American Board of Internal Medicine (ABIM) Certification Practice Exam

In refractory dysmotility cases in systemic sclerosis patients, which medication may be administered?

1. Metoclopramide

2. Octreotide

3. Hydroxyzine

4. Ciprofloxacin

The correct answer is: Octreotide

In the context of refractory dysmotility in patients with systemic sclerosis, octreotide is often administered due to its ability to modulate gut motility and improve symptoms associated with gastrointestinal dysmotility. Systemic sclerosis can lead to severe gastrointestinal complications, including esophageal dysmotility, with patients commonly experiencing symptoms such as dysphagia, reflux, and abdominal discomfort. Octreotide, a somatostatin analogue, has effects on the gastrointestinal system that can be particularly beneficial. It can reduce gastrointestinal secretion, slow gastric emptying, and help manage symptoms by potentially improving motility in the setting of neuropathic dysfunction seen in these patients. This makes it a suitable choice for alleviating refractory gastrointestinal symptoms in systemic sclerosis. In contrast, while metoclopramide is often used to treat gastrointestinal motility issues, it is typically less effective in this specific patient population due to the nature of their underlying condition. Hydroxyzine, an antihistamine, and ciprofloxacin, an antibiotic, do not address the dysmotility issue directly and would not be effective treatments for refractory gastrointestinal symptoms in systemic sclerosis.