American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the presumptive diagnosis for a patient with mild aminotransferase abnormalities and risk factors for fatty liver disease?

1. Alcoholic hepatitis

2. Nonalcoholic steatohepatitis

3. Chronic hepatitis B

4. Autoimmune hepatitis

The correct answer is: Nonalcoholic steatohepatitis

The presumptive diagnosis of nonalcoholic steatohepatitis (NASH) is highly appropriate for a patient who presents with mild aminotransferase abnormalities along with risk factors for fatty liver disease. NASH is a more severe form of nonalcoholic fatty liver disease (NAFLD) and is characterized by the accumulation of fat in the liver along with inflammation and cellular injury. In patients with risk factors such as obesity, diabetes, hyperlipidemia, and metabolic syndrome, the likelihood of developing NASH significantly increases. The presence of mild elevations in aminotransferases, specifically aspartate aminotransferase (AST) and alanine aminotransferase (ALT), aligns with the typical laboratory findings associated with NASH. This condition often occurs in the absence of excessive alcohol consumption, differentiating it from alcoholic liver diseases. In contrast, alcoholic hepatitis typically presents in individuals with significant alcohol use, leading to higher levels of aminotransferases, particularly AST. Chronic hepatitis B and autoimmune hepatitis would typically present with more pronounced, persistent aminotransferase abnormalities and additional laboratory findings, such as serology for hepatitis B or specific autoantibodies, respectively. Thus, given the mild nature of the aminotransfer