ABFM EXAM QUESTIONS AND
ANSWERS (GRADED A+)
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
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
2. BB
3. Statin
4. ASA
5. Anticoag (LVX or SQH)
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)
4 Important meds in HF (that decrease mortality)? - 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? - ANSWER-Hydralazine + isosorbide dinitrate
What common drugs do we avoid in HFrEF? - ANSWER-1. NSAIDs
2. non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
*think "non-dihydro - neg inotropes!"
3. Most antiarrhythmics
4. TZDs (pioglitazone) - d/t water retention
What med helps in HFpEF? When do we use it? - ANSWER-Aldosterone antags if:
GFR > 30, K <5, Cr < 2.5
, What are indications for ICD placement in advanced heart failure? - ANSWER--EF < or
equal to 35%
-NYHA class II or III
-Life expectancy > 1 yr
An increase in blood pressure of how much is directly related to risk of major cardiac
event? - ANSWER-For every 20mmHg increase in SBP and
10mmHg increase in DBP
Your risk of major CV event/stroke DOUBLES!
Definition of pediatric HTN? When do we start checking kids' BP? - ANSWER-> or
equal to 95%ile in BP for age, gender, and height
Start measuring BP at 3 yrs old
When do you work up pediatric HTN? What is the workup involved? - ANSWER--NOT
obese (Obesity is #1 cause)
-No FHx HTN
-Clinical signs suggestive of secondary cause (renovascular/parenchymal,
endocrine/rheum dx, coarctation of aorta, drugs)
Workup for secondary pedi HTN:
-fasting glucose
-lipid panel
-echo
-retinal exam
What are causes of secondary HTN? - ANSWER-- Hyperaldosteronism (dx by inc
aldosterone: renin ratio)
- Pheochromocytoma
- OSA
- Cushing's syndrome
- Pregnancy-induced hypertension
- KIDS: Aortic coarctation, renal parenchymal dx
- Aging
- Renal artery stenosis (dx by MRA renal arteries, CTA, duplex US)
-CKD
-Alcohol
-Hyperthyroidism
How much increase in Cr is expected with ACEi/ARBs and when do we worry it is
pathologic? - ANSWER-Normal to get increase in Cr up to 20-30%
(Due to dec BP in filtration apparatus of the kidney)
Increase in Cr > 30% is pathologic; switch to another class of meds and look for other
causes
ANSWERS (GRADED A+)
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
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
2. BB
3. Statin
4. ASA
5. Anticoag (LVX or SQH)
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)
4 Important meds in HF (that decrease mortality)? - 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? - ANSWER-Hydralazine + isosorbide dinitrate
What common drugs do we avoid in HFrEF? - ANSWER-1. NSAIDs
2. non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
*think "non-dihydro - neg inotropes!"
3. Most antiarrhythmics
4. TZDs (pioglitazone) - d/t water retention
What med helps in HFpEF? When do we use it? - ANSWER-Aldosterone antags if:
GFR > 30, K <5, Cr < 2.5
, What are indications for ICD placement in advanced heart failure? - ANSWER--EF < or
equal to 35%
-NYHA class II or III
-Life expectancy > 1 yr
An increase in blood pressure of how much is directly related to risk of major cardiac
event? - ANSWER-For every 20mmHg increase in SBP and
10mmHg increase in DBP
Your risk of major CV event/stroke DOUBLES!
Definition of pediatric HTN? When do we start checking kids' BP? - ANSWER-> or
equal to 95%ile in BP for age, gender, and height
Start measuring BP at 3 yrs old
When do you work up pediatric HTN? What is the workup involved? - ANSWER--NOT
obese (Obesity is #1 cause)
-No FHx HTN
-Clinical signs suggestive of secondary cause (renovascular/parenchymal,
endocrine/rheum dx, coarctation of aorta, drugs)
Workup for secondary pedi HTN:
-fasting glucose
-lipid panel
-echo
-retinal exam
What are causes of secondary HTN? - ANSWER-- Hyperaldosteronism (dx by inc
aldosterone: renin ratio)
- Pheochromocytoma
- OSA
- Cushing's syndrome
- Pregnancy-induced hypertension
- KIDS: Aortic coarctation, renal parenchymal dx
- Aging
- Renal artery stenosis (dx by MRA renal arteries, CTA, duplex US)
-CKD
-Alcohol
-Hyperthyroidism
How much increase in Cr is expected with ACEi/ARBs and when do we worry it is
pathologic? - ANSWER-Normal to get increase in Cr up to 20-30%
(Due to dec BP in filtration apparatus of the kidney)
Increase in Cr > 30% is pathologic; switch to another class of meds and look for other
causes
