American Board of Internal Medicine (ABIM) Certification Practice Exam

When is urgent endoscopic therapy indicated in the context of upper GI bleeding?

1. If the patient has active bleeding at the time of endoscopy

2. When clots are visible but nonbleeding

3. If a patient is fully stable with no other symptoms

4. When the patient is over 75 years old

The correct answer is: If the patient has active bleeding at the time of endoscopy

Urgent endoscopic therapy is indicated in the context of upper GI bleeding when the patient has active bleeding at the time of endoscopy. This situation requires immediate intervention because active bleeding signifies ongoing hemorrhage, which poses a high risk of significant morbidity or mortality. Endoscopic intervention can allow for therapeutic procedures such as cauterization, band ligation, or clipping to control the bleeding and potentially prevent further complications, such as shock or the need for surgical intervention. In cases where clots are visible but there is no active bleeding, endoscopy is typically not considered urgent since the situation is more stable. A fully stable patient with no symptoms would not require urgent therapy, as their condition does not indicate immediate risk. Age alone, such as being over 75 years old, does not in itself warrant urgent endoscopic intervention unless it is accompanied by other factors indicating active bleeding or instability. Thus, the need for urgent intervention is directly related to the presence of active bleeding, making this the critical criterion for endoscopic therapy in upper gastrointestinal bleeding scenarios.