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Idiopathic pulmonary fibrosis — USMLE Step 2 CK MCQ

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HardInternal MedicineIdiopathic pulmonary fibrosisUSMLE Step 2 CK

A 32-year-old woman presents with new encephalopathy, INR 2.4, AST 7,800 U/L and ALT 9,100 U/L without previous liver disease. She cannot provide a reliable ingestion history, and the initial acetaminophen concentration is undetectable. Which treatment should begin while the etiology is investigated and transplant-center transfer is arranged?

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Correct answer: B — Begin intravenous N-acetylcysteine empirically

Acute liver failure is acute hepatic injury with coagulopathy and encephalopathy in a patient without chronic liver disease. AASLD resources support empiric intravenous N-acetylcysteine during evaluation, particularly when acetaminophen exposure is possible or the circumstances are unreliable; a late concentration may be negative after hepatic injury has developed. Transfer to a transplant center should proceed in parallel. Plasma is reserved for bleeding or procedures because INR trends aid prognosis. Lactulose does not reverse hepatocellular necrosis, and empiric steroids can obscure infection and are not universal ALF therapy.

Reference: AASLD: Defining and managing acute liver failure. https://www.aasld.org/liver-fellow-network/core-series/back-basics/defining-and-managing-acute-liver-failure