BCOP Oncology Pharmacy Certification Exam 2026: Comprehensive
Board Practice Test — Cancer Diagnosis & Testing, Antineoplastic
Therapy, Patient Management, Treatment Monitoring & Professional
Practice — Multiple-Choice Questions with Answers & Detailed
Rationales
DOMAIN 1: ONCOLOGY DIAGNOSIS AND TESTING
Question 1
A 58-year-old patient with newly diagnosed non-small cell lung cancer undergoes next-
generation sequencing. Which biomarker result would most directly indicate candidacy for
first-line pembrolizumab monotherapy?
A. EGFR exon 19 deletion
B. ALK rearrangement
C. PD-L1 tumor proportion score of 65%
D. KRAS G12C mutation
Correct Answer: C
Explanation: Pembrolizumab monotherapy is indicated for advanced NSCLC with PD-L1 TPS
≥50%; EGFR/ALK alterations require targeted therapy instead.
Question 2
A 62-year-old man with chronic myeloid leukemia is started on imatinib. Which molecular
abnormality confirms the diagnosis and serves as the therapeutic target?
A. t(8;21) RUNX1-RUNX1T1
B. t(15;17) PML-RARA
C. t(9;22) BCR-ABL1
,D. t(11;14) CCND1-IGH
Correct Answer: C
Explanation: The Philadelphia chromosome t(9;22) produces BCR-ABL1 fusion with
constitutive tyrosine kinase activity; imatinib inhibits this target.
Question 3
A 47-year-old woman with breast cancer has a tumor that is ER-positive, PR-negative, and
HER2-equivocal by immunohistochemistry. What is the appropriate next step for HER2
determination?
A. Repeat core biopsy
B. Fluorescence in situ hybridization (FISH)
C. Initiate endocrine therapy
D. Order germline BRCA testing
Correct Answer: B
Explanation: HER2-equivocal results by IHC require reflex FISH testing to definitively establish
HER2 status before treatment selection.
Question 4
Which patient is at highest risk for developing tumor lysis syndrome following initiation of
cytotoxic therapy?
A. A patient with stage II colon cancer
B. A patient with low-grade prostate cancer
C. A patient with Burkitt lymphoma and bulky disease
,D. A patient with resected stage I breast cancer
Correct Answer: C
Explanation: Tumor lysis syndrome risk is highest with high-grade lymphomas and leukemias
with high tumor burden and rapid proliferation.
Question 5
A 55-year-old woman with newly diagnosed breast cancer undergoes Oncotype DX testing.
The result is a recurrence score of 28. What does this score most appropriately guide?
A. HER2-targeted therapy selection
B. Decision for adjuvant chemotherapy in hormone receptor-positive disease
C. Indication for checkpoint inhibitor therapy
D. Need for germline genetic testing
Correct Answer: B
Explanation: The Oncotype DX recurrence score predicts chemotherapy benefit in early-
stage, hormone receptor-positive, HER2-negative breast cancer.
Question 6
A patient receiving high-dose methotrexate for osteosarcoma requires leucovorin rescue.
What is the mechanism by which leucovorin protects normal cells?
A. It inhibits dihydrofolate reductase
B. It supplies reduced folate that bypasses the blocked enzyme
C. It enhances renal excretion of methotrexate
D. It binds methotrexate in the bloodstream
, Correct Answer: B
Explanation: Leucovorin (folinic acid) is a reduced folate that enters cells and provides
tetrahydrofolate needed for nucleotide synthesis despite DHFR inhibition.
Question 7
Which cancer screening recommendation is appropriate for a 50-year-old average-risk adult?
A. Annual mammography starting at age 40
B. Colonoscopy every 10 years or annual FIT
C. Annual PSA testing for all men
D. Annual low-dose CT for lung cancer
Correct Answer: B
Explanation: For average-risk adults aged 45–75, colorectal cancer screening is
recommended; colonoscopy every 10 years or annual FIT are accepted strategies.
Question 8
A 68-year-old man with prostate cancer has a PSA of 15 ng/mL and Gleason 4+3=7 disease.
Which staging modality is most appropriate for initial evaluation?
A. MRI of the brain
B. PSMA PET/CT or bone scan
C. PET/CT with FDG
D. Serum chromogranin A
Correct Answer: B
Board Practice Test — Cancer Diagnosis & Testing, Antineoplastic
Therapy, Patient Management, Treatment Monitoring & Professional
Practice — Multiple-Choice Questions with Answers & Detailed
Rationales
DOMAIN 1: ONCOLOGY DIAGNOSIS AND TESTING
Question 1
A 58-year-old patient with newly diagnosed non-small cell lung cancer undergoes next-
generation sequencing. Which biomarker result would most directly indicate candidacy for
first-line pembrolizumab monotherapy?
A. EGFR exon 19 deletion
B. ALK rearrangement
C. PD-L1 tumor proportion score of 65%
D. KRAS G12C mutation
Correct Answer: C
Explanation: Pembrolizumab monotherapy is indicated for advanced NSCLC with PD-L1 TPS
≥50%; EGFR/ALK alterations require targeted therapy instead.
Question 2
A 62-year-old man with chronic myeloid leukemia is started on imatinib. Which molecular
abnormality confirms the diagnosis and serves as the therapeutic target?
A. t(8;21) RUNX1-RUNX1T1
B. t(15;17) PML-RARA
C. t(9;22) BCR-ABL1
,D. t(11;14) CCND1-IGH
Correct Answer: C
Explanation: The Philadelphia chromosome t(9;22) produces BCR-ABL1 fusion with
constitutive tyrosine kinase activity; imatinib inhibits this target.
Question 3
A 47-year-old woman with breast cancer has a tumor that is ER-positive, PR-negative, and
HER2-equivocal by immunohistochemistry. What is the appropriate next step for HER2
determination?
A. Repeat core biopsy
B. Fluorescence in situ hybridization (FISH)
C. Initiate endocrine therapy
D. Order germline BRCA testing
Correct Answer: B
Explanation: HER2-equivocal results by IHC require reflex FISH testing to definitively establish
HER2 status before treatment selection.
Question 4
Which patient is at highest risk for developing tumor lysis syndrome following initiation of
cytotoxic therapy?
A. A patient with stage II colon cancer
B. A patient with low-grade prostate cancer
C. A patient with Burkitt lymphoma and bulky disease
,D. A patient with resected stage I breast cancer
Correct Answer: C
Explanation: Tumor lysis syndrome risk is highest with high-grade lymphomas and leukemias
with high tumor burden and rapid proliferation.
Question 5
A 55-year-old woman with newly diagnosed breast cancer undergoes Oncotype DX testing.
The result is a recurrence score of 28. What does this score most appropriately guide?
A. HER2-targeted therapy selection
B. Decision for adjuvant chemotherapy in hormone receptor-positive disease
C. Indication for checkpoint inhibitor therapy
D. Need for germline genetic testing
Correct Answer: B
Explanation: The Oncotype DX recurrence score predicts chemotherapy benefit in early-
stage, hormone receptor-positive, HER2-negative breast cancer.
Question 6
A patient receiving high-dose methotrexate for osteosarcoma requires leucovorin rescue.
What is the mechanism by which leucovorin protects normal cells?
A. It inhibits dihydrofolate reductase
B. It supplies reduced folate that bypasses the blocked enzyme
C. It enhances renal excretion of methotrexate
D. It binds methotrexate in the bloodstream
, Correct Answer: B
Explanation: Leucovorin (folinic acid) is a reduced folate that enters cells and provides
tetrahydrofolate needed for nucleotide synthesis despite DHFR inhibition.
Question 7
Which cancer screening recommendation is appropriate for a 50-year-old average-risk adult?
A. Annual mammography starting at age 40
B. Colonoscopy every 10 years or annual FIT
C. Annual PSA testing for all men
D. Annual low-dose CT for lung cancer
Correct Answer: B
Explanation: For average-risk adults aged 45–75, colorectal cancer screening is
recommended; colonoscopy every 10 years or annual FIT are accepted strategies.
Question 8
A 68-year-old man with prostate cancer has a PSA of 15 ng/mL and Gleason 4+3=7 disease.
Which staging modality is most appropriate for initial evaluation?
A. MRI of the brain
B. PSMA PET/CT or bone scan
C. PET/CT with FDG
D. Serum chromogranin A
Correct Answer: B
