American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which adjunctive treatment may optimize visibility during endoscopic therapy for high-risk ulcers?

  1. Administration of anticoagulation therapy

  2. Local injection of epinephrine

  3. Placement of a nasogastric tube

  4. Application of topical anesthetics

The correct answer is: Local injection of epinephrine

The local injection of epinephrine is an effective adjunctive treatment that can significantly optimize visibility during endoscopic therapy for high-risk ulcers. Epinephrine acts as a vasoconstrictor, reducing blood flow to the area where it is administered. This decrease in vascularity helps to minimize bleeding at the ulcer site. With reduced bleeding, the endoscopist can achieve a clearer view of the ulcer during therapeutic interventions, such as hemostatic procedures or other treatment modalities. This enhanced visibility is crucial, especially in high-risk ulcers that may bleed profusely. In contrast, while anticoagulation therapy is critical for certain patient populations, it can actually contribute to increased bleeding risk, complicating endoscopic procedures. The placement of a nasogastric tube is more relevant for gastric decompression or contents removal rather than improving visibility during an endoscopic procedure. Topical anesthetics are used to relieve discomfort but do not play a role in enhancing visibility during endoscopic intervention on high-risk ulcers and may not affect bleeding. Therefore, local injection of epinephrine stands out as the most beneficial approach to enhance visibility in this clinical scenario.