Liver Function Tests and Enzymes
Medium-difficulty multiple-choice quiz covering core concepts, interpretations, and clinical reasoning around liver enzymes and function testing.
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Quiz Questions & Answers
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Question 1: Why is gamma-glutamyl transferase (GGT) measured alongside alkaline phosphatase (ALP)?
Because GGT directly correlates with hepatic bilirubin conjugation capacity.
To determine whether elevated ALP originates from liver/biliary sources versus bone or placenta.
To quantify synthetic liver function and protein production.
Because GGT is more specific for viral hepatitis than ALT or AST.
Question 2: Which pattern of enzyme elevations most strongly suggests hepatocellular injury rather than cholestasis?
Isolated mild bilirubin elevation with normal transaminases and ALP.
Prominent alkaline phosphatase and gamma-glutamyl transferase (GGT) rise with mild ALT elevation.
Markedly elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) with relatively normal alkaline phosphatase (ALP).
Simultaneous massive increases in ALP, ALT, AST and normal bilirubin.
Question 3: A patient on long-term statin therapy has mild isolated ALT elevation but feels well. What is the best initial management step?
Immediately discontinue the statin and switch to another lipid-lowering drug.
Continue statin and recheck ALT in 4–6 weeks while evaluating for other causes.
Start high-dose corticosteroids to prevent progression to liver failure.
Order urgent liver biopsy to evaluate histology.
Question 4: Which interpretation best explains an AST:ALT ratio greater than 2 in a patient with elevated transaminases?
Alcohol-related liver injury is likely, especially with compatible history.
Autoimmune hepatitis is the most probable cause.
It indicates isolated cholestatic jaundice from biliary obstruction.
It reliably excludes chronic viral hepatitis.
Question 5: Which liver function test combination best assesses hepatic synthetic function?
Serum albumin level and international normalized ratio (INR).
Gamma-glutamyl transferase (GGT) and lactate dehydrogenase (LDH).
Total bilirubin and alkaline phosphatase (ALP).
ALT and AST levels measured fasting and postprandial.