AOCNP EXAM ADVANCED REVIEW
QUESTIONS & VERIFIED ANSWERS (A+
GUARANTEE)
1. A patient with high-grade lymphoma begins induction chemotherapy. Within 48 hours, labs
show uric acid 10.5 mg/dL, potassium 5.8 mEq/L, and phosphorus 5.2 mg/dL. Which
medication is most appropriate for rapid reduction of uric acid?
A. Allopurinol
B. Rasburicase
C. Febuxostat
D. Sodium Bicarbonate
Answer: B
Conceptual Explanation: Rasburicase is a recombinant urate oxidase that catalyzes the
oxidation of uric acid into allantoin, which is highly soluble. It is used for rapid reduction of
existing uric acid in Tumor Lysis Syndrome. Allopurinol prevents the formation of new uric
acid but does not reduce current levels.
2. Which of the following is a characteristic feature of Lynch Syndrome (HNPCC) that
differentiates it from sporadic colorectal cancer?
A. Predominance of left-sided (distal) colonic tumors
,B. Absence of extra-colonic malignancies
C. Microsatellite instability (MSI-H) due to mismatch repair gene mutations
D. Onset typically after age 65
Answer: C
Conceptual Explanation: Lynch syndrome is caused by germline mutations in DNA
mismatch repair (MMR) genes (MLH1, MSH2, MSH6, PMS2), leading to microsatellite
instability (MSI). Tumors are often right-sided and occur at an earlier age.
3. A patient receiving Cetuximab for metastatic colorectal cancer develops a Grade 3
acneiform rash. What is the recommended management strategy?
A. Permanent discontinuation of Cetuximab
B. Hold Cetuximab, initiate oral tetracycline and topical steroids, then resume at reduced
dose upon improvement
C. Topical steroids only and continue dose
D. Initiate antiviral therapy for suspected Herpes reactivation
Answer: B
Conceptual Explanation: Grade 3 EGFR inhibitor-induced rash requires holding the drug.
Management includes oral antibiotics (like doxycycline or minocycline) and medium-to-
high potency topical steroids. Once the rash improves to Grade 2 or less, the drug can be
resumed, often with a dose reduction.
, 4. In the TNM staging system, what does a ‘pT3N1c’ designation for colorectal cancer
specifically indicate regarding the ‘c’ in N1c?
A. Presence of tumor deposits in the subserosa without regional lymph node metastasis
B. Clinical staging instead of pathological
C. Contralateral lymph node involvement
D. Carcinoembryonic antigen (CEA) elevation
Answer: A
Conceptual Explanation: In the AJCC 8th edition for colorectal cancer, N1c refers to tumor
deposits in the subserosa, mesentery, or non-peritonealized pericolic/perirectal tissues
without regional nodal metastasis.
5. A patient on Pembrolizumab presents with Grade 2 diarrhea (4-6 stools per day over
baseline). After infectious causes are ruled out, what is the first-line treatment?
A. Infliximab 5mg/kg
B. Loperamide and continuation of immunotherapy
C. Immediate hospitalization for IV methylprednisolone
D. Oral corticosteroids (0.5–1 mg/kg/day prednisone) and hold immunotherapy
Answer: D
QUESTIONS & VERIFIED ANSWERS (A+
GUARANTEE)
1. A patient with high-grade lymphoma begins induction chemotherapy. Within 48 hours, labs
show uric acid 10.5 mg/dL, potassium 5.8 mEq/L, and phosphorus 5.2 mg/dL. Which
medication is most appropriate for rapid reduction of uric acid?
A. Allopurinol
B. Rasburicase
C. Febuxostat
D. Sodium Bicarbonate
Answer: B
Conceptual Explanation: Rasburicase is a recombinant urate oxidase that catalyzes the
oxidation of uric acid into allantoin, which is highly soluble. It is used for rapid reduction of
existing uric acid in Tumor Lysis Syndrome. Allopurinol prevents the formation of new uric
acid but does not reduce current levels.
2. Which of the following is a characteristic feature of Lynch Syndrome (HNPCC) that
differentiates it from sporadic colorectal cancer?
A. Predominance of left-sided (distal) colonic tumors
,B. Absence of extra-colonic malignancies
C. Microsatellite instability (MSI-H) due to mismatch repair gene mutations
D. Onset typically after age 65
Answer: C
Conceptual Explanation: Lynch syndrome is caused by germline mutations in DNA
mismatch repair (MMR) genes (MLH1, MSH2, MSH6, PMS2), leading to microsatellite
instability (MSI). Tumors are often right-sided and occur at an earlier age.
3. A patient receiving Cetuximab for metastatic colorectal cancer develops a Grade 3
acneiform rash. What is the recommended management strategy?
A. Permanent discontinuation of Cetuximab
B. Hold Cetuximab, initiate oral tetracycline and topical steroids, then resume at reduced
dose upon improvement
C. Topical steroids only and continue dose
D. Initiate antiviral therapy for suspected Herpes reactivation
Answer: B
Conceptual Explanation: Grade 3 EGFR inhibitor-induced rash requires holding the drug.
Management includes oral antibiotics (like doxycycline or minocycline) and medium-to-
high potency topical steroids. Once the rash improves to Grade 2 or less, the drug can be
resumed, often with a dose reduction.
, 4. In the TNM staging system, what does a ‘pT3N1c’ designation for colorectal cancer
specifically indicate regarding the ‘c’ in N1c?
A. Presence of tumor deposits in the subserosa without regional lymph node metastasis
B. Clinical staging instead of pathological
C. Contralateral lymph node involvement
D. Carcinoembryonic antigen (CEA) elevation
Answer: A
Conceptual Explanation: In the AJCC 8th edition for colorectal cancer, N1c refers to tumor
deposits in the subserosa, mesentery, or non-peritonealized pericolic/perirectal tissues
without regional nodal metastasis.
5. A patient on Pembrolizumab presents with Grade 2 diarrhea (4-6 stools per day over
baseline). After infectious causes are ruled out, what is the first-line treatment?
A. Infliximab 5mg/kg
B. Loperamide and continuation of immunotherapy
C. Immediate hospitalization for IV methylprednisolone
D. Oral corticosteroids (0.5–1 mg/kg/day prednisone) and hold immunotherapy
Answer: D
