UPSC Prelims Practice Questions — What Alanine aminotransferase level can reveal about liver health

Q1. Under the Enzyme Commission (EC) system of enzyme nomenclature, alanine aminotransferase (ALT) carries which one of the following classification numbers?

  • A. EC 1.1.1.27, placing it among the oxidoreductases
  • B. EC 2.6.1.1, placing it among the transferases
  • C. EC 2.6.1.2, placing it among the transferases
  • D. EC 3.1.3.1, placing it among the hydrolases

Q2. Consider the following statements regarding alanine aminotransferase (ALT): 1. It is also reported as serum glutamic-pyruvic transaminase (SGPT). 2. It requires pyridoxal-5'-phosphate as a cofactor for catalytic activity. 3. It catalyses a reversible transfer of an amino group between alanine and 2-oxoglutarate, yielding pyruvate and glutamate. 4. Within the liver it is concentrated in the mitochondria of zone 3 hepatocytes, which is why mitochondrial injury raises it more sharply than the other serum transaminase. Which of the above is/are NOT correct?

  1. It is also reported as serum glutamic-pyruvic transaminase (SGPT).
  2. It requires pyridoxal-5'-phosphate as a cofactor for catalytic activity.
  3. It catalyses a reversible transfer of an amino group between alanine and 2-oxoglutarate, yielding pyruvate and glutamate.
  4. Within the liver it is concentrated in the mitochondria of zone 3 hepatocytes, which is why mitochondrial injury raises it more sharply than the other serum transaminase.
  • A. 1 and 3
  • B. 2 and 4
  • C. 1, 2 and 4
  • D. 4 only

Q3. With reference to the components of a standard liver function test panel, consider the following: 1. Alkaline phosphatase — an enzyme related to the bile ducts, typically increased when they are blocked. 2. Serum albumin — a marker of the synthetic function of the liver. 3. Gamma-glutamyl transferase — a marker of alcoholic hepatitis or of biliary obstruction. 4. Prothrombin time — the panel's measure of hepatic excretory capacity and of bilirubin metabolism. Which of the above is/are correctly identified?

  1. Alkaline phosphatase — an enzyme related to the bile ducts, typically increased when they are blocked.
  2. Serum albumin — a marker of the synthetic function of the liver.
  3. Gamma-glutamyl transferase — a marker of alcoholic hepatitis or of biliary obstruction.
  4. Prothrombin time — the panel's measure of hepatic excretory capacity and of bilirubin metabolism.
  • A. 1, 2 and 3 only
  • B. 1 and 4 only
  • C. 2 and 3 only
  • D. 1, 3 and 4 only

Q4. In India, the programme under which people screened for hepatitis B and C receive free diagnostics — including liver function testing — and free drugs is operationalised by which one of the following?

  • A. The Indian Council of Medical Research, which is the sole approving authority for all diagnostic laboratories in the country
  • B. The National Health Mission of the Union Ministry of Health and Family Welfare
  • C. The National Health Authority, which exclusively operates every public health laboratory in the States and Union Territories
  • D. The Department of Biotechnology, which is the only agency permitted to procure diagnostic kits for all State governments

Q5. Consider the following statements comparing metabolic dysfunction-associated steatotic liver disease (MASLD) with the earlier nomenclature it replaced: 1. The 2023 change replaced both non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) with MASLD. 2. Whereas the older label defined the condition largely by the absence of other causes, MASLD requires hepatic steatosis together with at least one cardiometabolic risk factor such as obesity, type 2 diabetes, hypertension or dyslipidaemia. 3. One stated aim of the change was to adopt a less stigmatising name; accordingly, MASLD, unlike NAFLD, excludes from its scope any patient reporting alcohol consumption of any amount whatsoever. Which of the statements given above is/are correct?

  1. The 2023 change replaced both non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) with MASLD.
  2. Whereas the older label defined the condition largely by the absence of other causes, MASLD requires hepatic steatosis together with at least one cardiometabolic risk factor such as obesity, type 2 diabetes, hypertension or dyslipidaemia.
  3. One stated aim of the change was to adopt a less stigmatising name; accordingly, MASLD, unlike NAFLD, excludes from its scope any patient reporting alcohol consumption of any amount whatsoever.
  • A. 1 only
  • B. 1 and 2 only
  • C. 2 and 3 only
  • D. 1, 2 and 3

Q6. In India, the operational guidelines and training modules for the prevention and management of fatty liver disease have been mainstreamed through which one of the following?

  • A. The National AYUSH Mission, implemented by the Ministry of AYUSH
  • B. POSHAN Abhiyaan, implemented by the Ministry of Women and Child Development
  • C. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, implemented by the Ministry of Health and Family Welfare
  • D. The National Biopharma Mission, implemented by the Department of Biotechnology

Q7. A serum aspartate aminotransferase to alanine aminotransferase (AST:ALT) ratio exceeding how many times is regarded as highly suggestive of alcoholic liver disease?

  • A. One
  • B. Two
  • C. Three
  • D. Five

Q8. Among the enzymes routinely measured in blood, which one is regarded as the most specific serum marker of hepatocellular injury?

  • A. Aspartate aminotransferase
  • B. Alanine aminotransferase
  • C. Gamma-glutamyl transferase
  • D. Alkaline phosphatase

Q9. With reference to WHO guidance on managing hepatotoxicity during tuberculosis treatment, consider the following: 1. Hepatotoxic medicines are to be stopped when serum ALT or AST exceeds five times the upper limit of normal, even in the absence of symptoms. 2. Hepatotoxic medicines are to be stopped at more than three times the upper limit of normal when symptoms of hepatitis are present. 3. Reintroduction of medicines may be considered once ALT and total bilirubin have fallen below two times the upper limit of normal. 4. On reintroduction, isoniazid and pyrazinamide are restarted first, with liver function tests repeated after 3–7 days. Which of the above is/are correctly identified?

  1. Hepatotoxic medicines are to be stopped when serum ALT or AST exceeds five times the upper limit of normal, even in the absence of symptoms.
  2. Hepatotoxic medicines are to be stopped at more than three times the upper limit of normal when symptoms of hepatitis are present.
  3. Reintroduction of medicines may be considered once ALT and total bilirubin have fallen below two times the upper limit of normal.
  4. On reintroduction, isoniazid and pyrazinamide are restarted first, with liver function tests repeated after 3–7 days.
  • A. 1, 2 and 3 only
  • B. 2 and 4 only
  • C. 1 and 3 only
  • D. 1, 2 and 4 only

Q10. With reference to the global burden of viral hepatitis as reported by the World Health Organization for the year 2024, consider the following: 1. Hepatitis B and C together accounted for about 1.34 million deaths. 2. About 287 million people were living with chronic hepatitis B or C. 3. Hepatitis C accounted for the larger share of these deaths, at about 1.1 million. 4. New hepatitis B infections had declined by about 32 per cent compared with 2015. Which of the above is/are NOT correct?

  1. Hepatitis B and C together accounted for about 1.34 million deaths.
  2. About 287 million people were living with chronic hepatitis B or C.
  3. Hepatitis C accounted for the larger share of these deaths, at about 1.1 million.
  4. New hepatitis B infections had declined by about 32 per cent compared with 2015.
  • A. 1 and 3
  • B. 2 and 4
  • C. 3 only
  • D. 2, 3 and 4