CSP EXAM PRACTICE TEST (SPECIALTY
PHARMACY) – QUESTIONS & CORRECT
ANSWERS (2025
/2026)Introduction
This 2025/2026 CSP practice exam aligns with the SPCB Competency Blueprint,
emphasizing clinical management, onboarding, fulfillment, regulatory compliance, and
operations. Questions reflect USP <797>/<800>, FDA REMS, URAC/ACHC standards, and
payor requirements for specialty pharmacy certification. Use for exam prep; review SPCB
outline for disease-state focus and quality metrics.
Question [1]: In oncology specialty pharmacy, what is the primary monitoring parameter
for tyrosine kinase inhibitor (TKI) therapy?
A. Blood glucose levels
B. QT interval prolongation
C. Serum creatinine clearance
D. Liver function tests
Answer: D — Liver function tests
Rationale: TKIs (e.g., imatinib) require LFT monitoring for hepatotoxicity per NCCN
guidelines; QT for some (B), CrCl renal (C), glucose unrelated (A).
Question [2]: For a patient starting MS therapy with fingolimod, what baseline test is
required?
A. Echocardiogram
B. Varicella zoster titer
C. Pulmonary function test
D. Bone density scan
Answer: B — Varicella zoster titer
,Rationale: Fingolimod (Gilenya) REMS requires VZV screening to prevent reactivation per
FDA; echo cardiac (A), PFT respiratory (C), DEXA osteoporosis (D).
Question [3]: A patient on adalimumab for RA reports injection-site reaction; initial
management is?
A. Discontinue immediately
B. Apply cold compress and monitor
C. Switch to IV infusion
D. Increase dose
Answer: B — Apply cold compress and monitor
Rationale: Mild reactions common, managed conservatively per ACR guidelines;
discontinue severe (A), switch unnecessary (C), dose adjustment contraindicated (D).
Question [4]: In HIV management, what is the goal CD4 count for initiating ART if viral
load >100,000?
A. >500 cells/mm³
B. <200 cells/mm³
C. Any CD4 with high VL
D. >350 cells/mm³
Answer: C — Any CD4 with high VL
Rationale: DHHS guidelines recommend immediate ART regardless of CD4 if VL
>100,000; low CD4 opportunistic (B), high delay not (A,D).
Question [5]: For hemophilia A patient on factor VIII, what lab monitors efficacy?
A. PT/INR
B. aPTT
C. Platelet count
D. Fibrinogen
Answer: B — aPTT
Rationale: Factor VIII affects intrinsic pathway, monitored by aPTT per ASH guidelines;
PT extrinsic (A), platelets separate (C), fibrinogen common (D).
Question [6]: Patient on ustekinumab for psoriasis; what screening is needed before
initiation?
, A. PPD for TB
B. Hepatitis B surface antigen
C. Serum lipids
D. Thyroid function
Answer: A — PPD for TB
Rationale: IL-12/23 inhibitors increase TB reactivation risk; screen latent TB per AAD;
Hep B live vaccines (B), lipids metabolic (C), thyroid unrelated (D).
Question [7]: In cystic fibrosis, what is the mechanism of ivacaftor?
A. Mucolytic
B. CFTR potentiator
C. Antibiotic
D. Bronchodilator
Answer: B — CFTR potentiator
Rationale: Ivacaftor enhances CFTR channel gating in G551D mutation per CFF
guidelines; mucolytic N-acetylcysteine (A), antibiotic infection (C), bronchodilator
albuterol (D).
Question [8]: For Gaucher's disease enzyme replacement therapy, what monitors
response?
A. Bone density
B. Chitotriosidase levels
C. Liver biopsy
D. Hemoglobin only
Answer: B — Chitotriosidase levels
Rationale: Chitotriosidase/macrophage markers decline with velaglucerase per NORD;
bone/spleen response (A,C), anemia partial (D).
Question [9]: Patient on natalizumab for Crohn's; what is the primary risk?
A. Hepatotoxicity
B. PML (progressive multifocal leukoencephalopathy)
C. Nephrotoxicity
D. Cardiotoxicity
PHARMACY) – QUESTIONS & CORRECT
ANSWERS (2025
/2026)Introduction
This 2025/2026 CSP practice exam aligns with the SPCB Competency Blueprint,
emphasizing clinical management, onboarding, fulfillment, regulatory compliance, and
operations. Questions reflect USP <797>/<800>, FDA REMS, URAC/ACHC standards, and
payor requirements for specialty pharmacy certification. Use for exam prep; review SPCB
outline for disease-state focus and quality metrics.
Question [1]: In oncology specialty pharmacy, what is the primary monitoring parameter
for tyrosine kinase inhibitor (TKI) therapy?
A. Blood glucose levels
B. QT interval prolongation
C. Serum creatinine clearance
D. Liver function tests
Answer: D — Liver function tests
Rationale: TKIs (e.g., imatinib) require LFT monitoring for hepatotoxicity per NCCN
guidelines; QT for some (B), CrCl renal (C), glucose unrelated (A).
Question [2]: For a patient starting MS therapy with fingolimod, what baseline test is
required?
A. Echocardiogram
B. Varicella zoster titer
C. Pulmonary function test
D. Bone density scan
Answer: B — Varicella zoster titer
,Rationale: Fingolimod (Gilenya) REMS requires VZV screening to prevent reactivation per
FDA; echo cardiac (A), PFT respiratory (C), DEXA osteoporosis (D).
Question [3]: A patient on adalimumab for RA reports injection-site reaction; initial
management is?
A. Discontinue immediately
B. Apply cold compress and monitor
C. Switch to IV infusion
D. Increase dose
Answer: B — Apply cold compress and monitor
Rationale: Mild reactions common, managed conservatively per ACR guidelines;
discontinue severe (A), switch unnecessary (C), dose adjustment contraindicated (D).
Question [4]: In HIV management, what is the goal CD4 count for initiating ART if viral
load >100,000?
A. >500 cells/mm³
B. <200 cells/mm³
C. Any CD4 with high VL
D. >350 cells/mm³
Answer: C — Any CD4 with high VL
Rationale: DHHS guidelines recommend immediate ART regardless of CD4 if VL
>100,000; low CD4 opportunistic (B), high delay not (A,D).
Question [5]: For hemophilia A patient on factor VIII, what lab monitors efficacy?
A. PT/INR
B. aPTT
C. Platelet count
D. Fibrinogen
Answer: B — aPTT
Rationale: Factor VIII affects intrinsic pathway, monitored by aPTT per ASH guidelines;
PT extrinsic (A), platelets separate (C), fibrinogen common (D).
Question [6]: Patient on ustekinumab for psoriasis; what screening is needed before
initiation?
, A. PPD for TB
B. Hepatitis B surface antigen
C. Serum lipids
D. Thyroid function
Answer: A — PPD for TB
Rationale: IL-12/23 inhibitors increase TB reactivation risk; screen latent TB per AAD;
Hep B live vaccines (B), lipids metabolic (C), thyroid unrelated (D).
Question [7]: In cystic fibrosis, what is the mechanism of ivacaftor?
A. Mucolytic
B. CFTR potentiator
C. Antibiotic
D. Bronchodilator
Answer: B — CFTR potentiator
Rationale: Ivacaftor enhances CFTR channel gating in G551D mutation per CFF
guidelines; mucolytic N-acetylcysteine (A), antibiotic infection (C), bronchodilator
albuterol (D).
Question [8]: For Gaucher's disease enzyme replacement therapy, what monitors
response?
A. Bone density
B. Chitotriosidase levels
C. Liver biopsy
D. Hemoglobin only
Answer: B — Chitotriosidase levels
Rationale: Chitotriosidase/macrophage markers decline with velaglucerase per NORD;
bone/spleen response (A,C), anemia partial (D).
Question [9]: Patient on natalizumab for Crohn's; what is the primary risk?
A. Hepatotoxicity
B. PML (progressive multifocal leukoencephalopathy)
C. Nephrotoxicity
D. Cardiotoxicity
