BCPS UPDATED 2026 EXAM SCRIPT QUESTIONS AND
ANSWERS GRADED A+
✔✔Age >65 pneumococcal vaccination - ✔✔PPSV 23 all adults >65 yo at least 5 yr
after previous PPSV shot. PCV13 only considered for immunocompromised, CSF leak,
or cochlear implants
✔✔Age 19-64 pneumococcal vaccination with chronic med conditions (but not
immunocompromised, etc) - ✔✔One dose PPSV 23 for chronic medical conditions
✔✔Age 19-64 pneumococcal vaccination + immunocompromised - ✔✔3 dose series:
One dose PCV 13 f/b one dose PPSV 23 at least 8 weeks later, then another dose
PPSV 23 at least 5yrs after previous PPSV dose
✔✔Only inhaled anticholinergic for asthma for >=12yo? - ✔✔Tiotropium (Spiriva
Respimat)
✔✔CYP enzyme for diltiazem and verapamil - ✔✔CYP 3A4
✔✔CYP for cyclosporine metabolism - ✔✔CYP 3A4
✔✔P-gp major drug interaction - ✔✔Digoxin
✔✔Increasing off time on Sinemet in Parkinson's - ✔✔Start entacapone (COMT
inhibitor)
✔✔Therapeutic range total phenytoin - ✔✔10-20 mcg/mL
✔✔Therapeutic range total VPA - ✔✔50-100 mcg/mL
✔✔Meds for motor symptoms of Parkinson's - ✔✔Carbidopa-levodopa, dopamine
agonists (ropinirole), MAO-B inhibitors (rasagiline)
✔✔Hemorrhagic stroke SBP goal - ✔✔140-180, use nicardipine
✔✔Meds exhibiting zero order kinetics - ✔✔Ethanol, high dose phenytoin, aspirin
✔✔Relative infant dose (RID) acceptable for meds and breastfeeding - ✔✔<10%
✔✔Preferred antidepressant in breastfeeding - ✔✔sertraline
✔✔Carbamazepine: genetic factor - ✔✔HLA-A*1502
✔✔Abacavir: genetic factor - ✔✔HLA-B*5701
, ✔✔Allopurinol: genetic factor - ✔✔HLA-B*5801
✔✔Drug induced SJS/TENS: PCP LAPSE - ✔✔Phenytoin, CBZ, phenobarb,
lamotrigine, allopurinol, PCN, sulfa, erythromycin
✔✔# cigs per day for 21mg nicotine patch - ✔✔>25
✔✔Itraconazole administration instructions - ✔✔Tale w/ cola (or other acid), acidic
environments incr absorption
✔✔Duration of treatment for onychomycosis of fingernails, toenails? - ✔✔fingernails: 6
weeks
toenails: 12 weeks
✔✔Integrase inhibitors preferred in pregnancy - ✔✔Raltegravir, dolutegravir
✔✔Outpatient CAP treatment if comorbidities or recent abx - ✔✔Respiratory FQ
(moxi/levo) monotherapy OR beta-lactam+macrolide
✔✔Integrase inhibitor NOT recommended in pregnancy - ✔✔elvitegravir
✔✔Zoledronic acid 5mg dose indication - ✔✔Osteoporosis
✔✔Zoledronic acid 4mg dose indication - ✔✔Hypercalcemia of malignancy
✔✔How long after starting levothyroxine should thyroid levels be checked? - ✔✔6
weeks
✔✔PIONEER-AF trial - ✔✔PCI for CAD, use rivaroxaban 15mg qd + clopidogrel 75 qd
x12 months
*decr rivaroxaban to 10mg qd if Crcl 30-50
✔✔DAPT treatment duration for NSTEMI, medically managed - ✔✔At least 12 months
✔✔Elevated BP - ✔✔SBP 120-129 and DBP <80 mmHg
✔✔Stage 1 HTN - ✔✔Systolic: 130-139
Diastolic: 80-89
✔✔Stage 2 HTN - ✔✔SBP >=140 and DBP >=90
✔✔Normal BP - ✔✔SBP <120 and DBP <80 mmHg
ANSWERS GRADED A+
✔✔Age >65 pneumococcal vaccination - ✔✔PPSV 23 all adults >65 yo at least 5 yr
after previous PPSV shot. PCV13 only considered for immunocompromised, CSF leak,
or cochlear implants
✔✔Age 19-64 pneumococcal vaccination with chronic med conditions (but not
immunocompromised, etc) - ✔✔One dose PPSV 23 for chronic medical conditions
✔✔Age 19-64 pneumococcal vaccination + immunocompromised - ✔✔3 dose series:
One dose PCV 13 f/b one dose PPSV 23 at least 8 weeks later, then another dose
PPSV 23 at least 5yrs after previous PPSV dose
✔✔Only inhaled anticholinergic for asthma for >=12yo? - ✔✔Tiotropium (Spiriva
Respimat)
✔✔CYP enzyme for diltiazem and verapamil - ✔✔CYP 3A4
✔✔CYP for cyclosporine metabolism - ✔✔CYP 3A4
✔✔P-gp major drug interaction - ✔✔Digoxin
✔✔Increasing off time on Sinemet in Parkinson's - ✔✔Start entacapone (COMT
inhibitor)
✔✔Therapeutic range total phenytoin - ✔✔10-20 mcg/mL
✔✔Therapeutic range total VPA - ✔✔50-100 mcg/mL
✔✔Meds for motor symptoms of Parkinson's - ✔✔Carbidopa-levodopa, dopamine
agonists (ropinirole), MAO-B inhibitors (rasagiline)
✔✔Hemorrhagic stroke SBP goal - ✔✔140-180, use nicardipine
✔✔Meds exhibiting zero order kinetics - ✔✔Ethanol, high dose phenytoin, aspirin
✔✔Relative infant dose (RID) acceptable for meds and breastfeeding - ✔✔<10%
✔✔Preferred antidepressant in breastfeeding - ✔✔sertraline
✔✔Carbamazepine: genetic factor - ✔✔HLA-A*1502
✔✔Abacavir: genetic factor - ✔✔HLA-B*5701
, ✔✔Allopurinol: genetic factor - ✔✔HLA-B*5801
✔✔Drug induced SJS/TENS: PCP LAPSE - ✔✔Phenytoin, CBZ, phenobarb,
lamotrigine, allopurinol, PCN, sulfa, erythromycin
✔✔# cigs per day for 21mg nicotine patch - ✔✔>25
✔✔Itraconazole administration instructions - ✔✔Tale w/ cola (or other acid), acidic
environments incr absorption
✔✔Duration of treatment for onychomycosis of fingernails, toenails? - ✔✔fingernails: 6
weeks
toenails: 12 weeks
✔✔Integrase inhibitors preferred in pregnancy - ✔✔Raltegravir, dolutegravir
✔✔Outpatient CAP treatment if comorbidities or recent abx - ✔✔Respiratory FQ
(moxi/levo) monotherapy OR beta-lactam+macrolide
✔✔Integrase inhibitor NOT recommended in pregnancy - ✔✔elvitegravir
✔✔Zoledronic acid 5mg dose indication - ✔✔Osteoporosis
✔✔Zoledronic acid 4mg dose indication - ✔✔Hypercalcemia of malignancy
✔✔How long after starting levothyroxine should thyroid levels be checked? - ✔✔6
weeks
✔✔PIONEER-AF trial - ✔✔PCI for CAD, use rivaroxaban 15mg qd + clopidogrel 75 qd
x12 months
*decr rivaroxaban to 10mg qd if Crcl 30-50
✔✔DAPT treatment duration for NSTEMI, medically managed - ✔✔At least 12 months
✔✔Elevated BP - ✔✔SBP 120-129 and DBP <80 mmHg
✔✔Stage 1 HTN - ✔✔Systolic: 130-139
Diastolic: 80-89
✔✔Stage 2 HTN - ✔✔SBP >=140 and DBP >=90
✔✔Normal BP - ✔✔SBP <120 and DBP <80 mmHg
