The ABIM Cardiology Board Exam is a difficult test, but the content is very learnable. The average pass rate is ~93% over the past several years, which happens to be higher than most of the other Medical Specialty Boards. On the other hand, Cardiologists may simply be more prepared, and that’s the reason for the higher pass rate. Test your knowledge with some of our sample Cardiology Board Review Practice Questions!
Sample Cardiology Board Review Practice Questions
Question 1. ACS QID 75345
In 2017, the New England Journal of Medicine published the results of the Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation (RE-DUAL PCI) trial. Patients with atrial fibrillation who underwent PCI were assigned to (1) triple therapy with clopidogrel or ticagrelor associated with warfarin and aspirin or (2) dual therapy with dabigatran plus clopidogrel or ticagrelor only. The primary endpoint was a bleeding event. In addition, as a secondary endpoint, the trial evaluated noninferiority of dual therapy with respect to the incidence of a composite of thromboembolic events, death, or unplanned revascularization. What were the main findings of this clinical trial?
A. The study showed an increased incidence of the primary endpoint (significantly more bleeding events) in the triple therapy arm (p<0.001); the dual therapy group was inferior with respect to the secondary endpoint (p=0.15 for noninferiority).
B. The incidence of the primary endpoint was not statistically different between arms (p=0.12); triple therapy was inferior to dual therapy with respect to the secondary endpoint (p=0.15 for noninferiority).
C. The study showed an increased incidence of the primary endpoint (significantly more bleeding events) in the triple therapy arm (p<0.001); dual therapy was noninferior to triple therapy in relation to the secondary endpoint (p=0.005 for noninferiority).
D. The incidence of the primary endpoint was not statistically different between arms (p=0.12); for the secondary endpoint, dual therapy was noninferior to triple therapy (p=0.005 for noninferiority).
E. The incidence of the primary endpoint was not statistically different between arms (p=0.12); triple therapy was inferior to dual therapy with respect to the secondary endpoint (p=0.25 for noninferiority).
Answer: C. The study showed an increased incidence of the primary endpoint (significantly more bleeding events) in the triple therapy arm (p<0.001); dual therapy was noninferior to triple therapy in relation to the secondary endpoint (p=0.005 for noninferiority).
Explanation:
The RE-DUAL PCI trial evaluated differences between triple therapy and dual therapy using antiplatelets/anticoagulant. Other trials that evaluated this subject were the WOEST trial (2013), Pioneer AF-PCI trial (2016), and ISAR-TRIPLE (2015). These are the main aspects of the findings related to this trial.
Incorrect Answers:
A and E. The trial demonstrated that dual therapy was noninferior to triple therapy for thromboembolic events.
B. The trial demonstrated significantly more bleeding events in the triple therapy arm and also concluded that dual therapy was noninferior to triple therapy for thromboembolic events.
D. The trial demonstrated significantly more bleeding events in the triple therapy arm.
Question 2. ACS QID 3103
A 64 year old Caucasian male with a history of extensive tobacco use, hypertension, hyperlipidemia, and obesity presents with acute onset chest pain. On arrival, the EKG shown below was obtained: Emergency coronary angiography revealed complete occlusion of the culprit vessel. Percutaneous coronary intervention was unsuccessful and the plan was for medical management. Forty-eight hours after initial presentation, while in the coronary care unit, he suddenly became very dyspneic. His exam was notable for tachycardia, elevated jugular venous pressure, diffuse rales, and an early 2/6 systolic murmur loudest at the cardiac apex. Which of the following is most likely to account for his acute decompensation?
Click here to view larger image.
A. Ventricular septal rupture
B. Severe mitral stenosis
C. Hyperdynamic ventricle
D. Acute mitral regurgitation
E. Pericardial effusion
Answer: D. Acute mitral regurgitation.
Explanation:
The EKG illustrates an inferior STEMI. The history of failure to revascularize his right coronary artery followed by acute onset heart failure 48 hours after presentation, as well his examination is most consistent with acute onset mitral regurgitation, secondary to papillary muscle rupture. The regurgitation into a noncompliant left atrium results in a soft early systolic murmur heard best near the cardiac apex. Ventricular septal rupture causes a holosystolic murmur that is loud and associated with a left sternal border thrill. None of the other options can account for the scenario described.
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