Facts read from aanpcert.org and 2 more · last checked Nov 7, 2026
GI items reward two habits: spotting the alarm feature that turns heartburn or diarrhea into a scope or a same-day referral, and reading liver and hepatitis panels without guessing.
Practice questions
60 questions written to the FNP-C outline; each choice is explained once you pick.
A 55-year-old woman has lost 7 kg over 3 months with fatigue and early satiety. There is a palpable epigastric mass and a hard left supraclavicular lymph node. She has no jaundice. Hemoglobin is 9.8 g/dL with a low MCV. Which is the most likely diagnosis?
Chronic pancreatitis causes postprandial pain, steatorrhea, and weight loss in heavy drinkers, not an epigastric mass with a hard supraclavicular node and iron deficiency.
Peptic ulcer disease can cause anemia and pain but not a palpable mass with a metastatic-looking node.
Pancreatic head cancer usually presents with painless jaundice and a palpable gallbladder; she has no jaundice.
Weight loss, early satiety, an epigastric mass, and a left supraclavicular (Virchow) node with iron-deficiency anemia point to gastric cancer.
A 42-year-old woman has had three episodes of postprandial right upper quadrant pain lasting 2 hours in the past 3 months. She is now pain-free and afebrile, with normal liver enzymes. Ultrasound shows multiple gallstones without wall thickening or duct dilation. Which is the most appropriate management?
Ursodeoxycholic acid dissolves stones slowly and incompletely, and they recur after stopping; it is for patients who cannot have surgery.
Recurrent biliary colic with gallstones is an indication for elective laparoscopic cholecystectomy because further attacks and complications are likely.
Reassurance fits asymptomatic gallstones; once stones cause repeated colic, removal is recommended.
ERCP treats stones in the bile duct, but her ducts are not dilated and liver tests are normal.
A 30-year-old woman has had extensive ulcerative colitis (pancolitis) for 8 years and has been in remission on mesalamine. She has no family history of colorectal cancer or primary sclerosing cholangitis. Which colorectal cancer surveillance plan is most appropriate?
Extensive colitis for 8 years or more raises colorectal cancer risk, so surveillance colonoscopy starts now and repeats every 1 to 3 years, depending on findings and risk.
Average-risk screening ignores the cancer risk from long-standing extensive colitis.
Waiting for symptoms misses dysplasia, which is silent in a colon that looks clinically quiet.
Stool tests do not detect flat dysplasia and are not used for surveillance in ulcerative colitis.
A 24-year-old woman presents with 8 months of intermittent diarrhea, bloating, and fatigue, plus a 12-pound unintentional weight loss. She has an intensely itchy, blistering rash over both elbows. Symptoms consistently improve when she avoids bread and pasta. Labs show iron-deficiency anemia despite adequate dietary iron. What is the most likely diagnosis?
Crohn disease can cause diarrhea, weight loss, and anemia, but it does not improve when bread and pasta are avoided, and it does not cause an itchy blistering rash on the elbows.
Diarrhea and weight loss that improve off wheat, iron deficiency despite adequate intake, and dermatitis herpetiformis on the elbows point to celiac disease.
Lactose intolerance causes bloating and diarrhea after dairy, not after wheat, and it does not cause anemia or a rash.
IBS does not cause weight loss, iron deficiency, or a blistering rash; these are alarm features.
A 42-year-old woman with IBS with diarrhea has followed a low-FODMAP diet for 6 weeks. Bloating has improved, but she still has cramping pain and 3–4 loose stools daily. Celiac serology, CBC, and fecal calprotectin are normal, and she has no alarm features. What is the most appropriate next step?
Probiotics have weak evidence in IBS and are not recommended by the ACG for global symptoms.
Linaclotide speeds transit and is used for IBS with constipation; it would worsen her diarrhea.
Colonoscopy is not needed in IBS-D without alarm features and with normal calprotectin, celiac serology, and CBC.
Rifaximin for 14 days improves global symptoms, bloating, and loose stools in IBS-D and is an accepted option when diet has not been enough.
A 42-year-old woman has had IBS with predominant diarrhea for 2 years. Loperamide controls stool frequency, but she still has cramping abdominal pain most days that disturbs her sleep. CBC, CRP, celiac serology, and fecal calprotectin are normal. Which medication is most appropriate to add?
A low-dose tricyclic such as amitriptyline treats abdominal pain in IBS, and its constipating effect helps in IBS-D.
Linaclotide treats IBS with constipation and causes diarrhea.
Lubiprostone is a chloride-channel activator for constipation and would worsen diarrhea.
Polyethylene glycol is an osmotic laxative for constipation.
A 36-year-old woman has 1 year of dysphagia that started with both solids and liquids at the same time. She regurgitates undigested food at night and has lost 4 kg. She has no heartburn, and she has no Raynaud phenomenon or skin tightening. What is the most likely diagnosis?
Scleroderma esophagus causes reflux and solid-food dysphagia with Raynaud phenomenon and skin changes, which she does not have.
Diffuse esophageal spasm causes intermittent chest pain with dysphagia, not steady regurgitation of undigested food.
Esophageal cancer causes progressive dysphagia that starts with solids and moves to liquids, usually in older patients.
Dysphagia to both solids and liquids from the start, with regurgitation of undigested food, points to achalasia; manometry confirms it after endoscopy.
A 45-year-old man has recurrent epigastric burning relieved by food, without alarm features. You suspect peptic ulcer disease from Helicobacter pylori. Which noninvasive test is most appropriate to confirm active infection?
The stool antigen test or the urea breath test detects active infection and is the noninvasive test of choice; PPIs should be held for 2 weeks beforehand when possible.
A barium study can show an ulcer but says nothing about H. pylori.
IgG serology stays positive after the infection is cured, so it cannot confirm active infection.
Gastrin is measured when Zollinger-Ellison syndrome is suspected, as with multiple or refractory ulcers.
A 70-year-old woman has 1 day of fever of 39.2 °C with chills, right upper quadrant pain, and yellowing of her eyes. Blood pressure is 96/60 mm Hg and heart rate is 112/min. Bilirubin is 5.4 mg/dL and alkaline phosphatase is elevated. Which is the most likely diagnosis?
Fever, right upper quadrant pain, and jaundice (Charcot triad) with hypotension point to acute cholangitis, a biliary obstruction with infection that needs emergency care.
Hepatitis A causes jaundice with very high aminotransferases, usually without high fever and shock.
Pancreatic head cancer causes painless jaundice and weight loss, not acute fever and hypotension.
Acute cholecystitis causes fever and RUQ pain, but marked jaundice suggests the bile duct is obstructed.
A 74-year-old woman with hypertension and peripheral artery disease has sudden, crampy left lower abdominal pain followed within 12 hours by urgency and bloody diarrhea. She became dehydrated during a heat wave 2 days ago. Temperature is 37.6°C, and she has mild left-sided tenderness without peritoneal signs. What is the most likely diagnosis?
Acute mesenteric ischemia causes severe periumbilical pain out of proportion to the exam, often with atrial fibrillation; bleeding comes late.
Diverticulitis causes fever and LLQ pain without early bloody diarrhea; bleeding diverticula are usually painless.
Sudden crampy left-sided pain followed within hours by bloody diarrhea, in an older woman with vascular disease after dehydration, is ischemic colitis.
Ulcerative colitis usually starts in younger adults with weeks of bloody diarrhea, not an abrupt onset after dehydration.
A 52-year-old woman with Hashimoto thyroiditis has 8 months of fatigue and itching that is worse at night. She has xanthelasma. Alkaline phosphatase is 380 U/L and GGT is elevated, with near-normal aminotransferases and bilirubin. Ultrasound shows normal bile ducts. She has no inflammatory bowel disease. Which test is most likely to confirm the diagnosis?
p-ANCA is linked to primary sclerosing cholangitis, which usually occurs with inflammatory bowel disease.
Anti-smooth muscle antibody supports autoimmune hepatitis, which raises aminotransferases rather than alkaline phosphatase.
Itching, fatigue, xanthelasma, and a cholestatic pattern in a middle-aged woman with autoimmune thyroid disease suggest primary biliary cholangitis, confirmed by antimitochondrial antibody.
ERCP is invasive and the ducts look normal on ultrasound; MRCP would be the test if primary sclerosing cholangitis were suspected.
A 34-year-old woman has 8 months of postprandial fullness and early satiety several days a week. She has no weight loss, vomiting, dysphagia, anemia, or family history of GI cancer, does not have diabetes, and takes no NSAIDs. H. pylori stool antigen is negative, upper endoscopy is normal, and an 8-week trial of omeprazole did not help. What is the most likely diagnosis?
GERD causes heartburn and regurgitation, not mainly fullness and early satiety, and it would usually respond to a PPI.
Gastroparesis usually causes nausea and vomiting, mostly in diabetes or after surgery; she has neither.
Bothersome postprandial fullness and early satiety with a normal endoscopy, a negative H. pylori test, and no alarm features meet Rome IV criteria for functional dyspepsia.
Peptic ulcer disease is unlikely with a normal endoscopy and a negative H. pylori test.
A running total sits here; it fills in after your last pick.
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GI mistakes that recur
Testing for H. pylori on a PPI. PPIs in the previous 2 weeks, and bismuth or antibiotics in the previous 4, cause false-negative results on the tests for active infection (ACG 2024 H. pylori guideline).
Empiric clarithromycin triple therapy. For treatment-naive patients whose clarithromycin susceptibility is unknown, ACG 2024 prefers bismuth quadruple therapy for 14 days.
No test of cure. Eradication is confirmed at least 4 weeks after treatment ends.
Reflux with alarm features treated with another PPI trial. Dysphagia, bleeding, anemia, weight loss or recurrent vomiting call for endoscopy (ACG 2022 GERD guideline).
A hepatitis B panel misread. HBsAg means current infection; anti-HBs alone means vaccination; anti-HBs with anti-HBc means past infection; IgM anti-HBc marks acute infection (CDC).
A positive HCV antibody called active hepatitis C. Current infection is confirmed with HCV RNA (CDC).
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GI topics on other pages
Colorectal cancer screening and hepatitis screening:adult screening.