American Board of Internal Medicine (ABIM) Certification Practice Exam

What characterizes high-risk gastric ulcers?

1. Active arterial spurting or a nonbleeding visible vessel

2. Clean-based or nonprotuberant pigmented spot

3. Adherent clots

4. Presence of tender, subcutaneous nodules

The correct answer is: Active arterial spurting or a nonbleeding visible vessel

High-risk gastric ulcers are characterized by active arterial spurting or the presence of a nonbleeding visible vessel. These findings indicate a significant risk of rebleeding if intervention is not undertaken. The reason for the high-risk classification stems from the associated severity of the ulcer and the likelihood of major hemorrhage. Active arterial spurting suggests that a large blood vessel has been eroded by the ulcer, leading to an ongoing loss of blood. Similarly, a visible vessel, while not actively bleeding, indicates that the ulcer has penetrated deeply enough to expose a vessel that could potentially open up and cause bleeding in the future. These cases require urgent medical or surgical intervention to prevent life-threatening complications. The other options describe less severe presentations. Clean-based ulcers and nonprotuberant pigmented spots indicate a lower risk of bleeding, while adherent clots may suggest that an ulcer has recently bled but does not pose the same level of immediate risk as active bleeding or a visible vessel. Finally, the presence of tender, subcutaneous nodules is unrelated to gastric ulcers and pertains to other clinical conditions.