ABFM Exam
Indications for preop CXR - Answer-COPD, age > 60, functional dep, hypoalbuminemia, CHF,
emergency/prolonged procedure, surg sites (thorax, upper abd, AAA)
What study is needed for uncontrolled RA prior to surgery? - Answer-Cervical spine film (to eval for
atlanto-axial instability)
ChADs2 -VASc criteria & scoring - Answer-For Afib stroke risk:
CHF (HFrEF)
HTN
Age: 65-74(1), 75 & up (2)
DM
Stroke/TIA/VTE hx (2)
Vasc dx hx (prior MI, PAD, aortic plaque)
Sex (F - 1)
0(M) or 1(F) - no anticoag
1(M) or 2(F) - shared decision-making
2(M) or 3(F) - anticoag
ACC/AHA 2019
How soon is troponin detected after ACS?
How long is it elevated for? - Answer-Detected 3-6 hrs after ACS
,Elevated for 7-14d post-MI
*Renal dx can show elevated trops
Tx cocaine-induced angina? What do we NOT give? - Answer-Nitroglycerin, benzos
**Do NOT give beta blockers to avoid unopposed alpha stimulation
Management of NSTEMI (NSTE-ACS), low and high risk strategies? - Answer-Lower Risk Patients
(Ischemia guided strategy):
1. ASA 325mg
2. P2Y12i (Clopidogrel)
3. Anticoag (SQH)
Higher Risk Patients (Early Invasive strategy):
On the way to the CATH lab...
1. ASA 325
2. P2Y12i (Clopidogrel)
3. Anticoag (SQH)
4. Consider glycoprotein IIa/IIIbi (abciximab)
When do we consider higher risk strategy for treatment of NSTEMI (NSTE-ACS)? - Answer--sx ischemia
despite med tx
-prev PCI or CABG
-evidence of cardiac dx (EF < 40%, large ant perfusion defect, marked elevated trop, ventricular
dysrhythmias)
Management of STEMI? - Answer-1. Reperfusion (cath lab) ASAP! - w/i 12 hrs!!
2. PCI preferred
,3. If > 12 hrs away from PCI capable facility or if time from 1st medical contact at non-PCI hospital to
device time @ PCI hospital is > 2 hrs, consider fibrinolytics
What arteries and leads are affected in anterior MI, lateral MI, and inferior MI? - Answer-Ant MI:
-LAD
-V1-V4
Lat MI:
-circumflex
-V5-V6
Inferior MI:
-RCA
-II, III, AVF
How long is DAPT needed for: 1) Acute ACS?
2) scheduled cath w/ BMS vs DES? - Answer-1. Acute ACS: 1 yr of DAPT regardless of stent type*
2. Scheduled cath: 1 month of DAPT for BMS, 6 mos for DES
*Extending DAPT beyond 1 yr after MI may be reasonable if no increased risk of bleed
What are the 4 indicators for statin therapy? - Answer-1. Tertiary prevention for known CVD: ACS, PVD,
prior MI/angina/stroke/TiA, prior PCI
2. Secondary prevention in familial HLD w/ LDL 190+
, 3. DM age 40-75 + LDL 70+
4. Age 40-75 + LDL 70+ + 10 yr ASCVD risk:
7.5% or higher - discuss statin
7.5 -10% - consider statin if risk enhancers
10% or higher - start statin (low-mod)
What is primary, secondary, tertiary, and quaternary prevention?
Give examples for each. - Answer-Primary prevention - targets people w/ risk factors to prevent a
disease (ex: vaccinations)
Secondary prevention - targets people w/ an asx disease to catch it early (ex: breast cancer screening)
Tertiary prevention - targets people w/ known disease to prevent complications (screening diabetics for
microalbuminuria)
Quaternary prevention - goal of preventing over-treatment (no ASA for primary prevention, avoiding
unnecessary clinical breast exams or DRE)
When is coronary artery calcium score useful? - Answer-Used to help aid decision to start statin in:
-Adults 40-75 with no clinical ASCVD or DM
-w/ LDL at least 70
-ASCVD risk 7.5-19.9%
Score 0 - may hold statin
Score 1-99 + age at least 55 - start statin
Score at least 100 - start statin
5 Important meds in MI? - Answer-1. ACEi
Indications for preop CXR - Answer-COPD, age > 60, functional dep, hypoalbuminemia, CHF,
emergency/prolonged procedure, surg sites (thorax, upper abd, AAA)
What study is needed for uncontrolled RA prior to surgery? - Answer-Cervical spine film (to eval for
atlanto-axial instability)
ChADs2 -VASc criteria & scoring - Answer-For Afib stroke risk:
CHF (HFrEF)
HTN
Age: 65-74(1), 75 & up (2)
DM
Stroke/TIA/VTE hx (2)
Vasc dx hx (prior MI, PAD, aortic plaque)
Sex (F - 1)
0(M) or 1(F) - no anticoag
1(M) or 2(F) - shared decision-making
2(M) or 3(F) - anticoag
ACC/AHA 2019
How soon is troponin detected after ACS?
How long is it elevated for? - Answer-Detected 3-6 hrs after ACS
,Elevated for 7-14d post-MI
*Renal dx can show elevated trops
Tx cocaine-induced angina? What do we NOT give? - Answer-Nitroglycerin, benzos
**Do NOT give beta blockers to avoid unopposed alpha stimulation
Management of NSTEMI (NSTE-ACS), low and high risk strategies? - Answer-Lower Risk Patients
(Ischemia guided strategy):
1. ASA 325mg
2. P2Y12i (Clopidogrel)
3. Anticoag (SQH)
Higher Risk Patients (Early Invasive strategy):
On the way to the CATH lab...
1. ASA 325
2. P2Y12i (Clopidogrel)
3. Anticoag (SQH)
4. Consider glycoprotein IIa/IIIbi (abciximab)
When do we consider higher risk strategy for treatment of NSTEMI (NSTE-ACS)? - Answer--sx ischemia
despite med tx
-prev PCI or CABG
-evidence of cardiac dx (EF < 40%, large ant perfusion defect, marked elevated trop, ventricular
dysrhythmias)
Management of STEMI? - Answer-1. Reperfusion (cath lab) ASAP! - w/i 12 hrs!!
2. PCI preferred
,3. If > 12 hrs away from PCI capable facility or if time from 1st medical contact at non-PCI hospital to
device time @ PCI hospital is > 2 hrs, consider fibrinolytics
What arteries and leads are affected in anterior MI, lateral MI, and inferior MI? - Answer-Ant MI:
-LAD
-V1-V4
Lat MI:
-circumflex
-V5-V6
Inferior MI:
-RCA
-II, III, AVF
How long is DAPT needed for: 1) Acute ACS?
2) scheduled cath w/ BMS vs DES? - Answer-1. Acute ACS: 1 yr of DAPT regardless of stent type*
2. Scheduled cath: 1 month of DAPT for BMS, 6 mos for DES
*Extending DAPT beyond 1 yr after MI may be reasonable if no increased risk of bleed
What are the 4 indicators for statin therapy? - Answer-1. Tertiary prevention for known CVD: ACS, PVD,
prior MI/angina/stroke/TiA, prior PCI
2. Secondary prevention in familial HLD w/ LDL 190+
, 3. DM age 40-75 + LDL 70+
4. Age 40-75 + LDL 70+ + 10 yr ASCVD risk:
7.5% or higher - discuss statin
7.5 -10% - consider statin if risk enhancers
10% or higher - start statin (low-mod)
What is primary, secondary, tertiary, and quaternary prevention?
Give examples for each. - Answer-Primary prevention - targets people w/ risk factors to prevent a
disease (ex: vaccinations)
Secondary prevention - targets people w/ an asx disease to catch it early (ex: breast cancer screening)
Tertiary prevention - targets people w/ known disease to prevent complications (screening diabetics for
microalbuminuria)
Quaternary prevention - goal of preventing over-treatment (no ASA for primary prevention, avoiding
unnecessary clinical breast exams or DRE)
When is coronary artery calcium score useful? - Answer-Used to help aid decision to start statin in:
-Adults 40-75 with no clinical ASCVD or DM
-w/ LDL at least 70
-ASCVD risk 7.5-19.9%
Score 0 - may hold statin
Score 1-99 + age at least 55 - start statin
Score at least 100 - start statin
5 Important meds in MI? - Answer-1. ACEi
