Hope you all enjoy some free BCPS practice questions!  I’ve been asked to post the answers to the quiz, so here they are.  If you haven’t seen the questions yet and want to test yourself here’s the test without the answers:  BCPS 10 Questions

1.  Patient presents with recent lab test results and vitals. Currently receives propranolol, lubiprostone, methotrexate, and carbamazepine. Results were as follows: creatinine = 0.9, potassium = 4.6, pulse = 78, blood pressure = 126/74, sodium 124, ALT = 15, AST = 24. Which medication is the most likely cause of the lab abnormality?

1. Propranolol
2. Lubiprostone
3. Methotrexate
4. Carbamazepine

Carbamazepine, SSRI’s, Diuretics are a few common causes of hyponatremia.  Be especially cautious when these medications are used together on the same patient.

2.  Patient’s medication list includes metoprolol, omeprazole, pregabalin, and tramadol. Over time this patients renal function has declined from 66 mls/minute to 16 mls/min. Dose of each medication has remained constant. Patient presents with new prescription for furosemide to help treat edema. She has also had some fatigue as well. Which of the following is the most likely cause of current symptoms?

1. Tramadol
2. Pregabalin
3. metoprolol
4. omeprazole

Pregabalin and Gabapentin mainly used for neuropathy are common contributors to edema. They are also eliminated via the kidney and can accumulate with changes in renal function. Tramadol and metoprolol could contribute to the fatigue, but likely not the edema.

3.  Which of these agents is most likely to cause issues with diabetes in our patients?

1. Risperidone
2. Clozapine
3. Ziprasidone
4. Aripiprazole

Antipsychotics can certainly increase the risk of metabolic syndrome and worsen diabetes concerns. Zyprexa (olanzapine) and Clozapine are two of the worst antipsychotics as far as metabolic issues. Ziprasidone and Aripiprazole are two that tend to have less metabolic concerns.

4.  What does a p value represent?

1. The likelihood that a null hypothesis is true.
2. The likelihood that there is type 2 error
3. The likelihood that there is type 1 error
4. None of the above

Remember that type 1 error is the likelihood that you detected a difference, and in reality there isn’t. If a p value is <0.00001 for example, there is an extremely low risk that the difference detected is false. In general if p is greater than 0.05, the results are not considered statistically significant.

5.  78 year old male with increasing fatigue, feels like sleeping all day – history of Hypertension, diabetes, osteoarthritis, and CKD. Current medications include ferrous sulfate 325 mg daily, Folic acid 1 mg daily, hydrochlorothiazide, and glipizide. Labwork reveals occult blood negative, hemoglobin 8.4, ferritin 460, B-12 700, Folate – >20 MCV = 96, creatinine = 2.3. What would be most appropriate in treating this patient’s anemia?

1. Add GI protection like omeprazole
2. Add epoetin
3. Increase ferrous sulfate to twice daily
4. Add a B-12 supplement

Labs all reveal adequate stores of iron, B-12, and occults were negative so only option that would likely help this patient’s symptomatic anemia is erythropoietin therapy.  Remember that the kidney is where the body makes its erythropoietin – in kidney disease this production can decrease (noted elevated creatinine).

6.  Which of the following antiarrhythmics works via blocking potassium channels?

1. Sotolol
2. Flecainide
3. Lidocaine
4. Quinidine

Sotolol has both beta blocking and potassium channel blocking activity.  The others primarily work on sodium channels.

7.  Choosing only patients with severely high blood pressure for a study on hypertension medication that will help you prove statistical significance is an example of:

1. Observational Bias
2. Selection Bias
3. Recall Bias
4. Interviewer Bias

Bias in selection or choosing of participants in a study is selection bias.

8.  How much of a 1 liter bag of NS or LR solution will end up in the intravascular space?

1. 1 liter
2. 750 mls
3. 500 mls
4. 250 mls

Answer is 250 mls.

9.  34 year old male presents with painful urination. Reported being recently sexually active with multiple partners. There is no discharge noted, but symptoms have been ongoing for 2-3 days. Current allergies: Macrolides. Suspected bacterial STD with gonorrhea and chlamydia. What is the most appropriate therapy?

1. Ceftriaxone and Levofloxacin
2. Ceftriaxone and doxycycline
3. Doxycycline and Penicllin
4. Macrodantin and Ceftriaxone

Remember that quinolone resistance is highly reported in the literature. Normal first line therapy for co-infection is ceftriaxone and azithromycin, but with the allergy, doxycycline can be used as an alternate.

10.  Which of the following would not be an anticipated side effect of rivastigmine?

1. CNS changes
2. Weight Loss
3. Diarrhea
4. Urinary Retention

Rivastigmine is an acetylcholinesterase inhibitor – think opposite effects of anticholinergics. Urinary retention would not be anticipated.

If interested in more BCPS practice questions, please click here.