NP Digestive & Liver Disorders
Comprehensive Test Bank – 150 Questions
, Answers And Rationale
2025/2026
1. A 45-year-old man presents with epigastric pain that is worse at
night and relieved by eating. The most likely diagnosis is:
A. Gastric ulcer
B. Duodenal ulcer
C. Gastroesophageal reflux disease (GERD)
D. Pancreatitis
Rationale: Duodenal ulcers typically present with epigastric pain that is
worse at night and improves with food, unlike gastric ulcers which are
worsened by food.
2. Which laboratory finding is most specific for alcoholic liver
disease?
A. AST > ALT, AST:ALT ratio >2
B. ALT > AST
C. Elevated alkaline phosphatase
D. AST > ALT, AST:ALT ratio >2
Rationale: In alcoholic liver disease, AST is typically elevated more than
ALT, often in a 2:1 ratio, which is characteristic but not diagnostic alone.
3. The preferred initial test for suspected acute pancreatitis is:
A. Abdominal X-ray
B. Serum amylase and lipase
C. CT scan
D. MRI
,Rationale: Serum amylase and lipase are the initial tests of choice;
lipase is more specific for pancreatitis.
4. A patient presents with jaundice, pruritus, and fatigue. Lab results
show elevated ALP and GGT. The most likely pattern is:
A. Hepatocellular
B. Mixed
C. Cholestatic
D. Prehepatic
Rationale: Elevated alkaline phosphatase (ALP) and gamma-glutamyl
transferase (GGT) with jaundice suggest cholestatic liver disease.
5. The most common cause of chronic liver disease in the United
States is:
A. Alcoholic liver disease
B. Hepatitis B
C. Non-alcoholic fatty liver disease (NAFLD)
D. Hepatitis C
Rationale: NAFLD is the most common cause of chronic liver disease in
the U.S., often associated with metabolic syndrome.
6. A patient with cirrhosis develops confusion and asterixis. The
most likely diagnosis is:
A. Hepatorenal syndrome
B. Variceal bleeding
C. Hepatic encephalopathy
D. Spontaneous bacterial peritonitis
Rationale: Hepatic encephalopathy presents with neuropsychiatric
changes, confusion, and asterixis in patients with liver dysfunction.
7. First-line therapy for Helicobacter pylori infection includes:
A. Proton pump inhibitor (PPI) alone
, B. Triple therapy with PPI, clarithromycin, and amoxicillin
C. H2 blocker and antacid
D. Metronidazole alone
Rationale: Triple therapy (PPI + clarithromycin + amoxicillin or
metronidazole) is first-line treatment for H. pylori eradication.
8. Which screening test is recommended for patients at high risk for
hepatocellular carcinoma?
A. Colonoscopy
B. Abdominal ultrasound every 6 months
C. CT scan annually
D. MRI annually
Rationale: Patients with cirrhosis or chronic hepatitis B are
recommended to have abdominal ultrasound every 6 months for HCC
screening.
9. A patient presents with painless jaundice and weight loss. The
most likely cause is:
A. Viral hepatitis
B. Gallstones
C. Pancreatic cancer
D. Alcoholic hepatitis
Rationale: Painless jaundice with weight loss is a classic presentation
for pancreatic cancer causing biliary obstruction.
10. Which of the following is a complication of portal
hypertension?
A. Hepatic encephalopathy
B. Esophageal varices
C. Acute pancreatitis
D. Gallstones
, Rationale: Portal hypertension can lead to varices, ascites, and
splenomegaly due to increased pressure in the portal venous system.
11. A 35-year-old woman presents with chronic diarrhea, weight
loss, and iron deficiency anemia. The most likely diagnosis is:
A. Irritable bowel syndrome
B. Celiac disease
C. Crohn's disease
D. Ulcerative colitis
Rationale: Celiac disease causes malabsorption, leading to diarrhea,
weight loss, and micronutrient deficiencies such as iron deficiency
anemia.
12. Which antibody is most specific for autoimmune hepatitis?
A. ANA
B. SMA
C. Anti-LKM1
D. Anti-Smooth Muscle Antibody (SMA)
Rationale: SMA is highly specific for autoimmune hepatitis, especially
type 1.
13. The most common cause of acute viral hepatitis worldwide
is:
A. Hepatitis B
B. Hepatitis C
C. Hepatitis A
D. Hepatitis D
Rationale: Hepatitis A virus is the most common cause of acute viral
hepatitis globally, typically transmitted via fecal-oral route.
14. Which of the following medications is most likely to cause
hepatotoxicity?
Comprehensive Test Bank – 150 Questions
, Answers And Rationale
2025/2026
1. A 45-year-old man presents with epigastric pain that is worse at
night and relieved by eating. The most likely diagnosis is:
A. Gastric ulcer
B. Duodenal ulcer
C. Gastroesophageal reflux disease (GERD)
D. Pancreatitis
Rationale: Duodenal ulcers typically present with epigastric pain that is
worse at night and improves with food, unlike gastric ulcers which are
worsened by food.
2. Which laboratory finding is most specific for alcoholic liver
disease?
A. AST > ALT, AST:ALT ratio >2
B. ALT > AST
C. Elevated alkaline phosphatase
D. AST > ALT, AST:ALT ratio >2
Rationale: In alcoholic liver disease, AST is typically elevated more than
ALT, often in a 2:1 ratio, which is characteristic but not diagnostic alone.
3. The preferred initial test for suspected acute pancreatitis is:
A. Abdominal X-ray
B. Serum amylase and lipase
C. CT scan
D. MRI
,Rationale: Serum amylase and lipase are the initial tests of choice;
lipase is more specific for pancreatitis.
4. A patient presents with jaundice, pruritus, and fatigue. Lab results
show elevated ALP and GGT. The most likely pattern is:
A. Hepatocellular
B. Mixed
C. Cholestatic
D. Prehepatic
Rationale: Elevated alkaline phosphatase (ALP) and gamma-glutamyl
transferase (GGT) with jaundice suggest cholestatic liver disease.
5. The most common cause of chronic liver disease in the United
States is:
A. Alcoholic liver disease
B. Hepatitis B
C. Non-alcoholic fatty liver disease (NAFLD)
D. Hepatitis C
Rationale: NAFLD is the most common cause of chronic liver disease in
the U.S., often associated with metabolic syndrome.
6. A patient with cirrhosis develops confusion and asterixis. The
most likely diagnosis is:
A. Hepatorenal syndrome
B. Variceal bleeding
C. Hepatic encephalopathy
D. Spontaneous bacterial peritonitis
Rationale: Hepatic encephalopathy presents with neuropsychiatric
changes, confusion, and asterixis in patients with liver dysfunction.
7. First-line therapy for Helicobacter pylori infection includes:
A. Proton pump inhibitor (PPI) alone
, B. Triple therapy with PPI, clarithromycin, and amoxicillin
C. H2 blocker and antacid
D. Metronidazole alone
Rationale: Triple therapy (PPI + clarithromycin + amoxicillin or
metronidazole) is first-line treatment for H. pylori eradication.
8. Which screening test is recommended for patients at high risk for
hepatocellular carcinoma?
A. Colonoscopy
B. Abdominal ultrasound every 6 months
C. CT scan annually
D. MRI annually
Rationale: Patients with cirrhosis or chronic hepatitis B are
recommended to have abdominal ultrasound every 6 months for HCC
screening.
9. A patient presents with painless jaundice and weight loss. The
most likely cause is:
A. Viral hepatitis
B. Gallstones
C. Pancreatic cancer
D. Alcoholic hepatitis
Rationale: Painless jaundice with weight loss is a classic presentation
for pancreatic cancer causing biliary obstruction.
10. Which of the following is a complication of portal
hypertension?
A. Hepatic encephalopathy
B. Esophageal varices
C. Acute pancreatitis
D. Gallstones
, Rationale: Portal hypertension can lead to varices, ascites, and
splenomegaly due to increased pressure in the portal venous system.
11. A 35-year-old woman presents with chronic diarrhea, weight
loss, and iron deficiency anemia. The most likely diagnosis is:
A. Irritable bowel syndrome
B. Celiac disease
C. Crohn's disease
D. Ulcerative colitis
Rationale: Celiac disease causes malabsorption, leading to diarrhea,
weight loss, and micronutrient deficiencies such as iron deficiency
anemia.
12. Which antibody is most specific for autoimmune hepatitis?
A. ANA
B. SMA
C. Anti-LKM1
D. Anti-Smooth Muscle Antibody (SMA)
Rationale: SMA is highly specific for autoimmune hepatitis, especially
type 1.
13. The most common cause of acute viral hepatitis worldwide
is:
A. Hepatitis B
B. Hepatitis C
C. Hepatitis A
D. Hepatitis D
Rationale: Hepatitis A virus is the most common cause of acute viral
hepatitis globally, typically transmitted via fecal-oral route.
14. Which of the following medications is most likely to cause
hepatotoxicity?
