Sample Questions from our BCPS Exam Q-Bank

The sample BCPS questions below were taken directly from the BCPS Exam Q-Bank & Flashcard Database.  They represent over a 1,700 other practice test questions you will encounter with the use of our BCPS Q-Bank.  We believe our BCPS practice test questions and flashcards system will prepare you to pass the BCPS exam the first time.  Each BCPS question comes with a concise rationale supporting the right answer or concept being tested.   



Sample BCPS Question  1

A 14 yr old white female with asthma has been well controlled for the last 6 months on her current therapy of mometasone 200 mcg inhaler (1 inhalation per day, low dose), salmeterol inhaler (1 puff twice a day) and albuterol inhaler as needed (not used in > 6 months).  Which of the following recommendations would be most appropriate?

     a.     Discontinue albuterol as she is not currently using the inhaler. Continue mometasone and salmeterol.
     b.     Discontinue salmeterol. Continue scheduled mometasone and as needed albuterol.
     c.     Discontinue mometasone. Continue scheduled salmeterol and as needed albuterol.
     d.     Discontinue mometasone and salmeterol. Continue as needed albuterol.

Correct Answer = b

Rationale Provided:

Of the choices given, stopping the salmeterol (Serevent) would be the most appropriate option as this effectively steps her therapy down from Step 3 to Step 2 which is appropriate to consider in patients well controlled for greater than three months.  As the foundation of asthma therapy is inhaled corticosteroid use, discontinuing mometasone (Asmanex Twisthaler) would not be appropriate (and stopping both mometasone and salmeterol would effectively step her therapy down two steps from Step 3 to Step 1).   Finally, a short-acting beta2-agonist should always be available as needed as a quick-relief medication. 


Sample BCPS Question  2

What two factors can influence the pharmacological effect of phenytoin (Dilantin) and the interpretation of measured drug levels by the lab?  

     a.     Sodium and albumin levels
     b.     Potassium and bicarbonate levels
     c.     Albumin and creatinine kinase (CK) levels
     d.     Blood urea nitrogen and albumin levels

Correct Answer = d

Rationale Provided:

The two main factors that can increase the "free-fraction" or unbound concentrations of phenytoin are albumin and blood urea nitrogen levels.  In patients with low albumin levels, there are less protein binding sites for phenytoin and thus more free drug in plasma.  In patients with high BUN levels, the BUN can displaces phenytoin from albumin binding sites through competitive binding thereby also increasing the free fraction or unbound portion of phenytoin.  The clinical relevance of this has to do with an assessment of toxicity.  For example, if a patient comes into the hospital and on physical exam appears to be dilantin toxic, if a normal lab assessment of "dilantin levels" in a patient who also has low albumin levels or high BUN levels, the result that comes back from this lab may suggest the drug concentration is in the normal range of 10-20.  Simply reading the result of a lab test and not putting it in the context of the patient's situation could cause an inexperienced clinician to exclude dilantin as the cause for the patient's clinical presentation.  The truth is that the free fraction is elevated and the only way to know that is to order a special lab (not normally done) called a free dilantin level or a free phenytoin level.  This will most accurately determine the influence of dilantin on this patient's situation.  However, some clinicians will "adjust" the dilantin level based on the albumin and/or BUN to serve a surrogate marker of the likelihood of dilantin toxicity (see the example below where Cp is the concentration measure in the plasma for two situations).   Sodium and potassium have nothing to do with protein binding are distractors.  


Sample BCPS Question  3

A 55 year old patient with Stage 2A HER2 positive breast cancer receiving every three week adjuvant trastuzumab therapy.  At her appointment, she complains of fatigue and the inability to do her normal daily activities.  Her lab results show that she is anemic with a hemoglobin of 9.9 g/dL (hematocrit 29%).  Which of the following treatments would be best for this patient? 

     a.     Start epoetin alfa 40,000 units SQ weekly
     b.     Begin darbepoetin alfa 500 mcg SQ every three weeks
     c.     Initiate iron sucrose 200 mg IV followed by darbepoetin 500 mcg SQ every 3 weeks
     d.     No erythropoiesis stimulating agent (ESA) is indicated

Correct Answer = d

Rationale Provided:

This patient does not qualify for erythropoiesis stimulating agent (ESA) therapy for two main reasons that are stated in the package insert.  First she is an early stage breast cancer patient so ESA use is not indicated in curative patients.  Second she is not receiving myelosuppressive chemotherapy.  The use of monoclonal antibodies such as trastuzumab (Herceptin) are not considered myelosuppressive chemotherapy. Since ESAs have a small but significant risk of disease recurrence and death, ESA use in curative patients is not recommended.


Sample BCPS Question  4

Which one of the following HIV medications (i.e., antiretrovirals) are known to cause renal toxicity or failure at any time? 

     a.     Zidovudine (AZT, Retrovir)
     b.     Nevirapine (NVP, Viramune)
     c.     Tenofovir (TNF, Viread)
     d.     Famciclovir (FMV, Famvir)

Correct Answer = c

Rationale Provided:

Famciclovir (Famvir) is not an HIV medication, but rather is an anti-viral used in treatment of herpes simplex virus and varicella zoster virus.  Nevirapine is associated with causing liver damage (or hepatotoxicity).  Zidovudine (Retrovir) is a nucleoside reverse transcriptase inhibitor (NRTI) that is associated with bone marrow suppression (anemia, neutropenia) and macrocytosis).  Tenofovir (Viread) is also a NRTI and is associated with renal toxicity including Fanconi syndrome.  Unfortunately, it can happen without notice and thus clinicians should monitor the serum creatinine periodically. 


Sample BCPS Question  5

Which patient population and genetic polymorphism is known to significantly predispose the patient taking carbamazepine to a severe, life threatening rash such as Stevens Johnson Syndrome (SJS)? 

     a.     Caucasians; HLA-B*5701
     b.     Asians; HLA-B*1502
     c.     African Americans; VKORC1*2
     d.     Asians; CYP2C9*3

Correct Answer = b

Rationale Provided:

Carbamazepine (Tegretol) has a black box warning for the increased in people of Asian descent (especially Han Chinese) to develop severe and life-threatening rashes such as Stevens Johns Syndrome.  The company and the FDA now recommend avoiding carbamazepine in patients with HLB-B*1502.  This information applies to the use of carbamazepine for the treatment of epilepsy as well as bipolar disorder.  HLA-B*5701 would put patients at risk for an abacavir (Ziagen) hypersensitivity reaction.  Abacavir is a nucleoside reverse transcriptase inhibitor (NRTI) that is used in the treatment of HIV infection.  VKORC1*2 and CYP2C9*3 are involved in mainly warfarin (Coumadin) safety/efficacy.


Sample BCPS Question  6

A group of investigators have designed a study to determine if ezetimibe (Zetia) was more effective than cholestyramine (Questran) for the treatment of hyperlipidemia. They designed the study so that 500 patients would be randomly assigned to one of 2 groups: ezetimibe 10 mg once daily or cholestyramine 4 g by mouth twice a day with meals. At baseline, patients had fasting lipid profile done. These patients were then prospectively followed for 6 months.  At the end of the study (6-months) the patients had a follow up visit where fasting lipid profiles completed. The primary endpoint was to determine the change in LDL-c (mg/dL) from baseline. The secondary endpoints included: 1-The proportion of patients developing cholestasis or needing a cholecysectomy.  Which of the following statistical tests would you recommend for answering the primary objective (assume sample or population studied is normally distributed)? 

     a.     Student's t-test
     b.     Paired t-test
     c.     Chi Square
     d.     ANOVA

Correct Answer = a

Rationale Provided:

The best way to figure this is to do the following:  First ask, "How many groups (or samples) does this study have?" = 2.  Second, "Are these two groups (or samples) related (i.e., same patient) or independent (i.e., not the same patients in both groups)? = Independent.  Third, now determine the endpoint, "What is the endpoint?" In this case, the investigators specifically want to know the change in LDL-c or the amount of lowering in the LDL-c in mg/dL.  This is a concentration and thus each mg/dL is the same in magnitude and thus considered to be continuous (note: the change can be to infinity, there is no ranking or scale here).

Thus, a study using 2 independent groups evaluating a continuous data variable (with normal distribution), the correct statistical test would be a Student's t-test.  A paired t-test would have been used if the two groups were related (not independent).  A chi-square is used for assessing nominal or categorical data (i.e., an endpoint that causes you to have answer a "yes" or "no" question.  An ANOVA is used when there are 2 or more independent groups being evaluated.