What To Expect and Coding Tips for the ABIM CV Disease Certifying Exam

Day 1

Will include up to 240 single-best-answer multiple-choice questions, of which approximately 40 are new questions that are not counted in the overall score. Questions are generally case-based patient scenarios and require making a diagnosis, ordering and interpreting tests, recommending specific therapies, assessing risk and prognosis, and applying information from epidemiologic studies and randomized trials. Knowledge of the underlying pathophysiology is sometimes tested. Questions will often require interpretation of ECGs, telemetry or EP recordings, hemodynamics, x-rays, coronary angiograms, echocardiograms, nuclear myocardial perfusion studies, cardiac and vascular CT, cardiac MRI, and intravascular ultrasound images.

The distribution of questions on CV General Boards (ABIM CV Disease Certification Exam) by topic:

  • Arrhythmias: 15%

  • Atherosclerotic Coronary Artery Disease: 21.5%

  • Heart Failure and Cardiomyopathies: 17%

  • Valvular Disease: 15%

  • Pericardial Diseases: 4%

  • Congenital Heart Disease: 5%

  • Vascular Diseases: 6%

  • Systemic Hypertension and Hypotension: 7.5%

  • Pulmonary Circulation Disorders: 3%

  • Systemic Disorders Affecting the CV System: 4%

  • Normal CV Physiology and Anatomy: 2%

Questions/cases may also address clinical topics in:

  • Preventive and rehabilitative cardiology
  • CV disease in women
  • Geriatric CV disease
  • Preoperative assessment of noncardiac surgery
  • Postoperative CV care
  • Critical care medicine, CV surgery, and general internal medicine as encountered in the practice of Adult Cardiology (including some adolescent CV issues)

Day 2: ECG, Echo and Angiogram Interpretation/Scoring

Distribution of study types on Day 2 of CV Boards:

  • ECGs: 48%

  • Echocardiograms: 37%

  • Coronary Angiograms: 15%

Day 2 of CV Boards includes about 75 cases/questions (38 ECGs, 27 Echos, 10 angios). Day 2 (especially the ECG section) is often the portion of the test that causes the examinee to fail the CV General Boards. Special scoresheets are used for these 3 modules—ECG, Echo and Coronary Angiography. The instructions for the ABIM Cardiovascular Disease Certification Exam specify that it is important to focus on major diagnoses and key points rather than overcoding minor findings. In preparing for and taking the CV Disease Certifying Exam, one guiding principle is key: focus on what matters most. The American Board of Internal Medicine (ABIM) emphasizes that each exam question typically revolves around one or two key points. When interpreting an ECG, echo, or angiogram, don’t overcode minor, borderline or trivial findings. Your goal is to identify and prioritize the major diagnosis. Make sure to take the ABIM tutorial in the days prior to the CV Disease Certifying Exam to understand how to use the various features, enlarge the ECGs, use the calipers, etc.