ABIM INTERVENTIONAL CARDIOLOGY CERTIFICATION EXAMINATION PRACTICE
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A
Q1. A 62-year-old man presents with chronic stable angina despite maximal medical therapy. Coronary
angiography reveals a 90% stenosis in the proximal LAD and a 70% stenosis in the mid-RCA. His LVEF is
55%. What is the most appropriate treatment strategy?
A. Continued medical therapy alone
B. CABG
C. PCI of the LAD lesion
D. PCI of both lesions
Correct Answer: C
Rationale: In patients with chronic ischemic heart disease and suitable anatomy, PCI is indicated for
symptom relief when medical therapy fails. The LAD lesion is the culprit for his symptoms. CABG is
generally reserved for more extensive disease or complex anatomy .
Q2. During primary PCI for an inferior STEMI, the patient develops bradycardia and hypotension. The
right coronary artery is the culprit vessel. What is the most likely explanation?
A. Left ventricular failure
B. Right ventricular infarction
C. Papillary muscle rupture
D. Ventricular septal defect
Correct Answer: B
Rationale: Right ventricular infarction commonly complicates inferior STEMI due to proximal RCA
occlusion. It presents with bradycardia, hypotension, and elevated JVP, and is preload-dependent .
Q3. A patient undergoes PCI with drug-eluting stent placement. What is the minimum recommended
duration of dual antiplatelet therapy for a patient with stable ischemic heart disease?
,A. 1 month
B. 3 months
C. 6 months
D. 12 months
Correct Answer: C
Rationale: Current guidelines recommend at least 6 months of DAPT after DES placement in stable
patients, with consideration for longer duration based on ischemic and bleeding risk .
Q4. Which of the following is a contraindication to radial artery access for cardiac catheterization?
A. Prior CABG with left internal mammary artery graft
B. Abnormal Barbeau test (type D)
C. Female sex
D. Obesity
Correct Answer: B
Rationale: A type D Barbeau test indicates inadequate collateral circulation to the hand, making radial
access unsafe due to risk of hand ischemia .
Q5. During diagnostic catheterization, the patient develops sudden severe chest pain and ST elevation in
the inferior leads. What is the most likely cause?
A. Coronary air embolism
B. Coronary dissection
C. Coronary spasm
D. Guidewire perforation
,Correct Answer: A
Rationale: Coronary air embolism is a known complication of catheter manipulation and presents with
acute chest pain, ST changes, and hemodynamic compromise. Treatment includes 100% oxygen and
aspiration .
Q6. What is the primary mechanism of action of glycoprotein IIb/IIIa inhibitors?
A. Direct thrombin inhibition
B. Platelet ADP receptor blockade
C. Fibrinogen binding site blockade on platelets
D. Cyclooxygenase inhibition
Correct Answer: C
Rationale: GP IIb/IIIa inhibitors block the final common pathway of platelet aggregation by preventing
fibrinogen binding to the GP IIb/IIIa receptor .
Q7. A patient with severe aortic stenosis and high surgical risk is being evaluated for transcatheter aortic
valve replacement (TAVR). What is the most important pre-procedural imaging assessment?
A. Coronary angiography
B. Annular sizing by CT
C. Echocardiographic gradients
D. Carotid duplex
Correct Answer: B
Rationale: Accurate annular sizing by CT is critical for valve selection and preventing complications such
as annular rupture or paravalvular leak .
Q8. Which of the following is the most common complication of femoral artery access for cardiac
catheterization?
, A. Retroperitoneal hemorrhage
B. Access site hematoma
C. Arteriovenous fistula
D. Pseudoaneurysm
Correct Answer: B
Rationale: Access site hematoma is the most common complication of femoral access, occurring in up
to 5% of procedures .
Q9. A patient undergoing PCI develops no-reflow phenomenon after stent deployment. What is the
most appropriate initial treatment?
A. Intracoronary adenosine
B. Intracoronary epinephrine
C. Systemic heparin
D. Balloon inflation
Correct Answer: A
Rationale: Intracoronary adenosine is a first-line treatment for no-reflow, along with verapamil,
nitroprusside, or nicardipine .
Q10. What is the primary purpose of intravascular ultrasound (IVUS) during PCI?
A. Assess lesion severity and optimize stent deployment
B. Measure coronary flow reserve
C. Detect vulnerable plaque
D. Guide guidewire placement
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A
Q1. A 62-year-old man presents with chronic stable angina despite maximal medical therapy. Coronary
angiography reveals a 90% stenosis in the proximal LAD and a 70% stenosis in the mid-RCA. His LVEF is
55%. What is the most appropriate treatment strategy?
A. Continued medical therapy alone
B. CABG
C. PCI of the LAD lesion
D. PCI of both lesions
Correct Answer: C
Rationale: In patients with chronic ischemic heart disease and suitable anatomy, PCI is indicated for
symptom relief when medical therapy fails. The LAD lesion is the culprit for his symptoms. CABG is
generally reserved for more extensive disease or complex anatomy .
Q2. During primary PCI for an inferior STEMI, the patient develops bradycardia and hypotension. The
right coronary artery is the culprit vessel. What is the most likely explanation?
A. Left ventricular failure
B. Right ventricular infarction
C. Papillary muscle rupture
D. Ventricular septal defect
Correct Answer: B
Rationale: Right ventricular infarction commonly complicates inferior STEMI due to proximal RCA
occlusion. It presents with bradycardia, hypotension, and elevated JVP, and is preload-dependent .
Q3. A patient undergoes PCI with drug-eluting stent placement. What is the minimum recommended
duration of dual antiplatelet therapy for a patient with stable ischemic heart disease?
,A. 1 month
B. 3 months
C. 6 months
D. 12 months
Correct Answer: C
Rationale: Current guidelines recommend at least 6 months of DAPT after DES placement in stable
patients, with consideration for longer duration based on ischemic and bleeding risk .
Q4. Which of the following is a contraindication to radial artery access for cardiac catheterization?
A. Prior CABG with left internal mammary artery graft
B. Abnormal Barbeau test (type D)
C. Female sex
D. Obesity
Correct Answer: B
Rationale: A type D Barbeau test indicates inadequate collateral circulation to the hand, making radial
access unsafe due to risk of hand ischemia .
Q5. During diagnostic catheterization, the patient develops sudden severe chest pain and ST elevation in
the inferior leads. What is the most likely cause?
A. Coronary air embolism
B. Coronary dissection
C. Coronary spasm
D. Guidewire perforation
,Correct Answer: A
Rationale: Coronary air embolism is a known complication of catheter manipulation and presents with
acute chest pain, ST changes, and hemodynamic compromise. Treatment includes 100% oxygen and
aspiration .
Q6. What is the primary mechanism of action of glycoprotein IIb/IIIa inhibitors?
A. Direct thrombin inhibition
B. Platelet ADP receptor blockade
C. Fibrinogen binding site blockade on platelets
D. Cyclooxygenase inhibition
Correct Answer: C
Rationale: GP IIb/IIIa inhibitors block the final common pathway of platelet aggregation by preventing
fibrinogen binding to the GP IIb/IIIa receptor .
Q7. A patient with severe aortic stenosis and high surgical risk is being evaluated for transcatheter aortic
valve replacement (TAVR). What is the most important pre-procedural imaging assessment?
A. Coronary angiography
B. Annular sizing by CT
C. Echocardiographic gradients
D. Carotid duplex
Correct Answer: B
Rationale: Accurate annular sizing by CT is critical for valve selection and preventing complications such
as annular rupture or paravalvular leak .
Q8. Which of the following is the most common complication of femoral artery access for cardiac
catheterization?
, A. Retroperitoneal hemorrhage
B. Access site hematoma
C. Arteriovenous fistula
D. Pseudoaneurysm
Correct Answer: B
Rationale: Access site hematoma is the most common complication of femoral access, occurring in up
to 5% of procedures .
Q9. A patient undergoing PCI develops no-reflow phenomenon after stent deployment. What is the
most appropriate initial treatment?
A. Intracoronary adenosine
B. Intracoronary epinephrine
C. Systemic heparin
D. Balloon inflation
Correct Answer: A
Rationale: Intracoronary adenosine is a first-line treatment for no-reflow, along with verapamil,
nitroprusside, or nicardipine .
Q10. What is the primary purpose of intravascular ultrasound (IVUS) during PCI?
A. Assess lesion severity and optimize stent deployment
B. Measure coronary flow reserve
C. Detect vulnerable plaque
D. Guide guidewire placement
