ABIM Cardiovascular Disease Initial Certification Examination Practice Test
Cardiovascular disease practice questions address clinical reasoning across ischemic heart disease, heart failure, arrhythmias, valvular disease, congenital lesions, and pericardial conditions. Cases ask you to interpret symptoms, examination findings, ECGs, imaging, and hemodynamic data to distinguish diagnoses and select an appropriate next step.
Exam overview
About the ABIM Cardiovascular Disease Initial Certification Examination Exam
The question bank’s scenarios exercise decisions such as choosing imaging for suspected acute aortic disease, managing coronary stenosis alongside valve surgery, and treating acute pericarditis. Other cases involve interpreting pathologic Q waves, recognizing an infiltrative cardiomyopathy pattern on cardiac MRI, and responding to symptomatic complete heart block after myocardial infarction. Questions also test physiologic reasoning—for example, how a left-to-right shunt enlarges left-sided chambers or how hypertensive remodeling raises filling pressures despite preserved ejection fraction. Use these cases to practice linking clinical findings to mechanisms, assessing hemodynamic stability, and distinguishing diagnostic evaluation from immediate intervention.
Sample Practice Questions
Review a selection from this exam's published US Practice Tests practice bank.
A 68-year-old man with a history of hypertension presents with sudden severe chest pain radiating to his back. Blood pressure is 190/100 mm Hg in the right arm and 150/80 mm Hg in the left arm. Chest radiography shows a widened mediastinum. He is hemodynamically stable. What is the most appropriate diagnostic test?
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Correct answer: BIn a stable patient with suspected acute aortic syndrome, CT angiography is a rapid, widely available test that can define the extent of dissection and guide management. A substantial interarm blood pressure difference and widened mediastinum support the diagnosis but are not definitive.
A 70-year-old woman with severe symptomatic aortic stenosis is scheduled for valve replacement. Coronary angiography shows a 75% stenosis of the proximal right coronary artery. What is the usual approach to this coronary lesion when surgical valve replacement is performed?
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Correct answer: AWhen a patient undergoes surgical aortic valve replacement and has significant coronary artery disease, concomitant CABG is generally considered to address important stenoses and avoid a later separate revascularization procedure. The specific plan depends on coronary anatomy and the overall clinical context.
A 48-year-old man presents with acute pericarditic chest pain that improves when he sits forward. ECG shows diffuse concave ST-segment elevation and PR-segment depression. He is hemodynamically stable, and echocardiography shows no significant effusion. Which initial treatment is most appropriate?
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Correct answer: AFor uncomplicated acute pericarditis, an anti-inflammatory drug such as an NSAID combined with colchicine is standard initial treatment and helps reduce recurrence. The diffuse ECG pattern and positional pain support pericarditis rather than focal acute coronary occlusion; there is no indication here for surgery or anticoagulation.
A 65-year-old man with a prior myocardial infarction and preserved left ventricular ejection fraction has a resting ECG showing a pathologic Q wave in leads II, III, and aVF. Which statement best describes the meaning of this finding?
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Correct answer: APathologic Q waves can reflect electrically inactive myocardium from a prior infarction in the corresponding territory. Their presence alone does not establish that an infarction is acute; symptoms, ECG evolution, and cardiac biomarkers provide the clinical context.
A 42-year-old woman develops progressive dyspnea and peripheral edema. Echocardiography shows a small left ventricular cavity, increased wall thickness, and restrictive filling. Cardiac MRI shows diffuse subendocardial late gadolinium enhancement. Which diagnosis best explains this pattern?
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Correct answer: ACardiac amyloidosis commonly causes increased ventricular wall thickness, restrictive physiology, and diffuse subendocardial or transmural late gadolinium enhancement on cardiac MRI. The thickened appearance reflects infiltration rather than ordinary myocyte hypertrophy.
A 60-year-old man is scheduled for an elective procedure and is found to have a resting ECG with atrial fibrillation. He reports no palpitations, chest pain, or dyspnea, and his ventricular rate is 82 beats/min. Which statement best describes the initial approach to this finding?
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Correct answer: AA controlled ventricular rate does not remove the risk of atrial thromboembolism. Initial evaluation includes confirming the rhythm, assessing comorbidities and potentially reversible contributors, and estimating stroke risk to guide anticoagulation. Cardioversion and rhythm-control medication are not mandatory for every stable, asymptomatic patient.
A 58-year-old man with an inferior myocardial infarction develops hypotension and a heart rate of 38 beats/min. ECG shows complete atrioventricular block with a narrow-complex escape rhythm. He remains symptomatic after atropine. Which intervention is most appropriate next?
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Correct answer: ASymptomatic complete heart block that persists despite atropine requires prompt pacing. Transcutaneous pacing is an appropriate immediate bridge while transvenous pacing is considered if needed. Adenosine and verapamil can worsen conduction block; cardioversion is not indicated for bradycardia.
How to use this practice test
Access is free. The practice session draws up to 20 random questions from the available bank, which contains 50 published practice questions. After completing a session, review the results alongside each case’s clinical clues and decision point; use missed questions to identify concepts that need focused review.
Preparation tips
- For chest-pain cases, compare features of acute aortic syndromes, myocardial ischemia, and pericarditis, then identify which imaging or treatment decision follows from stability and ECG findings.
- Review ECG patterns and their clinical implications, including pathologic Q waves, atrial fibrillation, and complete atrioventricular block with an escape rhythm.
- Connect echocardiographic findings to physiology: practice explaining chamber enlargement from shunts and elevated filling pressures in hypertensive heart disease.
- Compare structural and myocardial disease patterns, including severe aortic stenosis and restrictive findings with diffuse subendocardial enhancement on cardiac MRI.
- For each case, state the immediate clinical risk, the most informative next test or intervention, and the finding that supports that choice.