ABIM Cardiology

Question 1

A 62-year-old man presents with crushing chest pain radiating to his left arm. ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

Accepted Answer

Right coronary artery

Answer

ST elevation in leads II, III, and aVF indicates an inferior STEMI, which is most commonly caused by occlusion of the right coronary artery.

Question 2

A patient with heart failure has an ejection fraction of 35%. Which medication class has been shown to reduce mortality in this population?

Accepted Answer

Beta-blockers

Answer

Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) have a Class I indication for reducing mortality in HFrEF with EF ≤40%.

Question 3

A 55-year-old woman presents with palpitations. ECG shows absent P waves and irregularly irregular rhythm. What is the most appropriate initial anticoagulation strategy if she has a CHA₂DS₂-VASc score of 3?

Accepted Answer

Oral anticoagulation with a DOAC

Answer

A CHA₂DS₂-VASc score ≥2 in women with atrial fibrillation warrants oral anticoagulation, and DOACs are preferred over warfarin for non-valvular AF.

Question 4

Which finding on echocardiography is most consistent with cardiac tamponade?

Accepted Answer

Right ventricular diastolic collapse

Answer

Right ventricular diastolic collapse is the classic echocardiographic sign of cardiac tamponade, caused by elevated pericardial pressure exceeding RV diastolic pressure.

Question 5

A patient with hypertrophic obstructive cardiomyopathy (HOCM) experiences syncope during exercise. Which medication is contraindicated?

Accepted Answer

Nitroglycerin

Answer

Nitroglycerin is contraindicated in HOCM because vasodilation reduces preload, worsening the dynamic outflow tract obstruction and potentially causing hemodynamic collapse.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Cardiology