BCCCP LATEST 2026 EXAM QUESTIONS AND SOLUTIONS
RATED A+
✔✔Treatment of digoxin toxicity - ✔✔-multidose activated charcoal
-correct K, Mg, Ca
-Digibind or digifab, 10-20 vials for acute toxicity of an unknown amount, 6 vials for
chronic toxicity
✔✔Why should you not get a dig level after giving Digibind or Digifab - ✔✔A dig level is
the total level (bound and free), so will include that bound by Digifab
✔✔MOA of digoxin toxicity - ✔✔Inhibition of Na/K ATP pump and suppression of AV
node
✔✔CV effects of TCA OD - ✔✔Increased QRS or QT interval, AV-conduction block,
complete heart block
✔✔Which pressor may not work in an antidepressant overdose? - ✔✔Dopamine -
endogenous NE stores are depleted in an overdose
✔✔Indication for bicarb in TCA overdose?
MOA of bicarb in TCA overdose? - ✔✔QRS > 100-120, wide complex tachy, cardiac
arrest, right bundle brand block, refractory hypotension
Alkalinization of blood causes drug to be more protein bound and less free drug,
increases sodium load to compete with TCAs
✔✔Key symptoms of serotonin syndrome - ✔✔AMS/agitation
clonus/hyperreflexia
diaphoresis
hyperthermia
✔✔Treatment of serotonin syndrome - ✔✔BZDs first line for agitation and muscle
rigitdity
Single dose of cyproheptadine 8-12 mg as an adjunct to BZDs
✔✔Which pressors would be best for hypotension associated with atypical antipsychotic
OD and why? - ✔✔NE or phenylephrine due to the alpha receptor antagonist activity of
atypical antipsychotics
✔✔Ketamine MOA - ✔✔Noncompetitive NMDA receptor antagonist (blocks glutamate
and aspartate)
,Mild to moderate blockade of catecholamine reuptake
✔✔How to correct Na for hyperglycemia - ✔✔Corrected serum Na = Measured serum
Na + [(BG-100)/100 * 2.4]
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: CHF, cirrhosis with ascites, nephrotic
syndrome - ✔✔<20 (low)
>100 (normal is 350-1000)
Hypervolemic
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: renal failure - ✔✔>20 (normal)
>100 (normal is 350-1000)
Hypervolemic
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: psychogenic polydipsia - ✔✔<20 (low)
<100 (low)
Euvolvemic
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: SIADH, cortisol deficiency,
hypothyroidism, drug-induced - ✔✔>20 (normal)
>100 (normal is 350-1000)
Euvolemic
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: extra-renal losses, third space losses -
✔✔<20 (low)
>450 (normal is 350-1000)
Hypovolemic
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: diuretics, adrenal insufficiency, CSW,
thiazide diuretics, salt wasting nephropathy - ✔✔>20 (normal)
>450 (normal is 350-1000)
Hypovolemic
✔✔Drugs that can induce SIADH by increasing hypothalamic production of ADH -
✔✔Amitriptyline, SSRIs, haloperidol, carbamazepine, VPA, chemo, nicotine, MOAI
,✔✔Drugs that can induce SIADH by increasing sensitivity to or exogenous
administration of ADH - ✔✔DDAVP, lamotrigine
✔✔Drugs that can induce SIADH through unknown mechanisms - ✔✔opiates,
barbiturates, NSAIDs, ACEI
✔✔Non-medication causes of SIADH - ✔✔TBI, brain tumor, stroke, brain infection,
SAH, ICH, PNA, lung cancer
✔✔Key differences between CSWS and SIADH - ✔✔ECF: low vs. high
Serum osmolality: high/normal vs. lowered
✔✔Opposite of SIADH and treatment - ✔✔Diabetes insipidus (decreased
ADH/vasopressin secretion) resulting in voluminous urine
Give hypotonic solutions, vasopressin analogs (desmopressin) or arginine vasopressin
✔✔Causes of CSW - ✔✔Can be associated with a relative adrenal insufficiency, TBI,
SAH, brain tumor
✔✔How to treat:
1. Hypervolemic hypotonic hyponatremia
2. Hypovolemic hypotonic hyponatremia
3. Euvolemic/isovolemic hypotonic hyponatremia - ✔✔1. Fluid and Na restriction
2. Give Na and fluids, reduce diuretic therapy
3. Fluid restriction first, consider diuretics, consider conivaptan/tolvaptan (inhibit renal
V1 vasopressin receptors)
✔✔Medication that can be considered in CSW neuro patients - ✔✔fludrocortisone 0.1-
0.4 mg/d
✔✔Normal serum osmolality
How to calculate serum osmolality - ✔✔278-305
(2 x Na) + (BUN / 2.8) + (BG / 18)
✔✔Which type of hyponatremia can be hypovolemic, isovolemic, or hypervolemic? -
✔✔Hypotonic hyponatremia
✔✔What are causes of hypertonic hyponatremia? - ✔✔Hyperglycemia, hypertonic
sodium-free solutions (i.e. mannitol)
, ✔✔What are causes of isotonic hyponatremia? - ✔✔Pseudohyponatremia,
hyperlipidemia, hyperproteinemia
✔✔IV Phos replacement doses (mmol/kg) based on serum phos (mg/dL) - ✔✔0.64 for
<1.6
0.32 for <2.2
0.16 for <3
✔✔What are other phos binders besides sevelamer - ✔✔calcium carbonate, calcium
acetate, lanthanum
✔✔Normal blood gas values - ✔✔pH 7.35-7.45
PCO2 35-45
PO2 80-100
HCO3 22-26
✔✔Metabolic acidosis/alkalosis look at ___ - ✔✔HCO3
✔✔Respiratory acidosis/alkalosis look at ___ - ✔✔PCO2
✔✔When do you calculate and anion gap?
How to calculate anion gap?
Corrected for albumin?
Normal range? - ✔✔Metabolic acidosis
AG = Na - Cl - HCO3
Corrected AG = AG - (2.5 x [4-serum albumin])
3-14
✔✔Causes of anion gap metabolic acidosis? - ✔✔(MUDPILES)
Methanol
Uremia
DKA
Paraldehyde
Infection/ischemia
Lactic acidosis
Ethylene glycol or ethanol
Salicylates
RATED A+
✔✔Treatment of digoxin toxicity - ✔✔-multidose activated charcoal
-correct K, Mg, Ca
-Digibind or digifab, 10-20 vials for acute toxicity of an unknown amount, 6 vials for
chronic toxicity
✔✔Why should you not get a dig level after giving Digibind or Digifab - ✔✔A dig level is
the total level (bound and free), so will include that bound by Digifab
✔✔MOA of digoxin toxicity - ✔✔Inhibition of Na/K ATP pump and suppression of AV
node
✔✔CV effects of TCA OD - ✔✔Increased QRS or QT interval, AV-conduction block,
complete heart block
✔✔Which pressor may not work in an antidepressant overdose? - ✔✔Dopamine -
endogenous NE stores are depleted in an overdose
✔✔Indication for bicarb in TCA overdose?
MOA of bicarb in TCA overdose? - ✔✔QRS > 100-120, wide complex tachy, cardiac
arrest, right bundle brand block, refractory hypotension
Alkalinization of blood causes drug to be more protein bound and less free drug,
increases sodium load to compete with TCAs
✔✔Key symptoms of serotonin syndrome - ✔✔AMS/agitation
clonus/hyperreflexia
diaphoresis
hyperthermia
✔✔Treatment of serotonin syndrome - ✔✔BZDs first line for agitation and muscle
rigitdity
Single dose of cyproheptadine 8-12 mg as an adjunct to BZDs
✔✔Which pressors would be best for hypotension associated with atypical antipsychotic
OD and why? - ✔✔NE or phenylephrine due to the alpha receptor antagonist activity of
atypical antipsychotics
✔✔Ketamine MOA - ✔✔Noncompetitive NMDA receptor antagonist (blocks glutamate
and aspartate)
,Mild to moderate blockade of catecholamine reuptake
✔✔How to correct Na for hyperglycemia - ✔✔Corrected serum Na = Measured serum
Na + [(BG-100)/100 * 2.4]
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: CHF, cirrhosis with ascites, nephrotic
syndrome - ✔✔<20 (low)
>100 (normal is 350-1000)
Hypervolemic
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: renal failure - ✔✔>20 (normal)
>100 (normal is 350-1000)
Hypervolemic
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: psychogenic polydipsia - ✔✔<20 (low)
<100 (low)
Euvolvemic
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: SIADH, cortisol deficiency,
hypothyroidism, drug-induced - ✔✔>20 (normal)
>100 (normal is 350-1000)
Euvolemic
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: extra-renal losses, third space losses -
✔✔<20 (low)
>450 (normal is 350-1000)
Hypovolemic
✔✔What will your urine Na (mEq/L) and urine osm (mOsm/kg) be for the following
scenarios and what type of hyponatremia is this: diuretics, adrenal insufficiency, CSW,
thiazide diuretics, salt wasting nephropathy - ✔✔>20 (normal)
>450 (normal is 350-1000)
Hypovolemic
✔✔Drugs that can induce SIADH by increasing hypothalamic production of ADH -
✔✔Amitriptyline, SSRIs, haloperidol, carbamazepine, VPA, chemo, nicotine, MOAI
,✔✔Drugs that can induce SIADH by increasing sensitivity to or exogenous
administration of ADH - ✔✔DDAVP, lamotrigine
✔✔Drugs that can induce SIADH through unknown mechanisms - ✔✔opiates,
barbiturates, NSAIDs, ACEI
✔✔Non-medication causes of SIADH - ✔✔TBI, brain tumor, stroke, brain infection,
SAH, ICH, PNA, lung cancer
✔✔Key differences between CSWS and SIADH - ✔✔ECF: low vs. high
Serum osmolality: high/normal vs. lowered
✔✔Opposite of SIADH and treatment - ✔✔Diabetes insipidus (decreased
ADH/vasopressin secretion) resulting in voluminous urine
Give hypotonic solutions, vasopressin analogs (desmopressin) or arginine vasopressin
✔✔Causes of CSW - ✔✔Can be associated with a relative adrenal insufficiency, TBI,
SAH, brain tumor
✔✔How to treat:
1. Hypervolemic hypotonic hyponatremia
2. Hypovolemic hypotonic hyponatremia
3. Euvolemic/isovolemic hypotonic hyponatremia - ✔✔1. Fluid and Na restriction
2. Give Na and fluids, reduce diuretic therapy
3. Fluid restriction first, consider diuretics, consider conivaptan/tolvaptan (inhibit renal
V1 vasopressin receptors)
✔✔Medication that can be considered in CSW neuro patients - ✔✔fludrocortisone 0.1-
0.4 mg/d
✔✔Normal serum osmolality
How to calculate serum osmolality - ✔✔278-305
(2 x Na) + (BUN / 2.8) + (BG / 18)
✔✔Which type of hyponatremia can be hypovolemic, isovolemic, or hypervolemic? -
✔✔Hypotonic hyponatremia
✔✔What are causes of hypertonic hyponatremia? - ✔✔Hyperglycemia, hypertonic
sodium-free solutions (i.e. mannitol)
, ✔✔What are causes of isotonic hyponatremia? - ✔✔Pseudohyponatremia,
hyperlipidemia, hyperproteinemia
✔✔IV Phos replacement doses (mmol/kg) based on serum phos (mg/dL) - ✔✔0.64 for
<1.6
0.32 for <2.2
0.16 for <3
✔✔What are other phos binders besides sevelamer - ✔✔calcium carbonate, calcium
acetate, lanthanum
✔✔Normal blood gas values - ✔✔pH 7.35-7.45
PCO2 35-45
PO2 80-100
HCO3 22-26
✔✔Metabolic acidosis/alkalosis look at ___ - ✔✔HCO3
✔✔Respiratory acidosis/alkalosis look at ___ - ✔✔PCO2
✔✔When do you calculate and anion gap?
How to calculate anion gap?
Corrected for albumin?
Normal range? - ✔✔Metabolic acidosis
AG = Na - Cl - HCO3
Corrected AG = AG - (2.5 x [4-serum albumin])
3-14
✔✔Causes of anion gap metabolic acidosis? - ✔✔(MUDPILES)
Methanol
Uremia
DKA
Paraldehyde
Infection/ischemia
Lactic acidosis
Ethylene glycol or ethanol
Salicylates
