ABIM Cardiology 1 — Questions and Answers
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?
- Left anterior descending artery
- Right coronary artery (Correct answer)
- Left circumflex artery
- Left main coronary artery
Correct answer: Right coronary artery
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?
- Calcium channel blockers
- Beta-blockers (Correct answer)
- Short-acting nitrates
- Loop diuretics
Correct answer: Beta-blockers
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?
- No anticoagulation needed
- Aspirin alone
- Oral anticoagulation with a DOAC (Correct answer)
- Heparin infusion only
Correct answer: Oral anticoagulation with a DOAC
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?
- Left ventricular hypertrophy
- Right ventricular diastolic collapse (Correct answer)
- Mitral valve prolapse
- Aortic stenosis with reduced gradient
Correct answer: Right ventricular diastolic collapse
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?
- Metoprolol
- Verapamil
- Nitroglycerin (Correct answer)
- Disopyramide
Correct answer: Nitroglycerin
Nitroglycerin is contraindicated in HOCM because vasodilation reduces preload, worsening the dynamic outflow tract obstruction and potentially causing hemodynamic collapse.
Question 6: A 70-year-old man has a resting heart rate of 48 bpm and an ECG showing PR interval of 280 ms with all P waves followed by QRS complexes. What is the diagnosis?
- Second-degree AV block Mobitz I
- Second-degree AV block Mobitz II
- First-degree AV block (Correct answer)
- Complete heart block
Correct answer: First-degree AV block
A PR interval greater than 200 ms with every P wave followed by a QRS complex and no dropped beats defines first-degree AV block.
ABIM Cardiology 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?