BCPS Exam 1 Latest Update 2024-2025 Questions and 100% Verified Correct Answers Guaranteed A+ 38 year old male with a history of Multiple Sclerosis. Past medical history is minimal other than MS. With treatment of Interferon Beta 1a for MS, what is the best choice for prevention of side effects?
- Low dose corticosteroid
- Acetaminophen scheduled three times daily
- Ibuprofen 600 mg with injection
- Benadryl 50 mg with injection - CORRECT ANSWER: Answer: C. Ibuprofen 600 mg
with injection - Flu like symptoms are common with Interferon Beta 1a. Acetaminophen or Ibuprofen would be appropriate. Three times daily acetaminophen would be excessive for prevention of injection site reaction. Steroids would not be indicated due to long term adverse effects risk like hyperglycemia, osteoporosis, adrenal suppression, etc. Benadryl doesn't have any analgesic properties.
A 17 year old male is having difficulty with acne. He has tried over the counter medications, says they didn't work, but can't remember what kind. What is best initial choice of therapy?
- Topical Erythromycin
- Topical tazarotene
- Oral Minocycline
- Isotretinoin - CORRECT ANSWER: Answer: B. Topical tazarotene - Topical retinoid
is generally first line drug of choice. Systemic medications are generally reserved as later/refractory treatment.
A 21 year old college student who lives in the dorm presents to the ED with a headache that he states is the worst in his life. He also has had a stiff neck, fever and chills for the last couple of hours. Brudzinski's sign is positive. Diagnosis of meningitis with likely causative organism of Neisseria Meningitidis. Should we consider prophylaxis for his dorm roommate? If so, what do you recommend?
- No prophylaxis at this point, have roommate self-monitor temperature
- No prophylaxis, but have roommate make clinic appointment in 2-3 days to check for
- Use prophylaxis - Amoxicillin/clavulanate twice daily for 10 days
- Use prophylaxis - Ceftriaxone 250 mg IM once - CORRECT ANSWER: Answer: D.
early symptoms
Use prophylaxis - Ceftriaxone 250 mg IM once - Rifampin is also used sometimes for prophylaxis of meningitis for people in close contact with infected individual.
A 24 year old female presents to you with symptoms of depression. She has been taking escitalopram 10 mg daily for about a week and is not feeling any better. What should you do?
- Recommend transition to citalopram 1 / 3
- Increase dose
- Reeducate patient
- Ask for her pill bottle and count them to check for non-compliance - CORRECT
ANSWER: Answer: C. Reeducate patient - Reeducation that antidepressants will normally take time weeks to a month or two to have an effect. Assessing for compliance/adherence is important, but counting her pills would be inappropriate.
A 32 year old female with a history of obesity and has been trying to get pregnant for over a year. She has not tried any fertility treatments at this time. She is diagnosed with PCOS. Of the following choices, what is the best treatment?
- Glipizide
- Metformin
- Sliding Scale insulin and checking blood sugars 3 times daily
- Sitagliptin - CORRECT ANSWER: Answer: B. Metformin and clomiphene are two
medications used in the potential treatment of PCOS.
A 41 year old male with history of treatment resistant schizophrenia on clozapine. WBC count has been consistently between 5,000 - 7,000 and ANC between 3,000-5,000.Upon this month's labwork, WBC was 1,500 and ANC was 650. What should you recommend?
- Discontinue clozapine and do not restart
- Discontinue clozapine for at least 2-4 weeks and reassess risk/benefit of restart
- Hold clozapine until WBC/ANC returns to baseline, then restart
D. Cut dose in half and check WBC/ANC at least weekly - CORRECT ANSWER:
Answer: A. Discontinue clozapine and do not restart - The drop in WBC/ANC is very significant, clozapine should be discontinued immediately and not restarted.
A 43 year old male is diagnosed with pneumonia. He has a history of AIDS, hypertension, and hypothyroidism. This is his first episode of pneumonia. Allergies to ACE Inhibitors and Sulfa drugs. The likely organism is Pneumocystis jiroveci. What do you recommend?
- Doxycycline
- Pentamidine
- Dapsone
- Ethambutol - CORRECT ANSWER: Answer: B. Pentamidine - Drug of choice here is
sulfamethoxazole/trimethoprim for 21 days, but with Sulfa allergy, pentamidine is the second best option.
A 45 year old female presents to you with a history of seizures, neuropathy, and recently diagnosed with OCD and started on Fluvoxamine within the last week. She is describing that she is having side effects from the new medication. She feels nauseated, confused, and very lethargic. She felt fine the first couple days after taking the medication, but her symptoms seem to be getting worse. Current medications include duloxetine, gabapentin, and phenytoin. What is most likely cause?
- Drug interaction with gabapentin
- Serotonin Syndrome 2 / 3
- Side effects
- Drug interaction with phenytoin - CORRECT ANSWER: Answer: D. Drug interaction
with phenytoin - Fluvoxamine is notorious for CYP mediated drug interactions.Gabapentin likely wouldn't interact via this pathway, symptoms not consistent with Serotonin syndrome, side effects are possible, but she probably would've noticed them the first few days especially the nausea. Drug interaction and likely accumulation of phenytoin is the best answer - phenytoin level could be checked to have the best assessment
A 46 year old male had a recent STEMI requiring stenting about 2 months ago. At recent checkup, BP was 156/98, pulse 78, creatinine = 1.0, potassium = 4.3, sodium =
- Current medications include Lisinopril 40 mg daily, Aspirin 325 mg daily, Plavix 75
- Increase Lisinopril to 80 mg daily
- Add hydrochlorothiazide 25 mg daily
- Add metoprolol 25 mg twice daily
- Add amlodipine 5 mg daily - CORRECT ANSWER: Answer: C. Add metoprolol 25
mg daily, and simvastatin 20 mg at night. What is the most appropriate recommendation?
mg twice daily - Beta-blocker would be indicated with recent MI. ACE inhibitors or ARBs are also recommended with MI, but the patient is already maxed out at 40 mg of lisinopril. Amlodipine is an option to reduce blood pressure, but doesn't have the compelling indication post MI that metoprolol does. Hydrochlorothiazide doesn't have the indication post MI either.
A 48 year old female in the ICU is receiving enteral nutrition. She is currently receiving PPI therapy twice daily. After a couple days of enteral nutrition, the patient is experiencing significant residuals and having some nausea associated as well. Which of the following would be most appropriate?
- Zofran
- Erythromycin
- Compazine suppositories
- Adding an H2 blocker - CORRECT ANSWER: Answer: B. Erythromycin - With the
tube feedings likely accumulating in the GI tract, there is likely low or no GI motility. A prokinetic agent would be appropriate. (usually metoclopramide or erythromycin) Zofran, Compazine could help nausea, but nausea is likely due to the large volume of feeding "stuck" in the GI tract. H2 blocker likely wouldn't help this problem either.
A 48 year old male is admitted with severe hyponatremia at 112 mEq/L. The patient was experiencing nausea and vomiting and a change in cognition. Hypertonic saline was initiated and the electrolytes were rechecked in 2 hours. Sodium is now at 120 mEq/L. What should be done?
- Likely a lab error so continue current hypertonic saline and recheck in about 4 hours
- Reduce rate in half and recheck in two hours
- Hold hypertonic saline and recheck in an hour
- Lab likely correct, appropriate to continue current hypertonic saline and recheck in 2
- / 3
hours - CORRECT ANSWER: Answer: C. Hold hypertonic saline and recheck in hour -