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Acute pancreatitis — USMLE Step 2 CK MCQ

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HardInternal MedicineAcute pancreatitisUSMLE Step 2 CK

A 21-year-old woman has jaundice, Coombs-negative hemolytic anemia, very low alkaline phosphatase relative to bilirubin, INR 3.1 and new asterixis. Wilson disease–associated acute liver failure is suspected. Which next step most affects survival?

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Correct answer: B — Initiate urgent liver-transplant evaluation and listing

The combination of acute liver failure, Coombs-negative hemolysis, disproportionately low alkaline phosphatase and high bilirubin is highly concerning for fulminant Wilson disease. Wilson-associated acute liver failure has extremely poor spontaneous survival and requires urgent transplant-center evaluation and listing. Chelation is useful in chronic Wilson disease but does not reliably rescue fulminant hepatic failure. Biopsy can be hazardous and must not delay transfer. Glucocorticoids and phlebotomy do not correct the underlying failure.

Reference: AASLD: 2026 hepatology practice board questions—Wilson disease acute liver failure. https://www.aasld.org/liver-fellow-network/core-series/practice-questions/2026-hepatology-practice-board-questions-2