Sample Questions from our BCACP Q-Bank

The sample questions below were taken directly from our BCACP Q-BanK.  They represent over a 1,750 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

When calculating power, the reduction in Beta (β) will likely result in what type of change to the sample size needed? 

     a.     Increase
     b.     Decrease
     c.     No change
     d.     Beta is not used in the calculation of Power

Correct Answer = a

Rational Provided:

Since Beta (β) by definition is the probability of a Type II error, then Power = 1-Beta is the probability of NOT making a Type II error. Note: the larger the Beta the lower the power of study and greater chance of making a Type II error.  Therefore, the smaller the Beta the larger the power and less chance of making a type II error, results in the study that needs more patients or larger sample size in order to find a difference if it in fact does exist. Type II error occurs when a study states there is no difference between the groups assessed but in reality there is a difference.  Any time a study fails to find a statistical difference between two groups the greater the chance that a Type II error has occurred. 

 

Sample BCACP Question  2

A 33 yr old Hispanic female with a past medical history for asthma reports for routine follow up.  She is currently on the following medications:  fluticasone 110mcg inhaler - 1 puff twice a day (low-dose therapy), albuterol inhaler - 1-2 puffs every 6 hours as needed, acetaminophen 500mg tablets - 1-2 tablets every day as needed for "muscle soreness after exercise".  When asked about her asthma symptoms, she reports waking up at night coughing 3-4 times in the last couple of weeks and is experiencing more shortness of breath and wheezing during exercise almost daily.  She also notes using her albuterol inhaler 4-5 times in the last couple of weeks.  Which of the following recommendations is most appropriate?

     a.     Her asthma is well controlled. Continue therapy and encourage use of her albuterol as needed.
     b.     Her asthma is not well controlled. Increase fluticasone to 2 puffs twice a day, continue albuterol as needed and re-evaluate in 2 weeks.
     c.     Her asthma is not weIl controlled. Increase albuterol to 2 puffs every 4 hrs PRN, continue fluticasone, and re-evaluate in 2 weeks.
     d.     Her asthma is poorly controlled. Initiate short course of oral steroids, increase fluticasone to 2 puffs twice a day, continue albuterol PRN, and re-evaluate in 2 weeks.

Correct Answer = b

Rationale Provided:

Based on the National Heart, Lung and Blood Institute's Asthma Guidelines, this patient's asthma is not well controlled based on the Assessing Asthma Control and Adjusting Therapy figure.  The appropriate option would be to step up one step in therapy (which would be increasing the inhaled corticosteroid) and re-evaluating soon.  Increasing albuterol use, the rescue inhaler, would not be the most appropriate choice as the controller medication, in this case fluticasone (Flovent), should be increased instead.  Use of oral corticosteroids would not be the most appropriate option at this point given she is not very poorly controlled.

 

Sample BCACP Questions  3

If you have a patient who comes to the emergency room with a soft tissue infection that is identified to be caused by community acquired methicillin resistant staphylococcus aureus (MRSA), which of the following antibiotics would be the best when treating this infection as an outpatient?

     a.     Trimethoprim/sulfamethoxazole
     b.     Amoxicillin/clavulanic acid
     c.     Levofloxacin
     d.     Tigecycline

Correct Answer = a

Rationale Provided:

Both trimethoprim/sulfamethoxazole (TMP/SMX; Bactrim; Septra) and tigecycline (Tygacil) are used in the treatment of MRSA, however tigecycline is typically reserved for hospital acquired (or more resistant) MRSA and is only available by intravenous (IV) infusion.  As such, tigecycline is reserved for patients in the inpatient hospital setting or through home health.  The best answer is TMP/SMX since it is also available as an oral dosage form.  Neither amoxicillin/clavulanic acid (Augmentin) nor levofloxacin (Levaquin) cover MRSA.  

 

Sample BCACP Question  4

Which cytochrome P450 enzyme is primarily responsible for the metabolic activation of clopidogrel (Plavix) and is known to have various genetic polymorphisms? 

     a.     1A2
     b.     2D6
     c.     2C9
     d.     2C19

Correct Answer = d

Rationale Provided: 

While CYP2C9 and 2D6 are subject to genetic polymorphisms, they are not involved in the metabolism of clopidogrel to a significant extent.  CYP2C19 is primarily involved in the metabolic activation of clopidogrel (Plavix).

Note:   While the below the information is beyond most board exams, it does help to further understand the influence of genetic polymorphisms on drug efficacy.  As it relates to CYP2C19, there are several known single-nucleotide polymorphisms (SNP) that can significantly influence the activity of that enzyme.  The majority of the population around the world have the wild-type or normal CYP2C19*1 and are known to be extensive metabolizers.  In mainly people of Asian descent (18-23%), there are four common SNPs that are known to result in an enzyme that is less functional.  These less functional CYP2C19 enzymes are designated as CYP2C19*2 (G681A), CYP2C19*3 (G636A), CYP2C19*4 (A1G), CYP2C19*5 (C1297T) and leads to very little to no metabolism of substrates.  While there are a number of factors that contribute to clopidogrel's activation, one avenue is through CYP2C19.  As such these genetic polymorphisms result in a decrease in the amount of active clopidogrel metabolite available to inhibit platelet aggregation and thus have now been associated with worsening of CV related endpoints (death, nonfatal myocardial infarction, stroke, and post-stent rethrombosis (see the table below)).  Interestingly, one study in patients who were poor metabolizers did show that increasing the loading and maintenance dose of clopidogrel improved the degree of platelet inhibition.

While most patients with the wild-type for CY2C19 are extensive metabolizers, there is a SNP that results in about 18% of Ethiopians and Swedes, 1.3% of Japanese and 0.6% of Chinese who are known to be ultrarapid metabolizers of CYP2C19.  This SNP is designated as CYP2C19*17 and results in an increased metabolic activity of CYP2C19.  It is unknown if this SNP confers any significant amount of protection against CVD in patients taking clopidogrel.   While genetic polymorphisms to CYP2C19 appear to contribute to an increase in CV-related events, the activation of clopidogrel and its ability to inhibit platelet aggregation are also influenced by a number of other factors such as smoking status and drug interactions through CYP2C19 and CYP3A4.

 

Sample BCACP Question  5

What change in the forced expired volume at 1 second (FEV1) is needed for a short-acting bronchodilator to be considered a positive response (or beneficial response) to a patient with asthma? 

     a.     2%
     b.     5%
     c.     10%
     d.     12%

Correct Answer = d

Rationale Provided:

This is the criteria generally recognized as an indicator that the patient has reversible hyperactive airway disease that is responsive to bronchodilator therapy (such as beta-2 agonists: albuterol, levalbuterol, pirbuterol).  The change in forced expiratory volume at 1 second (FEV1) is determined by doing pulmonary function tests (PFTs) before the use of a short-acting bronchodilator and then again after the use of a short-acting bronchodilator.  In addition, this criteria mainly applies in the context of treating asthma, not COPD where there is little bronchodilation from beta-2 agonists or anticholinergic agents due to the damage to the airways. 

 

Sample Questions  6

Which of the fibrates (fibric acid derivative) used in the management of hypertriglyceridemia are known to cause drug interactions with many of the HMG CoA reductase inhibitors (i.e., statins)? 

     a.     Fenofibrate
     b.     Ezetimibe
     c.     Gemfibrozil
     d.     Simvastatin

Correct Answer = c

Rationale Provided:

Of the two fibrates (fibric acid derivatives) it is important to differentiate their ability to inhibit the metabolism and/or elimination of many statins.  Gemfibrozil is the primary fibrate known to do this partially through its ability to inhibit glucuronidation (UGT) 1A1 and 1A3.  While most statins are metabolized by the cytochrome P450 (CYP) enzyme system, all statins also undergo some degree of glucuronidation (or phase II metabolism) in the body for the purpose of enhancing elimination into the bile and/or urine.  In addition, statins also utilize many influx and efflux transporters for their distribution throughout the body.  Inhibition of any one or a combination of these pathways (phase I, phase II and/or transporters) can result in the accumulation of statin in the body thereby putting the patient at greater risk for the development of rhabdomyolysis and/or hepatotoxicity.  While neither of the fibrates are inhibitors of any of the CYP450 enzymes used by statins currently on the market, gemfibrozil can inhibit glucuronidation and some of the transporters they do rely upon.  A review of the FDA adverse drug event reporting system from January 1998 to March 2002, suggested that there was a 15-fold greater risk of gemfibrozil causing a drug interaction with statins as compared to fenofibrate.  This report also found that there were 8.6 cases reported with gemfibrozil causing a drug interaction with statins per million prescriptions.  While this was significantly greater than with fenofibrate (0.58 cases per million prescriptions), it is obvious that the absolute number per million prescriptions is low.

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