American Board of Internal Medicine (ABIM) Certification Practice Exam

High-risk gastric ulcers are indicated by which of the following characteristics?

1. Low-grade bleeding with stable vitals

2. Active arterial spurting or a nonbleeding visible vessel

3. Presence of an underlying chronic ulcer

4. Normal blood test results

The correct answer is: Active arterial spurting or a nonbleeding visible vessel

High-risk gastric ulcers are characterized fundamentally by the nature and extent of bleeding. When evaluating a potential high-risk gastric ulcer, the presence of active arterial spurting or a nonbleeding visible vessel is a critical indicator. This is because these findings can signify significant and ongoing blood loss, which suggests that the ulcer is likely severe and may require more aggressive management, such as endoscopy or surgical intervention. Active arterial spurting indicates that an artery has been breached, leading to substantial bleeding, necessitating urgent care to prevent further patient deterioration. Similarly, the presence of a nonbleeding visible vessel indicates that although there might not be active bleeding at the moment, the ulcer is still at high risk for rebleeding due to the evident vascular involvement. These findings are linked to higher mortality rates and complications, making them essential for risk stratification and treatment planning. Other characteristics, such as low-grade bleeding with stable vitals, presence of an underlying chronic ulcer, or normal blood test results, do not indicate high-risk status in the same way. These scenarios may suggest a less severe condition and imply that the patient is less likely to have an urgent need for intervention compared to the findings indicative of significant bleeding and vascular compromise. Understanding these distinctions is crucial in managing gastric