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Albuminuric chronic kidney disease — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardAmbulatory Medicine / Primary CareAlbuminuric chronic kidney diseaseUSMLE Step 3

A 67-year-old man undergoes successful endoscopic clipping and thermal coagulation of an actively bleeding duodenal ulcer with a visible vessel. Hemodynamics and hemoglobin are now stable, and Helicobacter pylori testing is pending. He received an intravenous proton-pump inhibitor bolus before endoscopy. Which acid-suppression strategy is most appropriate now?

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Correct answer: A — Continue high-dose intravenous PPI for 72 hours, then twice-daily oral therapy

The best answer is “Continue high-dose intravenous PPI for 72 hours, then twice-daily oral therapy”. A high-risk ulcer requiring endoscopic hemostasis has its greatest rebleeding risk during the next 72 hours. High-dose proton-pump inhibition for 3 days, administered continuously or intermittently, stabilizes the clot; twice-daily oral therapy then continues through 2 weeks. Immediate low-dose oral therapy, abbreviated treatment, H2 blockade, and sucralfate do not provide equivalent post-hemostasis protection.

Reference: ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding: https://pubmed.ncbi.nlm.nih.gov/33929377/