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Physician Board Certification

ABIM Adult Congenital Heart Disease Initial Certification Examination Practice Test

Adult congenital heart disease care involves assessing residual lesions, late complications, and changes in cardiac function after childhood diagnosis or repair. The practice bank uses cases involving atrial and ventricular septal defects, coarctation, tetralogy of Fallot, Ebstein anomaly, and transposition of the great arteries, with attention to shunting, cyanosis, exercise symptoms, rhythm concerns, and pregnancy planning.

Exam overview

Exam providerAmerican Board of Internal Medicine
Exam codeNot listed
CategoryPhysician Board Certification

About the ABIM Adult Congenital Heart Disease Initial Certification Examination Exam

Clinical decisions in adult congenital cardiology often require linking anatomy and prior procedures to current physiology. Scenarios may ask you to assess pulmonary vascular disease before considering closure of a shunt, recognize complications that can persist after repair, and identify structural causes of cyanosis or exercise limitation. Follow-up reasoning includes surveillance for aortic complications after coarctation repair and evaluation of systemic right ventricular function or associated lesions after atrial-switch repair. Other relevant tasks include selecting ambulatory rhythm monitoring for intermittent palpitations, counseling about pregnancy when residual valve disease is present, and applying endocarditis prevention principles to procedures and routine oral health. These cases emphasize interpreting clinical findings in the context of congenital anatomy and repair history rather than treating each symptom as an isolated adult cardiac problem.

Sample Practice Questions

Review a selection from this exam's published US Practice Tests practice bank.

Question 1

An adult with an unrepaired large ventricular septal defect has pulmonary arterial hypertension and bidirectional shunting. What is the central concern when considering defect closure?

  1. AClosure may be harmful if pulmonary vascular disease is irreversible and right-to-left shunting is established
  2. BClosure is mandatory because any ventricular septal defect causes left ventricular failure
  3. CClosure will reliably reverse severe fixed pulmonary vascular disease
  4. DThe direction of shunting has no relevance to closure decisions
Show answerCorrect answer: A

With advanced, potentially irreversible pulmonary vascular disease, a ventricular septal defect may serve as a pressure-relief pathway for the right ventricle. Closing it in the presence of established right-to-left shunting can precipitate severe right ventricular failure; operability requires specialist hemodynamic assessment.

Question 2

A 28-year-old adult with a repaired secundum atrial septal defect has normal oxygen saturation and no significant residual shunt. Which long-term complication remains important to assess for during follow-up?

  1. AAtrial arrhythmias
  2. BProgressive pulmonary valve stenosis
  3. CCoronary artery dissection
  4. DAortic coarctation
Show answerCorrect answer: A

Atrial remodeling from a longstanding atrial septal defect can predispose to atrial flutter or fibrillation, and arrhythmia risk may persist after closure. Follow-up should include assessment for symptoms and rhythm abnormalities.

Question 3

A 30-year-old adult with a history of repaired coarctation of the aorta has normal arm and leg pulses at rest. Which surveillance issue remains important?

  1. ASystemic hypertension and recurrent or residual aortic narrowing
  2. BRoutine screening for mitral stenosis
  3. CAnnual measurement of pulmonary artery pressure by catheterization
  4. DLifelong anticoagulation solely because of the repair
Show answerCorrect answer: A

Hypertension and residual or recurrent coarctation can occur after repair, sometimes despite reassuring resting examination. Blood pressure assessment, including consideration of ambulatory monitoring, and aortic imaging are important components of follow-up.

Question 4

An adult with Ebstein anomaly has worsening cyanosis and exertional symptoms. Which anatomic feature can allow systemic venous blood to bypass the lungs and contribute to cyanosis?

  1. AAn interatrial communication with right-to-left shunting
  2. BA restrictive left-to-right patent ductus arteriosus
  3. CA closed ventricular septum with no intracardiac shunt
  4. DAortic valve regurgitation without an atrial communication
Show answerCorrect answer: A

Ebstein anomaly is often associated with an atrial-level communication, such as a patent foramen ovale or atrial septal defect. Elevated right atrial pressure can promote right-to-left shunting through it, causing systemic desaturation and cyanosis.

Question 5

A 37-year-old adult with a prosthetic valve placed during congenital heart surgery is scheduled for an invasive dental procedure involving gingival manipulation. Which general preventive approach is appropriate?

  1. AConsider guideline-indicated antibiotic prophylaxis because a prosthetic cardiac valve is a high-risk condition
  2. BUse prophylaxis only if the patient has a fever on the day of the procedure
  3. CAvoid all dental care permanently
  4. DReplace the prosthetic valve before dental treatment
Show answerCorrect answer: A

A prosthetic cardiac valve is a high-risk condition for which infective endocarditis prophylaxis is generally recommended for specified dental procedures that manipulate gingival tissue, the periapical region, or oral mucosa. The clinician should verify current guidance, allergies, and the exact procedure.

Question 6

A 34-year-old adult with a previously unrecognized atrial septal defect has a fixed split second heart sound. Which hemodynamic mechanism best explains this finding?

  1. ADelayed and relatively fixed variation in pulmonic valve closure because right-sided filling remains increased
  2. BEarly aortic valve closure caused by reduced left ventricular preload
  3. CRespiratory variation in mitral valve opening caused by elevated left atrial pressure
  4. DDelayed tricuspid valve closure caused by intermittent right-to-left shunting
Show answerCorrect answer: A

A left-to-right atrial shunt increases right-sided volume loading and delays pulmonic valve closure. Because the shunt tends to buffer respiratory changes in right ventricular filling, the splitting of S2 is characteristically wide and relatively fixed.

Question 7

An adult with an atrial-switch repair for d-transposition of the great arteries has progressive exercise intolerance. Which structural problem is particularly important to evaluate in addition to systemic right ventricular function?

  1. ABaffle obstruction or leakage
  2. BPulmonary valve atresia acquired after surgery
  3. CAortic coarctation caused by the atrial baffle
  4. DRupture of the interatrial septum as an expected late finding
Show answerCorrect answer: A

Atrial-switch repairs create systemic and pulmonary venous pathways using baffles. Baffle obstruction or leakage can cause exercise limitation, abnormal venous return, or desaturation and should be considered in symptomatic patients.

How to use this practice test

Access is free. A session presents up to 20 random questions from the 50-question practice bank, allowing focused work on congenital anatomy, late sequelae, surveillance, and clinical decisions. Results appear after the session so you can identify which concepts need another pass.

Preparation tips

  • For shunt scenarios, connect defect size and direction of flow with pulmonary vascular resistance and the risks of closure in pulmonary arterial hypertension.
  • Compare long-term surveillance needs after repaired coarctation, atrial septal defect, and tetralogy of Fallot, including aortic, residual shunt, and rhythm concerns.
  • Review how Ebstein anomaly can create right-to-left atrial-level flow, and how atrial-switch anatomy changes assessment of transposition-related exercise intolerance.
  • Practice matching intermittent palpitations with ambulatory ECG monitoring, and assess residual valve disease and hemodynamic status when considering pregnancy.
  • Distinguish endocarditis antibiotic-prophylaxis indications for selected procedures from oral-health measures applicable to all patients.
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