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liver function tests

Practice targeted AMC-style multiple-choice questions on liver function tests.

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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman presents for an elective abdominal ultrasound. Several months ago, she experienced a few episodes of intermittent, moderate-to-severe right upper quadrant pain that resolved spontaneously within a few hours each time. She denies any associated fever, chills, nausea, vomiting, or jaundice during those episodes or currently. She has no significant past medical history other than well-controlled hypertension. On examination today, she is afebrile, her vital signs are stable, and her abdomen is soft and non-tender. Routine blood tests performed prior to the ultrasound, including full blood count, liver function tests (bilirubin, alkaline phosphatase, AST, ALT, GGT), amylase, and lipase, are all within their respective normal reference ranges. The provided image is a representative view obtained during her ultrasound examination. Considering the patient's history, current clinical status, and the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with a history of chronic hepatitis C presents to his general practitioner for a routine check-up. He reports no new symptoms. His liver function tests from 6 months ago were within normal limits. However, recent blood work reveals an elevated alpha-fetoprotein (AFP) level of 600 ng/mL (normal <10 ng/mL). The GP orders a contrast-enhanced ultrasound of the liver, the images from which are shown. Based on the ultrasound findings and the patient's history, what is the MOST appropriate next step in management?

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A 55-year-old farmer presents with a week of high fever, severe retro-orbital headache, and profound muscle aches. He denies cough, sore throat, or rash. On examination, temperature is 39.5°C, pulse 90, BP 120/80. Lungs are clear to auscultation. Abdomen is soft, non-tender. Initial bloods show mildly elevated transaminases. What is the most likely diagnosis?

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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with cirrhosis secondary to alcohol abuse presents with new-onset ascites and a palpable liver mass. His AFP is 600 ng/mL. A contrast-enhanced ultrasound is performed. What is the MOST appropriate next step in confirming the diagnosis and guiding management?

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Gynaecomastia
Image by ProloSozz CC BY-SA 4.0 · Source

A 55-year-old man presents with the condition depicted, which has been present for 12 months and is mildly tender. Initial investigations including hormonal profile, liver function tests, and renal function tests are unremarkable. He takes no regular medications. Considering the clinical presentation and the findings shown, what is the most appropriate next step in the management of this patient?

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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 62-year-old male with a history of hepatitis C presents with new-onset right upper quadrant pain and a 5kg weight loss over the past 3 months. His liver function tests show elevated ALT and AST. An abdominal CT scan with and without contrast is performed (image attached). What is the MOST appropriate next step in management?

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