Sample Questions from our BCACP Q-Bank

The sample questions below were taken directly from our BCACP Q-BanK.  They represent over a 1,800 other practice test questions you will encounter with the use of our BCACP Q-Bank.  We believe our BCACP practice test questions will prepare you to pass the BCACP exam the first time.  Each question comes with a concise rationale supporting the right answer or concept being tested.   

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Sample BCACP Question 1

A 5 year old Hispanic male presents with clinical signs and symptoms consistent for Group A streptococcal (GAS) pharyngitis. He has no medication allergies and has no significant past medical history. Which of the following is the best option?

  1. Amoxicillin
  2. Ciprofloxacin
  3. Minocycline
  4. Sulfamethoxazole/trimethoprim

Answer = A

Rationale:

  • The IDSA Group A Streptococcal pharyngitis (GAS) guidelines recommend amoxicillin, which can also be dosed using a once daily dosing regimen of 50 mg/kg, max = 1000 mg.
  • The high rates of tetracycline resistance preclude their use.
  • Trimethoprim-sulfamethoxazole (Bactrim) does not eradicate GAS in acute pharyngitis.
  • Ciprofloxacin has limited activity against GAS pharyngitis and should not be used.

High-Yield Core Concept:

  • To identify the optimal empiric coverage for a patient being treated for Group A streptococcal (GAS) pharyngitis.

High-Yield Fast Fact(s):

  • Penicillin-resistant GAS has never been documented.
  • Amoxicillin is often used in place of penicillin V as oral therapy for young children because of the taste of the suspension. This efficacy appears to be equal.

References:

  • Clinical Infectious Diseases 2012;55(10):e86-102.
  • J Pediatr Pharmacol Ther 2010;15(4):244-248.
  • Pediatrics 1999;103(1):47-51.

 


Sample BCACP Question 2

A 43 yr old African American male is given a new diagnosis of glaucoma for which both of his parents suffered and lost their eye sight over.  He does not want to lose his eyesight and thus wants to get the glaucoma under control.  Unfortunately, he reports being severely allergic to sulfa containing drugs and was told by his allergist to never take medications with sulfa?  Which of the following ophthalmic agents used for the treatment of glaucoma contains a sulfonamide groups?

  1. Dorzolamide
  2. Levobunolol
  3. Brimonidine
  4. Travoprost

Answer = a

Rationale:

  • All of the carbonic anhydrase inhibitors (all dosage forms) contain sulfonamide groups and thus should be used with caution in this patient despite some evidence suggesting that antimicrobial sulfonamide containing medications are not the same as non-antimicrobial sulfonamide containing medications. 
  • The carbonic anhydrase inhibitors used in the management of glaucoma include: [acetazolamide (Diamox - tablet and injectable); methazolamide (Neptazane - a tablet); Brinzolamide (Azopt - suspension eye drop); dorzolamide (Truspot - eye drop)].
  • Developing Stevens Johns Syndrome (SJS) from a sulfa allergy can involve the conjunctiva and cornea of the eye which would be devastating in this patient scenario where other ophthalmic agents are available.  In addition, this patient is specifically requesting to avoid sulfonamide containing medications at the advice of an allergist which raises the stakes or your level of concern versus a patient who reports a vague or unclear "sulfa allergy".
  • Levobunolol (Betagan) is a non-selective beta-blocker ophthalmic solution that reduces the production of aqueous humor to lower intraocular pressure in the treatment of glaucoma.
  • Brimonidine (Alphagan P) is an ophthalmic alpha-2 agonist that decreases aqueous humor production and increases uveoscleral outflow to lower intraocular pressure in the treatment of glaucoma.
  • Travoprost (Travatan Z) is a prostaglandin analogue that increases the outflow of aqueous humor via the uveoscleral pathway to lower intraocular pressure in glaucoma.

High-Yield Core Concept:

  • All of the carbonic anhydrase inhibitors (all dosage forms) contain sulfonamide groups.

High-Yield Fast Fact(s):

  • Acetazolamide (Diamox) is not only used for glaucoma, but can be used for treatment of altitude sickness, edema, epilepsy, and pseudotumor cerebri (or also known as idiopathic intracranial hypertension (IIH)).

Reference:

  • J Ocul Pharmacol Ther 2013;29(5):456-61.

 


Sample BCACP Question 3

You are reviewing the labs of a patient with hyperaldosteronism and notice a potassium level of 2.8 mEq/L. Why would increased aldosterone levels cause this abnormal lab finding?

  1. Increase of sodium delivery to distal convoluted tubule
  2. Osmotic diuresis
  3. Polycythemia
  4. Retention of sodium and water

answer = D

Rationale:

  • Patients with hyperaldosteronism retain sodium and water and then have low levels of potassium because of renal excretion of potassium occurs as the nephron attempts to reabsorb the Na+ and water.  This leads to increased urinary potassium concentrations and low urine concentrations of sodium.
  • Renal loss of potassium can occur with drug induced increase of Na+ delivery to distal convoluted tubule by thiazide or loop diuretics, steroids and fludrocortisone, and high-dose penicillin.
  • Osmotic diuresis, which can be seen in diabetic ketoacidosis, causes renal loss of potassium due to increased flow through the kidney and the body is unable to reabsorb potassium.
  • Polycythemia may be an underlying cause of hyperkalemia with greater number of cells containing more potassium intracellularly.

High-Yield Core Concept:

  • Various underlying factors such as osmotic diuresis, hyperaldosteronism, certain drugs, and kidney injury can cause renal loss of potassium, which are important to consider in the differential diagnosis of patients with hypokalemia.

High-Yield Fast Facts:

  • Moderate hypokalemia is defined as a potassium level of 2.5-3.0 mEq/L.
  • Damages to areas in the kidney which reabsorb sodium affect potassium levels; thus, hypokalemia is seen in Type I and II acute tubular necrosis and renal tubular acidosis.

References:

  • Nat Rev Nephrol. 2011 Feb;7(2):75-84.
  • Basic Skills in Interpreting Laboratory Data, 4th edition. 2009:119-160.
  • The Renal Assoc. Treatment Guidelines. 2012.
  • Am Fam Physician. 2015 Sep 15;92(6):487-95.


Sample BCACP Question 4

JL is a 65 year old female and a new patient to your clinic. She is coming to clinic today for her annual Medicare Wellness visit and is asking questions regarding what medications and/or supplements that she should be taking. Knowing this information, which medication appropriateness reference do you utilize to help with JL?

  1. Anticholinergic Risk Score (ARS)
  2. BEERS' List
  3. START Criteria
  4. STOPP Criteria

Answer = C

Rationale:

  • The START criteria, or the Screening Tool to Alert doctors to the Right Treatment, was created to help identify what specific medications that an older adult may need. With JL, it would be an appropriate time to review her medications discuss what is needed.
  • The STOPP criteria are medications that should potentially be stopped or discontinued.
  • Beers' List is a list of medications which are potentially inappropriate.
  • The Anticholinergic Risk Score is a list of medications with a listed degree of anticholinergic risks and is not designed to answer the question of which medications should be added to an older adult.

High-Yield Core Concept:

  • These tools are still tools and they should be not be considered as "absolute guidelines".
  • A clinician must be able to use the START tool to assess if a patient not only needs the agent, but would also receive benefit before initiating a medication regimen.

High-Yield Fast Facts:

  • START is the only tool created with the intent to remind practitioners of when certain agents would be appropriate to add to an older adult's medication regimen as well identify omitted medications.
  • The START and STOPP tools were originally created in Ireland as a response to the initial shortfalls of the BEERS' List.

References:

  • Age Ageing 2015:44(2):213-218.
  • J Am Geriatr Soc 2015;63(11):2227-46.