Substance use: liver enzyme pattern in alcohol: practice question

A Psychiatry 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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Psychiatry · Substance use: liver enzyme pattern in alcohol

Sample item

A 46-year-old man with suspected alcohol dependence has aspartate aminotransferase 180 U/L, alanine aminotransferase 70 U/L and raised gamma-glutamyl transferase. Which pattern is this suggestive of?

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

The answer and the reasoning

B. AST to ALT ratio above 2, typical of alcoholic liver injury

In alcoholic liver disease the AST is usually higher than the ALT, with a ratio above 2, partly because of pyridoxine deficiency, which lowers ALT synthesis, and mitochondrial injury. In viral hepatitis the ALT is typically higher than the AST.

Option by option

  • A. Normal AST with rise in alkaline phosphatase alone

    AST is clearly elevated in this patient, so the description of a normal AST does not fit.

  • B. AST to ALT ratio above 2, typical of alcoholic liver injury (correct)

    Correct. A ratio greater than 2 with raised GGT points towards alcohol.

  • C. ALT greater than AST, typical of viral hepatitis

    ALT greater than AST is typical of viral and fatty liver disease, which is not the case here.

  • D. Isolated rise of GGT without transaminase change

    The transaminases are clearly raised here, so the description of an isolated GGT rise does not fit.

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 Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, AST to ALT ratio above 2, typical of alcoholic liver injury. In alcoholic liver disease the AST is usually higher than the ALT, with a ratio above 2, partly because of pyridoxine deficiency, which lowers ALT synthesis, and mitochondrial injury.

Why is "Normal AST with rise in alkaline phosphatase alone" not the answer?

AST is clearly elevated in this patient, so the description of a normal AST does not fit.

Why is "ALT greater than AST, typical of viral hepatitis" not the answer?

ALT greater than AST is typical of viral and fatty liver disease, which is not the case here.

Why is "Isolated rise of GGT without transaminase change" not the answer?

The transaminases are clearly raised here, so the description of an isolated GGT rise does not fit.

What concept does this question test?

It tests Substance use: liver enzyme pattern in alcohol in Psychiatry. In viral hepatitis the ALT is typically higher than the AST.

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 Substance use: liver enzyme pattern in alcohol?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry 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.