American Board of Internal Medicine (ABIM) Certification Practice Exam

What four criteria indicate that a patient with lower gastrointestinal bleeding does not require hospitalization?

1. Age less than 50 years

2. No evidence of gross rectal bleeding

3. Identification of an obvious anorectal source of bleeding

4. Age less than 60 years

The correct answer is: Identification of an obvious anorectal source of bleeding

The identification of an obvious anorectal source of bleeding is a significant criterion that indicates a patient with lower gastrointestinal bleeding may not require hospitalization. This is because if the source of the bleeding can be clearly determined and is something manageable, such as hemorrhoids or an anal fissure, the patient can often be treated on an outpatient basis. These conditions typically suggest a lower risk of serious complications compared to other potential causes of lower gastrointestinal bleeding. In contrast, factors like age or the presence of gross rectal bleeding could indicate a higher risk situation requiring more intensive evaluation or intervention. Age under 50 is generally associated with a lower risk of serious underlying pathology, but it does not alone dictate management decisions—other clinical signs must also be considered. Gross rectal bleeding raises concerns about more severe gastrointestinal issues that may require hospitalization for further investigation and management.