10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The BCIDP exam has 150 questions and runs 3 hours 45 minutes.
These 10 free BCIDP questions are organized by exam domain, so you can see how each part of the Board Certified Infectious Diseases Pharmacist blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Pathophysiology and Epidemiology of Infections 18% of exam
Question 1
An Enterobacter cloacae complex bloodstream isolate is initially ceftriaxone-susceptible. After four days of ceftriaxone, blood cultures remain positive, and the repeat isolate is ceftriaxone-resistant but remains susceptible to cefepime and meropenem. The isolates are the same strain, and testing identifies no newly acquired beta-lactamase gene. What most likely accounts for the change?
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Correct answer: A - Selection of bacteria with derepressed chromosomal AmpC expression
Question 2
New pulmonary nodules develop during profound neutropenia after induction chemotherapy for acute myeloid leukemia. The patient has been receiving voriconazole prophylaxis. Serum galactomannan and beta-D-glucan are negative. Lung biopsy shows broad, ribbon-like, pauciseptate hyphae invading blood vessels. Which pathogen best reconciles the tissue findings with the negative biomarkers and prophylaxis history?
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Correct answer: C - Rhizopus species
Domain 2: Therapeutics and Patient Management 60% of exam
Question 3
Despite decompression of an obstructed ureter, a 67-year-old with Escherichia coli bacteremia still requires norepinephrine. A molecular assay detects CTX-M. The isolate tests susceptible to all four antibiotics below. Serum albumin is 1.8 g/dL, and creatinine clearance is 90 mL/min. Which agent is preferred for definitive intravenous treatment during this phase of illness?
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Correct answer: C - Meropenem
Question 4
During treatment of MRSA bacteremia, vancomycin 1,500 mg IV every 12 hours produces a reliably estimated steady-state AUC24 of 780 mg·h/L and a trough of 13.2 mg/L. The broth-microdilution MIC is 1 mg/L. Blood cultures have cleared, and kidney function is stable. Assume unchanged clearance and an AUC proportional to total daily dose. Which maintenance prescription best corrects the exposure?
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Correct answer: D - Reduce vancomycin to 1,000 mg IV every 12 hours.
Question 5
Discharge planning begins after seven days of micafungin for catheter-associated Candida albicans bloodstream infection in a nonneutropenic adult. The catheter has been removed. Blood cultures became negative on treatment day 3 and have remained negative; fever also resolved that day. The isolate is fluconazole-susceptible, oral absorption is reliable, and evaluation has found no endocarditis, ocular infection, or other metastatic focus. Which discharge plan is supported?
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Correct answer: B - Switch to oral fluconazole; complete 14 days after bloodstream clearance.
Question 6
Clostridioides difficile colitis progresses to shock, marked abdominal distention, and radiographic ileus despite oral vancomycin 125 mg every six hours. Resuscitation and urgent surgical assessment are underway, and rectal vancomycin is being arranged. For the nasogastric and intravenous components of treatment, select the appropriate regimen.
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Correct answer: B - Vancomycin 500 mg by nasogastric tube every six hours plus metronidazole 500 mg IV every eight hours.
Question 7
Blood cultures and transesophageal echocardiography establish native aortic-valve endocarditis due to Enterococcus faecalis. The organism is ampicillin-susceptible and vancomycin-susceptible, but high-level gentamicin resistance is present. Creatinine clearance is 34 mL/min, and the patient has no beta-lactam allergy. Which regimen is preferred for this patient’s endocarditis?
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Correct answer: D - Ampicillin plus ceftriaxone
Question 8
An adult with previously untreated HIV and confirmed Pneumocystis jirovecii pneumonia starts trimethoprim-sulfamethoxazole this morning. A room-air arterial blood gas at sea level shows PaO2 74 mm Hg and PaCO2 28 mm Hg. Use PAO2 = 150 − (PaCO2/0.8) and an alveolar-arterial oxygen gradient of PAO2 − PaO2. Which calculation and corticosteroid decision are correct?
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Correct answer: C - The gradient is 41 mm Hg; add adjunctive prednisone.
Question 9
At 22 weeks of pregnancy, a woman is diagnosed with secondary syphilis. She previously developed urticaria, wheezing, and hypotension immediately after amoxicillin, and current penicillin skin testing is positive. She has no history of a severe delayed cutaneous reaction and no neurologic, ocular, or otic findings. Which approach should be used to treat maternal infection and prevent congenital syphilis?
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Correct answer: B - Perform penicillin desensitization, then administer benzathine penicillin G.
Domain 3: Professional Practice 22% of exam
Question 10
A medical ICU reports a Standardized Antimicrobial Administration Ratio (SAAR) of 1.28 for a defined broad-spectrum antibacterial category, with a 95% confidence interval of 1.15-1.43. Data validation identifies no reporting errors. The stewardship committee must explain the result to hospital leadership. Which interpretation is justified?
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Correct answer: A - Use exceeds the model prediction; patient-level review is needed to assess appropriateness.
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