid only" not the answer?

Cholestasis causes pruritus with raised bile acids without liver failure.

What concept does this question test?

It tests Medical disorders in pregnancy: acute fatty liver in OBG. It needs prompt delivery, glucose and correction of coagulopathy. Hypoglycaemia and coagulopathy distinguish it from HELLP and cholestasis.

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 Medical disorders in pregnancy: acute fatty liver?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG 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.