NR511 Final Exam: 100 Practice
Questions and Answer Explanations
Part One: Gastrointestinal Disorders
(1–20)
1. A 26-year-old man has diffuse crampy abdominal pain, weight loss, low-grade fevers,
and non-bloody diarrhea. On exam, he has RLQ tenderness and perianal fissures. Which
diagnosis is MOST consistent with these findings?
A. Ulcerative colitis
B. Irritable bowel syndrome
C. Crohn's disease
D. Diverticulitis
Answer: C
Explanation: Crohn's disease is associated with systemic symptoms, weight loss, RLQ
involvement, and perianal disease—features not seen in IBS or typical ulcerative colitis .
2. A 51-year-old woman with long-standing GERD has persistent symptoms despite an
adequate PPI trial. She denies alarm signs. What is the MOST appropriate next step?
A. Add H2 blocker and ignore persistent symptoms
B. Refer for gastroenterology evaluation and possible endoscopy
C. Discontinue PPI and switch to antacids only
D. Order routine colonoscopy
Answer: B
Explanation: Persistent GERD symptoms despite optimal medical therapy warrant specialty
evaluation and consideration of endoscopy to assess for complications .
3. A 48-year-old man with BMI 32 reports burning retrosternal discomfort after large
evening meals. Symptoms improve with antacids and avoiding late-night snacks. He denies
dysphagia, weight loss, or GI bleeding. What is the most appropriate initial pharmacologic
management?
A. Start omeprazole 20 mg once daily 30 minutes before breakfast for 8 weeks
B. Start pantoprazole 40 mg twice daily indefinitely
C. Start ranitidine 150 mg at bedtime and continue for 1 year
D. Start sucralfate 1 g four times daily for 12 weeks
Answer: A
Explanation: For typical, uncomplicated GERD symptoms without alarm features, the
,recommended initial therapy is an 8-week trial of a once-daily PPI taken 30–60 minutes
before the first meal .
4. A 62-year-old woman with a 10-year history of GERD presents with progressive solid-
food dysphagia and a 10-pound unintentional weight loss. What is the most appropriate
next step?
A. Increase PPI to twice daily and reassess in 8 weeks
B. Order a barium swallow only
C. Refer for esophagogastroduodenoscopy (EGD) now
D. Add an H2 blocker at bedtime
Answer: C
Explanation: Progressive dysphagia and weight loss are alarm features that warrant prompt
endoscopic evaluation rather than further empiric PPI therapy .
5. A 48-year-old man with intermittent epigastric pain has normal EGD but symptoms
consistent with dyspepsia. How is this BEST categorized?
A. Functional upper GI disorder
B. Functional lower GI disorder
C. Endocrine disorder
D. Psychological disorder
Answer: A
Explanation: Dyspepsia is categorized as a functional upper GI disorder when structural
causes have been excluded by appropriate evaluation .
6. A 60-year-old man presents with new-onset ascites, weight loss, and change in bowel
habits. Which category BEST fits these concerning findings?
A. Functional upper GI disorder
B. Functional lower GI disorder
C. Psychological disorder
D. Lower GI malignancy
Answer: D
Explanation: Ascites, weight loss, and altered bowel habits are serious conditions that must
be ruled out before diagnosing IBS, with lower GI malignancy being a primary concern .
7. A 35-year-old woman with chronic constipation-predominant IBS fails conservative
measures. Which is the MOST appropriate next step?
A. Immediate colonoscopy
B. Measure colonic transit time via specialist referral
C. Start chronic opioid therapy
D. Ignore symptoms if imaging is normal
Answer: B
Explanation: Patients with constipation-predominant IBS may require referral to a specialist
who can measure colonic transit time when initial management is insufficient .
, 8. A 43-year-old woman has episodic epigastric pain that radiates to the back, occurs after
fatty meals, and is associated with nausea. Murphy's sign is positive. Which diagnostic test
is MOST appropriate first?
A. Abdominal ultrasound
B. CT abdomen with contrast
C. Colonoscopy
D. Upper GI series with barium
Answer: A
Explanation: RUQ ultrasound is the initial imaging test for suspected biliary disease such as
cholelithiasis or acute cholecystitis .
9. A 21-year-old woman presents with sudden periumbilical pain that migrated to the right
lower quadrant over 24 hours, low-grade fever, and anorexia. RLQ tenderness with
guarding is present. Which is the MOST likely diagnosis?
A. Diverticulitis
B. Crohn's disease flare
C. Appendicitis
D. Irritable bowel syndrome
Answer: C
Explanation: Classic appendicitis manifests as initially vague periumbilical pain that localizes
to the RLQ with tenderness, fever, and anorexia .
10. A 40-year-old man has burning epigastric pain relieved by food and antacids. He takes
NSAIDs daily. You suspect peptic ulcer disease. Which H. pylori test is BEST for initial
noninvasive diagnosis?
A. Serum H. pylori IgG antibody
B. Urea breath test
C. Endoscopic biopsy with culture
D. Stool occult blood testing
Answer: B
Explanation: Noninvasive tests such as urea breath testing are preferred for detecting active
H. pylori infection, whereas serology may reflect past exposure .
11. A 62-year-old woman has chronic watery diarrhea, weight loss, and abdominal
cramping. Which finding would MOST strongly argue against IBS and prompt evaluation
for IBD or malignancy?
A. Symptoms that improve after defecation
B. Symptoms worsened by stress
C. Nocturnal diarrhea and rectal bleeding
D. Normal abdominal exam
Answer: C
Questions and Answer Explanations
Part One: Gastrointestinal Disorders
(1–20)
1. A 26-year-old man has diffuse crampy abdominal pain, weight loss, low-grade fevers,
and non-bloody diarrhea. On exam, he has RLQ tenderness and perianal fissures. Which
diagnosis is MOST consistent with these findings?
A. Ulcerative colitis
B. Irritable bowel syndrome
C. Crohn's disease
D. Diverticulitis
Answer: C
Explanation: Crohn's disease is associated with systemic symptoms, weight loss, RLQ
involvement, and perianal disease—features not seen in IBS or typical ulcerative colitis .
2. A 51-year-old woman with long-standing GERD has persistent symptoms despite an
adequate PPI trial. She denies alarm signs. What is the MOST appropriate next step?
A. Add H2 blocker and ignore persistent symptoms
B. Refer for gastroenterology evaluation and possible endoscopy
C. Discontinue PPI and switch to antacids only
D. Order routine colonoscopy
Answer: B
Explanation: Persistent GERD symptoms despite optimal medical therapy warrant specialty
evaluation and consideration of endoscopy to assess for complications .
3. A 48-year-old man with BMI 32 reports burning retrosternal discomfort after large
evening meals. Symptoms improve with antacids and avoiding late-night snacks. He denies
dysphagia, weight loss, or GI bleeding. What is the most appropriate initial pharmacologic
management?
A. Start omeprazole 20 mg once daily 30 minutes before breakfast for 8 weeks
B. Start pantoprazole 40 mg twice daily indefinitely
C. Start ranitidine 150 mg at bedtime and continue for 1 year
D. Start sucralfate 1 g four times daily for 12 weeks
Answer: A
Explanation: For typical, uncomplicated GERD symptoms without alarm features, the
,recommended initial therapy is an 8-week trial of a once-daily PPI taken 30–60 minutes
before the first meal .
4. A 62-year-old woman with a 10-year history of GERD presents with progressive solid-
food dysphagia and a 10-pound unintentional weight loss. What is the most appropriate
next step?
A. Increase PPI to twice daily and reassess in 8 weeks
B. Order a barium swallow only
C. Refer for esophagogastroduodenoscopy (EGD) now
D. Add an H2 blocker at bedtime
Answer: C
Explanation: Progressive dysphagia and weight loss are alarm features that warrant prompt
endoscopic evaluation rather than further empiric PPI therapy .
5. A 48-year-old man with intermittent epigastric pain has normal EGD but symptoms
consistent with dyspepsia. How is this BEST categorized?
A. Functional upper GI disorder
B. Functional lower GI disorder
C. Endocrine disorder
D. Psychological disorder
Answer: A
Explanation: Dyspepsia is categorized as a functional upper GI disorder when structural
causes have been excluded by appropriate evaluation .
6. A 60-year-old man presents with new-onset ascites, weight loss, and change in bowel
habits. Which category BEST fits these concerning findings?
A. Functional upper GI disorder
B. Functional lower GI disorder
C. Psychological disorder
D. Lower GI malignancy
Answer: D
Explanation: Ascites, weight loss, and altered bowel habits are serious conditions that must
be ruled out before diagnosing IBS, with lower GI malignancy being a primary concern .
7. A 35-year-old woman with chronic constipation-predominant IBS fails conservative
measures. Which is the MOST appropriate next step?
A. Immediate colonoscopy
B. Measure colonic transit time via specialist referral
C. Start chronic opioid therapy
D. Ignore symptoms if imaging is normal
Answer: B
Explanation: Patients with constipation-predominant IBS may require referral to a specialist
who can measure colonic transit time when initial management is insufficient .
, 8. A 43-year-old woman has episodic epigastric pain that radiates to the back, occurs after
fatty meals, and is associated with nausea. Murphy's sign is positive. Which diagnostic test
is MOST appropriate first?
A. Abdominal ultrasound
B. CT abdomen with contrast
C. Colonoscopy
D. Upper GI series with barium
Answer: A
Explanation: RUQ ultrasound is the initial imaging test for suspected biliary disease such as
cholelithiasis or acute cholecystitis .
9. A 21-year-old woman presents with sudden periumbilical pain that migrated to the right
lower quadrant over 24 hours, low-grade fever, and anorexia. RLQ tenderness with
guarding is present. Which is the MOST likely diagnosis?
A. Diverticulitis
B. Crohn's disease flare
C. Appendicitis
D. Irritable bowel syndrome
Answer: C
Explanation: Classic appendicitis manifests as initially vague periumbilical pain that localizes
to the RLQ with tenderness, fever, and anorexia .
10. A 40-year-old man has burning epigastric pain relieved by food and antacids. He takes
NSAIDs daily. You suspect peptic ulcer disease. Which H. pylori test is BEST for initial
noninvasive diagnosis?
A. Serum H. pylori IgG antibody
B. Urea breath test
C. Endoscopic biopsy with culture
D. Stool occult blood testing
Answer: B
Explanation: Noninvasive tests such as urea breath testing are preferred for detecting active
H. pylori infection, whereas serology may reflect past exposure .
11. A 62-year-old woman has chronic watery diarrhea, weight loss, and abdominal
cramping. Which finding would MOST strongly argue against IBS and prompt evaluation
for IBD or malignancy?
A. Symptoms that improve after defecation
B. Symptoms worsened by stress
C. Nocturnal diarrhea and rectal bleeding
D. Normal abdominal exam
Answer: C
