Liver, Gallbladder, and Pancreas Practice Questions

25 multiple-choice questions on Liver, gallbladder, and pancreas for paramedic and EMT students, from Chapter 21 (Abdominal and Gastrointestinal Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Acalculous cholecystitis, inflammation without gallstones, most often affects:

   1. A. Young women after meals
   2. B. Critically ill patients
   3. C. Children with strep throat
   4. D. Healthy athletes after exercise
   Show answer

   Answer: B. Critically ill patients

   Acalculous cholecystitis develops in severely ill patients, such as those with major burns, trauma, sepsis, or long ICU stays, and it carries high rates of gangrene and perforation. Gallstone disease, not acalculous disease, is the typical cause in young women.

2. The classic risk factors for gallstones are often summarized as:

   1. A. Female, forty, fertile, fat
   2. B. Male, thin, young, active
   3. C. Smoker, diabetic, male, older
   4. D. Child, fever, rash, recent cold
   Show answer

   Answer: A. Female, forty, fertile, fat

   Women in their 40s, obesity, pregnancy, and multiple pregnancies raise risk. Rapid weight loss is also a factor.

3. A 44-year-old woman has RUQ pain radiating to the right shoulder after a fatty dinner, with nausea and fever. The most likely diagnosis is:

   1. A. Acute appendicitis
   2. B. Kidney stone
   3. C. Acute cholecystitis
   4. D. Peptic ulcer perforation
   Show answer

   Answer: C. Acute cholecystitis

   Fatty meals trigger gallbladder contraction against a blocked duct. Right shoulder referral and fever suggest inflammation.

4. Murphy sign is:

   1. A. Pain in the RLQ on pressing the LLQ
   2. B. Flank bruising from bleeding
   3. C. Left shoulder pain when supine
   4. D. Stopping inhalation on RUQ pressure
   Show answer

   Answer: D. Stopping inhalation on RUQ pressure

   Pressing under the right costal margin while the patient inhales causes pain as the inflamed gallbladder hits the hand. Rovsing sign is for appendicitis.

5. Fever, jaundice, and RUQ pain together (Charcot triad) suggest:

   1. A. Simple biliary colic
   2. B. Ascending cholangitis
   3. C. Viral gastroenteritis
   4. D. Splenic rupture
   Show answer

   Answer: B. Ascending cholangitis

   Infection of an obstructed bile duct is life-threatening. Adding confusion and hypotension (Reynolds pentad) indicates septic shock.

6. The most common causes of acute pancreatitis are:

   1. A. Gallstones and alcohol
   2. B. Smoking and caffeine
   3. C. Viral colds and stress
   4. D. Spicy food and NSAIDs
   Show answer

   Answer: A. Gallstones and alcohol

   Gallstones blocking the pancreatic duct and heavy alcohol use account for most cases. High triglycerides and some drugs also contribute.

7. A patient with pancreatitis is most comfortable:

   1. A. Supine with legs straight
   2. B. Prone on the stretcher
   3. C. Sitting, leaning forward
   4. D. In Trendelenburg position
   Show answer

   Answer: C. Sitting, leaning forward

   Leaning forward takes pressure off the inflamed retroperitoneal pancreas. Lying flat usually worsens the pain.

8. Severe acute pancreatitis can lead to shock mainly because of:

   1. A. Massive fluid shifts
   2. B. Rapid external blood loss
   3. C. A high spinal cord injury
   4. D. A severe allergic reaction
   Show answer

   Answer: A. Massive fluid shifts

   Inflammation causes capillaries to leak, with large fluid losses into the retroperitoneum and abdomen. Patients may need substantial fluid resuscitation.

9. Which finding in a patient with cirrhosis reflects the liver's failure to clear estrogen?

   1. A. A flapping tremor of the outstretched hands
   2. B. Black, tarry stools
   3. C. Pain boring through to the back
   4. D. Spider angiomas and enlarged breasts
   Show answer

   Answer: D. Spider angiomas and enlarged breasts

   A failing liver clears estrogen poorly, leading to spider angiomas, palmar redness, and gynecomastia in men. A flapping tremor reflects encephalopathy, melena reflects bleeding, and boring back pain suggests pancreatitis.

10. Which hepatitis viruses spread mainly through blood and body fluids?

    1. A. Hepatitis A and E
    2. B. Hepatitis B and C
    3. C. Hepatitis A and B
    4. D. Hepatitis C and E
    Show answer

    Answer: B. Hepatitis B and C

    Hepatitis B and C are bloodborne and are the main occupational risk to EMS. Hepatitis A and E spread by the fecal-oral route.

11. The best protection for EMS providers against hepatitis B is:

    1. A. Hand sanitizer after each call
    2. B. Vaccination plus precautions
    3. C. Antibiotics after any exposure
    4. D. A surgical mask on every call
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    Answer: B. Vaccination plus precautions

    The hepatitis B vaccine is highly effective. Gloves, eye protection, and safe sharps handling prevent exposure to all bloodborne pathogens.

12. Kidney failure that develops because of advanced liver disease, without primary kidney damage, is called:

    1. A. Hepatorenal syndrome
    2. B. Nephrotic syndrome
    3. C. Polycystic kidney disease
    4. D. Pyelonephritis
    Show answer

    Answer: A. Hepatorenal syndrome

    In advanced cirrhosis, blood vessel changes reduce kidney blood flow, causing hepatorenal syndrome, a serious sign of end-stage disease. Nephrotic syndrome is protein loss from glomerular disease, and pyelonephritis is a kidney infection.

13. A procedure that drains fluid from the abdomen of a patient with cirrhosis through a needle is called:

    1. A. Thoracentesis
    2. B. Pericardiocentesis
    3. C. Cholecystostomy
    4. D. Paracentesis
    Show answer

    Answer: D. Paracentesis

    Paracentesis removes ascitic fluid to relieve pressure and to test for infection. Thoracentesis drains the pleural space, pericardiocentesis drains the pericardial sac, and cholecystostomy drains the gallbladder. After large-volume paracentesis, watch for hypotension and leakage at the site.

14. In a patient with stable cirrhosis, which event commonly triggers hepatic encephalopathy?

    1. A. Taking lactulose as prescribed
    2. B. Following a low-salt diet
    3. C. A GI bleed or an infection
    4. D. Starting a daily multivitamin
    Show answer

    Answer: C. A GI bleed or an infection

    GI bleeding (blood is a protein load), infections, constipation, dehydration, and sedatives can all tip a cirrhotic patient into encephalopathy. A confused cirrhotic patient should be assessed for these triggers, as well as for hypoglycemia. Lactulose is used to prevent encephalopathy, and a low-salt diet or a multivitamin does not trigger it.

15. Why are patients with liver failure prone to hypoglycemia?

    1. A. The liver stores and releases glucose
    2. B. They produce too much insulin
    3. C. The pancreas has stopped working
    4. D. They absorb too much sugar from the gut
    Show answer

    Answer: A. The liver stores and releases glucose

    The liver stores glycogen and makes new glucose. When it fails, blood sugar can drop, especially if the patient is not eating.

16. A 68-year-old has painless jaundice, dark urine, itching, and weight loss over a month. You should be concerned about:

    1. A. Acute viral gastroenteritis
    2. B. A simple muscle strain
    3. C. A ruptured appendix with abscess
    4. D. A pancreatic or bile duct tumor
    Show answer

    Answer: D. A pancreatic or bile duct tumor

    Gradual painless jaundice with weight loss in an older adult is classic for a tumor of the pancreatic head or bile duct blocking bile flow. Gastroenteritis and appendicitis do not cause jaundice.

17. A toddler's palms and soles look yellow-orange, but the whites of the eyes are white. He eats large amounts of carrots. This is most likely:

    1. A. Obstructive jaundice
    2. B. Acute hepatitis
    3. C. Carotenemia
    4. D. Hemolytic anemia
    Show answer

    Answer: C. Carotenemia

    Carotenemia from high beta-carotene intake yellows the skin, especially the palms and soles, but spares the sclera. In jaundice, the sclera turn yellow early because bilirubin binds to its tissue.

18. Why might pain medication dosing be different in a patient with cirrhosis?

    1. A. Cirrhosis speeds drug metabolism
    2. B. The liver clears many drugs
    3. C. Drugs cannot be given IV
    4. D. The kidneys stop working
    Show answer

    Answer: B. The liver clears many drugs

    Many drugs, including opioids and benzodiazepines, are metabolized by the liver. In cirrhosis, effects last longer and sedation is more likely.

19. Besides gallstones and alcohol, a well-known cause of acute pancreatitis is:

    1. A. A low blood sodium level
    2. B. A low blood calcium level
    3. C. Very high blood triglycerides
    4. D. A high HDL cholesterol level in the blood
    Show answer

    Answer: C. Very high blood triglycerides

    Severe hypertriglyceridemia (usually above 1,000 mg/dL) is the third most common cause of acute pancreatitis. Other causes include certain drugs, procedures (ERCP), and high blood calcium. Low calcium is a result of severe pancreatitis rather than a cause, and neither low sodium nor high HDL cholesterol triggers it.

20. A day after onset of severe pancreatitis, a patient has rapid breathing and falling SpO2 with crackles. You should suspect:

    1. A. Hyperventilation from the pain
    2. B. Spontaneous pneumothorax
    3. C. An asthma attack brought on by stress
    4. D. Acute respiratory distress syndrome
    Show answer

    Answer: D. Acute respiratory distress syndrome

    Severe pancreatitis releases inflammatory mediators that can injure the lungs, causing ARDS and hypoxia within days. It is a major cause of death in pancreatitis and needs oxygen and close monitoring. Crackles with falling SpO2 do not fit hyperventilation, which does not lower saturation, a pneumothorax, which causes absent rather than wet breath sounds, or asthma, which causes wheezing.

21. A heavy drinker who stopped drinking 2 days ago has epigastric pain, tremor, and agitation. Which two issues should you consider?

    1. A. Appendicitis and migraine
    2. B. Pancreatitis and withdrawal
    3. C. Kidney stone and anxiety
    4. D. Gastritis and an allergic reaction
    Show answer

    Answer: B. Pancreatitis and withdrawal

    Alcohol use is a major cause of pancreatitis, and withdrawal begins within 6 to 24 hours of the last drink. Both can be life-threatening.

22. When large-volume paracentesis is not available, a patient with tense ascites may get relief from:

    1. A. A shunt to lower portal pressure
    2. B. A higher-salt diet
    3. C. Extra IV fluid boluses
    4. D. Lying flat for several hours each day
    Show answer

    Answer: A. A shunt to lower portal pressure

    Refractory ascites can be treated with a TIPS (transjugular intrahepatic portosystemic shunt), which lowers portal pressure and reduces fluid buildup. Salt restriction, not added salt, is part of care, and lying flat worsens breathing.

23. Fatty liver disease is most commonly linked to:

    1. A. Viral hepatitis A infection
    2. B. Obesity and diabetes
    3. C. Smoking only
    4. D. Low blood pressure
    Show answer

    Answer: B. Obesity and diabetes

    Nonalcoholic fatty liver disease is common with obesity, diabetes, and high cholesterol. It can progress to cirrhosis.

24. A patient has a tender, distended abdomen with fever and known cirrhosis. Which finding should most concern you?

    1. A. Mild yellowing of the eyes
    2. B. A long history of ascites
    3. C. New confusion, hypotension
    4. D. Dry skin and itching
    Show answer

    Answer: C. New confusion, hypotension

    Confusion and hypotension suggest sepsis from spontaneous bacterial peritonitis or worsening liver failure.

25. Which finding helps distinguish biliary colic from cholecystitis?

    1. A. Fever, pain lasting over 6 hours
    2. B. Nausea after a fatty meal
    3. C. Pain in the right upper quadrant
    4. D. History of gallstones
    Show answer

    Answer: A. Fever, pain lasting over 6 hours

    Fever and pain that does not resolve after several hours suggest inflammation (cholecystitis) rather than temporary obstruction.