ABIM Cardiology 2 — Questions and Answers
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?
- Hydrochlorothiazide
- Spironolactone
- Furosemide (Correct answer)
- Acetazolamide
Correct answer: Furosemide
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?
- Reassure and recheck in 1 year
- Start high-intensity statin therapy (Correct answer)
- Start low-intensity statin therapy
- Refer for genetic testing only
Correct answer: Start high-intensity statin therapy
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?
- Prolonged QT interval
- Delta waves with short PR interval (Correct answer)
- Right bundle branch block
- ST depression in lateral leads
Correct answer: Delta waves with short PR interval
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?
- Immediate aortic valve replacement
- Watchful waiting with close follow-up (Correct answer)
- Start ACE inhibitor
- Balloon aortic valvuloplasty
Correct answer: Watchful waiting with close follow-up
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?
- Digoxin
- Amiodarone
- Spironolactone (Correct answer)
- Isosorbide mononitrate
Correct answer: Spironolactone
Spironolactone (or eplerenone), a mineralocorticoid receptor antagonist, reduces mortality in HFrEF when added to ACE inhibitor and beta-blocker in patients with EF ≤35%.
Question 6: What is the preferred treatment for a hemodynamically stable patient with new-onset atrial flutter with a ventricular rate of 140 bpm?
- Immediate electrical cardioversion
- Rate control with IV diltiazem (Correct answer)
- Digoxin loading
- Adenosine IV push
Correct answer: Rate control with IV diltiazem
For hemodynamically stable atrial flutter with rapid ventricular response, IV diltiazem or beta-blockers provide rapid rate control while anticoagulation and rhythm control are planned.
ABIM Cardiology 2
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?