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ABIM Cardiovascular Disease Practice Tests & Exam Prep Questions - Free Test


Our free ABIM Cardiovascular Disease (CARDDIS) Practice Test was created by experienced educators who designed them to align with the official American Board of Internal Medicine content guidelines. They were built to accurately mirror the real exam's structure, coverage of topics, difficulty, and types of questions.

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ABIM Cardiovascular Disease sample question

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A 68-year-old man is evaluated in the preoperative clinic 3 days before planned elective colectomy for colon cancer. Which of the following is the most appropriate next step in management?

Reason for evaluation

  • Preoperative clearance for elective colectomy

Past Medical History

  • Ischemic cardiomyopathy with prior MI 5 years ago
  • Hypertension
  • Chronic kidney disease stage 3 (baseline creatinine 1.6 mg/dL)

Current Medications

  • Metoprolol 50 mg twice daily
  • Lisinopril 10 mg daily
  • Aspirin 81 mg daily
  • Furosemide 20 mg daily

Vital Signs

  • BP 100/60 mm Hg
  • HR 98 bpm
  • RR 18 breaths/min
  • SpO2 96% on room air

Physical Examination

  • JVP 9 cm H2O with blunted y descent
  • Distant heart sounds
  • No peripheral edema

Laboratory Results

  • Creatinine 1.8 mg/dL
  • Troponin I 0.03 ng/mL (reference <0.04)
  • BNP 420 pg/mL (elevated)

ECG Findings

  • Low-voltage QRS complexes
  • Electrical alternans present

Echocardiography Findings

  • Transthoracic echo: large circumferential pericardial effusion measuring 25 mm posteriorly
  • Right atrial diastolic collapse and early right ventricular diastolic indentation
  • Respiratory variation of transvalvular Doppler velocities consistent with tamponade physiology
  • Left ventricular ejection fraction 35%

Imaging Findings

  • Chest radiograph: enlarged cardiac silhouette without pulmonary edema
Correct Answer:
Perform urgent percutaneous echocardiography-guided pericardiocentesis to relieve tamponade physiology before elective noncardiac surgery.

why rrect: this patient has clinical and echocardiographic evidence of cardiac tamponade (hypotension relative to baseline, elevated jvp, distant heart sounds, low-voltage qrs, electrical alternans, large circumferential effusion, right atrial diastolic collapse, rv diastolic indentation, and respiratory variation of doppler velocities). he is scheduled for elective major noncardiac surgery; proceeding to anesthesia and positive-pressure ventilation without first relieving tamponade risks cardiovascular collapse. urgent percutaneous echocardiography-guided pericardiocentesis is the recommended immediate intervention to relieve intrapericardial pressure, stabilize hemodynamics, and permit safe subsequent noncardiac surgery. percutaneous drainage is less invasive, can be performed promptly with echo guidance, and often provides sufficient decompression in hemodynamically significant effusions.

why the other answers are incorrect:

a: proceeding to elective surgery with monitoring is unsafe because tamponade physiology predisposes to rapid decompensation during induction of anesthesia and positive-pressure ventilation; waiting for intraoperative instability is hazardous.

c: a surgical pericardial window is appropriate in some patients with recurrent hemorrhagic effusion or when tissue diagnosis is prioritized, but it is more invasive and generally not required as the first urgent step to stabilize tamponade before urgent noncardiac surgery; percutaneous drainage is faster and effective for initial decompression.

d: anti-inflammatory therapy with nsaids and colchicine targets inflammatory pericarditis and is not appropriate when there is echocardiographic and clinical tamponade that requires immediate drainage; delaying surgery for medical therapy risks hemodynamic collapse.

in summary, the presence of tamponade physiology mandates urgent pericardial drainage prior to elective major noncardiac surgery. after stabilization, coordinate timing of colectomy with oncology and surgery, and evaluate the effusion etiology with fluid analysis and targeted testing as indicated.