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 presents with crushing chest pain at rest for 30 minutes.
ECG shows ST elevation in leads II, III, and aVF. Troponin I is elevated. What is the priority
treatment?
A. Immediate PCI within 90 minutes. [CORRECT]
B. Thrombolytics within 24 hours
C. Medical management with aspirin and heparin only
D. Stress testing in 48 hours
Correct Answer: A
Rationale: STEMI with ST elevation in inferior leads (II, III, aVF) requires immediate
reperfusion therapy. Primary PCI within 90 minutes of first medical contact is preferred over
thrombolytics (A). Thrombolytics (B) are used if PCI unavailable within 120 minutes. Medical
management alone (C) is insufficient. Stress testing (D) is contraindicated in acute STEMI.
,Q3: A 58-year-old female with stable angina is started on medical therapy. Which medication is
indicated for symptom relief but does not reduce mortality?
A. Aspirin
B. High-intensity statin
C. Beta-blocker
D. Sublingual nitroglycerin. [CORRECT]
Correct Answer: D
Rationale: Nitrates (sublingual nitroglycerin) provide effective symptom relief for angina by
reducing preload and afterload, but have not been shown to reduce mortality (D). Aspirin (A),
statins (B), and beta-blockers (C) all reduce cardiovascular events and mortality in CAD.
Q4: A 65-year-old male with NSTEMI is being discharged. Which combination of medications
constitutes optimal secondary prevention?
A. Aspirin, clopidogrel, atorvastatin 80mg, metoprolol, lisinopril. [CORRECT]
B. Aspirin alone
C. Atorvastatin 20mg only
D. Nitroglycerin PRN and diltiazem
Correct Answer: A
Rationale: Optimal secondary prevention post-ACS includes dual antiplatelet therapy (aspirin +
P2Y12 inhibitor), high-intensity statin, beta-blocker, and ACE inhibitor (especially with LV
dysfunction, diabetes, or CKD) (A). Single agents (B, C) or calcium channel blockers (D) are
insufficient.
Q5: A 70-year-old male with 3-vessel CAD and diabetes is being evaluated for revascularization.
Left ventricular function is preserved. Which approach has shown superior long-term outcomes
in this population?
A. PCI with drug-eluting stents
B. CABG (coronary artery bypass grafting). [CORRECT]
C. Medical therapy alone
D. PCI with bare metal stents
Correct Answer: B
,Rationale: In patients with multi-vessel CAD and diabetes, CABG has demonstrated superior
long-term survival and reduced repeat revascularization compared to PCI (B). PCI (A, D) is
appropriate for less complex disease. Medical therapy alone (C) is insufficient for significant 3-
vessel disease.
Q6: A 45-year-old male with family history of premature CAD has total cholesterol 240 mg/dL,
LDL 160 mg/dL, HDL 35 mg/dL. He smokes. What is his indication for statin therapy?
A. No indication for statin
B. Primary prevention with moderate-intensity statin
C. Primary prevention with high-intensity statin due to LDL ≥190. [CORRECT]
D. Secondary prevention only
Correct Answer: C
Rationale: LDL ≥190 mg/dL is an indication for high-intensity statin regardless of calculated 10-
year risk (C). This patient also has multiple risk factors (smoking, family history, low HDL) that
further support aggressive therapy. No statin (A) is incorrect. Moderate intensity (B) is
insufficient.
Q7: A 68-year-old female presents with chest pain. Stress testing with imaging shows reversible
perfusion defect in anterior wall. Coronary angiography shows 70% stenosis of LAD. What is
the recommended management?
A. Medical therapy only
B. PCI with stenting for symptomatic, significant stenosis. [CORRECT]
C. No further treatment needed
D. Warfarin anticoagulation
Correct Answer: B
Rationale: Significant stenosis (>50-70%) in a major epicardial artery with corresponding
symptoms and positive stress test is an indication for revascularization, typically PCI with
stenting (B). Medical therapy alone (A) may be insufficient for significant stenosis. No treatment
(C) is dangerous. Warfarin (D) is not indicated.
Q8: A 55-year-old male with CAD is prescribed ticagrelor after PCI. Which statement is correct
regarding this medication?
A. It can be used with aspirin indefinitely
B. It requires genetic testing before use
, C. It increases bleeding risk and is typically used for 12 months post-ACS. [CORRECT]
D. It is a prodrug requiring conversion to active metabolite
Correct Answer: C
Rationale: Ticagrelor is a reversible P2Y12 inhibitor used with aspirin for 12 months post-ACS
or post-PCI, with increased bleeding risk (C). It is not indefinite (A). Genetic testing (B) is for
clopidogrel metabolism. It is not a prodrug (D) - clopidogrel and prasugrel are prodrugs.
Q9: A 60-year-old male with stable angina continues to have symptoms despite beta-blocker and
statin. Which additional antianginal is most appropriate?
A. Diltiazem
B. Ranolazine. [CORRECT]
C. Digoxin
D. Hydralazine
Correct Answer: B
Rationale: Ranolazine is a late sodium channel blocker indicated for chronic angina when
symptoms persist despite beta-blocker therapy (B). Diltiazem (A) is a calcium channel blocker
but may be used if beta-blocker contraindicated. Digoxin (C) is for heart failure/AF. Hydralazine
(D) is not antianginal.
Q10: A 72-year-old male with STEMI develops ventricular fibrillation in the ED. What is the
immediate treatment?
A. Amiodarone 300mg IV push
B. Defibrillation with 200J biphasic shock. [CORRECT]
C. Lidocaine 1mg/kg IV
D. Cardiac pacing
Correct Answer: B
Rationale: Pulseless VT/VF requires immediate defibrillation (B). Amiodarone (A) and lidocaine
(C) are used after failed shocks and CPR. Pacing (D) is for bradyarrhythmias, not
tachyarrhythmias.
Q11: A 50-year-old female with CAD is prescribed atorvastatin 80mg. Which monitoring is
recommended?
A. Liver function tests at baseline, then only if symptoms
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 presents with crushing chest pain at rest for 30 minutes.
ECG shows ST elevation in leads II, III, and aVF. Troponin I is elevated. What is the priority
treatment?
A. Immediate PCI within 90 minutes. [CORRECT]
B. Thrombolytics within 24 hours
C. Medical management with aspirin and heparin only
D. Stress testing in 48 hours
Correct Answer: A
Rationale: STEMI with ST elevation in inferior leads (II, III, aVF) requires immediate
reperfusion therapy. Primary PCI within 90 minutes of first medical contact is preferred over
thrombolytics (A). Thrombolytics (B) are used if PCI unavailable within 120 minutes. Medical
management alone (C) is insufficient. Stress testing (D) is contraindicated in acute STEMI.
,Q3: A 58-year-old female with stable angina is started on medical therapy. Which medication is
indicated for symptom relief but does not reduce mortality?
A. Aspirin
B. High-intensity statin
C. Beta-blocker
D. Sublingual nitroglycerin. [CORRECT]
Correct Answer: D
Rationale: Nitrates (sublingual nitroglycerin) provide effective symptom relief for angina by
reducing preload and afterload, but have not been shown to reduce mortality (D). Aspirin (A),
statins (B), and beta-blockers (C) all reduce cardiovascular events and mortality in CAD.
Q4: A 65-year-old male with NSTEMI is being discharged. Which combination of medications
constitutes optimal secondary prevention?
A. Aspirin, clopidogrel, atorvastatin 80mg, metoprolol, lisinopril. [CORRECT]
B. Aspirin alone
C. Atorvastatin 20mg only
D. Nitroglycerin PRN and diltiazem
Correct Answer: A
Rationale: Optimal secondary prevention post-ACS includes dual antiplatelet therapy (aspirin +
P2Y12 inhibitor), high-intensity statin, beta-blocker, and ACE inhibitor (especially with LV
dysfunction, diabetes, or CKD) (A). Single agents (B, C) or calcium channel blockers (D) are
insufficient.
Q5: A 70-year-old male with 3-vessel CAD and diabetes is being evaluated for revascularization.
Left ventricular function is preserved. Which approach has shown superior long-term outcomes
in this population?
A. PCI with drug-eluting stents
B. CABG (coronary artery bypass grafting). [CORRECT]
C. Medical therapy alone
D. PCI with bare metal stents
Correct Answer: B
,Rationale: In patients with multi-vessel CAD and diabetes, CABG has demonstrated superior
long-term survival and reduced repeat revascularization compared to PCI (B). PCI (A, D) is
appropriate for less complex disease. Medical therapy alone (C) is insufficient for significant 3-
vessel disease.
Q6: A 45-year-old male with family history of premature CAD has total cholesterol 240 mg/dL,
LDL 160 mg/dL, HDL 35 mg/dL. He smokes. What is his indication for statin therapy?
A. No indication for statin
B. Primary prevention with moderate-intensity statin
C. Primary prevention with high-intensity statin due to LDL ≥190. [CORRECT]
D. Secondary prevention only
Correct Answer: C
Rationale: LDL ≥190 mg/dL is an indication for high-intensity statin regardless of calculated 10-
year risk (C). This patient also has multiple risk factors (smoking, family history, low HDL) that
further support aggressive therapy. No statin (A) is incorrect. Moderate intensity (B) is
insufficient.
Q7: A 68-year-old female presents with chest pain. Stress testing with imaging shows reversible
perfusion defect in anterior wall. Coronary angiography shows 70% stenosis of LAD. What is
the recommended management?
A. Medical therapy only
B. PCI with stenting for symptomatic, significant stenosis. [CORRECT]
C. No further treatment needed
D. Warfarin anticoagulation
Correct Answer: B
Rationale: Significant stenosis (>50-70%) in a major epicardial artery with corresponding
symptoms and positive stress test is an indication for revascularization, typically PCI with
stenting (B). Medical therapy alone (A) may be insufficient for significant stenosis. No treatment
(C) is dangerous. Warfarin (D) is not indicated.
Q8: A 55-year-old male with CAD is prescribed ticagrelor after PCI. Which statement is correct
regarding this medication?
A. It can be used with aspirin indefinitely
B. It requires genetic testing before use
, C. It increases bleeding risk and is typically used for 12 months post-ACS. [CORRECT]
D. It is a prodrug requiring conversion to active metabolite
Correct Answer: C
Rationale: Ticagrelor is a reversible P2Y12 inhibitor used with aspirin for 12 months post-ACS
or post-PCI, with increased bleeding risk (C). It is not indefinite (A). Genetic testing (B) is for
clopidogrel metabolism. It is not a prodrug (D) - clopidogrel and prasugrel are prodrugs.
Q9: A 60-year-old male with stable angina continues to have symptoms despite beta-blocker and
statin. Which additional antianginal is most appropriate?
A. Diltiazem
B. Ranolazine. [CORRECT]
C. Digoxin
D. Hydralazine
Correct Answer: B
Rationale: Ranolazine is a late sodium channel blocker indicated for chronic angina when
symptoms persist despite beta-blocker therapy (B). Diltiazem (A) is a calcium channel blocker
but may be used if beta-blocker contraindicated. Digoxin (C) is for heart failure/AF. Hydralazine
(D) is not antianginal.
Q10: A 72-year-old male with STEMI develops ventricular fibrillation in the ED. What is the
immediate treatment?
A. Amiodarone 300mg IV push
B. Defibrillation with 200J biphasic shock. [CORRECT]
C. Lidocaine 1mg/kg IV
D. Cardiac pacing
Correct Answer: B
Rationale: Pulseless VT/VF requires immediate defibrillation (B). Amiodarone (A) and lidocaine
(C) are used after failed shocks and CPR. Pacing (D) is for bradyarrhythmias, not
tachyarrhythmias.
Q11: A 50-year-old female with CAD is prescribed atorvastatin 80mg. Which monitoring is
recommended?
A. Liver function tests at baseline, then only if symptoms
