American Board of Internal Medicine (ABIM) Certification Practice Exam

The treatment recommendation for intermediate-risk ulcers involves which of the following?

1. Performing urgent surgical intervention

2. Vigorous irrigation to dislodge clots

3. Routine follow-up endoscopy

4. Initiating oral antibiotics

The correct answer is: Vigorous irrigation to dislodge clots

The treatment recommendation for intermediate-risk ulcers focuses on the importance of vigorous irrigation to dislodge clots. Intermediate-risk ulcers, often characterized by symptoms like bleeding, require careful management to prevent further complications. Vigorous irrigation can help clear the ulcers of any obstructive clots, which is essential for accurate assessment and proper healing of the ulcer. This approach helps to ensure that any underlying issues, such as active bleeding or the presence of lesions that warrant further treatment, can be appropriately addressed. Addressing clots through irrigation enhances the visibility of the ulcer during follow-up procedures and allows for necessary interventions, such as cauterization if bleeding is identified. In contrast, urgent surgical interventions are typically reserved for high-risk ulcers that present with more severe or uncontrolled bleeding complications. Routine follow-up endoscopy, while important for monitoring healing and assessing the ulcer, is not a primary treatment method for intermediate-risk ulcers. Initiating oral antibiotics may be indicated in specific circumstances but is not a routine recommendation for the management of intermediate-risk ulcers unless there is a significant risk of infection that requires antibiotic therapy.