BCPS EXAMS COMPILED
(LATEST UPDATE)
Unpaired T-test - ANSWER-Continuous data
2 independent samples
Paired T-test - ANSWER-Continuous data
2 paired samples
ANOVA - ANSWER-Continuous outcome data
Categorical exposure data
3+ independent variables
ANCOVA - ANSWER-Continuous outcome data
Categorical exposure data
3+ independent variables
Controls for covariates
Wilcoxon Rank Sum Test (Mann-Whitney U Test) - ANSWER-Ordinal data
2 independent samples
Wilcoxon Signed Rank Test - ANSWER-Ordinal data
2 paired samples
Chi Squared Test - ANSWER-Categorical data
2 independent samples
Values >5
Fisher's Exact Test - ANSWER-Categorical data
2 independent samples
Values <5
McNemar Test - ANSWER-Categorical data
2 paired samples
Kruskal-Wallis Test - ANSWER-Ordinal data
3+ independent samples
,Mantel-Haenszel Test - ANSWER-Categorical data
Controls for confounders
What decreases power? - ANSWER-Low sample size
Incorrect study design
Incorrect statistical test
Kendall Rank Correlation - ANSWER-Ordinal variables
Pearson Product Moment Correlation - ANSWER-Normally distributed continuous
variables
Spearman Rank Order Correlation - ANSWER-Ordinal or non-normally distributed
continuous data
Linear Regression - ANSWER-One continuous independent (exposure) variable
2+ continuous dependent (outcome) variables
Simple Logistic Regression - ANSWER-2+ categorical or continuous independent
variables
One categorical dependent variable
Non-valvular AF - ANSWER-AF in the absence of moderate or severe mitral stenosis,
mitral valve repair, or mechanical heart valves
CHADS2 vs CHADS2VASc - ANSWER-CHADS2 = CHF, HTN, Age 75+, DM, stroke (2)
CHADS2VASc = CHF, HTN, Age 75+ (2), DM, stroke (2), vascular disease, Age 65-74,
female
OAC indicated for score 2+ in men and 3+ in women
When to cardiovert AF - ANSWER-AF >48h, anticoagulate for at least 3 weeks before
cardioversion and at least 4 weeks after cardioversion regardless of CHADS2VASc
score
May utilize a TEE to visualize the atria to skip the anticoagulation prior to cardioversion
HASBLED - ANSWER-HTN (>160)
Abnormal renal (SCr >2.26, dialysis)
Abnormal liver (3x ULN)
Stroke (hx)
Bleed (hx or tendency)
Labile INR
Elder (>65)
,Antiplatelets/NSAIDs
EtOH >8drink/wk
≥3 high risk
Warfarin - ANSWER-MOA: Inhibits vitamin K epoxide reductase, preventing production
of clotting factors 2 (72h), 7 (6h), 9 (24h), 10 (36h) and inhibits activation of protein C
and S
S-warfarin is 5x more potent than R-warfarin
Antibiotics reduce vitamin K synthesis by the intestinal flora
Warfarin clearance affected by amiodarone, propafenone, cimetidine
Enzyme inducers - ANSWER-phenytoin
phenobarbital
carbamazepine
rifampin
St. John's Wort
Enzyme inhibitors - ANSWER-fluconazole
azithromycin
Bactrim
Flagyl
amiodarone
Dabigatran for AF - ANSWER-150mg twice daily
75mg twice daily for CrCl 15-30 or CrCl 30-50 with ketoconazole or dronedarone
Avoid with CrCl <15, dialysis, rifampin, CrCl 15-30 with amiodarone, verapamil,
ketoconazole, dronedarone, diltiazem, clarithromycin
Bleeding, dyspepsia, cannot use pillbox
To warfarin: Overlap by 3 days (CrCl >50), 2 days (CrCl 31-50), or 1 day (CrCl 15-30)
From warfarin: INR <2
Rivaroxaban for AF - ANSWER-20mg daily with meals
15mg daily with meals for CrCl 15-50 or dialysis
Avoid with rifampin, phenytoin, carbamazepine, St. John's Wort, protease inhibitors,
azoles, conivaptan
To warfarin: Bridge with parenteral anticoagulant
, From warfarin: INR <3
Apixaban for AF - ANSWER-5mg twice daily
2.5mg twice daily for at least 2 of age 80+, weight <60, or SCr 1.5+ (or dialysis per
package insert)
Avoid with rifampin, phenytoin, carbamazepine, St. John's Wort, protease inhibitors,
azoles, conivaptan
To warfarin: Bridge with parenteral anticoagulant
From warfarin: INR <2
Edoxaban for AF - ANSWER-60mg once daily
30mg once daily for CrCl 15-50, weight <60kg, verapamil, dronedarone, quinidine
Avoid CrCl >95, CrCl <15, dialysis, rifampin
To warfarin: Bridge with parenteral anticoagulant or reduce edoxaban dose by 50% until
INR >2
From warfarin: INR ≤ 2.5
What anticoagulant is best for AF? - ANSWER-All DOAC non-inferior to warfarin for
stroke/SE
All DOAC superior to warfarin for hemorrhagic stroke
Only dabigatran superior to warfarin for ischemic stroke (unblinded study)
Apixaban and edoxaban safer than warfarin for major bleeding
Only apixaban significantly reduced mortality over warfarin
What to do if patient requires "triple therapy" with DAPT + anticoagulant for AF? -
ANSWER-Discontinue the aspirin and continue with anticoagulant plus P2Y12 inhibitor
Limit triple therapy to 1 month only in the highest risk patients with low risk of bleeding
What is the target heart rate in AF? - ANSWER-<80 bpm if symptomatic
<110 bpm if asymptomatic and without HFrEF
beta blockers, diltiazem, verapamil, digoxin, amiodarone
dig may be agent of choice for uncontrolled HR and concomitant decompensated HF
What agent should be chosen for maintenance of sinus rhythm in symptomatic
patients? - ANSWER-Flecainide or propafenone if the patient does not have CHD, HF,
left ventricular hypertrophy, valvular heart disease
Amiodarone may be used in HF
(LATEST UPDATE)
Unpaired T-test - ANSWER-Continuous data
2 independent samples
Paired T-test - ANSWER-Continuous data
2 paired samples
ANOVA - ANSWER-Continuous outcome data
Categorical exposure data
3+ independent variables
ANCOVA - ANSWER-Continuous outcome data
Categorical exposure data
3+ independent variables
Controls for covariates
Wilcoxon Rank Sum Test (Mann-Whitney U Test) - ANSWER-Ordinal data
2 independent samples
Wilcoxon Signed Rank Test - ANSWER-Ordinal data
2 paired samples
Chi Squared Test - ANSWER-Categorical data
2 independent samples
Values >5
Fisher's Exact Test - ANSWER-Categorical data
2 independent samples
Values <5
McNemar Test - ANSWER-Categorical data
2 paired samples
Kruskal-Wallis Test - ANSWER-Ordinal data
3+ independent samples
,Mantel-Haenszel Test - ANSWER-Categorical data
Controls for confounders
What decreases power? - ANSWER-Low sample size
Incorrect study design
Incorrect statistical test
Kendall Rank Correlation - ANSWER-Ordinal variables
Pearson Product Moment Correlation - ANSWER-Normally distributed continuous
variables
Spearman Rank Order Correlation - ANSWER-Ordinal or non-normally distributed
continuous data
Linear Regression - ANSWER-One continuous independent (exposure) variable
2+ continuous dependent (outcome) variables
Simple Logistic Regression - ANSWER-2+ categorical or continuous independent
variables
One categorical dependent variable
Non-valvular AF - ANSWER-AF in the absence of moderate or severe mitral stenosis,
mitral valve repair, or mechanical heart valves
CHADS2 vs CHADS2VASc - ANSWER-CHADS2 = CHF, HTN, Age 75+, DM, stroke (2)
CHADS2VASc = CHF, HTN, Age 75+ (2), DM, stroke (2), vascular disease, Age 65-74,
female
OAC indicated for score 2+ in men and 3+ in women
When to cardiovert AF - ANSWER-AF >48h, anticoagulate for at least 3 weeks before
cardioversion and at least 4 weeks after cardioversion regardless of CHADS2VASc
score
May utilize a TEE to visualize the atria to skip the anticoagulation prior to cardioversion
HASBLED - ANSWER-HTN (>160)
Abnormal renal (SCr >2.26, dialysis)
Abnormal liver (3x ULN)
Stroke (hx)
Bleed (hx or tendency)
Labile INR
Elder (>65)
,Antiplatelets/NSAIDs
EtOH >8drink/wk
≥3 high risk
Warfarin - ANSWER-MOA: Inhibits vitamin K epoxide reductase, preventing production
of clotting factors 2 (72h), 7 (6h), 9 (24h), 10 (36h) and inhibits activation of protein C
and S
S-warfarin is 5x more potent than R-warfarin
Antibiotics reduce vitamin K synthesis by the intestinal flora
Warfarin clearance affected by amiodarone, propafenone, cimetidine
Enzyme inducers - ANSWER-phenytoin
phenobarbital
carbamazepine
rifampin
St. John's Wort
Enzyme inhibitors - ANSWER-fluconazole
azithromycin
Bactrim
Flagyl
amiodarone
Dabigatran for AF - ANSWER-150mg twice daily
75mg twice daily for CrCl 15-30 or CrCl 30-50 with ketoconazole or dronedarone
Avoid with CrCl <15, dialysis, rifampin, CrCl 15-30 with amiodarone, verapamil,
ketoconazole, dronedarone, diltiazem, clarithromycin
Bleeding, dyspepsia, cannot use pillbox
To warfarin: Overlap by 3 days (CrCl >50), 2 days (CrCl 31-50), or 1 day (CrCl 15-30)
From warfarin: INR <2
Rivaroxaban for AF - ANSWER-20mg daily with meals
15mg daily with meals for CrCl 15-50 or dialysis
Avoid with rifampin, phenytoin, carbamazepine, St. John's Wort, protease inhibitors,
azoles, conivaptan
To warfarin: Bridge with parenteral anticoagulant
, From warfarin: INR <3
Apixaban for AF - ANSWER-5mg twice daily
2.5mg twice daily for at least 2 of age 80+, weight <60, or SCr 1.5+ (or dialysis per
package insert)
Avoid with rifampin, phenytoin, carbamazepine, St. John's Wort, protease inhibitors,
azoles, conivaptan
To warfarin: Bridge with parenteral anticoagulant
From warfarin: INR <2
Edoxaban for AF - ANSWER-60mg once daily
30mg once daily for CrCl 15-50, weight <60kg, verapamil, dronedarone, quinidine
Avoid CrCl >95, CrCl <15, dialysis, rifampin
To warfarin: Bridge with parenteral anticoagulant or reduce edoxaban dose by 50% until
INR >2
From warfarin: INR ≤ 2.5
What anticoagulant is best for AF? - ANSWER-All DOAC non-inferior to warfarin for
stroke/SE
All DOAC superior to warfarin for hemorrhagic stroke
Only dabigatran superior to warfarin for ischemic stroke (unblinded study)
Apixaban and edoxaban safer than warfarin for major bleeding
Only apixaban significantly reduced mortality over warfarin
What to do if patient requires "triple therapy" with DAPT + anticoagulant for AF? -
ANSWER-Discontinue the aspirin and continue with anticoagulant plus P2Y12 inhibitor
Limit triple therapy to 1 month only in the highest risk patients with low risk of bleeding
What is the target heart rate in AF? - ANSWER-<80 bpm if symptomatic
<110 bpm if asymptomatic and without HFrEF
beta blockers, diltiazem, verapamil, digoxin, amiodarone
dig may be agent of choice for uncontrolled HR and concomitant decompensated HF
What agent should be chosen for maintenance of sinus rhythm in symptomatic
patients? - ANSWER-Flecainide or propafenone if the patient does not have CHD, HF,
left ventricular hypertrophy, valvular heart disease
Amiodarone may be used in HF
