American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended management for patients with active overt gastrointestinal bleeding?

1. Immediate endoscopy

2. Angiography for bleeding identification and intervention

3. Intravenous proton pump inhibitors

4. Observation and monitoring

The correct answer is: Angiography for bleeding identification and intervention

The recommended management for patients with active overt gastrointestinal bleeding that requires prompt intervention often involves angiography for bleeding identification and intervention. This approach is particularly beneficial in cases where the source of the bleeding can be localized, allowing for therapeutic interventions such as embolization. Angiography can quickly identify the site of hemorrhage, which is crucial in managing severe cases since it allows for immediate treatment to control bleeding and stabilize the patient. Endoscopy can also be an effective tool for managing certain types of gastrointestinal bleeding, particularly from upper gastrointestinal sources, but it may not be feasible in all cases, especially if the patient is unstable or if the source is in the lower gastrointestinal tract. While intravenous proton pump inhibitors are important in managing conditions like peptic ulcer disease to reduce acid secretion, they do not address the immediate need for identification and control of active bleeding. Finally, observation and monitoring are typically inappropriate in the setting of active bleeding, as they do not provide the necessary intervention to prevent deterioration in the patient's condition.