1 | Page
AOCNP® PRACTICE EXAM — QUESTIONS
WITH VERIFIED ANSWERS & COMPLETE
RATIONALES
## SECTION 1: CANCER CONTINUUM (28%)
**1. A 55-year-old female with no personal history of cancer
presents for a routine visit. Her mother was diagnosed with
breast cancer at age 48 and her sister at age 52. Which is the
most appropriate breast cancer screening recommendation?**
A. Begin annual mammography at age 50
B. Begin annual mammography at age 40
C. Begin annual mammography and breast MRI at age 30
D. Begin annual mammography 10 years before the youngest
affected relative's age of diagnosis
**Correct answer:** D
**Rationale:** For patients with a first-degree relative
diagnosed with breast cancer before age 50, screening should
begin 10 years before the youngest affected relative's age of
diagnosis, but not before age 30. The youngest affected relative
here is the sister diagnosed at 52, so screening begins at age
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42. Annual mammography is recommended. Breast MRI may
be considered for high-risk patients based on risk assessment
models .
**2. Which genetic syndrome is associated with an increased
risk of colorectal cancer and requires early screening
colonoscopy?**
A. BRCA1 mutation
B. Lynch syndrome
C. Li-Fraumeni syndrome
D. Von Hippel-Lindau syndrome
**Correct answer:** B
**Rationale:** Lynch syndrome (hereditary nonpolyposis
colorectal cancer) is associated with significantly increased
colorectal cancer risk. Screening colonoscopy typically begins
at age 20-25 or 2-5 years before the youngest affected relative.
Lynch syndrome-associated colorectal cancers are typically
right-sided (proximal colon) and often present with poorly
differentiated histology, mucoid features, and signet cell
characteristics .
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**3. A patient with newly diagnosed non-small cell lung cancer
undergoes biomarker testing. Which biomarker predicts
response to EGFR tyrosine kinase inhibitors?**
A. ALK rearrangement
B. EGFR mutation
C. PD-L1 expression
D. KRAS mutation
**Correct answer:** B
**Rationale:** EGFR mutations (exon 19 deletion, exon 21
L858R) predict response to EGFR TKIs such as osimertinib,
erlotinib, and gefitinib. ALK rearrangements predict response to
ALK inhibitors; PD-L1 expression predicts response to immune
checkpoint inhibitors .
**4. The TNM staging system classifies cancer based on:**
A. Tumor grade, nodal involvement, and metastasis
B. Tumor size/invasion, nodal involvement, and metastasis
C. Tumor type, nuclear grade, and mitotic rate
D. Tumor location, necrosis, and molecular markers
AOCNP® PRACTICE EXAM — QUESTIONS
WITH VERIFIED ANSWERS & COMPLETE
RATIONALES
## SECTION 1: CANCER CONTINUUM (28%)
**1. A 55-year-old female with no personal history of cancer
presents for a routine visit. Her mother was diagnosed with
breast cancer at age 48 and her sister at age 52. Which is the
most appropriate breast cancer screening recommendation?**
A. Begin annual mammography at age 50
B. Begin annual mammography at age 40
C. Begin annual mammography and breast MRI at age 30
D. Begin annual mammography 10 years before the youngest
affected relative's age of diagnosis
**Correct answer:** D
**Rationale:** For patients with a first-degree relative
diagnosed with breast cancer before age 50, screening should
begin 10 years before the youngest affected relative's age of
diagnosis, but not before age 30. The youngest affected relative
here is the sister diagnosed at 52, so screening begins at age
,2 | Page
42. Annual mammography is recommended. Breast MRI may
be considered for high-risk patients based on risk assessment
models .
**2. Which genetic syndrome is associated with an increased
risk of colorectal cancer and requires early screening
colonoscopy?**
A. BRCA1 mutation
B. Lynch syndrome
C. Li-Fraumeni syndrome
D. Von Hippel-Lindau syndrome
**Correct answer:** B
**Rationale:** Lynch syndrome (hereditary nonpolyposis
colorectal cancer) is associated with significantly increased
colorectal cancer risk. Screening colonoscopy typically begins
at age 20-25 or 2-5 years before the youngest affected relative.
Lynch syndrome-associated colorectal cancers are typically
right-sided (proximal colon) and often present with poorly
differentiated histology, mucoid features, and signet cell
characteristics .
, 3 | Page
**3. A patient with newly diagnosed non-small cell lung cancer
undergoes biomarker testing. Which biomarker predicts
response to EGFR tyrosine kinase inhibitors?**
A. ALK rearrangement
B. EGFR mutation
C. PD-L1 expression
D. KRAS mutation
**Correct answer:** B
**Rationale:** EGFR mutations (exon 19 deletion, exon 21
L858R) predict response to EGFR TKIs such as osimertinib,
erlotinib, and gefitinib. ALK rearrangements predict response to
ALK inhibitors; PD-L1 expression predicts response to immune
checkpoint inhibitors .
**4. The TNM staging system classifies cancer based on:**
A. Tumor grade, nodal involvement, and metastasis
B. Tumor size/invasion, nodal involvement, and metastasis
C. Tumor type, nuclear grade, and mitotic rate
D. Tumor location, necrosis, and molecular markers
