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Sample BCPS Question 1

A 45-year-old female who has been newly diagnosed with type 2 DM and is being evaluated for treatment. Her initial vitals and labs are: 128/72 mmHg, BMI = 33 kg/m², A1c = 8.7%, eGFR > 60 mL/min/1.73m², UACR = 18 mg/g. What is the best initial treatment?

Metformin

Metformin and lifestyle changes

Metformin and dulaglutide

Metformin and pioglitazone

Answer: C

Rationale:

Metformin and dulaglutide (Trulicity) provide early combination therapy that has been shown to potentially reduce the decline in glycemic control while also promoting weight loss. The VERIFY trial demonstrated a reduction in the decline of glycemic control with initial metformin and vildagliptin treatment compared to metformin or sequential use of metformin and vildagliptin, which is typically how providers initiate therapy.
Initial combination therapy should be started if A1c is >1.5% above target to slow the decline in glycemic control but does not limit this combination to metformin and vildagliptin or another DPP-4 inhibitor.
Pioglitazone would be a less desirable option since this patient is obese, and pioglitazone can promote weight gain.

High-Yield Core Concept:

Initial combination therapy should be considered in type 2 DM management because it can reduce the decline in glycemic control, and a discussion should occur with the patient to determine their preference.
Initial combination therapy for type 2 DM should be considered if the patient is >1.5% above A1c goal.

High-Yield Fast Fact(s):

Dulaglutide (Trulicity) is a GLP-1 receptor agonist that does not require titration from 0.75 mg weekly to 1.5 mg weekly; however, GLP-1 naïve patients may experience increased adverse effects starting at 1.5 mg weekly.

References:

Diabetes Care 2020;43(Suppl. 1):S1-S212.
Lancet 2019;394:159-1529.

Sample BCPS Question 2

A 56-year-old female presents to your clinic with the following fasting laboratory test results: total cholesterol 218 mg/dL, triglycerides 153 mg/dL, HDL 51 mg/dL, LDL 139 mg/dL, and A1c 5.9%. She does not take any prescription medications. She follows a heart healthy diet, does not use tobacco products and does not drink alcohol. Her atherosclerotic cardiovascular disease (ASCVD) risk score is 2.3%. Her liver and kidney function are within normal limits. Which of the following is the best recommendation for this patient?

Start fish oil

Start atorvastatin 40 mg daily

Start rosuvastatin 5 mg daily

Initiate lifestyle changes to reduce risk factors

Answer: D

Rationale:

The fourth answer choice is correct because this patient has a low 10-year ASCVD risk score at <5%. At this point, it is important to emphasize lifestyle changes to help reduce risk factors. A diet rich in vegetables, legume, nuts, whole grains and fish is recommended with minimized intake of refined carbohydrates and sweetened beverages. Adults should engage in at least 150 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic physical activity.
The first answer choice is not necessary because this patient does not have elevated triglycerides > 500 mg/dL to warrant fish oil therapy.
The second answer choice is not appropriate because atorvastatin 40 mg daily is a high intensity statin and this patient has a low ASCVD risk score. A high intensity statin would be appropriate if her ASCVD risk score was ≥ 20%.
The third answer choice is incorrect because a moderate intensity statin such as rosuvastatin 5 mg daily can be considered when the ASCVD risk score is between 5% and 20%.

High-Yield Core Concept:

For adults age 40-75 and LDL-C of 70–189 mg/dL without diabetes, a 10-year ASCVD risk score is needed to determine therapy. If the 10-year ASCVD risk is > 5% with risk enhancers present, risk discussion regarding moderate intensity statin therapy is appropriate. If the 10-year ASCVD risk is > 20%, initiate high intensity statin therapy to reduce the LDL-C by > 50%.

High-Yield Fast Fact(s):

Examples of ASCVD risk enhancers include: family history of premature ASCVD, elevated LDL-C >160 mg/dL, chronic kidney disease, metabolic syndrome, pre-eclampsia, premature menopause, inflammatory disease (rheumatoid arthritis, psoriasis, HIV/AIDS), and South Asian ethnicity.

Reference:

J Am Coll Cardiol. 2019 Sep 10;74(10):1376-1414.

Sample Biostatistics Question

(Included in Premium Packages)

A study was completed and revealed a p-value between the two treatment groups to be p = 0.01. Assuming an alpha = 0.05, which of the following offers the best interpretation of this p-value?

There is a 5% chance the study has made a type II error

There is a 1% chance that the study results are due to random error

There is a 5% chance that the study results are due to chance alone

There is a 0.01% chance that the results are due to chance alone

Answer: B

Rationale:

This is a high-yield concept that you must know.
A p-value only helps you to know whether the results that were found in the study were due to random error or due to chance alone.
In order to interpret this p-value fully you have to convert it into a percentage. To do this all you have to do is multiple it by 100 or move the decimal point over to the right by two spaces. Therefore, the p-value of 0.01 is the same as 1%. Therefore, based on the definition of a p-value above, there is a 1% chance that the study results are due to random error or chance.
The alpha value is the level or chance an investigator could be making a type I error. As a reminder, a type I error occurs when the study or investigators say there is a difference between two studied interventions, but in reality, there is actually no difference at all. Its use in this case is simply basic information and not meant to be something to focus on.

High-Yield Core Concept:

A p-value does not determine if the results are clinically significant, but rather if the results are due to random error or due to chance alone. A study attempts to measure the truth and reduce bias and random error since we are only studying a sample from the entire general population.

High-Yield Fast Fact:

The most accepted cut-off value for determining when to accept or reject the null hypothesis is about 0.05, which corresponds to 2 standard deviations from the mean.

Sample BCPS Questions

We ensure you learn to Apply Core Concepts

so that You can pass the BCPS Exam

You Need to Pass the BCPS Exam.

Here's how Our Q-Bank Questions Can Help.

✓ Our Questions align with the BCPS exam objectives

✓ written by board certified clinical pharmacists

✓ Our premium course also covers biostatistics

✓ Compare your performance with peers

✓ Trusted for over a decade by pharmacists

Sample BCPS Q-Bank Questions

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Sample BCPS Question 1

Answer: C

Rationale:

High-Yield Core Concept:

High-Yield Fast Fact(s):

References:

Sample BCPS Question 2

Answer: D

Rationale:

High-Yield Core Concept:

High-Yield Fast Fact(s):

Reference:

Sample Biostatistics Question

(Included in Premium Packages)

Answer: B

Rationale:

High-Yield Core Concept:

High-Yield Fast Fact:

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