AOCNP COMPREHENSIVE BOARD
EXAM REVIEW QUESTIONS AND
ANSWERS
1. Which molecular mechanism is the primary driver of resistance to first-generation EGFR
tyrosine kinase inhibitors, such as erlotinib, in patients with non-small cell lung cancer
(NSCLC)?
A. T790M mutation in exon 20
B. MET amplification
C. HER2 amplification
D. PIK3CA mutation
Answer: A
Conceptual Explanation: The T790M mutation in exon 20 of the EGFR gene accounts for
approximately 50-60% of resistance to first- and second-generation EGFR TKIs by
increasing the affinity of the receptor for ATP.
,2. When managing a patient on immune checkpoint inhibitors who develops Grade 2 Colitis,
what is the recommended first-line intervention according to ASCO/NCCN guidelines?
A. Infliximab 5mg/kg every 2 weeks
B. Continue immunotherapy and start loperamide
C. Withhold immunotherapy and initiate 0.5-1 mg/kg/day of prednisone
D. Immediate permanent discontinuation of immunotherapy
Answer: C
Conceptual Explanation: For Grade 2 immune-related colitis, the standard of care is to
hold the checkpoint inhibitor and initiate corticosteroids (prednisone or
methylprednisolone) at 0.5-1 mg/kg/day.
3. Which of the following describes the most significant risk associated with the
administration of vincristine via the intrathecal route?
A. Aseptic meningitis
B. Acute renal failure
C. Fatal ascending myeloencephalopathy
D. Severe peripheral neuropathy
Answer: C
Conceptual Explanation: Vincristine is neurotoxic and must never be given intrathecally;
accidental administration is almost always fatal due to ascending myeloencephalopathy.
, 4. A patient with metastatic breast cancer presents with new-onset back pain, lower
extremity weakness, and urinary retention. What is the most appropriate next step in
management?
A. Start physical therapy for suspected sciatica
B. Order an outpatient X-ray of the spine
C. Administer high-dose dexamethasone and order an emergent MRI of the entire spine
D. Schedule a bone scan for next week
Answer: C
Conceptual Explanation: These symptoms are classic for Spinal Cord Compression (SCC),
an oncologic emergency requiring immediate steroids and emergent MRI imaging.
5. In the context of tumor lysis syndrome (TLS), which metabolic abnormality is NOT part of
the Cairo-Bishop laboratory criteria?
A. Hyperuricemia
B. Hyperphosphatemia
C. Hyperkalemia
D. Hypercalcemia
Answer: D
Conceptual Explanation: TLS is characterized by hyperuricemia, hyperkalemia,
hyperphosphatemia, and hypocalcemia (due to calcium binding with excess phosphorus).
EXAM REVIEW QUESTIONS AND
ANSWERS
1. Which molecular mechanism is the primary driver of resistance to first-generation EGFR
tyrosine kinase inhibitors, such as erlotinib, in patients with non-small cell lung cancer
(NSCLC)?
A. T790M mutation in exon 20
B. MET amplification
C. HER2 amplification
D. PIK3CA mutation
Answer: A
Conceptual Explanation: The T790M mutation in exon 20 of the EGFR gene accounts for
approximately 50-60% of resistance to first- and second-generation EGFR TKIs by
increasing the affinity of the receptor for ATP.
,2. When managing a patient on immune checkpoint inhibitors who develops Grade 2 Colitis,
what is the recommended first-line intervention according to ASCO/NCCN guidelines?
A. Infliximab 5mg/kg every 2 weeks
B. Continue immunotherapy and start loperamide
C. Withhold immunotherapy and initiate 0.5-1 mg/kg/day of prednisone
D. Immediate permanent discontinuation of immunotherapy
Answer: C
Conceptual Explanation: For Grade 2 immune-related colitis, the standard of care is to
hold the checkpoint inhibitor and initiate corticosteroids (prednisone or
methylprednisolone) at 0.5-1 mg/kg/day.
3. Which of the following describes the most significant risk associated with the
administration of vincristine via the intrathecal route?
A. Aseptic meningitis
B. Acute renal failure
C. Fatal ascending myeloencephalopathy
D. Severe peripheral neuropathy
Answer: C
Conceptual Explanation: Vincristine is neurotoxic and must never be given intrathecally;
accidental administration is almost always fatal due to ascending myeloencephalopathy.
, 4. A patient with metastatic breast cancer presents with new-onset back pain, lower
extremity weakness, and urinary retention. What is the most appropriate next step in
management?
A. Start physical therapy for suspected sciatica
B. Order an outpatient X-ray of the spine
C. Administer high-dose dexamethasone and order an emergent MRI of the entire spine
D. Schedule a bone scan for next week
Answer: C
Conceptual Explanation: These symptoms are classic for Spinal Cord Compression (SCC),
an oncologic emergency requiring immediate steroids and emergent MRI imaging.
5. In the context of tumor lysis syndrome (TLS), which metabolic abnormality is NOT part of
the Cairo-Bishop laboratory criteria?
A. Hyperuricemia
B. Hyperphosphatemia
C. Hyperkalemia
D. Hypercalcemia
Answer: D
Conceptual Explanation: TLS is characterized by hyperuricemia, hyperkalemia,
hyperphosphatemia, and hypocalcemia (due to calcium binding with excess phosphorus).
