American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients with underlying malignancy concerns, what should be done concerning gastric ulcers?

1. Ignore the symptoms

2. Repeat endoscopy and take biopsies

3. Start a high-dose PPI

4. Consult a surgeon immediately

The correct answer is: Repeat endoscopy and take biopsies

The optimal approach regarding gastric ulcers in patients with underlying malignancy concerns is to repeat endoscopy and take biopsies. This is crucial because individuals with a history of cancer, especially those with symptoms suggestive of gastric ulcers, are at an increased risk for malignancies like gastric cancer. Biopsies obtained during endoscopy allow for a definitive diagnosis, which can differentiate between benign ulcers and potential malignancies. Given the prevalence of gastric carcinoma in patients with chronic ulcer symptoms, especially those with underlying risk factors or malignancy, obtaining biopsy specimens is an essential step in managing these patients. It not only helps ensure an accurate diagnosis but can also guide further management and treatment decisions based on the findings. Other approaches, such as starting high-dose proton pump inhibitors or referring immediately to surgery, may address symptoms or provide treatment for ulcers but do not confirm the diagnosis or address the underlying malignancy concern. Similarly, ignoring the symptoms could lead to missed diagnoses and potential complications, making it critical to prioritize diagnostic evaluation through repeat endoscopy and biopsies.