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Gastrointestinal CCRN Practice Questions

10 free CCRN-style gastrointestinal practice questions with full rationales. Perfect for last-minute review or rapid drilling on high-yield concepts.

Question Index

  1. Q1: Grey Turner sign and Cullen sign are associated with:
  2. Q2: Asterixis (flapping tremor) in a patient with cirrhosis indicates:
  3. Q3: Intra-abdominal pressure is measured via:
  4. Q4: The MOST specific lab test for acute pancreatitis is:
  5. Q5: A patient with cirrhosis and ascites develops fever, abdominal pain, and cloudy …
  6. Q6: Upper GI bleeding is characterized by which finding?
  7. Q7: The treatment of choice for esophageal variceal bleeding includes all EXCEPT:
  8. Q8: A patient with liver failure has a PT/INR of 4.5. This indicates:
  9. Q9: Enteral nutrition is preferred over parenteral nutrition because:
  10. Q10: Acetaminophen overdose is treated with:
Question 1

Grey Turner sign and Cullen sign are associated with:

  1. Appendicitis
  2. Severe pancreatitis
  3. Small bowel obstruction
  4. Gastric ulcer

Correct Answer: B. Severe pancreatitis

Rationale: Grey Turner sign (flank ecchymosis) and Cullen sign (periumbilical ecchymosis) indicate retroperitoneal hemorrhage and are associated with severe hemorrhagic pancreatitis. These are late findings suggesting necrotizing pancreatitis with poor prognosis. They result from blood tracking through fascial planes.
Question 2

Asterixis (flapping tremor) in a patient with cirrhosis indicates:

  1. Variceal bleeding
  2. Hepatic encephalopathy
  3. Spontaneous bacterial peritonitis
  4. Hepatorenal syndrome

Correct Answer: B. Hepatic encephalopathy

Rationale: Asterixis (flapping tremor) is a classic sign of hepatic encephalopathy caused by ammonia and other toxins not cleared by the failing liver. It is elicited by having the patient extend arms with wrists dorsiflexed. Other signs include confusion, personality changes, and progression to coma. Treat with lactulose and rifaximin.
Question 3

Intra-abdominal pressure is measured via:

  1. Nasogastric tube
  2. Arterial line
  3. Bladder catheter
  4. Central venous catheter

Correct Answer: C. Bladder catheter

Rationale: Intra-abdominal pressure (IAP) is measured via the bladder catheter. Technique: clamp the drainage tube, instill 25 mL sterile saline, connect to pressure transducer, measure at end-expiration with patient supine. Normal IAP is 5-7 mmHg. IAP >20 mmHg with organ dysfunction defines Abdominal Compartment Syndrome.
Question 4

The MOST specific lab test for acute pancreatitis is:

  1. Amylase
  2. Lipase
  3. AST
  4. Alkaline phosphatase

Correct Answer: B. Lipase

Rationale: Lipase is the most specific marker for pancreatitis. It is elevated longer than amylase and more specific to the pancreas. Amylase can be elevated from other sources (salivary glands, intestine). Diagnosis requires lipase or amylase elevation ≥3x upper limit of normal, plus characteristic abdominal pain or imaging findings.
Question 5

A patient with cirrhosis and ascites develops fever, abdominal pain, and cloudy ascitic fluid with >250 PMNs/mm³. This indicates:

  1. Peptic ulcer disease
  2. Spontaneous bacterial peritonitis
  3. Hepatorenal syndrome
  4. Portal vein thrombosis

Correct Answer: B. Spontaneous bacterial peritonitis

Rationale: Spontaneous bacterial peritonitis (SBP) is diagnosed when ascitic fluid PMN count is >250 cells/mm³. Symptoms include fever, abdominal pain, altered mental status. It occurs due to bacterial translocation across edematous gut wall in cirrhotic patients. Treat with ceftriaxone or fluoroquinolone. Albumin infusion reduces mortality.
Question 6

Upper GI bleeding is characterized by which finding?

  1. Hematochezia only
  2. Hematemesis or melena
  3. Bright red blood per rectum only
  4. Occult blood only

Correct Answer: B. Hematemesis or melena

Rationale: Upper GI bleeding (above ligament of Treitz) presents with hematemesis (bloody or coffee-ground vomit) and/or melena (black, tarry stools from digested blood). Lower GI bleeding typically presents with hematochezia (bright red blood per rectum). Note: Massive upper GI bleeds can cause hematochezia due to rapid transit.
Question 7

The treatment of choice for esophageal variceal bleeding includes all EXCEPT:

  1. Octreotide infusion
  2. Endoscopic band ligation
  3. NSAIDs
  4. Antibiotic prophylaxis

Correct Answer: C. NSAIDs

Rationale: NSAIDs are contraindicated in variceal bleeding (and liver disease in general) due to bleeding risk and nephrotoxicity. Treatment includes: Octreotide (reduces portal pressure), endoscopic band ligation/sclerotherapy, PPI, antibiotics (cirrhotic patients have high infection risk), and TIPS if refractory. Balloon tamponade is a bridge to definitive therapy.
Question 8

A patient with liver failure has a PT/INR of 4.5. This indicates:

  1. Increased clotting factor production
  2. Decreased synthesis of clotting factors
  3. Vitamin K excess
  4. Normal liver synthetic function

Correct Answer: B. Decreased synthesis of clotting factors

Rationale: Elevated PT/INR indicates impaired synthesis of vitamin K-dependent clotting factors (II, VII, IX, X) by the failing liver. This is an acute marker of liver synthetic function. Unlike albumin (which has a long half-life), clotting factors have short half-lives, making PT/INR more sensitive to acute liver injury.
Question 9

Enteral nutrition is preferred over parenteral nutrition because:

  1. It provides more calories
  2. It maintains gut mucosal integrity
  3. It has fewer electrolyte requirements
  4. It is faster to initiate

Correct Answer: B. It maintains gut mucosal integrity

Rationale: Enteral nutrition maintains gut mucosal integrity and function, reduces bacterial translocation, decreases infectious complications, and is more cost-effective than TPN. "If the gut works, use it." Start enteral feeding within 24-48 hours in ICU patients when possible. TPN is reserved for contraindications to enteral feeding.
Question 10

Acetaminophen overdose is treated with:

  1. Dialysis
  2. N-acetylcysteine
  3. Activated charcoal only
  4. Flumazenil

Correct Answer: B. N-acetylcysteine

Rationale: N-acetylcysteine (NAC) is the antidote for acetaminophen toxicity. It replenishes glutathione stores, which helps detoxify the toxic metabolite NAPQI. Most effective if given within 8 hours of ingestion, but beneficial up to 24+ hours. Can be given IV or PO. Acetaminophen is the most common cause of acute liver failure in the US.

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