Clinical enzymology: practice question

A Biochemistry 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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Biochemistry · Clinical enzymology

Sample item

A patient has a raised serum alkaline phosphatase. Which additional finding best indicates a hepatobiliary rather than bone source?

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

The answer and the reasoning

D. Raised gamma-glutamyl transferase

Alkaline phosphatase is found in liver, bone and placenta. Gamma-glutamyl transferase is raised in biliary disease but is normal in bone disease, so a raised GGT alongside raised ALP points to a hepatobiliary origin.

Option by option

  • A. Low serum calcium

    Serum calcium is not a reliable marker of the ALP source.

  • B. Raised urinary hydroxyproline

    Raised urinary hydroxyproline reflects increased bone collagen turnover, pointing to a bone source of the ALP.

  • C. Raised serum acid phosphatase

    Acid phosphatase relates mainly to the prostate and does not discriminate the source of ALP.

  • D. Raised gamma-glutamyl transferase (correct)

    Correct. GGT rises with cholestasis and is normal in 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 Biochemistry question

What is the answer to this Biochemistry question?

The best answer is D, Raised gamma-glutamyl transferase. Alkaline phosphatase is found in liver, bone and placenta.

Why is "Low serum calcium" not the answer?

Serum calcium is not a reliable marker of the ALP source.

Why is "Raised urinary hydroxyproline" not the answer?

Raised urinary hydroxyproline reflects increased bone collagen turnover, pointing to a bone source of the ALP.

Why is "Raised serum acid phosphatase" not the answer?

Acid phosphatase relates mainly to the prostate and does not discriminate the source of ALP.

What concept does this question test?

It tests Clinical enzymology in Biochemistry. Gamma-glutamyl transferase is raised in biliary disease but is normal in bone disease, so a raised GGT alongside raised ALP points to a hepatobiliary origin.

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 Clinical enzymology?

Build one table of enzyme deficiency, disease, inheritance and key finding, then revise it by spaced recall. Then use the flashcards and the other Biochemistry 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.