BCPS QUESTIONS AND ANSWERS
components of CHADsVASc score - Answers :C: congestive HF (+1)
H: hypertension (+1)
A: age > 75 (+2)
D: DM (+1)
S: stroke/TIA/thromboembolism (+2)
V: vascular disease (+1)
A: age 65-74 (+1)
S: sex = female (+1)
components of HAS-BLED score - Answers :H: hypertension - SBP > 160 (+1)
A: abnormal liver/renal function (+1 for either)
S: stroke hx (+1)
B: bleeding predisposition (+1)
L: labile INR (+1)
E: elderly > 65 (+1)
D: drug/alcohol use - blood thinners (+1), alc > 8 drinks/week (+1)
When to use apixaban 2.5 mg BID? - Answers :2/3 Criteria:
1. age 80 or older
2. weight 60 kg or less
3. SCr 1.5 or greater
When to dose reduce rivaroxaban and edoxaban for renal function? - Answers :CrCl <
50
Rivaroxaban to 15 mg daily and edoxaban to 30 mg daily
When to dose reduce dabigatran for renal function? - Answers :CrCl < 30 to 74 mg BID
Protamine is a reversal agent for: - Answers :Heparin
Off label: LMWH
Andexanet alfa is a reversal agent for: - Answers :Factor Xa inhibitors (apixaban &
rivaroxaban)
Idarucizumab (Praxbind) is the reversal agent for: - Answers :Dabigatran
INR goal for mechanical mitral valve - Answers :2.5-3.5
Duration of treatment with aspirin for patients with bioprosthetic surgical aortic or mitral
valves - Answers :indefinitely
Duration of treatment with DAPT for patients with bare metal stent - Answers :at least 1
month
,Duration of treatment with warfarin for patients with bioprosthetic surgical aortic or mitral
valves - Answers :at least 3 months
Duration of treatment with DAPT for patients with a drug-eluting stent - Answers :at
least 1 year
Risk factors for developing VTE - Answers :Age > or = 40
Surgery
Trauma
Hypercoagulable states
Central venous catheterization
Estrogen use or selective estrogen receptor modulators
Erythropoiesis-stimulating agents
Previous VTE
Cancer & treatments
Immobility or lower-extremity paresis
Various medical conditions/disease states
Smoking
Obesity
VTE treatment strategies - Answers :Bridging -- Injectable + warfarin w/ at least 5 days
overlap or until INR > 2
Switching -- Injectable x 5 days then start edoxaban or dabigatran
Monotherapy -- apixaban or rivaroxaban at high dose then lower maintenance
Dabigatran dosing for VTE treatment - Answers :150 mg BID after 5-10 days of
injectable
Rivaroxaban dosing for VTE treatment - Answers :15 mg BID w/ food x 21 days then 20
mg daily w/ food
after 6 months, may be reduced to 10 mg daily
Apixaban dosing for VTE treatment - Answers :10 mg BID for 7 days then 5 mg BID
after 6 months, may be reduced to 2.5 mg BID
Edoxaban dosing for VTE treatment - Answers :60 mg daily after 5-10 days of injectable
Duration of VTE treatment - Answers :3 months
How to dose protamine - Answers :1 mg for every 100 units of UFH given in the past 3
hours, not to exceed 50mg
Hierarchy of clinical study design - Answers :1. Systematic reviews/meta-analysis
, 2. RCT
3. Cohort
4. Case-control
5. Cross-sectional
6. Case series/case reports
7. Ideas, opinions, reviews
internal validity - Answers :the degree to which the outcome can be explained by
differences in assigned groups
Factors affecting internal validity - Answers :poor design
inadequate randomization
lack of or inappropriate blinding
imprecise/inaccurate measurement or inappropriate stat method
incomplete or selective outcome reporting
external validity - Answers :the degree to which the findings can be generalized or
extrapolated to a population beyond the study
factors affecting external validity - Answers :setting of trial
patient selection -- exclusions, etc
patient characteristics
trial protocol vs. routine practice
outcome measures and follow-up
adverse effects of treatment
bias - Answers :difference caused by systematic, nonrandom error
selection bias - Answers :error in selection or sampling of individuals
observational or information bias - Answers :incorrect determination of outcomes or
exposures
recall bias - Answers :Systematic error due to differences in accuracy or completeness
of recall to memory of past events or experiences.
interviewer bias - Answers :interviews not conducted in a uniform manner for all
participants
misclassification bias - Answers :subject categorized incorrectly potentially altering
outcome
publication bias - Answers :studies that report positive findings are more likely to be
published than studies that report negative findings
components of CHADsVASc score - Answers :C: congestive HF (+1)
H: hypertension (+1)
A: age > 75 (+2)
D: DM (+1)
S: stroke/TIA/thromboembolism (+2)
V: vascular disease (+1)
A: age 65-74 (+1)
S: sex = female (+1)
components of HAS-BLED score - Answers :H: hypertension - SBP > 160 (+1)
A: abnormal liver/renal function (+1 for either)
S: stroke hx (+1)
B: bleeding predisposition (+1)
L: labile INR (+1)
E: elderly > 65 (+1)
D: drug/alcohol use - blood thinners (+1), alc > 8 drinks/week (+1)
When to use apixaban 2.5 mg BID? - Answers :2/3 Criteria:
1. age 80 or older
2. weight 60 kg or less
3. SCr 1.5 or greater
When to dose reduce rivaroxaban and edoxaban for renal function? - Answers :CrCl <
50
Rivaroxaban to 15 mg daily and edoxaban to 30 mg daily
When to dose reduce dabigatran for renal function? - Answers :CrCl < 30 to 74 mg BID
Protamine is a reversal agent for: - Answers :Heparin
Off label: LMWH
Andexanet alfa is a reversal agent for: - Answers :Factor Xa inhibitors (apixaban &
rivaroxaban)
Idarucizumab (Praxbind) is the reversal agent for: - Answers :Dabigatran
INR goal for mechanical mitral valve - Answers :2.5-3.5
Duration of treatment with aspirin for patients with bioprosthetic surgical aortic or mitral
valves - Answers :indefinitely
Duration of treatment with DAPT for patients with bare metal stent - Answers :at least 1
month
,Duration of treatment with warfarin for patients with bioprosthetic surgical aortic or mitral
valves - Answers :at least 3 months
Duration of treatment with DAPT for patients with a drug-eluting stent - Answers :at
least 1 year
Risk factors for developing VTE - Answers :Age > or = 40
Surgery
Trauma
Hypercoagulable states
Central venous catheterization
Estrogen use or selective estrogen receptor modulators
Erythropoiesis-stimulating agents
Previous VTE
Cancer & treatments
Immobility or lower-extremity paresis
Various medical conditions/disease states
Smoking
Obesity
VTE treatment strategies - Answers :Bridging -- Injectable + warfarin w/ at least 5 days
overlap or until INR > 2
Switching -- Injectable x 5 days then start edoxaban or dabigatran
Monotherapy -- apixaban or rivaroxaban at high dose then lower maintenance
Dabigatran dosing for VTE treatment - Answers :150 mg BID after 5-10 days of
injectable
Rivaroxaban dosing for VTE treatment - Answers :15 mg BID w/ food x 21 days then 20
mg daily w/ food
after 6 months, may be reduced to 10 mg daily
Apixaban dosing for VTE treatment - Answers :10 mg BID for 7 days then 5 mg BID
after 6 months, may be reduced to 2.5 mg BID
Edoxaban dosing for VTE treatment - Answers :60 mg daily after 5-10 days of injectable
Duration of VTE treatment - Answers :3 months
How to dose protamine - Answers :1 mg for every 100 units of UFH given in the past 3
hours, not to exceed 50mg
Hierarchy of clinical study design - Answers :1. Systematic reviews/meta-analysis
, 2. RCT
3. Cohort
4. Case-control
5. Cross-sectional
6. Case series/case reports
7. Ideas, opinions, reviews
internal validity - Answers :the degree to which the outcome can be explained by
differences in assigned groups
Factors affecting internal validity - Answers :poor design
inadequate randomization
lack of or inappropriate blinding
imprecise/inaccurate measurement or inappropriate stat method
incomplete or selective outcome reporting
external validity - Answers :the degree to which the findings can be generalized or
extrapolated to a population beyond the study
factors affecting external validity - Answers :setting of trial
patient selection -- exclusions, etc
patient characteristics
trial protocol vs. routine practice
outcome measures and follow-up
adverse effects of treatment
bias - Answers :difference caused by systematic, nonrandom error
selection bias - Answers :error in selection or sampling of individuals
observational or information bias - Answers :incorrect determination of outcomes or
exposures
recall bias - Answers :Systematic error due to differences in accuracy or completeness
of recall to memory of past events or experiences.
interviewer bias - Answers :interviews not conducted in a uniform manner for all
participants
misclassification bias - Answers :subject categorized incorrectly potentially altering
outcome
publication bias - Answers :studies that report positive findings are more likely to be
published than studies that report negative findings
