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 (Q1-25)
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 female presents with chest pain at rest that began 2 hours ago. She has
diaphoresis and nausea. ECG shows ST elevation in leads V1-V4. Troponin I is elevated. What is
the immediate management priority?
A. Administer aspirin, load with P2Y12 inhibitor, and activate the cath lab for primary PCI.
[CORRECT]
B. Schedule stress testing for the next day
C. Begin heparin infusion only and observe
D. Administer thrombolytics if PCI is not available within 24 hours
Correct Answer: A
Rationale: This is a STEMI (ST elevation in anterior leads V1-V4 with elevated troponin).
Immediate reperfusion therapy is indicated: aspirin, P2Y12 loading (ticagrelor or prasugrel),
anticoagulation, and emergency primary PCI within 90 minutes (A). Stress testing (B) is
,contraindicated in acute MI. Observation only (C) is dangerous. Thrombolytics (D) are only if
PCI not available within 120 minutes.
Q3: A 58-year-old male with NSTEMI is being managed medically. Which medication
combination is most appropriate for secondary prevention?
A. Aspirin, high-intensity statin, beta-blocker, and ACE inhibitor. [CORRECT]
B. Aspirin and clopidogrel only
C. Statin alone
D. Beta-blocker and nitroglycerin PRN only
Correct Answer: A
Rationale: Secondary prevention after MI requires comprehensive risk reduction: antiplatelet
(aspirin ± P2Y12 for 12 months), high-intensity statin (atorvastatin 40-80mg or rosuvastatin 20-
40mg), beta-blocker (reduces mortality), and ACE inhibitor (especially with diabetes,
hypertension, or LV dysfunction) (A). Incomplete regimens (B, C, D) are suboptimal.
Q4: A patient with stable angina continues to have chest pain despite maximal medical therapy.
Coronary angiography shows 70% stenosis of the left anterior descending artery and preserved
LV function. What is the best management?
A. Continue medical therapy only
B. PCI with stenting to the LAD lesion. [CORRECT]
C. CABG for single-vessel disease
D. No further intervention needed
Correct Answer: B
Rationale: For stable angina with significant stenosis and symptoms despite medical therapy,
revascularization is indicated. PCI with stenting is appropriate for single or double vessel disease
without left main involvement and preserved LV function (B). CABG (C) is preferred for left
main, triple vessel, or complex disease.
Q5: A 45-year-old male with no risk factors has atypical chest pain. Stress test with imaging
shows no ischemia. What is the next step?
A. Immediate coronary angiography
,B. Reassurance and risk factor modification counseling. [CORRECT]
C. Empiric treatment with aspirin and statin
D. Repeat stress test in 1 month
Correct Answer: B
Rationale: A negative stress test with imaging has high negative predictive value for coronary
artery disease. With atypical symptoms and negative testing, reassurance and lifestyle counseling
are appropriate (B). Invasive testing (A) is not indicated. Empiric therapy (C) without diagnosis
is not indicated. Immediate repeat testing (D) is unnecessary.
Q6: A patient with ACS is being discharged on dual antiplatelet therapy (DAPT). How long
should DAPT be continued after drug-eluting stent placement?
A. 1 month
B. At least 12 months. [CORRECT]
C. 3 months
D. Indefinitely
Correct Answer: B
Rationale: Current guidelines recommend DAPT (aspirin + P2Y12 inhibitor) for at least 12
months after drug-eluting stent placement to prevent stent thrombosis (B). Shorter durations (A,
C) increase thrombosis risk. Indefinite DAPT (D) increases bleeding risk and is not standard
unless high ischemic risk.
Q7: Which cardiac biomarker is most specific for myocardial injury?
A. CK-MB
B. Myoglobin
C. Troponin I or T. [CORRECT]
D. LDH
Correct Answer: C
Rationale: Cardiac troponins (I and T) are the most specific and sensitive biomarkers for
myocardial injury and are the preferred markers for diagnosing MI (C). CK-MB (A) is less
specific. Myoglobin (B) is early but nonspecific. LDH (D) is outdated for MI diagnosis.
, Q8: A patient with CAD has LDL of 110 mg/dL on atorvastatin 20mg. What is the appropriate
management?
A. Maintain current therapy
B. Increase to high-intensity statin (atorvastatin 40-80mg or rosuvastatin 20-40mg). [CORRECT]
C. Add ezetimibe only
D. Discontinue statin and start fibrate
Correct Answer: B
Rationale: Post-ACS or established CAD patients require high-intensity statin therapy
regardless of baseline LDL. Atorvastatin 20mg is moderate intensity; increasing to 40-80mg (or
rosuvastatin 20-40mg) achieves high-intensity therapy and ≥50% LDL reduction (B). Adding
ezetimibe (C) is second-line if statin-intolerant or at goal.
Q9: A patient with stable angina is prescribed ranolazine. The mechanism of action is:
A. Beta-blockade
B. Calcium channel blockade
C. Late sodium current inhibition, reducing intracellular calcium overload. [CORRECT]
D. Nitrate-like vasodilation
Correct Answer: C
Rationale: Ranolazine inhibits the late sodium current in myocardial cells, reducing intracellular
calcium overload and improving myocardial relaxation and oxygen consumption without
affecting heart rate or blood pressure (C). It is used as second-line antianginal when beta-
blockers and CCBs are maximized or contraindicated.
Q10: A patient with CAD and diabetes has an HbA1c of 8.5%. Which glucose-lowering
medication has cardiovascular benefit?
A. Glipizide
B. Empagliflozin or dapagliflozin (SGLT2 inhibitors). [CORRECT]
C. NPH insulin only
D. Pioglitazone
2026/2027 Complete Questions and Verified Answers
with Detailed Rationales Grade A 100% Correct Pass
Guaranteed - A+ Graded
SECTION 1: CORONARY ARTERY DISEASE (Q1-25)
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 female presents with chest pain at rest that began 2 hours ago. She has
diaphoresis and nausea. ECG shows ST elevation in leads V1-V4. Troponin I is elevated. What is
the immediate management priority?
A. Administer aspirin, load with P2Y12 inhibitor, and activate the cath lab for primary PCI.
[CORRECT]
B. Schedule stress testing for the next day
C. Begin heparin infusion only and observe
D. Administer thrombolytics if PCI is not available within 24 hours
Correct Answer: A
Rationale: This is a STEMI (ST elevation in anterior leads V1-V4 with elevated troponin).
Immediate reperfusion therapy is indicated: aspirin, P2Y12 loading (ticagrelor or prasugrel),
anticoagulation, and emergency primary PCI within 90 minutes (A). Stress testing (B) is
,contraindicated in acute MI. Observation only (C) is dangerous. Thrombolytics (D) are only if
PCI not available within 120 minutes.
Q3: A 58-year-old male with NSTEMI is being managed medically. Which medication
combination is most appropriate for secondary prevention?
A. Aspirin, high-intensity statin, beta-blocker, and ACE inhibitor. [CORRECT]
B. Aspirin and clopidogrel only
C. Statin alone
D. Beta-blocker and nitroglycerin PRN only
Correct Answer: A
Rationale: Secondary prevention after MI requires comprehensive risk reduction: antiplatelet
(aspirin ± P2Y12 for 12 months), high-intensity statin (atorvastatin 40-80mg or rosuvastatin 20-
40mg), beta-blocker (reduces mortality), and ACE inhibitor (especially with diabetes,
hypertension, or LV dysfunction) (A). Incomplete regimens (B, C, D) are suboptimal.
Q4: A patient with stable angina continues to have chest pain despite maximal medical therapy.
Coronary angiography shows 70% stenosis of the left anterior descending artery and preserved
LV function. What is the best management?
A. Continue medical therapy only
B. PCI with stenting to the LAD lesion. [CORRECT]
C. CABG for single-vessel disease
D. No further intervention needed
Correct Answer: B
Rationale: For stable angina with significant stenosis and symptoms despite medical therapy,
revascularization is indicated. PCI with stenting is appropriate for single or double vessel disease
without left main involvement and preserved LV function (B). CABG (C) is preferred for left
main, triple vessel, or complex disease.
Q5: A 45-year-old male with no risk factors has atypical chest pain. Stress test with imaging
shows no ischemia. What is the next step?
A. Immediate coronary angiography
,B. Reassurance and risk factor modification counseling. [CORRECT]
C. Empiric treatment with aspirin and statin
D. Repeat stress test in 1 month
Correct Answer: B
Rationale: A negative stress test with imaging has high negative predictive value for coronary
artery disease. With atypical symptoms and negative testing, reassurance and lifestyle counseling
are appropriate (B). Invasive testing (A) is not indicated. Empiric therapy (C) without diagnosis
is not indicated. Immediate repeat testing (D) is unnecessary.
Q6: A patient with ACS is being discharged on dual antiplatelet therapy (DAPT). How long
should DAPT be continued after drug-eluting stent placement?
A. 1 month
B. At least 12 months. [CORRECT]
C. 3 months
D. Indefinitely
Correct Answer: B
Rationale: Current guidelines recommend DAPT (aspirin + P2Y12 inhibitor) for at least 12
months after drug-eluting stent placement to prevent stent thrombosis (B). Shorter durations (A,
C) increase thrombosis risk. Indefinite DAPT (D) increases bleeding risk and is not standard
unless high ischemic risk.
Q7: Which cardiac biomarker is most specific for myocardial injury?
A. CK-MB
B. Myoglobin
C. Troponin I or T. [CORRECT]
D. LDH
Correct Answer: C
Rationale: Cardiac troponins (I and T) are the most specific and sensitive biomarkers for
myocardial injury and are the preferred markers for diagnosing MI (C). CK-MB (A) is less
specific. Myoglobin (B) is early but nonspecific. LDH (D) is outdated for MI diagnosis.
, Q8: A patient with CAD has LDL of 110 mg/dL on atorvastatin 20mg. What is the appropriate
management?
A. Maintain current therapy
B. Increase to high-intensity statin (atorvastatin 40-80mg or rosuvastatin 20-40mg). [CORRECT]
C. Add ezetimibe only
D. Discontinue statin and start fibrate
Correct Answer: B
Rationale: Post-ACS or established CAD patients require high-intensity statin therapy
regardless of baseline LDL. Atorvastatin 20mg is moderate intensity; increasing to 40-80mg (or
rosuvastatin 20-40mg) achieves high-intensity therapy and ≥50% LDL reduction (B). Adding
ezetimibe (C) is second-line if statin-intolerant or at goal.
Q9: A patient with stable angina is prescribed ranolazine. The mechanism of action is:
A. Beta-blockade
B. Calcium channel blockade
C. Late sodium current inhibition, reducing intracellular calcium overload. [CORRECT]
D. Nitrate-like vasodilation
Correct Answer: C
Rationale: Ranolazine inhibits the late sodium current in myocardial cells, reducing intracellular
calcium overload and improving myocardial relaxation and oxygen consumption without
affecting heart rate or blood pressure (C). It is used as second-line antianginal when beta-
blockers and CCBs are maximized or contraindicated.
Q10: A patient with CAD and diabetes has an HbA1c of 8.5%. Which glucose-lowering
medication has cardiovascular benefit?
A. Glipizide
B. Empagliflozin or dapagliflozin (SGLT2 inhibitors). [CORRECT]
C. NPH insulin only
D. Pioglitazone
