nbme1 b2-13 - mama

[ArchivalUser]

13. A 42-year-old woman comes to the physician for an annual pelvic examination and Pap smear. Over the past year, she has had increasing fatigue and difficulty sleeping. She has two children who both attend college. She is currently looking for part-time work outside the home. Her husband has been busy in a new start-up business. Examination shows no abnormalities. Laboratory studies show:

Hemoglobin 15 g/dL
Mean corpuscular volume 95 μm3
Leukocyte count 6000/mm3 with a normal differential
Serum
Na+ 145 mEq/L
Cl“ 102 mEq/L
K+ 4.5 mEq/L
HCO3“ 25 mEq/L
Urea nitrogen (BUN) 18 mg/dL
Creatinine 1.0 mg/dL
Alkaline phosphatase 70 U/L
Aspartate aminotransferase
(AST, GOT) 22 U/L
Alanine aminotransferase
(ALT, GPT) 19 U/L
γ-Glutamyltransferase
(GGT) 83 U/L
(N=5“50 U/L)

Which of the following is the most likely explanation for this patient's laboratory abnormalities?

A) Acetaminophen

B) Alcohol

C) Diphenhydramine

D) Estrogen effect

E) Ibuprofen

[ArchivalUser]

alcohol

[ArchivalUser]

most specific test could be cdt+ggt

[ArchivalUser]

bb

[ArchivalUser]

in alcoholic hepatitis AST:ALT should >=2:1
but here is not , any one clearify?thx

[ArchivalUser]

Alcohol use can cause a transient elevation in liver enzymes which is what this lady has. If she had alcoholic liver disease, assuming that the liver is not cooked, she would have an AST level of atleast four times the upper bound of the reference range which is not the case here.

[ArchivalUser]

alcohol
ggt is raised in her which is more specific for alcohol intake

[ArchivalUser]

thank you suportboy and harrison82