Hepatology And Advanced Liver Disease Practice Test

A 62-year-old woman was treated for an uncomplicated urinary tract infection with a 7-day course of nitrofurantoin. Two weeks after completing the course, she develops profound fatigue, nausea, and dark urine. On examination, she is jaundiced. Laboratory studies show an AST of 850 U/L, ALT of 990 U/L, and a total bilirubin of 7.5 mg/dL. An extensive workup, including viral hepatitis serologies and autoimmune markers, is negative. An abdominal ultrasound is unremarkable.

A 45-year-old woman presents with a 6-month history of progressive fatigue and generalized pruritus. On physical examination, she has several xanthelasmas around her eyes. Laboratory studies show a total bilirubin of 1.5 mg/dL, AST of 55 U/L, ALT of 60 U/L, and an alkaline phosphatase of 450 U/L. A subsequent test reveals a positive anti-mitochondrial antibody (AMA) titer of 1:160.