ABIM Cardiology 5

Question 1

A 31-year-old woman at 34 weeks' gestation has new HFrEF (EF 30%). Which afterload-reducing regimen is most appropriate before delivery?

Accepted Answer

Hydralazine plus isosorbide dinitrate

Answer

ACE inhibitors, ARBs/ARNIs, and mineralocorticoid antagonists are avoided in pregnancy because of fetal toxicity, so hydralazine-nitrate is used.

Question 2

A patient with an LVEF of 30% has an aortic valve area of 0.8 cm² and a mean gradient of 25 mmHg. Which test best distinguishes true severe aortic stenosis from pseudo-severe stenosis?

Accepted Answer

Low-dose dobutamine stress echocardiography

Answer

With dobutamine, true severe AS keeps a small valve area as the gradient rises, while in pseudo-severe AS the valve area increases.

Question 3

A 46-year-old man has blood pressure of 168/100 mmHg on three agents including a diuretic, plus spontaneous hypokalemia. What is the best initial screening test?

Accepted Answer

Plasma aldosterone-to-renin ratio

Answer

Resistant hypertension with hypokalemia strongly suggests primary aldosteronism, which is screened with the aldosterone-renin ratio.

Question 4

Which patient should receive antibiotic prophylaxis before a dental extraction?

Accepted Answer

A patient with prior infective endocarditis

Answer

Prophylaxis is limited to the highest-risk groups (prosthetic valves, prior IE, certain congenital heart disease, and cardiac transplant valvulopathy).

Question 5

A 60-year-old woman with moderate rheumatic mitral stenosis develops atrial fibrillation. Which anticoagulant is preferred?

Accepted Answer

Warfarin

Answer

Patients with AF and moderate-to-severe rheumatic mitral stenosis were excluded from DOAC trials, so warfarin is recommended.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Cardiology 5