Part 2: Tackling the Case-Based Question

BPS exams demand that test-takers strengthen BOTH pharmaceutical knowledge and test-taking skills. Unlike most situations pharmacists face, there is no option for providing rationale or qualifying an answer. It is vital on these multiple-choice exams to practice consistently and become accustomed to quickly demonstrating knowledge.  If knowledge is not transmitted from your brain to the paper, you won't receive credit. Our experienced editors provide simple, straightforward strategies to help shore up any weaknesses and enhance the necessary test-taking skills for BPS exams.

In Part 1 of this series, you learned about the importance of planning, knowing the rules, practicing, maintaining the mindset, time management, and understanding how to approach the first 6 types of questions found on BPS exams. If you haven't read Part 1 of this series, be sure to catch up here: Part 1: Study Planning & Question Types .

In Part 2 of the series, we will be exploring how to tackle the 7th and most complex type of question, the case-based question.  We'll also give some pointers to avoid the panic that can sneak in when you don't know an answer.  Let's get started!


What is it?

Case-based questions present a clinical scenario with multiple pieces of information (i.e. past medical history, exam findings, and lab results) and typically ask for the proper plan of action. These questions are meant to test your ability to analyze information quickly, interpret it accurately, and think critically to solve the problem. The same is true for real-life patient scenarios. Keep in mind that the board is assessing your ability to think at a higher level for the good of your patients.  The exam aims to test your knowledge and ability to provide safe and effective treatment that is evidence-based and follows universal standards of care. Take each question seriously!

Important: You WILL be expected to interpret basic lab findings. Therefore, brush up on basic labs and lab values (i.e. comprehensive metabolic profile, white blood cells, TSH, and basic lipids). Need a refresher?  Choose a Premium Review Course for a comprehensive exam review.

The sheer amount of information presented in case-based questions means they are long and require extra reading and additional time. Remember, this is a timed test, so you will need to be efficient at time management. Move swiftly through shorter, explicit knowledge questions to balance out the time and attention needed for analyzing the information provided in case-based questions.

Beware, these questions may also present multiple answer options that could be considered "correct" or "viable,"; however, there will always be only one "best" choice. In these instances, look for a detail in the case scenario that reveals why the "right answer" is best for this specific patient. Ensure that you are choosing the best treatment for each specific patient scenario, and not simply the most commonly used. Remember, this exam assesses the ability to go beyond basic knowledge and make more complex judgments.

How to Tackle It

Work in order. While the last sentence is typically the main question, a clinical case develops and evolves. Approach the question in the order presented to maintain a clear timeline, notice the succession of elements as they build on each other, and ensure you don't miss any important details. While many people think jumping to the end to read the question will save the time of reading the entire case, beware! This tactic can easily backfire. The questions are written so that a pattern of association will build up and direct you to the right answer.   Take the time to follow it.

Look for a pattern. Try not to be overwhelmed by the length of the question or by trying to memorize all of the information. Rather, look for the association between the details. Again, there will be a pattern of association that is directing you to the right answer.

Judge the information. As you read through the labs, current medications, etc. that are provided for the scenario, don't just notice the information; evaluate and judge it. For example, ask yourself, "Do I see an indication for that medication? Are those labs expected because of their PMH or might it indicate a new issue? Is their present treatment plan correct or might it, in fact, be causing the new symptoms?".

Don't presume. Of course, it is essential to think through possible causes for test results, vitals, and symptoms.  However, you must take care not to assume a likely cause as fact unless it is stated in the question. It is possible the question is assessing if you can think outside of what is typical and catch less common situations. Evaluate and determine what you can, but also keep an open mind.  Almost nothing is black and white or one-size-fits-all in medicine. Likewise, if you are thinking "I would ask the patient for more information," then you are likely not on the right track - the details you need to reach the right conclusion are provided.

Consider the how. You must move beyond simply memorization of guidelines and protocols.   Consider how the medications do what they do.  This will help you recognize what other consequences (good or bad) their use may have.

Formulate your own answer. As you are reading through the scenario, try to think critically and formulate your own answer before reading the answer options. This will ensure that you keep a clear mind and are less likely to be drawn in by a distractor answer that seems right but is not the "best" answer. If one of the answers aligns with what your gut was telling you, then you are probably right. 

Finally, consider mortality. When choosing a best answer, keep in mind that if both treatment options would do the job, but one of them reduces mortality or adds to quality of life, then that is the better answer.

To see examples of going through these steps with actual question examples, watch the webinar on solving case-based questions here.


If you find yourself panicking... 

Remember a core concept is being tested here - this is not a trick question.  Go back to basics and think of how you can best treat this patient. 

Trust your initial gut reaction and avoid changing your answers unless there is a clear reason to do so. 

If you're running out of time, answer all unfinished questions.  Try to narrow it down, or if necessary, guess.  Remember, with 4 answer choices, you have a 25% chance of picking the right answer. If you eliminate 1-2 answer options, you now have a 50 - 75% chance of being right.   Do not leave any questions blank. 

Take a deep breath to clear your mind just like you would moving from one patient to the next. 

And remember, at the end of the day, your goal is providing the best possible care to your community. Pass or fail, there is a bigger picture here. Your test results do not define you. You are a medical professional striving to improve your knowledge and skills so you can continue to serve your patients. Don't think about the board exam as intimidating - show up ready to demonstrate the quality of care you know you can provide.

Additional Resources

Check out our FREE webinars on Board Certification & Test-Taking Strategies!

Blog: 6 Reasons to Become a Board Certified Pharmacist

Blog: BPS Test-Taking Strategies Series: Part I

Blog: BPS Test-Taking Strategies Series: Part III

Blog: How Important are Biostatistics & Clinical Literature on BPS Exams?