American Board of Internal Medicine (ABIM) Certification Practice Exam

Which type of gastric ulcer is indicated by a clean-based appearance?

1. High-risk gastric ulcer

2. Low-risk gastric ulcer

3. Intermediate-risk gastric ulcer

4. Active arterial ulcer

The correct answer is: Low-risk gastric ulcer

A clean-based appearance of a gastric ulcer is indicative of a low-risk gastric ulcer. This feature suggests that the ulcer is less likely to be associated with malignancy or other complications. In general, gastric ulcers that present with a clean base are typically characterized by the absence of suspicious features, such as irregular margins or hefty surrounding tissue, which would indicate a higher risk of malignancy. Radiologic and endoscopic assessments often play important roles in differentiating the types of gastric ulcers, but the clean-based appearance serves as a key indicator of a lower risk category. This aspect guides physicians in management strategies, as low-risk ulcers typically have a more favorable prognosis and may not necessitate aggressive diagnostic follow-up compared to high-risk ulcers. In contrast, other types of gastric ulcers, such as high-risk or active arterial ulcers, are usually accompanied by concerning characteristics and often require more immediate intervention or monitoring due to their association with potential malignancies or serious complications. Intermediate-risk ulcers would similarly present with more ambiguous findings, necessitating additional evaluation.