NP GI & Liver Disease Clinical Mastery Exam
2025/2026
(150Questions,Answers And Rationales)
1. A 45-year-old male presents with epigastric pain that improves
with eating. Which is the most likely diagnosis?
Peptic ulcer disease (duodenal ulcer)
Duodenal ulcers often present with epigastric pain that improves
after meals, whereas gastric ulcers typically worsen after meals.
2. The most common cause of acute pancreatitis in the U.S. is:
Gallstones
Gallstones and alcohol use account for the majority of acute
pancreatitis cases; gallstones are slightly more common in the
U.S.
3. Which lab finding is most indicative of hepatocellular injury?
Elevated ALT > AST
ALT is more specific to liver cells, whereas AST is also found in
other tissues like muscle.
4. A patient with chronic GERD develops dysphagia. The best next
step is:
Upper endoscopy
Endoscopy is indicated in patients with alarm symptoms such as
dysphagia to rule out strictures or Barrett’s esophagus.
5. A 35-year-old presents with chronic diarrhea and abdominal pain.
Labs show anti-tTG antibodies positive. The most likely diagnosis
is:
Celiac disease
, Anti-tTG antibodies are highly sensitive and specific for celiac
disease.
6. First-line treatment for H. pylori infection includes:
Triple therapy with PPI, clarithromycin, and
amoxicillin/metronidazole
This regimen eradicates H. pylori in most cases; therapy duration
is usually 10–14 days.
7. Which liver enzyme pattern is seen in alcoholic hepatitis?
AST > ALT, typically AST:ALT ratio >2
Alcoholic hepatitis commonly causes AST to be elevated more
than ALT, usually less than 300 IU/L.
8. A 50-year-old presents with jaundice, pruritus, and fatigue. Labs:
elevated alkaline phosphatase, positive antimitochondrial
antibodies. Diagnosis:
Primary biliary cholangitis (PBC)
PBC is an autoimmune disease affecting intrahepatic bile ducts,
causing cholestasis and positive AMA.
9. First-line therapy for acute uncomplicated diverticulitis is:
Oral antibiotics targeting gram-negative and anaerobes (e.g.,
ciprofloxacin + metronidazole)
Mild outpatient diverticulitis is treated with antibiotics that
cover common gut flora.
10. A 60-year-old male with chronic liver disease presents with
confusion and asterixis. Initial management includes:
Lactulose
Lactulose reduces blood ammonia levels and is first-line for
hepatic encephalopathy.
, 11. The most common cause of chronic liver disease in the U.S.
is:
Non-alcoholic fatty liver disease (NAFLD)
NAFLD prevalence has increased with obesity and metabolic
syndrome; it can progress to NASH and cirrhosis.
12. The gold standard for diagnosing cirrhosis is:
Liver biopsy
Although non-invasive tests exist, liver biopsy remains the
definitive diagnostic method.
13. A patient presents with hematemesis and melena. The next
best step is:
Upper endoscopy
UGIB is evaluated primarily with upper endoscopy to identify
source and provide therapy.
14. The most common cause of small bowel obstruction in
adults is:
Adhesions
Post-surgical adhesions account for the majority of SBO cases,
followed by hernias and malignancy.
15. Preferred imaging for suspected acute cholecystitis is:
Ultrasound
Ultrasound is sensitive for gallstones and can detect gallbladder
wall thickening or pericholecystic fluid.
16. A patient with chronic hepatitis B is at highest risk for which
complication?
Hepatocellular carcinoma
Chronic HBV infection increases HCC risk even in the absence of
cirrhosis.
2025/2026
(150Questions,Answers And Rationales)
1. A 45-year-old male presents with epigastric pain that improves
with eating. Which is the most likely diagnosis?
Peptic ulcer disease (duodenal ulcer)
Duodenal ulcers often present with epigastric pain that improves
after meals, whereas gastric ulcers typically worsen after meals.
2. The most common cause of acute pancreatitis in the U.S. is:
Gallstones
Gallstones and alcohol use account for the majority of acute
pancreatitis cases; gallstones are slightly more common in the
U.S.
3. Which lab finding is most indicative of hepatocellular injury?
Elevated ALT > AST
ALT is more specific to liver cells, whereas AST is also found in
other tissues like muscle.
4. A patient with chronic GERD develops dysphagia. The best next
step is:
Upper endoscopy
Endoscopy is indicated in patients with alarm symptoms such as
dysphagia to rule out strictures or Barrett’s esophagus.
5. A 35-year-old presents with chronic diarrhea and abdominal pain.
Labs show anti-tTG antibodies positive. The most likely diagnosis
is:
Celiac disease
, Anti-tTG antibodies are highly sensitive and specific for celiac
disease.
6. First-line treatment for H. pylori infection includes:
Triple therapy with PPI, clarithromycin, and
amoxicillin/metronidazole
This regimen eradicates H. pylori in most cases; therapy duration
is usually 10–14 days.
7. Which liver enzyme pattern is seen in alcoholic hepatitis?
AST > ALT, typically AST:ALT ratio >2
Alcoholic hepatitis commonly causes AST to be elevated more
than ALT, usually less than 300 IU/L.
8. A 50-year-old presents with jaundice, pruritus, and fatigue. Labs:
elevated alkaline phosphatase, positive antimitochondrial
antibodies. Diagnosis:
Primary biliary cholangitis (PBC)
PBC is an autoimmune disease affecting intrahepatic bile ducts,
causing cholestasis and positive AMA.
9. First-line therapy for acute uncomplicated diverticulitis is:
Oral antibiotics targeting gram-negative and anaerobes (e.g.,
ciprofloxacin + metronidazole)
Mild outpatient diverticulitis is treated with antibiotics that
cover common gut flora.
10. A 60-year-old male with chronic liver disease presents with
confusion and asterixis. Initial management includes:
Lactulose
Lactulose reduces blood ammonia levels and is first-line for
hepatic encephalopathy.
, 11. The most common cause of chronic liver disease in the U.S.
is:
Non-alcoholic fatty liver disease (NAFLD)
NAFLD prevalence has increased with obesity and metabolic
syndrome; it can progress to NASH and cirrhosis.
12. The gold standard for diagnosing cirrhosis is:
Liver biopsy
Although non-invasive tests exist, liver biopsy remains the
definitive diagnostic method.
13. A patient presents with hematemesis and melena. The next
best step is:
Upper endoscopy
UGIB is evaluated primarily with upper endoscopy to identify
source and provide therapy.
14. The most common cause of small bowel obstruction in
adults is:
Adhesions
Post-surgical adhesions account for the majority of SBO cases,
followed by hernias and malignancy.
15. Preferred imaging for suspected acute cholecystitis is:
Ultrasound
Ultrasound is sensitive for gallstones and can detect gallbladder
wall thickening or pericholecystic fluid.
16. A patient with chronic hepatitis B is at highest risk for which
complication?
Hepatocellular carcinoma
Chronic HBV infection increases HCC risk even in the absence of
cirrhosis.
