Nurse Practitioner Gastrointestinal and
Liver Pathology Final Exam – 150 Questions
Answers And Rationale (2025/2026)
1. Which enzyme is most specific for diagnosing acute pancreatitis?
A. AST
B. ALT
C. Lipase
D. Alkaline phosphatase
Lipase is more specific and remains elevated longer than amylase in
acute pancreatitis.
2. A patient with chronic GERD reports new dysphagia. What is the
most appropriate next step?
A. Start sucralfate
B. Increase PPI dose
C. Upper endoscopy
D. Barium swallow
Dysphagia with GERD symptoms is an alarm feature requiring
endoscopic evaluation to rule out strictures or malignancy.
3. Which condition is associated with a positive anti–tissue
transglutaminase (tTG-IgA) test?
A. Ulcerative colitis
B. Irritable bowel syndrome
C. Celiac disease
,D. Crohn’s disease
tTG-IgA has high sensitivity and specificity for celiac disease.
4. A 55-year-old man with heavy alcohol use presents with painless
jaundice. The most likely diagnosis is:
A. Viral hepatitis
B. Alcoholic hepatitis
C. Pancreatic cancer
D. Hemochromatosis
Painless jaundice with weight loss is classic for pancreatic cancer due
to biliary obstruction.
5. What is the recommended first-line treatment for H. pylori
infection?
A. Clarithromycin monotherapy
B. Bismuth quadruple therapy
C. Metronidazole alone
D. Ciprofloxacin
Quadruple therapy has the highest eradication rates due to rising
clarithromycin resistance.
6. A patient with ulcerative colitis has continuous inflammation
limited to the colon. Which finding supports this diagnosis?
A. Skip lesions
B. Cobblestoning
C. Rectal involvement
D. Fistula formation
,UC always involves the rectum and has continuous inflammation
without skip lesions.
7. Which hepatitis virus is transmitted primarily through the fecal–
oral route?
A. Hepatitis B
B. Hepatitis C
C. Hepatitis A
D. Hepatitis D
Hepatitis A is spread via contaminated food or water.
8. A patient with suspected Crohn’s disease should undergo which
initial diagnostic test?
A. Abdominal ultrasound
B. Colonoscopy with terminal ileum intubation
C. Upper GI series
D. CT chest
Colonoscopy with biopsies is the gold standard to confirm Crohn’s
disease.
9. Which lab abnormality is commonly seen in advanced liver
cirrhosis?
A. Elevated albumin
B. Increased platelet count
C. Elevated INR
D. Decreased bilirubin
INR increases due to decreased hepatic production of clotting factors.
, 10. A patient has RUQ pain radiating to the shoulder after eating fatty
foods. Most likely diagnosis?
A. Gastritis
B. Cholelithiasis
C. Pancreatitis
D. Hepatitis C
Classic biliary colic symptoms include RUQ pain after fatty meals
radiating to the right scapula.
11. A 64-year-old with cirrhosis presents with confusion and asterixis.
Best initial treatment?
A. Rifaximin alone
B. Lactulose
C. High-protein diet
D. Albumin infusion
Lactulose lowers ammonia levels by promoting excretion in hepatic
encephalopathy.
12. Which condition is associated with a “string sign” on imaging?
A. Ulcerative colitis
B. Crohn’s disease
C. IBS
D. Diverticulosis
The string sign reflects luminal narrowing in Crohn’s disease.
13. Barrett’s esophagus is caused by which mechanism?
Liver Pathology Final Exam – 150 Questions
Answers And Rationale (2025/2026)
1. Which enzyme is most specific for diagnosing acute pancreatitis?
A. AST
B. ALT
C. Lipase
D. Alkaline phosphatase
Lipase is more specific and remains elevated longer than amylase in
acute pancreatitis.
2. A patient with chronic GERD reports new dysphagia. What is the
most appropriate next step?
A. Start sucralfate
B. Increase PPI dose
C. Upper endoscopy
D. Barium swallow
Dysphagia with GERD symptoms is an alarm feature requiring
endoscopic evaluation to rule out strictures or malignancy.
3. Which condition is associated with a positive anti–tissue
transglutaminase (tTG-IgA) test?
A. Ulcerative colitis
B. Irritable bowel syndrome
C. Celiac disease
,D. Crohn’s disease
tTG-IgA has high sensitivity and specificity for celiac disease.
4. A 55-year-old man with heavy alcohol use presents with painless
jaundice. The most likely diagnosis is:
A. Viral hepatitis
B. Alcoholic hepatitis
C. Pancreatic cancer
D. Hemochromatosis
Painless jaundice with weight loss is classic for pancreatic cancer due
to biliary obstruction.
5. What is the recommended first-line treatment for H. pylori
infection?
A. Clarithromycin monotherapy
B. Bismuth quadruple therapy
C. Metronidazole alone
D. Ciprofloxacin
Quadruple therapy has the highest eradication rates due to rising
clarithromycin resistance.
6. A patient with ulcerative colitis has continuous inflammation
limited to the colon. Which finding supports this diagnosis?
A. Skip lesions
B. Cobblestoning
C. Rectal involvement
D. Fistula formation
,UC always involves the rectum and has continuous inflammation
without skip lesions.
7. Which hepatitis virus is transmitted primarily through the fecal–
oral route?
A. Hepatitis B
B. Hepatitis C
C. Hepatitis A
D. Hepatitis D
Hepatitis A is spread via contaminated food or water.
8. A patient with suspected Crohn’s disease should undergo which
initial diagnostic test?
A. Abdominal ultrasound
B. Colonoscopy with terminal ileum intubation
C. Upper GI series
D. CT chest
Colonoscopy with biopsies is the gold standard to confirm Crohn’s
disease.
9. Which lab abnormality is commonly seen in advanced liver
cirrhosis?
A. Elevated albumin
B. Increased platelet count
C. Elevated INR
D. Decreased bilirubin
INR increases due to decreased hepatic production of clotting factors.
, 10. A patient has RUQ pain radiating to the shoulder after eating fatty
foods. Most likely diagnosis?
A. Gastritis
B. Cholelithiasis
C. Pancreatitis
D. Hepatitis C
Classic biliary colic symptoms include RUQ pain after fatty meals
radiating to the right scapula.
11. A 64-year-old with cirrhosis presents with confusion and asterixis.
Best initial treatment?
A. Rifaximin alone
B. Lactulose
C. High-protein diet
D. Albumin infusion
Lactulose lowers ammonia levels by promoting excretion in hepatic
encephalopathy.
12. Which condition is associated with a “string sign” on imaging?
A. Ulcerative colitis
B. Crohn’s disease
C. IBS
D. Diverticulosis
The string sign reflects luminal narrowing in Crohn’s disease.
13. Barrett’s esophagus is caused by which mechanism?
