25-pack-year Smoking History in Medicine / Internal Medicine — 49yo Man | Hepatology | SMLE Q#329
SMLE Question #329
Medicine / Internal Medicine
Hepatology
Objective: OBJ-HEP-01
Last updated: February 2026
A 49-year-old man with a 25-pack-year smoking history and daily alcohol intake (4–5 standard drinks/day for 15 years) reports progressive fatigue for several months. He has persistently abnormal liver enzymes and iron studies. Hepatitis B serology shows immunity without evidence of active infection. Abdominal ultrasound shows mildly increased liver echogenicity without portal hypertension. Which of the following is the most likely cause of this patient’s developing liver cirrhosis?
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