Cardiology Boards 2024

[munnadoc]

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We had two identical ECGs of pericardial effusion. One was a 60 yr old something and another was a 40 yr old something. Exact same ECG with low voltage everywhere except V2 and alternans in III

Speaking of ECGs, since I’m thinking about it… the ECG of the 18 year old who drowned; I put hypothermia because it was brady and looked like big osborn waves across the precordial leads (and not just V2) but one of my EP colleagues said he coded Brugada (speaking of unhelpful scenario; either could be correct). Anyone care to chime in?

I went back and forth on this one ended up stating hypothermia. It looked brugadaish only on V3. Also how many normal ecgs did yall get

 

[cardioblue]

We had two identical ECGs of pericardial effusion. One was a 60 yr old something and another was a 40 yr old something. Exact same ECG with low voltage everywhere except V2 and alternans in III

Speaking of ECGs, since I’m thinking about it… the ECG of the 18 year old who drowned; I put hypothermia because it was brady and looked like big osborn waves across the precordial leads (and not just V2) but one of my EP colleagues said he coded Brugada (speaking of unhelpful scenario; either could be correct). Anyone care to chime in?

I also did same as your friend did. Looked tented in anterior pericardial leads. Who knows🤷‍♂️

 

[Albein]

We had two identical ECGs of pericardial effusion. One was a 60 yr old something and another was a 40 yr old something. Exact same ECG with low voltage everywhere except V2 and alternans in III

Speaking of ECGs, since I’m thinking about it… the ECG of the 18 year old who drowned; I put hypothermia because it was brady and looked like big osborn waves across the precordial leads (and not just V2) but one of my EP colleagues said he coded Brugada (speaking of unhelpful scenario; either could be correct). Anyone care to chime in?

I also did same as your friend did. Looked tented in anterior pericardial leads. Who knows🤷‍♂️

same, i think i put Brugada as well. welp, missed the two effusion ones, dont think i coded anything remotely close to effusion

 

[cardioblue]

We had two identical ECGs of pericardial effusion. One was a 60 yr old something and another was a 40 yr old something. Exact same ECG with low voltage everywhere except V2 and alternans in III

Speaking of ECGs, since I’m thinking about it… the ECG of the 18 year old who drowned; I put hypothermia because it was brady and looked like big osborn waves across the precordial leads (and not just V2) but one of my EP colleagues said he coded Brugada (speaking of unhelpful scenario; either could be correct). Anyone care to chime in?

Same exact same ekg . Copy paste ekg.

 

[PinkPlumpy]

Same exact same ekg . Copy paste ekg

I wonder if there is were multiple versions because I remember coding the same thing but not the same exact ecg. I know in past years there have been different versions. On last year’s test there was a vascular angiogram that couldn’t be coded I think but not everyone got that question

 

[cardioblue]

I wonder if there is were multiple versions because I remember coding the same thing but not the same exact ecg. I know in past years there have been different versions. On last year’s test there was a vascular angiogram that couldn’t be coded I think but not everyone got that question

I think that’s the case. I heard about vascular angiogram and not all people got it.

 

[cardiologytexas]

I put hypothermia because the Osborne waves were throughout in all leads. Brugada is mainly on V1 and V2. That was my reasoning… but idk.



I didn’t know how to code the prosthetic valve. The aortic looked ok but the mitral had DVI 2.5?

 

[Kryptodoc1938]

I am lost for options too this is my third attempt at this test. Did ACCSAP, Mayo Videos, Okeefe and ECG source. Not sure how what are other resources are left. Also wondering what would be the worst case scenario if we are not ABIM certified??

Eventually jobs will not hire you, I am on multiple attempts and left my last job as they require certification after a certain time. I’m hopeful this time was the charm.

 

[cardiologytexas]

The issue is that after 7 years you’re not board eligible anymore. And then they won’t hire you and to be able to sit for boards you’ll have to do an extra year of fellowship.

Hope we all pass. If we don’t I recommend you do boardsvitals qbank. It’s more like these questions, ACCsap doesn’t prepare you well for this exam, it just goes over the high yield material in my opinion.

 

[Kryptodoc1938]

Whoever does pass, i implore that you put your thoughts here on Day #2. I am so tired of trying this exam. I have actually passed the written portion on multiple occasions and can’t figure out how to code these last few things. Doesn’t help that they can literally grab any ekg or any echo or any cath from the last thirty years either. If I do have to take it again, I’d really appreciate all thoughts. Thank you.

 

[cardiologist4life]

The issue is that after 7 years you’re not board eligible anymore. And then they won’t hire you and to be able to sit for boards you’ll have to do an extra year of fellowship.

Hope we all pass. If we don’t I recommend you do boardsvitals qbank. It’s more like these questions, ACCsap doesn’t prepare you well for this exam, it just goes over the high yield material in my opinion.

We need to inform the leadership of the new board that is being created about the horrible job ABIM is doing with the initial certification exam. They are focused more on recertification because they all have already passed the initial exam many decades ago but they cannot forget about how painful and stressful it can be. The Day 2 the way it is set up currently is unacceptable. This impacts people's careers and lives. It impacts patients.

Get rid of the 7 year requirement (and if they keep it create an actual pathway to restore eligibility that is doable and realistic, no general fellowship will take you just for 1 year so that you can restore eligibility), and also create a new initial certification exam that actually tests day to day high yield knowledge that simulates real world practice of cardiology (actual echo study with full clinical context). 2 second clips with no real clinical context shouldn't be determining people's future.

 

[cardioblue]

We need to inform the leadership of the new board that is being created about the horrible job ABIM is doing with the initial certification exam. They are focused more on recertification because they all have already passed the initial exam many decades ago but they cannot forget about how painful and stressful it can be. This impacts people's careers and lives.

Get rid of the 7 year requirement (and if they keep it create an actual pathway to restore eligibility that is doable and realistic, no general fellowship will take you just for 1 year so that you can restore eligibility), and also create a new initial certification exam that actually tests day to day high yield knowledge that simulates real world practice of cardiology (actual echo study with full clinical context). 2 second clips with no real clinical context shouldn't be determining people's future.

We should get rid of ABIM. So stupid exam. EKG most you cant magnify , and some pictures are so blurry.
I think there is already a purposal submitted to create a new cardiovascular board . Purposal was already submitted January 2024

 

[cardiologist4life]

We should get rid of ABIM. So stupid exam. EKG most you cant magnify , and some pictures are so blurry.
I think there is already a purposal submitted to create a new cardiovascular board . Purposal was already submitted January 2024

Yes but if you look at their website it seems their initial focus is on recertification. Not initial certification. Recertification doesn't have a Day 2. Of course if they become the new board they will take over initial certification but who knows when that will happen. They likely will advise people to still take initial certification with ABIM during the transition period.

 

[cardioblue]

Yes but if you look at their website it seems their initial focus is on recertification. Not initial certification. Recertification doesn't have a Day 2. Of course if they become the new board they will take over initial certification but who knows when that will happen. They advise people to still take initial certification with ABIM.

That’s sad

 

[cardiologist4life]

The issue is that after 7 years you’re not board eligible anymore. And then they won’t hire you and to be able to sit for boards you’ll have to do an extra year of fellowship.

Hope we all pass. If we don’t I recommend you do boardsvitals qbank. It’s more like these questions, ACCsap doesn’t prepare you well for this exam, it just goes over the high yield material in my opinion.

Nothing prepares you for this exam because every question, every image, every poor quality ECG is not presented as the standard textbook high yield question the way they present it to you in ACCSAP or Mayo Clinic. ABIM purposefully makes it a bit ambiguous or puts a twist on it, every image will be unclear or off axis or poorly magnified to confuse you or trip you with poor wording or poor option choices and unclear diagnosis. The 3-4 word clinical descriptions are not there to help, there more there to intentionally confuse you. I get it for maybe a few items but not every question item should be presented that way. This is suppose to be a standardized test. Ideal world conditions should be used to assess basic competency.

 

[cardioblue]

Nothing prepares you for this exam because every question, every image, every poor quality ECG is not presented as the standard textbook high yield question they way they present it to you in ACCSAP or Mayo Clinic. ABIM purposefully makes it a bit ambiguous or puts a twist on it to confuse you or trip you with poor wording or poor option choices and unclear diagnosis. I get it for maybe a few items but not every question item should be presented that way. This is suppose to be a standardized test. Ideal world conditions should be used to assess basic competency.

Those ekgs, where do you even get those. O’Keefe ekg or ekgsource. I did all okeffe , ekg source and still had no idea and now scared will fail in ekg.

 

[rushmore4]

It’s ridiculous, there was one echo case I still can’t figure out what view I was looking at since there was nothing clear on the image.

Same with EKG… I felt like the same pathology was repeating over and over or I was just coding it wrong.

I still feel the worse was day one, some questions I wouldn’t be able to answer even if I had Internet access. Then missed a few freebies out of exhaustion.. the first block felt easy, 3rd and 4th massacre. So much PPM interpretation.

Agreed. Particularly the last 2 sections on day 1 particularly section 4. In general, timing wasn’t an issue but that was a section a few more minutes may have helped to think about a bit more. A good amount of esoteric things that I don’t think is in the least bit relevant for a general cardiologist to know.

 

[rushmore4]

We had two identical ECGs of pericardial effusion. One was a 60 yr old something and another was a 40 yr old something. Exact same ECG with low voltage everywhere except V2 and alternans in III

Speaking of ECGs, since I’m thinking about it… the ECG of the 18 year old who drowned; I put hypothermia because it was brady and looked like big osborn waves across the precordial leads (and not just V2) but one of my EP colleagues said he coded Brugada (speaking of unhelpful scenario; either could be correct). Anyone care to chime in?

it was brugada from different people i spoke too. I put that as well.

 

[cardioblue]

it was brugada from different people i spoke too. I put that as well.

I hope so .

 

[rushmore4]

same, i think i put Brugada as well. welp, missed the two effusion ones, dont think i coded anything remotely close to effusion

I think I put acute pericarditis rather than effusion.

 

[cardiologytexas]

Did anyone get a stress echo with ischemia?
I put anterolateral hypok and then the EF looked sluggish in recovery.

 

[rushmore4]

Did anyone get a stress echo with ischemia?
I put anterolateral hypok and then the EF looked sluggish in recovery.

yes i think i only coded anterior but yes. this is my issue with coding section particularly the echos and angiograms. there is no guidelines on what should and shouldn’t be coded. there needs to be a standard so you aren’t penalized for over or undercoding. i felt like damned if i do…damned if i don’t.

 

[cardioblue]

yes i think i only coded anterior but yes. this is my issue with coding section particularly the echos and angiograms. there is no guidelines on what should and shouldn’t be coded. there needs to be a standard so you aren’t penalized for over or undercoding. i felt like damned if i do…damned if i don’t.

I coded anterior and septal ischemia I think.

 

[rushmore4]

I coded anterior and septal I think.

i can’t remember if i took septal out. at one point i coded it and then may have removed it but i do remember the short axis was convincing

 

[cardioblue]

i can’t remember if i took septal out. at one point i coded it and then may have removed it but i do remember the short axis was convincing

Yeah on short axis and I think one more view. 🤷‍♂️

 

[MRmiyagi]

We had two identical ECGs of pericardial effusion. One was a 60 yr old something and another was a 40 yr old something. Exact same ECG with low voltage everywhere except V2 and alternans in III

Speaking of ECGs, since I’m thinking about it… the ECG of the 18 year old who drowned; I put hypothermia because it was brady and looked like big osborn waves across the precordial leads (and not just V2) but one of my EP colleagues said he coded Brugada (speaking of unhelpful scenario; either could be correct). Anyone care to chime in?

I did brugada , looked like Itype 2

 

[MRmiyagi]

Did anyone get a stress echo with ischemia?
I put anterolateral hypok and then the EF looked sluggish in recovery.

Same but I didn't know how to code it exactly

 

[MRmiyagi]

I had a LIMA to LAD patent,but wasn't sure if I just code the LAD that it has a graft, and nothing else because the graft was normal and I didn't see any native disease retro grade
Also anomalus LM but I also coded LAD and lcx

 

[MRmiyagi]

I had 2 similar EKGs but changed one answer because I didn't think it would be test twice 😔

The coding is killer
Aflutter do you also put 2-1 ?

 

[MRmiyagi]

I put hypothermia because the Osborne waves were throughout in all leads. Brugada is mainly on V1 and V2. That was my reasoning… but idk.



I didn’t know how to code the prosthetic valve. The aortic looked ok but the mitral had DVI 2.5?

Yes and the prosthetics were mitral and aortic with the same scoring sheet ,no idea how to code

 

[cardioblue]

I had 2 similar EKGs but changed one answer because I didn't think it would be test twice 😔

The coding is killer
Aflutter do you also put 2-1 ?

Yes

I had a LIMA to LAD patent,but wasn't sure if I just code the LAD that it has a graft, and nothing else because the graft was normal and I didn't see any native

Same but I didn't know how to code it exactly

i coded ischemia on stress echo
disease retro grade
Also anomalus LM but I also coded LAD and

 

[cardioblue]

I had a LIMA to LAD patent,but wasn't sure if I just code the LAD that it has a graft, and nothing else because the graft was normal and I didn't see any native disease retro grade
Also anomalus LM but I also coded LAD and lcx

I think mine were different. I only got 2 graft questions one avg to rca occluded other patent avg to lcx .

 

[cardioblue]

I think mine were different. I only got 2 graft questions one avg to rca occluded other patent avg to lcx .

I heard there are 2,3 different groups not everyone get same questions

 

[munnadoc]

What did you guys code for ecg shown after given interleukin 2 i was like wtf

 

[MRmiyagi]

What did you guys code for ecg shown after given interleukin 2 i was like wtf

i put svt

 

[Kryptodoc1938]

I had 2 similar EKGs but changed one answer because I didn't think it would be test twice 😔

The coding is killer
Aflutter do you also put 2-1 ?

Yes 2:1

 

[Kryptodoc1938]

i put svt

Also svt here

 

[Kryptodoc1938]

What a tough exam, especially day 2 given the coding ambiguity.

Does anyone know if there are experimental questions on day 2 like there are on day 1?

The website says 10 experimental questions that they don’t count towards the end score.

 

[MRmiyagi]

there was a ekg w/ a lady with breast cancer and dyspnea - i had no idea what it was i put hypercalcemia

 

[rushmore4]

The website says 10 experimental questions that they don’t count towards the end score. I really hope any of those ten you get right do count towards your score though.

That’s almost never the case. They are experimental so they don’t count whether you get them right or wrong.

 

[cardioblue]

That’s almost never the case. They are experimental so they don’t count whether you get them right or wrong.

Then let’s hope we only screw up experimental questions.

 

[Kryptodoc1938]

That’s almost never the case. They are experimental so they don’t count whether you get them right or wrong.

Sounds right. That is fine too

 

[yelloworange123]

Ugh, for the stress echo I overthought it so much I changed my answer to viability of the inferior and septal walls because they seemed to improve then go back down instead of the obvious hypokinesis of the anterior and lateral. And I think for IL2 I thought it was sinus tachycardia because we could see p waves upright across the leads.

Anyone remember the older woman who looked like she had first degree, LVH, and sensing issues with her pacemaker?

 

[jospeed]

I put Atach, almost did svt but you could see the p waves unless it was very long RP. Didn’t think it was flutter. Mastectomy I almost did effusion but it wasn’t all low voltage, so I did normal 🤦‍♂️ but who knows.
Did anyone terminate pregnancy on day 1. Didn’t even know what syndrome they were talking about

 

[dje91090]

I put Sinus tach for the IL2 questions. I also put long QT. The P waves were very present and it was before the QRS.
For the breast cancer patient I put hypercalcemia.
The a flutter I believe you also need to code the 2:1.
I also only had two grafts, one was a vein to the circ system (coded occluded circ also), but that one was so annoying because it also had collaterals and you couldn’t code anything else or where it was going. The other graft was just a stump so I coded occluded graft but I did NOT code where it was grafted to (yes it came off the right seemingly but who knows if it’s a graft to the RPDA or LPDA or jump graft or whatever; because you have no idea where it’s going, I only coded the graft). I did not have any LIMA questions. The thing that annoys me is when they give you a stent with like a 99% lesion, do you code it as occluded or patent?? We had one in the LAD on the exam.
The ECG with the sensing issues was a KILLER. To me, that one definitely had a sinus rhythm (I believe it may have been bradycardia), however, the PR intervals to the non-paced beats were not 100% constant and they were long (like 450-550 ms) so I didn’t want to code that there was a heart block because you legitimately can’t determine it. So I coded it as junctional escape complexes. There was also LVH on that one.

I had a LIMA to LAD patent,but wasn't sure if I just code the LAD that it has a graft, and nothing else because the graft was normal and I didn't see any native disease retro grade
Also anomalus LM but I also coded LAD and lcx

I had 2 similar EKGs but changed one answer because I didn't think it would be test twice 😔

The coding is killer
Aflutter do you also put 2-1 ?

I think mine were different. I only got 2 graft questions one avg to rca occluded other patent avg to lcx .

i put svt

Ugh, for the stress echo I overthought it so much I changed my answer to viability of the inferior and septal walls because they seemed to improve then go back down instead of the obvious hypokinesis of the anterior and lateral. And I think for IL2 I thought it was sinus tachycardia because we could see p waves upright across the leads.

Anyone remember the older woman who looked like she had first degree, LVH, and sensing issues with her pacemaker?

I put Atach, almost did svt but you could see the p waves unless it was very long RP. Didn’t think it was flutter. Mastectomy I almost did effusion but it wasn’t all low voltage, so I did normal 🤦‍♂️ but who knows.
Did anyone terminate pregnancy on day 1. Didn’t even know what syndrome they were talking about

 

[cardioblue]

I put Sinus tach for the IL2 questions. I also put long QT. The P waves were very present and it was before the QRS.
For the breast cancer patient I put hypercalcemia.
The a flutter I believe you also need to code the 2:1.
I also only had two grafts, one was a vein to the circ system (coded occluded circ also), but that one was so annoying because it also had collaterals and you couldn’t code anything else or where it was going. The other graft was just a stump so I coded occluded graft but I did NOT code where it was grafted to (yes it came off the right seemingly but who knows if it’s a graft to the RPDA or LPDA or jump graft or whatever; because you have no idea where it’s going, I only coded the graft). I did not have any LIMA questions. The thing that annoys me is when they give you a stent with like a 99% lesion, do you code it as occluded or patent?? We had one in the LAD on the exam.
The ECG with the sensing issues was a KILLER. To me, that one definitely had a sinus rhythm (I believe it may have been bradycardia), however, the PR intervals to the non-paced beats were not 100% constant and they were long (like 450-550 ms) so I didn’t want to code that there was a heart block because you legitimately can’t determine it. So I coded it as junctional escape complexes. There was also LVH on that one.

I did sinus tech too. 🤷‍♂️
Yeah I had same 2 grafts I put occluded graft to rca. But you right it’s nonsense guessing it.
I dnt even remember getting anyone with breast cancer . I just have missed it.

 

[MRmiyagi]

I put Sinus tach for the IL2 questions. I also put long QT. The P waves were very present and it was before the QRS.
For the breast cancer patient I put hypercalcemia.
The a flutter I believe you also need to code the 2:1.
I also only had two grafts, one was a vein to the circ system (coded occluded circ also), but that one was so annoying because it also had collaterals and you couldn’t code anything else or where it was going. The other graft was just a stump so I coded occluded graft but I did NOT code where it was grafted to (yes it came off the right seemingly but who knows if it’s a graft to the RPDA or LPDA or jump graft or whatever; because you have no idea where it’s going, I only coded the graft). I did not have any LIMA questions. The thing that annoys me is when they give you a stent with like a 99% lesion, do you code it as occluded or patent?? We had one in the LAD on the exam.
The ECG with the sensing issues was a KILLER. To me, that one definitely had a sinus rhythm (I believe it may have been bradycardia), however, the PR intervals to the non-paced beats were not 100% constant and they were long (like 450-550 ms) so I didn’t want to code that there was a heart block because you legitimately can’t determine it. So I coded it as junctional escape complexes. There was also LVH on that one.

yeah i had a lcx stent with severe isr i wsnt sure what to code
and i had another cath with patent stent in rca but the vessel was occluded distally
and the ectatic vessels couldnt tell if the lcx was also ectatic but of so much overlap

 

[Kryptodoc1938]

I coded the stents as patent even though they were extremely restenosed. What did other people do?

 

[TAVR4life]

Can't believe they make this exam so ambiguous and no transparency on how to code. I'm sorry the examples they gave on their website are not enough and they choose the easiest high yield examples instead of ambiguous one they give us on the exam. They need to give multiple examples to truly get a sense. This exam should not be based on coding with no guidance especially when coding options are limited and rigid and don't make sense for what they present.

 

[rushmore4]

I did sinus tech too. 🤷‍♂️

i’m pretty confident that was svt. same ekg that was in ecg source