BCCCP EXAM EVALUATION ACTUAL QUESTIONS AND
SOLUTIONS RATED A+
✔✔Why can seizures occur during TTM? - ✔✔Seizures are a complication of the
cardiac arrest itself and therapeutic hypothermia
✔✔What affect does TTM have on arrhythmias - ✔✔Sinus brady, prolonged PR, QRS,
and QT intervals
✔✔Does hyper or hypoglycemia occur during TTM and why? - ✔✔Hyperglycemia
caused by decreased insulin production may require insulin gtt
✔✔Why should you use caution with electrolyte replacement in patients undergoing
TTM - ✔✔Electrolytes shift during the cooling phase but then reverse upon rewarming
✔✔Why can patients become coagulopathic during TTM - ✔✔Impaired activation and
activity of clotting factors, impaired platelet function
✔✔Which medication is affected by TTM in which it may have less activity (instead of
decreased clearance) - ✔✔morphine receptor affinity decreases as temperature
decreases
✔✔Dopamine doses and receptor activity - ✔✔2-5 mcg/kg/min dopamine receptor
5-10 mcg/kg/min beta 1
>10 mcg/kg/min alpha 1
✔✔Why does dobutamine cause less systemic vascular resistance decrease compared
to milrinone? In what way is milrinone better than dobutamine? - ✔✔alpha 1 agonist and
beta 2 agonist counterbalance, leading to little change in SVR
Milrinone has less tachycardia than dobutamine but a similar risk of ventricular
arrhythmias
✔✔What are the benefits of prophylactic antibiotics in TTM patients - ✔✔association
between ppx abx and decreased pneumonia and sepsis however impact on length of
stay or neurologic outcome was not demonstrated
✔✔Definition of hypertensive urgency vs. hypertensive emergency and treatment goals
for each - ✔✔Urgency: SBP >= 180 and/or DBP >=110. Lower BP slowly during the first
24-48 hours using oral medications
Emergency: SBP >200 and/or DBP >120 w/ concurrent target organ dysfunction. Within
60 min decrease DBP by 10-15% or MAP by 25% with goal DBP >=100. Within hours 2-
,6 goal SBP 160 and goal DBP 100-110, maintain for first 24 hours, then outpatient BP
targets
✔✔Goals for acute aortic dissection - ✔✔Goal HR <60 and SBP <100 ASAP (within 5-
10 min)
✔✔When do you treat BP in an AIS - ✔✔If thrombolytic is required (goal SBP <185,
goal DBP <110), other target organ damage occurs, or SBP >220 and/or DBP >120
✔✔ICH BP goal - ✔✔<140
✔✔Which medication for HTN should be avoided in patients with elevated ICP -
✔✔nitroprusside
✔✔Which medications for HTN emergency are ok for pregnant patients and what is the
BP goal - ✔✔Hydralazine and labetolol
160/110 (decrease slowly by 20-25% in first few minutes to hours to prevent harmful
fetal effects)
✔✔Which medication can be used for catecholamine-induced hypertensive emergency
or cocaine-induced hypertensive emergency and what is the MOA - ✔✔phentolamine:
competitively inhibits alpha adrenergic receptors
✔✔Retrospective case-control study - ✔✔Two groups (with and without the outcome)
are compared to identify the differences and risk factors for developing the outcome of
interest
✔✔Prospective or retrospective cohort study - ✔✔Observational study of a given
population during a given time to determine the association between risk factors and the
outcome of interest (identifies the relationship between exposure and outcome)
✔✔Type I (alpha) error - ✔✔To reject the null when in fact it is true
aka to find a difference when there is no difference
✔✔Type II (beta) error - ✔✔Not to reject the null when in fact there is a difference
between groups
aka to find no difference when there is a difference
✔✔Continuous data - ✔✔Blood pressure, height, weight, etc.
,✔✔Categorical data - ✔✔Ordinal (ordered categories such as RASS, SOFA) and
nominal (unordered categories such as M or F, alive or dead)
✔✔Correlation value (r) meaning and what are the two tests - ✔✔An r of -1 or +1
indicates a perfect negative or positive relationship. The closer the values are to 1, the
stronger the relationship between the 2 variables
Pearson: parametric continuous data
Spearman rank: nonparametric continuous or ordinal data
✔✔Linear vs. logistic regression - ✔✔Linear regression is used when the dependent
variable is continuous (i.e. LOS)
Logistic regression is used when the dependent variable is a categorical variable (i.e.
mortality)
✔✔Kaplan-Meier method - ✔✔A survival (or time-to-event) analysis that describes the
impact of a single predictor variable on the time-to-event between cohorts; typically
analyzed using the log-rank test
Results reported as OR w/ 95% CI
✔✔Cox proportional hazards model - ✔✔A survival (or time-to-event) analysis that
describes the impact of several predictor variables on the time-to-event
Results reported as HR w/ 95% CI
✔✔Test for continuous data for one group in which the outcome is assessed at only one
point in time - ✔✔1 sample t-test
✔✔Test for nominal data for one group in which the outcome is assessed at only one
point in time - ✔✔Binomial test
✔✔Test for ordinal data for one group in which the outcome is assessed at only one
point in time - ✔✔Sign test
✔✔Test for continuous data for one group in which the outcome is assessed at 2 points
in time - ✔✔Paired t-test
✔✔Test for nominal data for one group in which the outcome is assessed at 2 points in
time - ✔✔McNemer test
, ✔✔Test for ordinal data for one group in which the outcome is assessed at 2 points in
time - ✔✔Wilcoxon Signed Ranks Test
✔✔Test for continuous data for 2 independent groups in which the outcome is assessed
at only 1 point in time - ✔✔Independent groups t-test aka student's t-test
✔✔Test for nominal data for 2 independent groups in which the outcome is assessed at
only 1 point in time - ✔✔Chi-Square test or Fisher's exact test
✔✔Test for ordinal data for 2 independent groups in which the outcome is assessed at
only 1 point in time - ✔✔Wilcoxon Rank Sum Test (aka Mann-Whitney U)
✔✔Test for continuous data for 3 or more independent groups in which the outcome is
assessed at only 1 point in time - ✔✔1-way ANOVA
✔✔Test for nominal data for 3 or more independent groups in which the outcome is
assessed at only 1 point in time - ✔✔Chi-Square test
✔✔Test for ordinal data for 3 or more independent groups in which the outcome is
assessed at only 1 point in time - ✔✔Kruskal-Wallis ANOVA
✔✔Number needed to treat - ✔✔NNT = 1/absolute risk reduction
✔✔What are the time spectrums of AKI as classified in the RIFLE, AKIN, and KDIGO
criteria - ✔✔RIFLE is a change over 7 days, AKIN over no more than 48 hours, and
KDIGO combines both with SCr increase 1.5- to 2-fold above baseline over 7 days or
0.3 mg/dL within 48 hr
✔✔KDIGO criteria for AKI - ✔✔Stage 1: increase to 1.5- to 2-fold above baseline over 7
days or 0.3 mg/dL within 48 hours
Stage 2: Increase to 2- to 3-fold above baseline
Stage 3: Increase > 3-fold above baseline or >=4 mg/dL with an acute rise of >= 0.5
mg/dL or on RRT
✔✔UOP criteria for AKI - ✔✔Stage 1: < 0.5 mL/kg/hr x 6 hrs
Stage 2: < 0.5 mL/kg/hr x 12 hrs
Stage 3: < 0.3 mL/kg/hr x 24 hrs or anuria for 12 hrs
SOLUTIONS RATED A+
✔✔Why can seizures occur during TTM? - ✔✔Seizures are a complication of the
cardiac arrest itself and therapeutic hypothermia
✔✔What affect does TTM have on arrhythmias - ✔✔Sinus brady, prolonged PR, QRS,
and QT intervals
✔✔Does hyper or hypoglycemia occur during TTM and why? - ✔✔Hyperglycemia
caused by decreased insulin production may require insulin gtt
✔✔Why should you use caution with electrolyte replacement in patients undergoing
TTM - ✔✔Electrolytes shift during the cooling phase but then reverse upon rewarming
✔✔Why can patients become coagulopathic during TTM - ✔✔Impaired activation and
activity of clotting factors, impaired platelet function
✔✔Which medication is affected by TTM in which it may have less activity (instead of
decreased clearance) - ✔✔morphine receptor affinity decreases as temperature
decreases
✔✔Dopamine doses and receptor activity - ✔✔2-5 mcg/kg/min dopamine receptor
5-10 mcg/kg/min beta 1
>10 mcg/kg/min alpha 1
✔✔Why does dobutamine cause less systemic vascular resistance decrease compared
to milrinone? In what way is milrinone better than dobutamine? - ✔✔alpha 1 agonist and
beta 2 agonist counterbalance, leading to little change in SVR
Milrinone has less tachycardia than dobutamine but a similar risk of ventricular
arrhythmias
✔✔What are the benefits of prophylactic antibiotics in TTM patients - ✔✔association
between ppx abx and decreased pneumonia and sepsis however impact on length of
stay or neurologic outcome was not demonstrated
✔✔Definition of hypertensive urgency vs. hypertensive emergency and treatment goals
for each - ✔✔Urgency: SBP >= 180 and/or DBP >=110. Lower BP slowly during the first
24-48 hours using oral medications
Emergency: SBP >200 and/or DBP >120 w/ concurrent target organ dysfunction. Within
60 min decrease DBP by 10-15% or MAP by 25% with goal DBP >=100. Within hours 2-
,6 goal SBP 160 and goal DBP 100-110, maintain for first 24 hours, then outpatient BP
targets
✔✔Goals for acute aortic dissection - ✔✔Goal HR <60 and SBP <100 ASAP (within 5-
10 min)
✔✔When do you treat BP in an AIS - ✔✔If thrombolytic is required (goal SBP <185,
goal DBP <110), other target organ damage occurs, or SBP >220 and/or DBP >120
✔✔ICH BP goal - ✔✔<140
✔✔Which medication for HTN should be avoided in patients with elevated ICP -
✔✔nitroprusside
✔✔Which medications for HTN emergency are ok for pregnant patients and what is the
BP goal - ✔✔Hydralazine and labetolol
160/110 (decrease slowly by 20-25% in first few minutes to hours to prevent harmful
fetal effects)
✔✔Which medication can be used for catecholamine-induced hypertensive emergency
or cocaine-induced hypertensive emergency and what is the MOA - ✔✔phentolamine:
competitively inhibits alpha adrenergic receptors
✔✔Retrospective case-control study - ✔✔Two groups (with and without the outcome)
are compared to identify the differences and risk factors for developing the outcome of
interest
✔✔Prospective or retrospective cohort study - ✔✔Observational study of a given
population during a given time to determine the association between risk factors and the
outcome of interest (identifies the relationship between exposure and outcome)
✔✔Type I (alpha) error - ✔✔To reject the null when in fact it is true
aka to find a difference when there is no difference
✔✔Type II (beta) error - ✔✔Not to reject the null when in fact there is a difference
between groups
aka to find no difference when there is a difference
✔✔Continuous data - ✔✔Blood pressure, height, weight, etc.
,✔✔Categorical data - ✔✔Ordinal (ordered categories such as RASS, SOFA) and
nominal (unordered categories such as M or F, alive or dead)
✔✔Correlation value (r) meaning and what are the two tests - ✔✔An r of -1 or +1
indicates a perfect negative or positive relationship. The closer the values are to 1, the
stronger the relationship between the 2 variables
Pearson: parametric continuous data
Spearman rank: nonparametric continuous or ordinal data
✔✔Linear vs. logistic regression - ✔✔Linear regression is used when the dependent
variable is continuous (i.e. LOS)
Logistic regression is used when the dependent variable is a categorical variable (i.e.
mortality)
✔✔Kaplan-Meier method - ✔✔A survival (or time-to-event) analysis that describes the
impact of a single predictor variable on the time-to-event between cohorts; typically
analyzed using the log-rank test
Results reported as OR w/ 95% CI
✔✔Cox proportional hazards model - ✔✔A survival (or time-to-event) analysis that
describes the impact of several predictor variables on the time-to-event
Results reported as HR w/ 95% CI
✔✔Test for continuous data for one group in which the outcome is assessed at only one
point in time - ✔✔1 sample t-test
✔✔Test for nominal data for one group in which the outcome is assessed at only one
point in time - ✔✔Binomial test
✔✔Test for ordinal data for one group in which the outcome is assessed at only one
point in time - ✔✔Sign test
✔✔Test for continuous data for one group in which the outcome is assessed at 2 points
in time - ✔✔Paired t-test
✔✔Test for nominal data for one group in which the outcome is assessed at 2 points in
time - ✔✔McNemer test
, ✔✔Test for ordinal data for one group in which the outcome is assessed at 2 points in
time - ✔✔Wilcoxon Signed Ranks Test
✔✔Test for continuous data for 2 independent groups in which the outcome is assessed
at only 1 point in time - ✔✔Independent groups t-test aka student's t-test
✔✔Test for nominal data for 2 independent groups in which the outcome is assessed at
only 1 point in time - ✔✔Chi-Square test or Fisher's exact test
✔✔Test for ordinal data for 2 independent groups in which the outcome is assessed at
only 1 point in time - ✔✔Wilcoxon Rank Sum Test (aka Mann-Whitney U)
✔✔Test for continuous data for 3 or more independent groups in which the outcome is
assessed at only 1 point in time - ✔✔1-way ANOVA
✔✔Test for nominal data for 3 or more independent groups in which the outcome is
assessed at only 1 point in time - ✔✔Chi-Square test
✔✔Test for ordinal data for 3 or more independent groups in which the outcome is
assessed at only 1 point in time - ✔✔Kruskal-Wallis ANOVA
✔✔Number needed to treat - ✔✔NNT = 1/absolute risk reduction
✔✔What are the time spectrums of AKI as classified in the RIFLE, AKIN, and KDIGO
criteria - ✔✔RIFLE is a change over 7 days, AKIN over no more than 48 hours, and
KDIGO combines both with SCr increase 1.5- to 2-fold above baseline over 7 days or
0.3 mg/dL within 48 hr
✔✔KDIGO criteria for AKI - ✔✔Stage 1: increase to 1.5- to 2-fold above baseline over 7
days or 0.3 mg/dL within 48 hours
Stage 2: Increase to 2- to 3-fold above baseline
Stage 3: Increase > 3-fold above baseline or >=4 mg/dL with an acute rise of >= 0.5
mg/dL or on RRT
✔✔UOP criteria for AKI - ✔✔Stage 1: < 0.5 mL/kg/hr x 6 hrs
Stage 2: < 0.5 mL/kg/hr x 12 hrs
Stage 3: < 0.3 mL/kg/hr x 24 hrs or anuria for 12 hrs
