GI High-Yield: Gastroenterology Questions the FNP Boards Love
Clinical High-Yield · 9 min read · May 8, 2026
GERD
Diagnosis: Clinical. Typical symptoms: heartburn, regurgitation. Atypical: chronic cough, hoarseness, asthma.
Management:
- Lifestyle: Elevate head of bed, avoid triggers (caffeine, alcohol, fatty foods, chocolate, mint), weight loss, avoid eating 2–3 hours before bed.
- Step-up: Antacids → H2 blockers → PPIs.
- PPIs are first-line for erosive esophagitis and frequent symptoms.
Alarm symptoms requiring endoscopy: dysphagia, odynophagia, weight loss, GI bleeding, anemia, age >45 with new symptoms.
Barrett's esophagus: Metaplasia of esophageal epithelium. Risk factor for esophageal adenocarcinoma. Surveillance endoscopy required.
Peptic Ulcer Disease
H. pylori: Most common cause. Test with urea breath test or stool antigen (preferred over serology). Treat with triple therapy: PPI + clarithromycin + amoxicillin × 14 days.
NSAID-induced: Second most common. Stop NSAID if possible. Add PPI.
Complications: Bleeding (melena, hematemesis), perforation (sudden severe abdominal pain, rigid abdomen), gastric outlet obstruction.
IBD
Crohn's disease: Can affect any part of GI tract, skip lesions, transmural inflammation, cobblestone appearance, fistulas/abscesses common. Associated with smoking.
Ulcerative colitis: Colon only, continuous from rectum, mucosal inflammation, bloody diarrhea. Protective effect of smoking (counterintuitive board question).
Key distinction: Crohn's — skip lesions, transmural, any GI segment. UC — continuous, mucosal, colon only.
Extraintestinal manifestations (both): Arthritis, uveitis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis (more common in UC).
IBS
Diagnosis: Rome IV criteria — recurrent abdominal pain ≥1 day/week for 3 months, associated with defecation or change in stool frequency/form. No alarm features.
Types: IBS-C (constipation predominant), IBS-D (diarrhea predominant), IBS-M (mixed).
Management: Dietary modifications (low-FODMAP diet), fiber supplementation, antispasmodics, antidepressants (TCAs for IBS-D, SSRIs for IBS-C), psychological therapies.
Hepatitis
Hepatitis A: Fecal-oral. Self-limited. Vaccine-preventable. No chronic disease.
Hepatitis B: Blood/sexual/perinatal. Can become chronic. Vaccine-preventable. HBsAg = active infection. Anti-HBs = immunity. HBeAg = high infectivity.
Hepatitis C: Blood-borne. Most common cause of chronic liver disease in the US. No vaccine. Direct-acting antivirals (DAAs) cure >95%.
Cirrhosis complications: Portal hypertension → esophageal varices, ascites, splenomegaly. Hepatic encephalopathy. Hepatorenal syndrome. Hepatocellular carcinoma.
Colorectal Cancer Screening
Average risk: Start at age 45.
- Colonoscopy every 10 years, OR
- Annual FIT/gFOBT, OR
- Cologuard every 3 years, OR
- CT colonography every 5 years
High risk (first-degree relative with CRC or adenoma <60): Start at 40 or 10 years before youngest affected relative, whichever is earlier. Colonoscopy every 5 years.
Lynch syndrome: Start at 20–25, colonoscopy every 1–2 years.