ABFM HEART DISEASE EXAM |
QUESTIONS AND CORRECT ANSWERS
RATED A+ | WITH RATONALE | LATEST
GUIDE 2026
A 78-year-old male with chronic hypertension presents with a sudden onset
of severe chest pain radiating to the back, associated with dyspnea and
near-syncope. Which one of the following would suggest a diagnosis other
than acute myocardial infarction?
A 3/6 holosystolic apical murmur and diffuse ST-segment elevation
A 2/6 diastolic murmur and weak radial and femoral pulses
Diffuse ST-segment elevation of 1-2 mm
A pulsus paradoxus of 10 mm Hg
Chest and back pain that was mild initially and increased over the next 2
hours
-Correct Answer- B
The chest pain of aortic dissection is typically described as searing, ripping,
or tearing, and frequently radiates to the back or lower extremities. The
pain is worst at the time of onset and lasts for hours. Helpful findings on
physical examination include asymmetry of pulses or blood pressure, as
well as a new murmur of aortic regurgitation (a decrescendo early diastolic
murmur heard best in the aortic area, as opposed to holosystolic murmurs).
This type of murmur indicates a dissection involving the ascending aorta.
,The dissection can extend to the pericardial sac and produce a pericardial
friction rub on examination, as well as findings of cardiac tamponade.
Pulsus paradoxus is a common finding of cardiac tamponade and is
defined by a decrease in blood pressure of at least 12 mm Hg with
inspiration.Aortic dissection is not usually associated with acute ischemic
electrocardiographic changes. Data from the International Registry of Aortic
Dissection indicates that ischemic changes were present on an EKG in only
15% of cases. The diagnosis can be established with transesophageal
echocardiography, CT, or MRI. The importance of early diagnosis in a
patient being evaluated for myocardial infarction is underscored by the fact
that aortic dissection is exacerbated by fibrinolytic therapy and
anticoagulation.Acute aortic dissection has a lethality rate of 1%-2% per
hour after the onset of symptoms in untreated patients. Prompt diagnosis is
therefore vital to increase the patient's chances of survival and prevent
serious complications. Advanced age, male sex, a long-term history of
arterial hypertension, and the presence of an aortic aneurysm confer the
greatest population-attributable risk. However, patients with genetic
connective tissue disorders such as Marfan, Loeys-Dietz, or Ehlers-Danlos
syndrome, and patients wit
A 62-year-old male comes to your office for a routine health maintenance
evaluation. He has a history of hypertension, type 2 diabetes, and New
York Heart Association class II heart failure. His current medications include
metformin (Glucophage), 500 mg twice daily; benazepril (Lotensin), 40 mg
daily; chlorthalidone, 12.5 mg daily; atorvastatin (Lipitor), 10 mg daily; and
aspirin, 81 mg daily. A physical examination is notable only for a BMI of 29
kg/m2 and a blood pressure of 135/80 mm Hg. His hemoglobin A1c is
,6.9%.Which one of the following additional medications would be
appropriate to help manage his heart failure?
Amlodipine (Norvasc)
Digoxin
Losartan (Cozaar)
Metoprolol succinate (Toprol-XL)
Metoprolol tartrate (Lopressor)
-Correct Answer- D
Current American Heart Association guidelines recommend that a β-
blocker, specifically either carvedilol, bisoprolol, or metoprolol succinate, be
prescribed to all patients with stable heart failure with a reduced left
ventricular ejection fraction. These three β-blockers have all been shown to
prolong survival in patients with current or prior symptoms of heart failure. A
class effect cannot be assumed. Studies have shown short-acting
metoprolol tartrate to be less effective than sustained-release metoprolol
succinate in reducing the risk of death in patients with chronic heart failure.
Losartan should not be added to an ACE inhibitor. Amlodipine adds no
benefit for heart failure. Digoxin would not be indicated in this patient since
there is no history of atrial fibrillation or other tachyarrhythmia.
You see a 63-year-old female for follow-up 2 months after coronary artery
bypass graft (CABG) surgery. In addition to clopidogrel or a similar
antiplatelet medication, which one of the following should you recommend
to reduce the repeat revascularization rate following CABG surgery?
, Aspirin and β-blockers
Aspirin and statin therapy
β-Blockers and statin therapy
Postmenopausal hormone therapy and statin therapy
-Correct Answer- B
Aspirin has been shown to significantly reduce vein graft closures through
the first postoperative year. According to current guidelines it should be
continued indefinitely, given its benefit in preventing subsequent clinical
events. After off-pump coronary artery bypass graft (CABG) surgery, dual
antiplatelet therapy should be administered for 1 year using a combination
of aspirin, 81-162 mg daily, and clopidogrel, 75 mg daily, to reduce graft
occlusion. Aggressive statin therapy following CABG has been shown to
result in less disease progression in saphenous vein grafts and to reduce
the repeat revascularization rate. The American Heart Association
recommends high-intensity statin therapy (atorvastatin, 40-80 mg daily, or
rosuvastatin, 20-40 mg daily) after surgery for all CABG patients <75 years
of age and moderate-intensity statin therapy for patients intolerant of high-
intensity statin therapy and those >75 years of age. Hormone therapy and
β-blockers have not been shown to affect the revascularization rate.
Postmenopausal hormone therapy (estrogen/progesterone) should not be
given to women undergoing CABG (SOR B).
A 68-year-old male with New York Heart Association class III heart failure
with reduced ejection fraction and a blood pressure of 110/70 mm Hg is
QUESTIONS AND CORRECT ANSWERS
RATED A+ | WITH RATONALE | LATEST
GUIDE 2026
A 78-year-old male with chronic hypertension presents with a sudden onset
of severe chest pain radiating to the back, associated with dyspnea and
near-syncope. Which one of the following would suggest a diagnosis other
than acute myocardial infarction?
A 3/6 holosystolic apical murmur and diffuse ST-segment elevation
A 2/6 diastolic murmur and weak radial and femoral pulses
Diffuse ST-segment elevation of 1-2 mm
A pulsus paradoxus of 10 mm Hg
Chest and back pain that was mild initially and increased over the next 2
hours
-Correct Answer- B
The chest pain of aortic dissection is typically described as searing, ripping,
or tearing, and frequently radiates to the back or lower extremities. The
pain is worst at the time of onset and lasts for hours. Helpful findings on
physical examination include asymmetry of pulses or blood pressure, as
well as a new murmur of aortic regurgitation (a decrescendo early diastolic
murmur heard best in the aortic area, as opposed to holosystolic murmurs).
This type of murmur indicates a dissection involving the ascending aorta.
,The dissection can extend to the pericardial sac and produce a pericardial
friction rub on examination, as well as findings of cardiac tamponade.
Pulsus paradoxus is a common finding of cardiac tamponade and is
defined by a decrease in blood pressure of at least 12 mm Hg with
inspiration.Aortic dissection is not usually associated with acute ischemic
electrocardiographic changes. Data from the International Registry of Aortic
Dissection indicates that ischemic changes were present on an EKG in only
15% of cases. The diagnosis can be established with transesophageal
echocardiography, CT, or MRI. The importance of early diagnosis in a
patient being evaluated for myocardial infarction is underscored by the fact
that aortic dissection is exacerbated by fibrinolytic therapy and
anticoagulation.Acute aortic dissection has a lethality rate of 1%-2% per
hour after the onset of symptoms in untreated patients. Prompt diagnosis is
therefore vital to increase the patient's chances of survival and prevent
serious complications. Advanced age, male sex, a long-term history of
arterial hypertension, and the presence of an aortic aneurysm confer the
greatest population-attributable risk. However, patients with genetic
connective tissue disorders such as Marfan, Loeys-Dietz, or Ehlers-Danlos
syndrome, and patients wit
A 62-year-old male comes to your office for a routine health maintenance
evaluation. He has a history of hypertension, type 2 diabetes, and New
York Heart Association class II heart failure. His current medications include
metformin (Glucophage), 500 mg twice daily; benazepril (Lotensin), 40 mg
daily; chlorthalidone, 12.5 mg daily; atorvastatin (Lipitor), 10 mg daily; and
aspirin, 81 mg daily. A physical examination is notable only for a BMI of 29
kg/m2 and a blood pressure of 135/80 mm Hg. His hemoglobin A1c is
,6.9%.Which one of the following additional medications would be
appropriate to help manage his heart failure?
Amlodipine (Norvasc)
Digoxin
Losartan (Cozaar)
Metoprolol succinate (Toprol-XL)
Metoprolol tartrate (Lopressor)
-Correct Answer- D
Current American Heart Association guidelines recommend that a β-
blocker, specifically either carvedilol, bisoprolol, or metoprolol succinate, be
prescribed to all patients with stable heart failure with a reduced left
ventricular ejection fraction. These three β-blockers have all been shown to
prolong survival in patients with current or prior symptoms of heart failure. A
class effect cannot be assumed. Studies have shown short-acting
metoprolol tartrate to be less effective than sustained-release metoprolol
succinate in reducing the risk of death in patients with chronic heart failure.
Losartan should not be added to an ACE inhibitor. Amlodipine adds no
benefit for heart failure. Digoxin would not be indicated in this patient since
there is no history of atrial fibrillation or other tachyarrhythmia.
You see a 63-year-old female for follow-up 2 months after coronary artery
bypass graft (CABG) surgery. In addition to clopidogrel or a similar
antiplatelet medication, which one of the following should you recommend
to reduce the repeat revascularization rate following CABG surgery?
, Aspirin and β-blockers
Aspirin and statin therapy
β-Blockers and statin therapy
Postmenopausal hormone therapy and statin therapy
-Correct Answer- B
Aspirin has been shown to significantly reduce vein graft closures through
the first postoperative year. According to current guidelines it should be
continued indefinitely, given its benefit in preventing subsequent clinical
events. After off-pump coronary artery bypass graft (CABG) surgery, dual
antiplatelet therapy should be administered for 1 year using a combination
of aspirin, 81-162 mg daily, and clopidogrel, 75 mg daily, to reduce graft
occlusion. Aggressive statin therapy following CABG has been shown to
result in less disease progression in saphenous vein grafts and to reduce
the repeat revascularization rate. The American Heart Association
recommends high-intensity statin therapy (atorvastatin, 40-80 mg daily, or
rosuvastatin, 20-40 mg daily) after surgery for all CABG patients <75 years
of age and moderate-intensity statin therapy for patients intolerant of high-
intensity statin therapy and those >75 years of age. Hormone therapy and
β-blockers have not been shown to affect the revascularization rate.
Postmenopausal hormone therapy (estrogen/progesterone) should not be
given to women undergoing CABG (SOR B).
A 68-year-old male with New York Heart Association class III heart failure
with reduced ejection fraction and a blood pressure of 110/70 mm Hg is
