ABFM Exam 2024 Study Guide 210 Questions with

ABFM Exam 2024 Study Guide 210 Questions with Complete Solutions Indications for preop CXR - Correct 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? - Correct Answer Cervical spine film (to eval for atlanto-axial instability)

ChADs2 -VASc criteria & scoring - Correct 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

How soon is troponin detected after ACS?How long is it elevated for? - Correct 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? - Correct Answer Nitroglycerin, benzos **Do NOT give beta blockers to avoid unopposed alpha stimulation 1 / 4

Management of NSTEMI (NSTE-ACS), low and high risk strategies? - Correct Answer Lower Risk

Patients (Ischemia guided strategy):

• ASA 325mg
• P2Y12i (Clopidogrel)
• Anticoag (SQH)

Higher Risk Patients (Early Invasive strategy):

On the way to the CATH lab...

1. ASA 325

• P2Y12i (Clopidogrel)
• Anticoag (SQH)
• Consider glycoprotein IIa/IIIbi (abciximab)

When do we consider higher risk strategy for treatment of NSTEMI (NSTE-ACS)? - Correct 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? - Correct Answer 1. Reperfusion (cath lab) ASAP! - w/i 12 hrs!!

• PCI preferred
• 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? - Correct Answer Ant

MI:

-LAD

-V1-V4

Lat MI:

-circumflex

-V5-V6 2 / 4

Inferior MI:

-RCA

-II, III, AVF

How long is DAPT needed for: 1) Acute ACS?

2) scheduled cath w/ BMS vs DES? - Correct 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? - Correct Answer 1. Tertiary prevention for known CVD: ACS, PVD, prior MI/angina/stroke/TiA, prior PCI

• Secondary prevention in familial HLD w/ LDL 190+
• 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. - Correct 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) 3 / 4

When is coronary artery calcium score useful? - Correct 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

• Important meds in MI? - Correct Answer 1. ACEi

2. BB

• Statin

4. ASA

• Anticoag (LVX or SQH)
• Important meds in HF (that decrease mortality)? - Correct Answer 1. ACEi or ARBs
• BB - metoprolol succinate, carvedilol, and bisoprolol ONLY

*start when stable

• Aldosterone antags - if GFR > 30
• 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? - Correct Answer Hydralazine + isosorbide dinitrate What common drugs do we avoid in HFrEF? - Correct Answer 1. NSAIDs

• non-dihydropyridine calcium channel blockers (verapamil, diltiazem)

*think "non-dihydro - neg inotropes!"

• Most antiarrhythmics
• TZDs (pioglitazone) - d/t water retention
• / 4