Professional and Linguistic Assessments Board (PLAB) Practice Exam

Elevated liver enzymes and an increase in indirect bilirubin are indicative of what condition?

1. Alcoholic hepatitis

2. Drug-induced hepatitis

3. Viral hepatitis

4. Cholestatic liver disease

The correct answer is: Drug-induced hepatitis

Elevated liver enzymes and an increase in indirect bilirubin can indicate a range of liver conditions, but this presentation is particularly characteristic of drug-induced hepatitis. In drug-induced hepatitis, the liver may be affected by various medications, leading to hepatocellular damage, which results in the release of liver enzymes into the bloodstream. Meanwhile, indirect bilirubin—which is a product of the breakdown of red blood cells—can accumulate if the liver's ability to conjugate and excrete bilirubin is impaired. Since drug-induced mechanisms often disrupt normal liver function, both liver enzymes and indirect bilirubin levels can rise significantly. In contrast, alcoholic hepatitis typically presents with elevated liver enzymes as well, but the pattern is usually different, with a more pronounced increase in AST compared to ALT. Viral hepatitis usually leads to an increase in both liver enzymes and may cause the bilirubin levels to rise, but indirect conjugated bilirubin is more common in post-hepatic jaundice, often related to obstructive causes or bile duct issues. Cholestatic liver diseases typically exhibit a predominance of alkaline phosphatase elevation rather than an isolated increase in indirect bilirubin and liver enzymes. Understanding the nuances of how different liver conditions present is crucial for diagnosis and management, as this influences