American Board of Internal Medicine (ABIM) Certification Practice Exam

What follow-up care is necessary after managing intermediate-risk ulcers with persistent clots?

1. Continuous intravenous PPI therapy for 72 hours

2. Outpatient monitoring with primary care

3. Immediate endoscopic intervention

4. Administering oral medication for pain control

The correct answer is: Continuous intravenous PPI therapy for 72 hours

In the context of managing intermediate-risk ulcers that present with persistent clots, continuous intravenous PPI (proton pump inhibitor) therapy for 72 hours is a crucial aspect of follow-up care. This approach is supported by evidence suggesting that PPIs significantly reduce gastric acid secretion, which can help in stabilizing the ulcer and reducing the risk of bleeding. The intravenous administration ensures immediate and effective acid suppression, which is often critical in the acute phase of ulcer management, particularly when clots are still persisting. This strategy not only aids in the healing process of the ulcer but also helps prevent potential complications such as rebleeding, which is especially concerning in cases where there has been significant clotting observed. By maintaining a controlled acidic environment in the gastrointestinal tract, the risk of further damage to the ulcerated area is minimized. In contrast, while outpatient monitoring with primary care could be beneficial in the long term, it does not address the immediate needs associated with managing the active problem of a bleeding ulcer or persistent clotting. Immediate endoscopic intervention might be considered if there is ongoing bleeding or if PPI therapy fails to stabilize the ulcer, but it may not be necessary in all cases where intravenous PPI therapy is initiated effectively. Administering oral medications