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Physician Board Certification

ABIM Interventional Cardiology Initial Certification Examination Practice Test

Interventional cardiology applies catheter-based techniques to diagnose and treat coronary and peripheral vascular disease, structural heart conditions, and device-related problems. The practice questions sample procedural judgment in angiography and percutaneous coronary intervention, vascular access complications, lesion preparation, transcatheter valve procedures, antithrombotic therapy, and pacing-device interpretation.

Exam overview

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

About the ABIM Interventional Cardiology Initial Certification Examination Exam

Interventional decisions require matching anatomy, hemodynamics, imaging, and clinical urgency to an appropriate procedure. Cases may call for recognizing complications such as coronary no-reflow, access-site bleeding, or compartment syndrome; selecting lesion-modification strategies for calcified coronary disease; and interpreting pressure gradients in peripheral stenoses. Structural-heart scenarios test assessment of aortic stenosis severity and mitral regurgitation during transcatheter treatment. Other questions connect acute coronary syndrome management with P2Y12 inhibition and evaluate device function from ECG findings, including failure to capture. Use this range to practice identifying the immediate threat, choosing the next action, and understanding how procedural findings change treatment decisions.

Sample Practice Questions

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

Question 1

During coronary angiography, a patient has a brief episode of ventricular fibrillation. What is the immediate treatment?

  1. APrompt unsynchronized defibrillation
  2. BSynchronized cardioversion at a low energy setting
  3. CObservation until spontaneous conversion
  4. DAdenosine administered as a rapid intravenous bolus
Show answerCorrect answer: A

Ventricular fibrillation is a pulseless shockable rhythm and requires immediate unsynchronized defibrillation and resuscitation. Synchronized cardioversion is used for selected organized tachyarrhythmias, not ventricular fibrillation.

Question 2

During transradial coronary angiography, a patient develops forearm pain and swelling, and the forearm feels tense. What is the most important immediate action?

  1. AAssess urgently for compartment syndrome and obtain immediate surgical evaluation if suspected
  2. BApply a tight circumferential compression band and discharge the patient
  3. CWait several hours because forearm swelling is always benign after radial access
  4. DAdminister a vasodilator and continue the procedure without reassessment
Show answerCorrect answer: A

Painful, tense swelling after radial access can indicate a forearm hematoma with evolving compartment syndrome. Prompt assessment and urgent surgical consultation are important because delayed decompression can cause permanent injury.

Question 3

A patient with symptomatic peripheral artery disease has a short, focal iliac artery stenosis with a substantial pressure gradient. Which endovascular treatment is commonly used to improve flow across this lesion?

  1. ABalloon angioplasty, with stent placement when indicated
  2. BTranscatheter closure with an atrial septal occluder
  3. CCoronary rotational atherectomy as sole therapy
  4. DPulmonary artery balloon valvuloplasty
Show answerCorrect answer: A

Endovascular balloon angioplasty is a standard treatment for suitable focal iliac stenoses, and stenting is commonly used for recoil, residual stenosis, or flow-limiting dissection. The other listed devices or procedures are intended for different vascular or structural conditions.

Question 4

A patient with an acute coronary syndrome is found to have a heavily calcified lesion that cannot be crossed with a standard noncompliant balloon. Which approach is most appropriate to modify the lesion before stenting?

  1. AUse an appropriate calcium-modification device, such as rotational atherectomy, if anatomy and expertise permit
  2. BDeploy a stent directly without lesion preparation
  3. CUse a thrombus aspiration catheter as the primary calcium-modification tool
  4. DAbandon intravascular imaging because calcification prevents useful assessment
Show answerCorrect answer: A

Severe calcification that prevents balloon crossing or adequate expansion may require plaque modification. Rotational atherectomy is one option in selected lesions; device choice depends on anatomy, clinical context, and operator expertise.

Question 5

A patient with severe symptomatic aortic stenosis is being considered for transcatheter valve replacement. Echocardiography shows a low gradient despite a small calculated valve area and reduced left ventricular ejection fraction. Which additional finding would support true severe, rather than pseudo-severe, aortic stenosis during low-dose dobutamine stress echocardiography?

  1. AValve area increases substantially as flow increases
  2. BValve area remains small while the transvalvular gradient rises with increased flow
  3. CThe transvalvular gradient falls while stroke volume increases
  4. DMitral regurgitation becomes moderate
Show answerCorrect answer: B

In low-flow, low-gradient aortic stenosis with reduced ejection fraction, dobutamine stress echocardiography can distinguish true severe from pseudo-severe disease. True severe stenosis is supported when increased flow raises the gradient while the valve area remains small; pseudo-severe stenosis typically shows a meaningful increase in valve area.

Question 6

A patient with a non-ST-elevation myocardial infarction has a severe culprit lesion and undergoes PCI. Which antiplatelet drug is a P2Y12 receptor inhibitor commonly used as part of dual antiplatelet therapy after acute coronary syndrome PCI?

  1. AClopidogrel
  2. BApixaban
  3. CWarfarin
  4. DDipyridamole
Show answerCorrect answer: A

Clopidogrel inhibits the platelet P2Y12 receptor and is one of the established agents used with aspirin as dual antiplatelet therapy after PCI. Apixaban and warfarin are anticoagulants, while dipyridamole is not a standard substitute for a P2Y12 inhibitor in this setting.

Question 7

A patient with an acute STEMI undergoes primary PCI through femoral access. After the procedure, the patient develops flank pain, hypotension, and a falling hemoglobin level without visible access-site bleeding. Which complication should be suspected?

  1. ARetroperitoneal hemorrhage
  2. BRadial artery occlusion
  3. CCholesterol embolization
  4. DVasovagal reaction
Show answerCorrect answer: A

Femoral access can cause bleeding into the retroperitoneal space, which may present with hypotension, flank or back pain, and a hemoglobin decrease despite no obvious groin hematoma. Urgent assessment and management of suspected hemorrhage are required.

How to use this practice test

Access the free practice set to work through up to 20 randomly selected questions from the 50-question bank in a session. After submitting, review the results to identify which procedural decisions or cardiovascular concepts need further attention.

Preparation tips

  • For angiography and PCI scenarios, distinguish immediate threats such as ventricular fibrillation, concealed retroperitoneal bleeding, and a tense swollen forearm; identify the first safety action for each.
  • Review coronary lesion-preparation options and relate calcification, balloon crossability, and intravascular imaging findings to the choice of technique before stenting.
  • Practice interpreting aortic stenosis measurements in low-flow, low-gradient settings, including how contractile response and valve-area changes during dobutamine stress help distinguish true severe disease.
  • Connect acute coronary syndrome PCI and prior stent thrombosis scenarios with P2Y12 inhibitor selection and the rationale for antiplatelet therapy.
  • Use ECG and procedural imaging findings to assess pacemaker capture and residual mitral regurgitation before deciding on further device or clip intervention.
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