ABFM KSA HEART DISEASE Actual Exam
2026/2027 Complete Questions and Verified Answers
with Detailed Rationales Grade A 100% Correct Pass
Guaranteed - A+ Graded
SECTION 1: CORONARY ARTERY DISEASE
Q1: A 55-year-old male presents with substernal chest pressure radiating to his left arm that
occurs with exertion and resolves with rest. Symptoms have been stable for several months. An
ECG during an episode of pain shows ST depression. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina. [CORRECT]
C. NSTEMI
D. STEMI
Correct Answer: B
Rationale: Stable angina is characterized by predictable chest pain with exertion that is relieved
by rest or nitroglycerin, with stable pattern over time. ECG may show ST depression during pain
(B). Unstable angina (A) has a changing pattern or occurs at rest. NSTEMI (C) and STEMI (D)
are acute coronary syndromes with elevated biomarkers.
Q2: A 62-year-old male with diabetes presents with chest pain at rest for 20 minutes. ECG shows
ST depression in leads V4-V6. Troponin I is elevated at 0.8 ng/mL. What is the diagnosis?
A. Stable angina
B. Unstable angina
C. NSTEMI. [CORRECT]
D. STEMI
Correct Answer: C
Rationale: NSTEMI is diagnosed when there is acute coronary syndrome with elevated cardiac
biomarkers (troponin) but without ST elevation on ECG (C). Stable angina (A) is exertional.
Unstable angina (B) has similar presentation but no biomarker elevation. STEMI (D) requires ST
elevation.
Q3: A patient with STEMI presents within 90 minutes of symptom onset. The gold standard
reperfusion therapy is:
,A. Fibrinolytic therapy within 30 minutes
B. Primary PCI within 90 minutes. [CORRECT]
C. Medical management with aspirin only
D. CABG as first-line treatment
Correct Answer: B
Rationale: Primary PCI (percutaneous coronary intervention) within 90 minutes of first medical
contact is the preferred reperfusion strategy for STEMI when available (B). Fibrinolysis (A) is
alternative if PCI not available within 120 minutes. Medical management alone (C) is
insufficient. Emergency CABG (D) is rare first-line.
Q4: A patient with acute coronary syndrome is started on dual antiplatelet therapy. Which
combination is most commonly used?
A. Aspirin + warfarin
B. Aspirin + clopidogrel (or ticagrelor or prasugrel). [CORRECT]
C. Aspirin + dipyridamole
D. Clopidogrel alone
Correct Answer: B
Rationale: Dual antiplatelet therapy (DAPT) for ACS consists of aspirin plus a P2Y12 inhibitor
(clopidogrel, ticagrelor, or prasugrel) for 12 months post-PCI or ACS (B). Warfarin (A) is
anticoagulation. Dipyridamole (C) is for stroke prevention. Single antiplatelet (D) is insufficient.
Q5: A 58-year-old post-MI patient is discharged. Which medication combination constitutes
optimal medical therapy for secondary prevention?
A. Aspirin, statin, beta-blocker, ACE inhibitor. [CORRECT]
B. Aspirin and nitroglycerin PRN only
C. Statin and calcium channel blocker
D. Beta-blocker and diuretic only
Correct Answer: A
Rationale: Optimal medical therapy post-MI includes antiplatelet (aspirin), high-intensity statin,
beta-blocker, and ACE inhibitor (especially with reduced EF, diabetes, or CKD) (A). Incomplete
regimens (B, C, D) do not provide mortality benefit.
,Q6: A patient with stable angina continues to have symptoms despite beta-blocker therapy.
Which agent is appropriate for symptom relief?
A. Diltiazem
B. Nitroglycerin. [CORRECT]
C. Digoxin
D. Hydralazine
Correct Answer: B
Rationale: Nitrates (nitroglycerin) are effective for acute angina relief and prophylaxis (B).
Diltiazem (A) is for vasospastic angina or if beta-blocker contraindicated. Digoxin (C) is for
heart failure. Hydralazine (D) is for hypertension/heart failure, not angina.
Q7: A patient with high-risk stable angina undergoes stress testing. Which result indicates need
for coronary angiography?
A. No ST changes with exercise
B. 1 mm ST depression at peak exercise
C. ST elevation >1 mm in leads without Q waves. [CORRECT]
D. Achievement of target heart rate
Correct Answer: C
Rationale: ST elevation during stress testing in leads without prior Q waves indicates transmural
ischemia and high-risk coronary disease requiring angiography (C). No changes (A) is negative.
1 mm depression (B) may be equivocal. Target heart rate (D) is expected.
Q8: A patient with NSTEMI and TIMI risk score ≥3 should receive:
A. Conservative management with aspirin only
B. Early invasive strategy with coronary angiography within 24-72 hours. [CORRECT]
C. Fibrinolytic therapy
D. No anticoagulation
Correct Answer: B
Rationale: High-risk NSTEMI patients benefit from early invasive strategy with coronary
angiography and possible PCI within 24-72 hours (B). Conservative strategy (A) is for low-risk.
Fibrinolysis (C) is contraindicated in NSTEMI. Anticoagulation is required (D).
Q9: A patient is on atorvastatin 80 mg daily post-ACS. What is the goal LDL cholesterol?
, A. <100 mg/dL
B. <70 mg/dL. [CORRECT]
C. <130 mg/dL
D. <160 mg/dL
Correct Answer: B
Rationale: Post-ACS patients are very high risk and should achieve LDL <70 mg/dL with high-
intensity statin therapy (B). Lower thresholds (A, C, D) are insufficient for this high-risk
population per ACC/AHA guidelines.
Q10: A patient with left main coronary artery disease and diabetes requires revascularization.
Which approach has survival benefit?
A. PCI with drug-eluting stent
B. CABG (coronary artery bypass grafting). [CORRECT]
C. Medical therapy alone
D. PCI with bare metal stent
Correct Answer: B
Rationale: For left main disease, especially with diabetes or complex disease, CABG provides
survival advantage over PCI (B). PCI (A, D) may be alternative in select cases. Medical therapy
alone (C) is insufficient for left main disease.
Q11: A patient on clopidogrel after stent placement needs elective surgery. When should
clopidogrel be stopped?
A. 24 hours before surgery
B. 5 days before surgery. [CORRECT]
C. 2 weeks before surgery
D. Continue through surgery
Correct Answer: B
Rationale: Clopidogrel should be stopped 5 days before elective surgery to allow platelet
function recovery and reduce bleeding risk, while aspirin is typically continued (B). 24 hours (A)
is insufficient. 2 weeks (C) is longer than necessary. Continuing (D) increases bleeding.
Q12: A patient with variant (Prinzmetal's) angina has chest pain at rest with transient ST
elevation. First-line treatment is:
2026/2027 Complete Questions and Verified Answers
with Detailed Rationales Grade A 100% Correct Pass
Guaranteed - A+ Graded
SECTION 1: CORONARY ARTERY DISEASE
Q1: A 55-year-old male presents with substernal chest pressure radiating to his left arm that
occurs with exertion and resolves with rest. Symptoms have been stable for several months. An
ECG during an episode of pain shows ST depression. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina. [CORRECT]
C. NSTEMI
D. STEMI
Correct Answer: B
Rationale: Stable angina is characterized by predictable chest pain with exertion that is relieved
by rest or nitroglycerin, with stable pattern over time. ECG may show ST depression during pain
(B). Unstable angina (A) has a changing pattern or occurs at rest. NSTEMI (C) and STEMI (D)
are acute coronary syndromes with elevated biomarkers.
Q2: A 62-year-old male with diabetes presents with chest pain at rest for 20 minutes. ECG shows
ST depression in leads V4-V6. Troponin I is elevated at 0.8 ng/mL. What is the diagnosis?
A. Stable angina
B. Unstable angina
C. NSTEMI. [CORRECT]
D. STEMI
Correct Answer: C
Rationale: NSTEMI is diagnosed when there is acute coronary syndrome with elevated cardiac
biomarkers (troponin) but without ST elevation on ECG (C). Stable angina (A) is exertional.
Unstable angina (B) has similar presentation but no biomarker elevation. STEMI (D) requires ST
elevation.
Q3: A patient with STEMI presents within 90 minutes of symptom onset. The gold standard
reperfusion therapy is:
,A. Fibrinolytic therapy within 30 minutes
B. Primary PCI within 90 minutes. [CORRECT]
C. Medical management with aspirin only
D. CABG as first-line treatment
Correct Answer: B
Rationale: Primary PCI (percutaneous coronary intervention) within 90 minutes of first medical
contact is the preferred reperfusion strategy for STEMI when available (B). Fibrinolysis (A) is
alternative if PCI not available within 120 minutes. Medical management alone (C) is
insufficient. Emergency CABG (D) is rare first-line.
Q4: A patient with acute coronary syndrome is started on dual antiplatelet therapy. Which
combination is most commonly used?
A. Aspirin + warfarin
B. Aspirin + clopidogrel (or ticagrelor or prasugrel). [CORRECT]
C. Aspirin + dipyridamole
D. Clopidogrel alone
Correct Answer: B
Rationale: Dual antiplatelet therapy (DAPT) for ACS consists of aspirin plus a P2Y12 inhibitor
(clopidogrel, ticagrelor, or prasugrel) for 12 months post-PCI or ACS (B). Warfarin (A) is
anticoagulation. Dipyridamole (C) is for stroke prevention. Single antiplatelet (D) is insufficient.
Q5: A 58-year-old post-MI patient is discharged. Which medication combination constitutes
optimal medical therapy for secondary prevention?
A. Aspirin, statin, beta-blocker, ACE inhibitor. [CORRECT]
B. Aspirin and nitroglycerin PRN only
C. Statin and calcium channel blocker
D. Beta-blocker and diuretic only
Correct Answer: A
Rationale: Optimal medical therapy post-MI includes antiplatelet (aspirin), high-intensity statin,
beta-blocker, and ACE inhibitor (especially with reduced EF, diabetes, or CKD) (A). Incomplete
regimens (B, C, D) do not provide mortality benefit.
,Q6: A patient with stable angina continues to have symptoms despite beta-blocker therapy.
Which agent is appropriate for symptom relief?
A. Diltiazem
B. Nitroglycerin. [CORRECT]
C. Digoxin
D. Hydralazine
Correct Answer: B
Rationale: Nitrates (nitroglycerin) are effective for acute angina relief and prophylaxis (B).
Diltiazem (A) is for vasospastic angina or if beta-blocker contraindicated. Digoxin (C) is for
heart failure. Hydralazine (D) is for hypertension/heart failure, not angina.
Q7: A patient with high-risk stable angina undergoes stress testing. Which result indicates need
for coronary angiography?
A. No ST changes with exercise
B. 1 mm ST depression at peak exercise
C. ST elevation >1 mm in leads without Q waves. [CORRECT]
D. Achievement of target heart rate
Correct Answer: C
Rationale: ST elevation during stress testing in leads without prior Q waves indicates transmural
ischemia and high-risk coronary disease requiring angiography (C). No changes (A) is negative.
1 mm depression (B) may be equivocal. Target heart rate (D) is expected.
Q8: A patient with NSTEMI and TIMI risk score ≥3 should receive:
A. Conservative management with aspirin only
B. Early invasive strategy with coronary angiography within 24-72 hours. [CORRECT]
C. Fibrinolytic therapy
D. No anticoagulation
Correct Answer: B
Rationale: High-risk NSTEMI patients benefit from early invasive strategy with coronary
angiography and possible PCI within 24-72 hours (B). Conservative strategy (A) is for low-risk.
Fibrinolysis (C) is contraindicated in NSTEMI. Anticoagulation is required (D).
Q9: A patient is on atorvastatin 80 mg daily post-ACS. What is the goal LDL cholesterol?
, A. <100 mg/dL
B. <70 mg/dL. [CORRECT]
C. <130 mg/dL
D. <160 mg/dL
Correct Answer: B
Rationale: Post-ACS patients are very high risk and should achieve LDL <70 mg/dL with high-
intensity statin therapy (B). Lower thresholds (A, C, D) are insufficient for this high-risk
population per ACC/AHA guidelines.
Q10: A patient with left main coronary artery disease and diabetes requires revascularization.
Which approach has survival benefit?
A. PCI with drug-eluting stent
B. CABG (coronary artery bypass grafting). [CORRECT]
C. Medical therapy alone
D. PCI with bare metal stent
Correct Answer: B
Rationale: For left main disease, especially with diabetes or complex disease, CABG provides
survival advantage over PCI (B). PCI (A, D) may be alternative in select cases. Medical therapy
alone (C) is insufficient for left main disease.
Q11: A patient on clopidogrel after stent placement needs elective surgery. When should
clopidogrel be stopped?
A. 24 hours before surgery
B. 5 days before surgery. [CORRECT]
C. 2 weeks before surgery
D. Continue through surgery
Correct Answer: B
Rationale: Clopidogrel should be stopped 5 days before elective surgery to allow platelet
function recovery and reduce bleeding risk, while aspirin is typically continued (B). 24 hours (A)
is insufficient. 2 weeks (C) is longer than necessary. Continuing (D) increases bleeding.
Q12: A patient with variant (Prinzmetal's) angina has chest pain at rest with transient ST
elevation. First-line treatment is:
