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alcoholic hepatitis - line
#1
Can anyone help with this?

A 47-year-old woman comes to the emergency department because of severe abdominal pain for 3 hours. The pain began after a 2-week drinking binge. She has a 15-year history of alcoholism. She has no history of jaundice or hepatitis. Current medications include multivitamins and iron. Her temperature is 38°C (100.4°F), blood pressure is 110/80 mm Hg, and pulse is 110/min. Examination shows mild jaundice and diffuse spider angiomata over the trunk and abdomen. The liver is tender to palpation. A complete blood count shows mild anemia with normal red cell indices. Ultrasonography of the abdomen shows normal-sized hepatic ducts. Which of the following is the most likely set of laboratory findings?

Total Indirect Alkaline
Bilirubin Bilirubin Phosphatase Reticulocyte
(mg/dL) (mg/dL) (U/L) (ALT, GPT) (U/L) Count (%)

A) 2 0.9 80 30 1.2
B) 3 2.8 70 30 1.0
C) 3 2.8 80 20 3.0
D) 4 2.0 800 200 1.5
E) 4 1.0 150 400 1.0
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#2
EE
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#3
PLEASE WRITE DOWN IT IS AN NBME QUESTION PLEAAAAAAAAAAAASSSSSSSSSSSSSSEEEEEEEEEEEEEEEEEEEEEEEEE
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#4
look for AST/ALT reversal.. u ave given 5 values and only 4 names of test on the top panel.. i sth is missing but if wats missing is the name AST then i agree with forever07 its EE...
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#5
also i think, in my opinion, one more thing to look out for is
"no past history of hepatitis/jaundice"
we are lucky in this question they mentioned this.. cause if not, if its a chronic dx in which the liver has already been totally raped, we cannot consider AST ALT values anymore as they would return to baseline..
one thing i dun understand is the fact that they mentioned pt has been takin multi vits.. from my understanding the reason for reversal is cause one of these is a mitochondrial enzyme and the other is a cytoplasmic enzyme.. and its cause the liver needs to keep producing thse that a patient of alc gets pyridox def.. now since they mention that the patient has been on multivits, i dunno if this will make a significant difference to the ans... if any1 knows anything diff.. pls do ans (: and add to the lack of my knowledge
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