ABIM ACTUAL TEST QUESTIONS WITH
COMPLETE ANSWER KEY
●● Aortic stenosis: murmur increases with
Answer: Increased preload
●● Aortic stenosis: Survival
Answer: Angina: 5 years
Syncope: 3 years
Heart failure: 2 years
●● When is aortic balloon valvuloplasty done?
Answer: As bridge to AVR
●● Aortic stenosis: Indications for surgery
Answer: If Sx
Asx with EF <50%
Mean gradient >60 mmHg
Cardiac surgery planned
●● Aortic stenosis: Type of surgery
Answer: AVR
,Transcatheter if high surgical risk
●● Aortic stenosis: Use caution with
Answer: Vasodilators
●● Aortic stenosis: When diagnosed, also image the
Answer: Aorta
●● Describe murmur of aortic stenosis
Answer: Systolic ejection murmur at right upper sternal border or
suprasternal notch radiating to neck, paradoxically split S2, systolic
thrill, slowed carotid upstroke, sustained apical impulse
●● Decrescendo early diastolic high-pitched blowing murmur at left or
right sternal border, rapid carotid upstroke and decline, wide and
bounding pulse
Answer: Aortic regurgitation
●● Gold standard for diagnosing aortic regurgitation
Answer: Cath
●● Rx chronic AR
Answer: Vasodilators, ACE/ARB
,●● Aortic regurgitation: Indications for surgery
Answer: If symptomatic
EF <55%
LV end-systolic length >55 mm
●● Aortic regurgitation: What else should be repaired, and when?
Answer: Aorta if >45 mm
●● Acute aortic regurgitation is associated with
Answer: Aortic dissection
●● Rx acute aortic regurgitation
Answer: Surgery
●● Pulmonic stenosis is virtually always
Answer: Congenital
●● Describe murmur of aortic regurgitation
Answer: Decrescendo early diastolic high-pitched blowing murmur at
left or right sternal border, rapid carotid upstroke and decline, wide and
bounding pulse
, ●● Systolic crescendo-decrescendo murmur at left intercostal space
louder with inspiration, ejection click softer with inspiration, increased a
wave, thrill
Answer: Pulmonic stenosis
●● Describe murmur of pulmonic stenosis
Answer: Systolic crescendo-decrescendo murmur at left intercostal
space louder with inspiration, ejection click softer with inspiration,
increased a wave, thrill
●● Low-set ears and hairline + pulmonic stenosis
Answer: Noonan syndrome
●● How does inspiration affect murmur and ejection click in pulmonic
stenosis?
Answer: Increases murmur
Decreases ejection click
●● Echo findings in pulmonic stenosis
Answer: RV hypertrophy
Dilated pulmonary arteries
●● Pulmonic stenosis: Indications for surgery
COMPLETE ANSWER KEY
●● Aortic stenosis: murmur increases with
Answer: Increased preload
●● Aortic stenosis: Survival
Answer: Angina: 5 years
Syncope: 3 years
Heart failure: 2 years
●● When is aortic balloon valvuloplasty done?
Answer: As bridge to AVR
●● Aortic stenosis: Indications for surgery
Answer: If Sx
Asx with EF <50%
Mean gradient >60 mmHg
Cardiac surgery planned
●● Aortic stenosis: Type of surgery
Answer: AVR
,Transcatheter if high surgical risk
●● Aortic stenosis: Use caution with
Answer: Vasodilators
●● Aortic stenosis: When diagnosed, also image the
Answer: Aorta
●● Describe murmur of aortic stenosis
Answer: Systolic ejection murmur at right upper sternal border or
suprasternal notch radiating to neck, paradoxically split S2, systolic
thrill, slowed carotid upstroke, sustained apical impulse
●● Decrescendo early diastolic high-pitched blowing murmur at left or
right sternal border, rapid carotid upstroke and decline, wide and
bounding pulse
Answer: Aortic regurgitation
●● Gold standard for diagnosing aortic regurgitation
Answer: Cath
●● Rx chronic AR
Answer: Vasodilators, ACE/ARB
,●● Aortic regurgitation: Indications for surgery
Answer: If symptomatic
EF <55%
LV end-systolic length >55 mm
●● Aortic regurgitation: What else should be repaired, and when?
Answer: Aorta if >45 mm
●● Acute aortic regurgitation is associated with
Answer: Aortic dissection
●● Rx acute aortic regurgitation
Answer: Surgery
●● Pulmonic stenosis is virtually always
Answer: Congenital
●● Describe murmur of aortic regurgitation
Answer: Decrescendo early diastolic high-pitched blowing murmur at
left or right sternal border, rapid carotid upstroke and decline, wide and
bounding pulse
, ●● Systolic crescendo-decrescendo murmur at left intercostal space
louder with inspiration, ejection click softer with inspiration, increased a
wave, thrill
Answer: Pulmonic stenosis
●● Describe murmur of pulmonic stenosis
Answer: Systolic crescendo-decrescendo murmur at left intercostal
space louder with inspiration, ejection click softer with inspiration,
increased a wave, thrill
●● Low-set ears and hairline + pulmonic stenosis
Answer: Noonan syndrome
●● How does inspiration affect murmur and ejection click in pulmonic
stenosis?
Answer: Increases murmur
Decreases ejection click
●● Echo findings in pulmonic stenosis
Answer: RV hypertrophy
Dilated pulmonary arteries
●● Pulmonic stenosis: Indications for surgery
