American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be tested for in patients younger than 50 to 55 years with dyspepsia without alarm features?

1. Atrial fibrillation

2. IgE levels

3. H. pylori infection

4. Proton Pump Inhibitor sensitivity

The correct answer is: H. pylori infection

In patients younger than 50 to 55 years presenting with dyspepsia who do not exhibit alarm features, testing for H. pylori infection is recommended. This is because H. pylori is a common cause of dyspepsia and can lead to conditions such as gastritis and peptic ulcers. Evaluating for H. pylori allows for targeted treatment if the infection is present, which can help alleviate symptoms and prevent potential complications. For patients within this age range without alarm features, the clinical guidelines suggest that the management approach should initially focus on non-invasive testing for H. pylori. Alarm features typically include symptoms such as unexplained weight loss, gastrointestinal bleeding, or anemia, which would warrant more urgent investigation through endoscopy or other means. Since this patient demographic lacks those concerning symptoms, H. pylori testing is the appropriate next step in the evaluation process. The other testing options generally do not align with the common etiologies of dyspepsia in this population. For instance, atrial fibrillation and IgE levels pertain more to other clinical concerns unrelated to dyspeptic symptoms, and assessing proton pump inhibitor sensitivity is not typically performed as a first-line strategy in this context. Thus, focusing on H.