American Board of Internal Medicine (ABIM) Certification Practice Exam

What characterizes high-risk ulcers noted during upper endoscopy?

1. Presence of adherent clots

2. Active arterial spurting or visible vessel

3. Clean-based appearance

4. Nonprofident pigmented spot

The correct answer is: Active arterial spurting or visible vessel

High-risk ulcers identified during upper endoscopy are primarily characterized by the presence of active arterial spurting or a visible vessel. These indicators suggest that the ulcer has active bleeding or a high likelihood of rebleeding, which categorize it as a high-risk condition. The identification of such features necessitates immediate intervention to control bleeding and prevent potential complications, such as significant blood loss or shock. In the context of ulcers, active bleeding can often lead to more severe outcomes, thus requiring urgent management. When a visible vessel or spurting is observed, it reflects a more severe state of the ulcer, demanding a prompt endoscopic intervention such as cauterization, clipping, or banding to achieve hemostasis. While the presence of adherent clots might indicate hemorrhage, they pertain more to a status that has already addressed bleeding, making this less concerning than active bleeding represented by a visible vessel. A clean-based appearance indicates a lower risk for rebleeding, and the nonprofident pigmented spot does not typically indicate a high-risk scenario for ongoing bleeding or complications. Hence, the presence of active arterial spurting or a visible vessel distinctly outlines the most acute risk and necessitates immediate clinical attention.