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 (Questions 1-25)
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 male with diabetes and hypertension presents with chest pain at rest that began
2 hours ago. Troponin I is elevated at 2.5 ng/mL (normal <0.04). ECG shows ST depression in
leads V4-V6. 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) without persistent ST elevation (C). Stable angina (A) has no biomarker
elevation. Unstable angina (B) has symptoms but no biomarker elevation. STEMI (D) requires
ST elevation or new LBBB.
,Q3: A 58-year-old male presents with crushing chest pain for 1 hour. ECG shows ST elevation in
leads II, III, and aVF. What is the priority management?
A. Administer aspirin, clopidogrel, heparin, and arrange for immediate PCI. [CORRECT]
B. Schedule stress testing for next week
C. Administer nitroglycerin only and observe
D. Begin thrombolytics if PCI unavailable within 24 hours
Correct Answer: A
Rationale: STEMI requires immediate reperfusion therapy. Primary PCI within 90 minutes is
preferred. Dual antiplatelet therapy (aspirin + P2Y12 inhibitor), anticoagulation, and statin
should be initiated (A). Delay (B) or nitroglycerin only (C) is dangerous. Thrombolytics (D) are
second-line if PCI delay >120 minutes.
Q4: Which cardiac biomarker is most specific for myocardial injury?
A. Creatine kinase (CK)
B. Myoglobin
C. Troponin I or T. [CORRECT]
D. LDH
Correct Answer: C
Rationale: Troponin I and T are the most specific and sensitive biomarkers for myocardial injury,
with high specificity for cardiac tissue (C). CK (A) and myoglobin (B) are less specific. LDH
(D) is not used for acute diagnosis.
Q5: A 65-year-old male with NSTEMI is being discharged. Which medication combination is
indicated for secondary prevention?
A. Aspirin, clopidogrel, atorvastatin, metoprolol, and lisinopril. [CORRECT]
B. Aspirin alone
C. Clopidogrel alone
D. Atorvastatin and metoprolol only
Correct Answer: A
Rationale: Post-ACS secondary prevention includes dual antiplatelet therapy (aspirin + P2Y12
inhibitor for 12 months), high-intensity statin, beta-blocker, and ACE inhibitor (especially with
,diabetes, hypertension, or LV dysfunction) (A). Single agents or incomplete regimens (B, C, D)
are insufficient.
Q6: A patient with stable angina continues to have chest pain despite maximal medical therapy.
Coronary angiography shows three-vessel disease with reduced LVEF. The preferred
revascularization strategy is:
A. Percutaneous coronary intervention (PCI)
B. Coronary artery bypass grafting (CABG). [CORRECT]
C. Medical therapy alone
D. Thrombolytic therapy
Correct Answer: B
Rationale: CABG is preferred over PCI for multi-vessel disease, especially with reduced LVEF
or diabetes, due to improved survival (B). PCI (A) is preferred for single or double vessel
disease. Medical therapy alone (C) is insufficient given symptoms. Thrombolytics (D) are for
STEMI.
Q7: A 60-year-old male with CAD is prescribed high-intensity statin therapy. Which regimen
meets this definition?
A. Atorvastatin 10 mg daily
B. Atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily. [CORRECT]
C. Simvastatin 20 mg daily
D. Pravastatin 40 mg daily
Correct Answer: B
Rationale: High-intensity statins reduce LDL by ≥50% and include atorvastatin 40-80 mg and
rosuvastatin 20-40 mg (B). Lower doses (A, C, D) are moderate or low intensity.
Q8: A patient with ACS is prescribed ticagrelor. Which statement is correct?
A. It can be used with any dose of aspirin
B. It requires twice daily dosing and has reversible binding. [CORRECT]
C. It is a prodrug requiring CYP2C19 metabolism
D. It has no bleeding risk
Correct Answer: B
, Rationale: Ticagrelor is a reversible P2Y12 inhibitor dosed twice daily that does not require
metabolic activation (B). Aspirin dose should be ≤100 mg (A is incorrect). Clopidogrel (not
ticagrelor) is a prodrug (C). All P2Y12 inhibitors increase bleeding risk (D).
Q9: A 55-year-old female with CAD has LDL of 110 mg/dL on atorvastatin 40 mg. What is the
next step?
A. Add ezetimibe. [CORRECT]
B. Discontinue statin and start PCSK9 inhibitor
C. Switch to simvastatin 80 mg
D. Maintain current therapy as LDL is acceptable
Correct Answer: A
Rationale: For very high-risk ASCVD patients, LDL goal is <70 mg/dL. Adding ezetimibe is the
next step if not at goal on maximally tolerated statin (A). PCSK9 inhibitors (B) are considered if
still above goal. Simvastatin 80 mg (C) is not recommended due to myopathy risk. 110 mg/dL
(D) is above goal for very high risk.
Q10: A patient with stable angina reports chest pain while walking uphill. Which medication is
most appropriate for symptom relief?
A. Aspirin
B. Sublingual nitroglycerin. [CORRECT]
C. Warfarin
D. Digoxin
Correct Answer: B
Rationale: Sublingual nitroglycerin is first-line for acute angina relief and prophylaxis before
exertion (B). Aspirin (A) is for prevention. Warfarin (C) is not indicated. Digoxin (D) is for heart
failure or atrial fibrillation, not angina.
Q11: A 70-year-old male with prior MI presents with new dyspnea on exertion. Stress testing
shows reversible ischemia in the anterior wall. The next step is:
A. Immediate thrombolysis
B. Cardiac catheterization with intent for revascularization. [CORRECT]
C. Observation only
D. Start antibiotics for possible endocarditis
2026/2027 Complete Questions and Verified Answers
with Detailed Rationales Grade A 100% Correct Pass
Guaranteed - A+ Graded
SECTION 1: CORONARY ARTERY DISEASE (Questions 1-25)
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 male with diabetes and hypertension presents with chest pain at rest that began
2 hours ago. Troponin I is elevated at 2.5 ng/mL (normal <0.04). ECG shows ST depression in
leads V4-V6. 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) without persistent ST elevation (C). Stable angina (A) has no biomarker
elevation. Unstable angina (B) has symptoms but no biomarker elevation. STEMI (D) requires
ST elevation or new LBBB.
,Q3: A 58-year-old male presents with crushing chest pain for 1 hour. ECG shows ST elevation in
leads II, III, and aVF. What is the priority management?
A. Administer aspirin, clopidogrel, heparin, and arrange for immediate PCI. [CORRECT]
B. Schedule stress testing for next week
C. Administer nitroglycerin only and observe
D. Begin thrombolytics if PCI unavailable within 24 hours
Correct Answer: A
Rationale: STEMI requires immediate reperfusion therapy. Primary PCI within 90 minutes is
preferred. Dual antiplatelet therapy (aspirin + P2Y12 inhibitor), anticoagulation, and statin
should be initiated (A). Delay (B) or nitroglycerin only (C) is dangerous. Thrombolytics (D) are
second-line if PCI delay >120 minutes.
Q4: Which cardiac biomarker is most specific for myocardial injury?
A. Creatine kinase (CK)
B. Myoglobin
C. Troponin I or T. [CORRECT]
D. LDH
Correct Answer: C
Rationale: Troponin I and T are the most specific and sensitive biomarkers for myocardial injury,
with high specificity for cardiac tissue (C). CK (A) and myoglobin (B) are less specific. LDH
(D) is not used for acute diagnosis.
Q5: A 65-year-old male with NSTEMI is being discharged. Which medication combination is
indicated for secondary prevention?
A. Aspirin, clopidogrel, atorvastatin, metoprolol, and lisinopril. [CORRECT]
B. Aspirin alone
C. Clopidogrel alone
D. Atorvastatin and metoprolol only
Correct Answer: A
Rationale: Post-ACS secondary prevention includes dual antiplatelet therapy (aspirin + P2Y12
inhibitor for 12 months), high-intensity statin, beta-blocker, and ACE inhibitor (especially with
,diabetes, hypertension, or LV dysfunction) (A). Single agents or incomplete regimens (B, C, D)
are insufficient.
Q6: A patient with stable angina continues to have chest pain despite maximal medical therapy.
Coronary angiography shows three-vessel disease with reduced LVEF. The preferred
revascularization strategy is:
A. Percutaneous coronary intervention (PCI)
B. Coronary artery bypass grafting (CABG). [CORRECT]
C. Medical therapy alone
D. Thrombolytic therapy
Correct Answer: B
Rationale: CABG is preferred over PCI for multi-vessel disease, especially with reduced LVEF
or diabetes, due to improved survival (B). PCI (A) is preferred for single or double vessel
disease. Medical therapy alone (C) is insufficient given symptoms. Thrombolytics (D) are for
STEMI.
Q7: A 60-year-old male with CAD is prescribed high-intensity statin therapy. Which regimen
meets this definition?
A. Atorvastatin 10 mg daily
B. Atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily. [CORRECT]
C. Simvastatin 20 mg daily
D. Pravastatin 40 mg daily
Correct Answer: B
Rationale: High-intensity statins reduce LDL by ≥50% and include atorvastatin 40-80 mg and
rosuvastatin 20-40 mg (B). Lower doses (A, C, D) are moderate or low intensity.
Q8: A patient with ACS is prescribed ticagrelor. Which statement is correct?
A. It can be used with any dose of aspirin
B. It requires twice daily dosing and has reversible binding. [CORRECT]
C. It is a prodrug requiring CYP2C19 metabolism
D. It has no bleeding risk
Correct Answer: B
, Rationale: Ticagrelor is a reversible P2Y12 inhibitor dosed twice daily that does not require
metabolic activation (B). Aspirin dose should be ≤100 mg (A is incorrect). Clopidogrel (not
ticagrelor) is a prodrug (C). All P2Y12 inhibitors increase bleeding risk (D).
Q9: A 55-year-old female with CAD has LDL of 110 mg/dL on atorvastatin 40 mg. What is the
next step?
A. Add ezetimibe. [CORRECT]
B. Discontinue statin and start PCSK9 inhibitor
C. Switch to simvastatin 80 mg
D. Maintain current therapy as LDL is acceptable
Correct Answer: A
Rationale: For very high-risk ASCVD patients, LDL goal is <70 mg/dL. Adding ezetimibe is the
next step if not at goal on maximally tolerated statin (A). PCSK9 inhibitors (B) are considered if
still above goal. Simvastatin 80 mg (C) is not recommended due to myopathy risk. 110 mg/dL
(D) is above goal for very high risk.
Q10: A patient with stable angina reports chest pain while walking uphill. Which medication is
most appropriate for symptom relief?
A. Aspirin
B. Sublingual nitroglycerin. [CORRECT]
C. Warfarin
D. Digoxin
Correct Answer: B
Rationale: Sublingual nitroglycerin is first-line for acute angina relief and prophylaxis before
exertion (B). Aspirin (A) is for prevention. Warfarin (C) is not indicated. Digoxin (D) is for heart
failure or atrial fibrillation, not angina.
Q11: A 70-year-old male with prior MI presents with new dyspnea on exertion. Stress testing
shows reversible ischemia in the anterior wall. The next step is:
A. Immediate thrombolysis
B. Cardiac catheterization with intent for revascularization. [CORRECT]
C. Observation only
D. Start antibiotics for possible endocarditis
