Hepatobiliary and pancreatic surgery: acute liver failure prognosis: practice question

A General Surgery 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 Surgery · Hepatobiliary and pancreatic surgery: acute liver failure prognosis

Sample item

A 24-year-old woman presents 3 days after a deliberate paracetamol overdose with encephalopathy, rising INR and jaundice. Despite full fluid resuscitation and acetylcysteine, which finding most strongly supports urgent referral for liver transplantation?

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

The answer and the reasoning

A. Arterial pH below 7.3

In paracetamol-induced acute liver failure the King's College criteria use an arterial pH below 7.3 after resuscitation, or a combination of grade 3-4 encephalopathy, very prolonged INR and raised creatinine. A transaminase peak does not predict outcome.

Option by option

  • A. Arterial pH below 7.3 (correct)

    Correct. A persistent acidosis after fluid resuscitation is a transplant criterion.

  • B. Serum bilirubin of 3 mg/dL with normal INR

    A modest bilirubin with normal INR does not indicate failing synthetic function.

  • C. Isolated rise in ALT above 1000 U/L

    A high ALT reflects hepatocyte injury but has no prognostic power.

  • D. Mild leucocytosis

    Leucocytosis is nonspecific.

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 Surgery question

What is the answer to this General Surgery question?

The best answer is A, Arterial pH below 7.3. In paracetamol-induced acute liver failure the King's College criteria use an arterial pH below 7.

Why is "Serum bilirubin of 3 mg/dL with normal INR" not the answer?

A modest bilirubin with normal INR does not indicate failing synthetic function.

Why is "Isolated rise in ALT above 1000 U/L" not the answer?

A high ALT reflects hepatocyte injury but has no prognostic power.

Why is "Mild leucocytosis" not the answer?

Leucocytosis is nonspecific.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: acute liver failure prognosis in General Surgery. 3 after resuscitation, or a combination of grade 3-4 encephalopathy, very prolonged INR and raised creatinine. A transaminase peak does not predict outcome.

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 Hepatobiliary and pancreatic surgery: acute liver failure prognosis?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.