ABFM Exam 2022
Indications for preop CXR - verified 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? - verified answer Cervical spine film (to
eval for atlanto-axial instability)
ChADs2 -VASc criteria & scoring - verified 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? - verified 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? - verified answer Nitroglycerin, benzos
**Do NOT give beta blockers to avoid unopposed alpha stimulation
,Management of NSTEMI (NSTE-ACS), low and high risk strategies? - verified 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)? - verified 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? - verified 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? - verified 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? - verified 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? - verified 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. - verified 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? - verified 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? - verified answer 1. ACEi
2. BB
3. Statin
4. ASA
5. Anticoag (LVX or SQH)
4 Important meds in HF (that decrease mortality)? - verified answer 1. ACEi or ARBs
2. BB - metoprolol succinate, carvedilol, and bisoprolol ONLY
*start when stable
3. Aldosterone antags - if GFR > 30
4. Entresto (ARNI) - 36 hrs after stopping ACE/ARBs
In African Amer's w/ HFrEF, what med combo causes decreased mortality and increased quality of
life? - verified answer Hydralazine + isosorbide dinitrate
What common drugs do we avoid in HFrEF? - verified answer 1. NSAIDs
2. non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
*think "non-dihydro - neg inotropes!"
3. Most antiarrhythmics
Indications for preop CXR - verified 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? - verified answer Cervical spine film (to
eval for atlanto-axial instability)
ChADs2 -VASc criteria & scoring - verified 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? - verified 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? - verified answer Nitroglycerin, benzos
**Do NOT give beta blockers to avoid unopposed alpha stimulation
,Management of NSTEMI (NSTE-ACS), low and high risk strategies? - verified 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)? - verified 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? - verified 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? - verified 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? - verified 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? - verified 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. - verified 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? - verified 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? - verified answer 1. ACEi
2. BB
3. Statin
4. ASA
5. Anticoag (LVX or SQH)
4 Important meds in HF (that decrease mortality)? - verified answer 1. ACEi or ARBs
2. BB - metoprolol succinate, carvedilol, and bisoprolol ONLY
*start when stable
3. Aldosterone antags - if GFR > 30
4. Entresto (ARNI) - 36 hrs after stopping ACE/ARBs
In African Amer's w/ HFrEF, what med combo causes decreased mortality and increased quality of
life? - verified answer Hydralazine + isosorbide dinitrate
What common drugs do we avoid in HFrEF? - verified answer 1. NSAIDs
2. non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
*think "non-dihydro - neg inotropes!"
3. Most antiarrhythmics
