American Board of Internal Medicine (ABIM) Certification Practice Exam

What symptom is associated with the need for repeat endoscopy in patients with ulcers?

1. The occurrence of melena

2. Persistent symptoms despite therapy

3. Weight loss greater than 10% of body weight

4. Iron deficiency anemia

The correct answer is: Persistent symptoms despite therapy

The need for repeat endoscopy in patients with ulcers is often indicated by persistent symptoms despite therapy. This situation suggests that the ulcer may not be healing properly or that there could be complications such as malignancy or other underlying conditions that have not been addressed. Persistent symptoms, such as ongoing pain or discomfort, are a strong signal that further investigation is necessary to determine the current state of the ulcer and the effectiveness of the treatment. While the occurrence of melena, weight loss greater than 10% of body weight, and iron deficiency anemia can indicate complications related to ulcers and may warrant further investigation or management, they do not specifically highlight the ongoing treatment efficacy as clearly as persistent symptoms do. Persistent symptoms directly suggest that the initial treatment regimen may not be adequate or that the pathology involved is more complex, necessitating a repeat endoscopy for proper assessment and management.