American Board of Internal Medicine (ABIM) Certification Practice Exam

For the management of gastrointestinal bleeding due to a high-risk ulcer, which method is recommended?

1. Observation and follow-up

2. Endoscopic treatment with hemostatic clips or thermal therapy

3. Oral proton pump inhibitors and dietary changes

4. Immediate surgical intervention

The correct answer is: Endoscopic treatment with hemostatic clips or thermal therapy

Endoscopic treatment with hemostatic clips or thermal therapy is recommended for the management of gastrointestinal bleeding due to a high-risk ulcer. This approach involves direct intervention at the bleeding site, which can effectively control and stop the hemorrhage. Endoscopy allows for real-time visualization of the ulcer, enabling the clinician to assess the severity of the bleeding and apply targeted treatments such as clips to mechanically occlude the source of bleeding or thermal therapy to coagulate and seal small blood vessels. This method has several advantages over other approaches. It is minimally invasive compared to surgical intervention and can often be performed on an outpatient basis. Moreover, endoscopic techniques not only address the acute bleeding but can also be accompanied by other therapeutic measures, such as the application of medications, to prevent future bleeding episodes. Observation and follow-up, while sometimes a strategy for less severe cases, is not adequate for high-risk ulcers where active bleeding is present. Oral proton pump inhibitors and dietary changes may play a role in the long-term management of ulcers but do not provide immediate control over active bleeding. Immediate surgical intervention, although a potential option in severe cases, is generally reserved for scenarios where endoscopic methods fail or when there are complications such as perforation or massive hemorrhage, making it less favorable