American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the characteristic feature of intermediate-risk gastric ulcers?

1. Active arterial spurting

2. Clean-based appearance

3. Presence of adherent clots

4. Visible vessel with bleeding

The correct answer is: Presence of adherent clots

The characteristic feature of intermediate-risk gastric ulcers is the presence of adherent clots. In the context of upper gastrointestinal bleeding, gastric ulcers can be classified based on their risk of rebleeding, and the presence of adherent clots indicates that there has been bleeding, but it has stabilized to some extent. This suggests that although there is some concern for ongoing issues, the bleeding is not severe at the moment, which is why the ulcer is categorized as intermediate-risk. Active arterial spurting would indicate a high risk for rebleeding and usually requires more immediate and aggressive management. A clean-based appearance suggests that the ulcer is more stable and lacks risk for rebleeding, which does not fit the intermediate-risk category. Visible vessels that are bleeding signal very high risk and require urgent intervention. Thus, the presence of adherent clots is the hallmark of intermediate-risk gastric ulcers, as it reflects a complication that needs monitoring but may not require the same level of intervention as active bleeding.