ABIM Cardiology 2

Question 1

A patient presents with dyspnea, orthopnea, and bilateral lower extremity edema. BNP is 1,200 pg/mL. Which diuretic is the first-line treatment for acute decompensated heart failure?

Accepted Answer

Furosemide

Answer

Furosemide (a loop diuretic) is the first-line agent for acute decompensated heart failure due to its rapid onset of diuresis and venodilatory effects.

Question 2

A 50-year-old woman is found to have an LDL of 195 mg/dL despite lifestyle modifications. She has no cardiovascular disease or diabetes. What is the most appropriate next step?

Accepted Answer

Start high-intensity statin therapy

Answer

An LDL ≥190 mg/dL meets the threshold for initiating high-intensity statin therapy regardless of 10-year ASCVD risk score.

Question 3

Which ECG finding is most characteristic of Wolff-Parkinson-White (WPW) syndrome during sinus rhythm?

Accepted Answer

Delta waves with short PR interval

Answer

WPW is characterized by a delta wave (slurred upstroke of the QRS), short PR interval (<120 ms), and wide QRS due to ventricular pre-excitation via an accessory pathway.

Question 4

A 65-year-old man with aortic stenosis has a valve area of 0.7 cm², mean gradient of 55 mmHg, and LVEF of 60%. He is asymptomatic. What is the most appropriate management?

Accepted Answer

Watchful waiting with close follow-up

Answer

Asymptomatic severe aortic stenosis with preserved EF is managed with watchful waiting and close surveillance every 6–12 months, with valve replacement upon symptom development.

Question 5

A patient with dilated cardiomyopathy and EF of 30% is already on maximally tolerated doses of ACE inhibitor and beta-blocker. What additional medication reduces mortality?

Accepted Answer

Spironolactone

Answer

Spironolactone (or eplerenone), a mineralocorticoid receptor antagonist, reduces mortality in HFrEF when added to ACE inhibitor and beta-blocker in patients with EF ≤35%.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Cardiology 2