AOCNP COMPREHENSIVE ADVANCED
PRACTICE ONCOLOGY EXAM
QUESTIONS AND ANSWERS
1. A patient receiving pembrolizumab for NSCLC presents with Grade 3 diarrhea. What is the
most appropriate initial management step according to NCCN guidelines?
A. Hold pembrolizumab and start loperamide.
B. Hold pembrolizumab and start methylprednisolone 1-2 mg/kg/day.
C. Continue pembrolizumab and start oral budesonide.
D. Permanent discontinuation and urgent surgical consult.
Answer: B
Conceptual Explanation: For Grade 3 immune-related colitis, the standard of care is to
hold the checkpoint inhibitor and initiate high-dose corticosteroids (1-2 mg/kg/day of
prednisone or equivalent).
2. In Tumor Lysis Syndrome (TLS), which of the following electrolyte patterns is
characteristically observed?
A. Hypokalemia, Hypophosphatemia, Hypercalcemia
,B. Hyperkalemia, Hyperphosphatemia, Hypocalcemia
C. Hyperkalemia, Hypophosphatemia, Hypercalcemia
D. Hypokalemia, Hyperphosphatemia, Hypocalcemia
Answer: B
Conceptual Explanation: TLS involves the rapid release of intracellular contents, leading
to high potassium, high phosphorus, high uric acid, and secondary low calcium due to
phosphorus binding.
3. Which genetic mutation is most strongly associated with Lynch Syndrome?
A. BRCA1
B. TP53
C. MSH2
D. APC
Answer: C
Conceptual Explanation: Lynch Syndrome (Hereditary Non-Polyposis Colorectal Cancer)
is caused by mutations in DNA mismatch repair genes, including MLH1, MSH2, MSH6, and
PMS2.
4. A patient with metastatic breast cancer is planned for Doxorubicin therapy. What is the
cumulative lifetime dose limit to minimize the risk of congestive heart failure?
A. 300 mg/m2
, B. 450-550 mg/m2
C. 700 mg/m2
D. 1000 mg/m2
Answer: B
Conceptual Explanation: The risk of irreversible cardiomyopathy increases significantly
once the cumulative dose of Doxorubicin exceeds 450-550 mg/m2.
5. Which of the following is a specific side effect of bevacizumab that necessitates holding the
drug before elective surgery?
A. Impaired wound healing
B. Cardiomyopathy
C. Ototoxicity
D. Peripheral neuropathy
Answer: A
Conceptual Explanation: Bevacizumab, a VEGF inhibitor, interferes with angiogenesis and
wound healing. It should be held for at least 28 days before and after elective surgery.
6. What is the primary mechanism of action of Tamoxifen in the treatment of breast cancer?
A. Aromatase inhibition
B. Selective Estrogen Receptor Modulation (SERM)
PRACTICE ONCOLOGY EXAM
QUESTIONS AND ANSWERS
1. A patient receiving pembrolizumab for NSCLC presents with Grade 3 diarrhea. What is the
most appropriate initial management step according to NCCN guidelines?
A. Hold pembrolizumab and start loperamide.
B. Hold pembrolizumab and start methylprednisolone 1-2 mg/kg/day.
C. Continue pembrolizumab and start oral budesonide.
D. Permanent discontinuation and urgent surgical consult.
Answer: B
Conceptual Explanation: For Grade 3 immune-related colitis, the standard of care is to
hold the checkpoint inhibitor and initiate high-dose corticosteroids (1-2 mg/kg/day of
prednisone or equivalent).
2. In Tumor Lysis Syndrome (TLS), which of the following electrolyte patterns is
characteristically observed?
A. Hypokalemia, Hypophosphatemia, Hypercalcemia
,B. Hyperkalemia, Hyperphosphatemia, Hypocalcemia
C. Hyperkalemia, Hypophosphatemia, Hypercalcemia
D. Hypokalemia, Hyperphosphatemia, Hypocalcemia
Answer: B
Conceptual Explanation: TLS involves the rapid release of intracellular contents, leading
to high potassium, high phosphorus, high uric acid, and secondary low calcium due to
phosphorus binding.
3. Which genetic mutation is most strongly associated with Lynch Syndrome?
A. BRCA1
B. TP53
C. MSH2
D. APC
Answer: C
Conceptual Explanation: Lynch Syndrome (Hereditary Non-Polyposis Colorectal Cancer)
is caused by mutations in DNA mismatch repair genes, including MLH1, MSH2, MSH6, and
PMS2.
4. A patient with metastatic breast cancer is planned for Doxorubicin therapy. What is the
cumulative lifetime dose limit to minimize the risk of congestive heart failure?
A. 300 mg/m2
, B. 450-550 mg/m2
C. 700 mg/m2
D. 1000 mg/m2
Answer: B
Conceptual Explanation: The risk of irreversible cardiomyopathy increases significantly
once the cumulative dose of Doxorubicin exceeds 450-550 mg/m2.
5. Which of the following is a specific side effect of bevacizumab that necessitates holding the
drug before elective surgery?
A. Impaired wound healing
B. Cardiomyopathy
C. Ototoxicity
D. Peripheral neuropathy
Answer: A
Conceptual Explanation: Bevacizumab, a VEGF inhibitor, interferes with angiogenesis and
wound healing. It should be held for at least 28 days before and after elective surgery.
6. What is the primary mechanism of action of Tamoxifen in the treatment of breast cancer?
A. Aromatase inhibition
B. Selective Estrogen Receptor Modulation (SERM)
