Hepatobiliary Disease USMLE Step 1 Practice Question
A 55-year-old man with a 30-year history of heavy alcohol use presents to the emergency department with abdominal distension and hematemesis. On examination, he has ascites, spider angiomas on his chest, and a firm, nontender hepatomegaly. Vital signs show BP 95/60 mmHg and HR 110 bpm. Laboratory studies reveal: AST 240 U/L, ALT 85 U/L, ALP 98 U/L, total bilirubin 4.1 mg/dL, albumin 2.5 g/dL, INR 2.2, and platelet count 98,000/μL. Abdominal ultrasound shows a cirrhotic-appearing liver with nodular contours and portal vein flow reversal. Which of the following findings would be most specific for confirming the diagnosis of hepatic cirrhosis?
Answer choices
- AAST-to-ALT ratio greater than 2
- BPresence of ascites, spider angiomas, and coagulopathy
- CLiver biopsy showing bridging fibrosis with nodular regenerationCorrect answer
- DAbdominal ultrasound demonstrating hepatomegaly with heterogeneous echogenicity and portal vein flow reversal
- EElevated total bilirubin and low albumin with prolonged INR
- FUpper endoscopy revealing esophageal varices with recent bleeding
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.