Liver function test interpretation MCQs With Answer

Introduction

Liver function tests (LFTs) are essential tools in clinical pharmacy practice for assessing hepatic injury, synthetic capacity, and cholestatic processes. This set of MCQs is designed for M.Pharm students to deepen understanding of LFT interpretation, patterns of enzyme abnormalities, bilirubin fractions, synthetic markers (albumin, PT/INR), and common disease and drug-related scenarios. Questions emphasize differentiating hepatocellular versus cholestatic injury, recognizing diagnostic clues for specific disorders (e.g., Gilbert’s, Wilson’s, alcoholic hepatitis), and applying LFT results to clinical decision-making and drug dosing considerations. Use these practice questions to refine analytical skills required for therapeutic monitoring and safe pharmacotherapy in patients with liver disease.

Q1. Which of the following interpretations is most consistent with an AST:ALT ratio greater than 2?

• Acute viral hepatitis
• Alcoholic hepatitis
• Cholestatic jaundice
• Isolated Gilbert’s syndrome

Correct Answer: Alcoholic hepatitis

Q2. A patient has a markedly elevated alkaline phosphatase (ALP) and gamma‑glutamyl transferase (GGT) with only mild ALT/AST increases. This pattern most likely indicates:

• Primary hepatocellular necrosis
• Extrahepatic or intrahepatic cholestasis
• Hemolytic jaundice
• Isolated synthetic dysfunction

Correct Answer: Extrahepatic or intrahepatic cholestasis

Q3. An otherwise healthy patient has intermittent mild jaundice, normal ALT/AST/ALP, and isolated unconjugated hyperbilirubinemia. The most likely diagnosis is:

• Dubin-Johnson syndrome
• Rotor syndrome
• Gilbert’s syndrome
• Primary sclerosing cholangitis

Correct Answer: Gilbert’s syndrome

Q4. Which laboratory parameter is the most sensitive indicator of acute changes in hepatic synthetic function?

• Serum albumin concentration
• Platelet count
• Prothrombin time / INR
• Serum bilirubin

Correct Answer: Prothrombin time / INR

Q5. A patient presents with jaundice, elevated indirect (unconjugated) bilirubin, normal ALT/AST, reticulocytosis and increased LDH. This pattern most likely represents:

• Obstructive (post‑hepatic) jaundice
• Hepatocellular injury from viral hepatitis
• Pre‑hepatic (hemolytic) jaundice
• Crigler‑Najjar syndrome type I

Correct Answer: Pre‑hepatic (hemolytic) jaundice

Q6. If ALP is elevated but GGT is within reference range, the most likely source of ALP is:

• Hepatobiliary tract
• Bone
• Renal tubular cells
• Pancreas

Correct Answer: Bone

Q7. Which commonly prescribed drug is most frequently associated with cholestatic drug‑induced liver injury (DILI)?

• Acetaminophen
• Amoxicillin‑clavulanate
• Isoniazid
• Statins (HMG‑CoA reductase inhibitors)

Correct Answer: Amoxicillin‑clavulanate

Q8. Which combination of findings best supports a diagnosis of Wilson’s disease in a young patient with liver disease?

• Elevated ceruloplasmin, low urinary copper
• Low ceruloplasmin, increased 24‑hour urinary copper
• Normal ceruloplasmin, elevated serum ferritin
• Elevated alkaline phosphatase and GGT only

Correct Answer: Low ceruloplasmin, increased 24‑hour urinary copper

Q9. The MELD (Model for End‑Stage Liver Disease) score is calculated using which laboratory parameters?

• Bilirubin, creatinine, INR
• ALT, AST, albumin
• ALP, GGT, bilirubin
• Platelets, albumin, ALT

Correct Answer: Bilirubin, creatinine, INR

Q10. Extremely high transaminase levels (AST and ALT often >1000 IU/L) are classically seen in which of the following scenarios?

• Chronic hepatitis C infection without cirrhosis
• Acetaminophen (paracetamol) overdose causing acute hepatic necrosis
• Non‑alcoholic fatty liver disease
• Gilbert’s syndrome

Correct Answer: Acetaminophen (paracetamol) overdose causing acute hepatic necrosis

Q11. A persistently low serum albumin in a patient with liver disease most likely indicates:

• Acute transient hepatic inflammation
• Chronic impairment of hepatic synthetic function
• Isolated cholestasis without synthetic dysfunction
• Hemolytic anemia

Correct Answer: Chronic impairment of hepatic synthetic function

Q12. Dark urine, pale (acholic) stools, and markedly elevated conjugated bilirubin are most consistent with which diagnosis?

• Hemolytic jaundice
• Obstructive (post‑hepatic) jaundice
• Unconjugated hyperbilirubinemia (Gilbert’s syndrome)
• Acute hepatitis without cholestasis

Correct Answer: Obstructive (post‑hepatic) jaundice

Q13. An ALT greater than AST (ALT:AST ratio >1), with moderate elevations of transaminases, is most typical of which condition?

• Alcoholic liver disease
• Viral hepatitis or non‑alcoholic fatty liver disease (NAFLD)
• Bone disease causing ALP rise
• Hemolytic anemia

Correct Answer: Viral hepatitis or non‑alcoholic fatty liver disease (NAFLD)

Q14. In pre‑hepatic (hemolytic) jaundice, which of the following urine/serum findings is expected?

• Positive urine bilirubin and low urinary urobilinogen
• Negative urine bilirubin and increased urinary urobilinogen
• High conjugated bilirubin in urine and pale stools
• Markedly elevated ALP and GGT

Correct Answer: Negative urine bilirubin and increased urinary urobilinogen

Q15. Which liver enzyme is most sensitive as an initial screening test for cholestasis?

• Aspartate aminotransferase (AST)
• Alanine aminotransferase (ALT)
• Alkaline phosphatase (ALP)
• Creatine kinase (CK)

Correct Answer: Alkaline phosphatase (ALP)

Q16. In acute liver failure, which laboratory measurement is most useful for short‑term prognosis and transplant decision making?

• Serum albumin
• INR / Prothrombin time
• Serum alkaline phosphatase
• Serum GGT

Correct Answer: INR / Prothrombin time

Q17. Non‑alcoholic fatty liver disease (NAFLD) typically produces which pattern on liver tests?

• Severe ALP and GGT elevation with normal transaminases
• Mild to moderate ALT predominance over AST, often with metabolic risk factors
• Very high bilirubin with normal enzymes
• Isolated prolonged prothrombin time without enzyme changes

Correct Answer: Mild to moderate ALT predominance over AST, often with metabolic risk factors

Q18. Which statement about AST is correct regarding its cellular localization and clinical relevance?

• AST is found only in the cytosol of hepatocytes
• AST has both cytosolic and mitochondrial isoforms; mitochondrial involvement contributes to higher AST in alcoholic hepatitis
• AST is specific to biliary epithelium and indicates cholestasis
• AST is produced only by the kidney and indicates renal disease

Correct Answer: AST has both cytosolic and mitochondrial isoforms; mitochondrial involvement contributes to higher AST in alcoholic hepatitis

Q19. The biochemical defect in Gilbert’s syndrome that leads to intermittent unconjugated hyperbilirubinemia is:

• Absence of bilirubin uptake into hepatocytes
• Impaired conjugation due to reduced UDP‑glucuronosyltransferase (UGT1A1) activity
• Defective bilirubin excretion into bile ducts (Dubin‑Johnson type)
• Excessive bilirubin production from heme turnover

Correct Answer: Impaired conjugation due to reduced UDP‑glucuronosyltransferase (UGT1A1) activity

Q20. Regarding hepatic clearance of drugs, which statement is correct and relevant for dose adjustment in liver disease?

• Clearance of high extraction ratio drugs is primarily determined by hepatic enzyme activity and protein binding
• Clearance of low extraction ratio drugs is primarily blood‑flow dependent
• Clearance of high extraction ratio drugs is primarily liver blood‑flow dependent
• All hepatic drug clearance is independent of hepatic blood flow

Correct Answer: Clearance of high extraction ratio drugs is primarily liver blood‑flow dependent

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