American Board of Internal Medicine (ABIM) Certification Practice Exam

Which factors are noted as strong predictors of recurrent bleeding after endoscopic therapy?

1. Age under 60 and previous hospital admissions

2. Low hemoglobin and active bleeding at endoscopy

3. History of diabetes and hypertension

4. Non-compliance with medications

The correct answer is: Low hemoglobin and active bleeding at endoscopy

The factors identified as strong predictors of recurrent bleeding after endoscopic therapy include low hemoglobin levels and active bleeding at the time of endoscopy. Low hemoglobin can indicate significant blood loss and an associated higher risk of complications, including recurrent bleeding. When a patient presents with active bleeding during the endoscopic procedure, it suggests a current and possibly severe underlying issue that may not be fully addressed during the initial intervention. The presence of active bleeding can represent a more complex pathology or a failure of earlier treatments, thereby increasing the likelihood of recurrence. In contrast, while the other options contain factors that may influence patient outcomes, they do not directly correlate with the immediate risks of recurrent bleeding following specific endoscopic interventions in the way that low hemoglobin and active bleeding do. Factors such as age, previous hospital admissions, diabetes, hypertension, and medication compliance are relevant to overall patient health but are not as closely related to the likelihood of bleeding recurrence in the setting immediately following endoscopic therapy.