AOCNP Advanced Oncology Certified Nurse Practitioner Exam
Study Guide
1. Which of the following best describes the function of a tumor suppressor gene?
A. Promotes uncontrolled cell division when activated
B. Normally inhibits cell proliferation and its loss of function contributes to carcinogenesis
C. Repairs damaged mitochondrial DNA exclusively
D. Encodes structural proteins of the cytoskeleton only
2. A patient with a germline BRCA1 mutation has an increased lifetime risk of which cancers?
A. Colorectal and gastric cancer
B. Breast and ovarian cancer
C. Renal cell and bladder cancer
D. Thyroid and adrenal cancer
3. Lynch syndrome is most strongly associated with which genetic mechanism?
A. Defective DNA mismatch repair genes
B. Amplification of the HER2 oncogene
C. Loss of the RB1 tumor suppressor gene
D. Trinucleotide repeat expansion
4. The proto-oncogene HER2/neu, when amplified, contributes to carcinogenesis primarily by:
A. Silencing tumor suppressor transcription
B. Driving excessive growth factor receptor signaling and cell proliferation
C. Inhibiting angiogenesis
D. Increasing apoptosis of malignant cells
5. Which statement about the cell cycle checkpoint at G1/S is most accurate?
A. It allows repair of DNA damage before replication proceeds
B. It occurs only in postmitotic neurons
C. It is regulated exclusively by telomerase
D. It has no relationship to p53 function
6. A mutation in the p53 gene is significant in oncogenesis because p53 normally:
A. Promotes unregulated cell growth
B. Arrests the cell cycle to allow DNA repair or triggers apoptosis in damaged cells
C. Synthesizes new telomeres
D. Suppresses immune surveillance of tumor cells
7. Which of the following is an example of an oncogenic virus associated with a specific malignancy?
A. Human papillomavirus and cervical cancer
B. Influenza virus and lung cancer
C. Rhinovirus and laryngeal cancer
, D. Rotavirus and colorectal cancer
8. Telomerase reactivation in cancer cells contributes to malignant transformation by:
A. Shortening telomeres to trigger apoptosis
B. Preventing telomere shortening, allowing cells to bypass replicative senescence
C. Increasing chromosomal fragility
D. Blocking DNA replication entirely
9. Angiogenesis is important in tumor progression primarily because it:
A. Provides the tumor with blood supply for oxygen and nutrients, enabling growth beyond 1-2
mm
B. Prevents metastasis
C. Increases apoptosis in the tumor core
D. Blocks the epithelial-mesenchymal transition
10. Which inheritance pattern is typical of most hereditary cancer syndromes, such as Li-Fraumeni
syndrome?
A. Autosomal recessive
B. Autosomal dominant
C. X-linked recessive
D. Mitochondrial
11. The process by which malignant cells lose adhesion, invade the basement membrane, and spread to
distant sites is called:
A. Apoptosis
B. Metastasis
C. Differentiation
D. Senescence
12. Epithelial-mesenchymal transition (EMT) contributes to cancer progression by:
A. Increasing cell adhesion and preventing invasion
B. Allowing epithelial tumor cells to acquire migratory, invasive mesenchymal characteristics
C. Restoring normal apoptotic pathways
D. Reducing angiogenic signaling
13. A patient with familial adenomatous polyposis (FAP) has a germline mutation in which gene?
A. APC
B. BRCA2
C. MLH1
D. RET
14. Which of the following best characterizes a driver mutation in cancer biology?
A. A mutation that confers no growth advantage
B. A mutation that confers a selective growth advantage and contributes directly to oncogenesis
C. A silent mutation with no phenotypic effect
, D. A mutation only found in noncoding DNA
15. Multiple endocrine neoplasia type 2 (MEN2) is associated with germline mutation of which gene?
A. RET proto-oncogene
B. TP53
C. PTEN
D. VHL
16. The Warburg effect in cancer cells refers to:
A. Increased reliance on aerobic glycolysis for energy production even in the presence of oxygen
B. Complete shutdown of glucose metabolism
C. Exclusive use of oxidative phosphorylation
D. Enhanced fatty acid oxidation as the primary energy source
17. Which of the following is a hallmark of cancer as originally described by Hanahan and Weinberg?
A. Increased sensitivity to growth-inhibitory signals
B. Sustained proliferative signaling and evasion of growth suppressors
C. Enhanced contact inhibition
D. Obligatory anchorage dependence
18. A tumor with high microsatellite instability (MSI-H) is most relevant clinically because it:
A. Predicts poor response to immunotherapy
B. Is associated with defective mismatch repair and may respond well to immune checkpoint
inhibitors
C. Indicates a low tumor mutational burden
D. Rules out a diagnosis of Lynch syndrome
19. Which factor is most important in determining whether a genetic cancer risk assessment referral is
indicated?
A. Patient age alone
B. Family history pattern suggestive of hereditary cancer syndrome (early onset, multiple
affected relatives, bilateral/multiple primaries)
C. Presence of any first-degree relative with any cancer at any age
D. Patient's personal preference regardless of history
20. Loss of heterozygosity (LOH) is a key concept in tumor suppressor gene inactivation because:
A. Both alleles of a tumor suppressor gene typically must be inactivated for loss of function
(Knudson two-hit hypothesis)
B. A single mutated allele is always sufficient to cause cancer
C. LOH only occurs in oncogenes, not tumor suppressors
D. LOH prevents cancer development
21. According to current general screening guidelines, average-risk adults should begin colorectal cancer
screening at what age?
A. Age 30
, B. Age 45
C. Age 60
D. Age 65
22. Low-dose CT lung cancer screening is recommended for which population?
A. All adults over age 40 regardless of smoking history
B. Adults aged 50-80 with a significant smoking history (e.g., 20 pack-year) who currently
smoke or quit within the past 15 years
C. Only never-smokers with a family history of lung cancer
D. Adults under age 30 with occupational asbestos exposure
23. A woman with average risk for breast cancer is typically advised to begin mammographic screening
at:
A. Age 25
B. Age 40
C. Age 55
D. Age 65
24. The primary purpose of the Pap test in cervical cancer screening is to detect:
A. Invasive cervical cancer only
B. Precancerous cervical cellular changes before progression to invasive cancer
C. HPV vaccination status
D. Ovarian cancer cells
25. HPV vaccination is most effective when administered:
A. After the onset of sexual activity
B. Before exposure to HPV, ideally in preadolescence
C. Only to individuals already diagnosed with cervical dysplasia
D. Only to female patients
26. Which lifestyle factor has the strongest evidence for increasing risk of multiple cancer types,
including lung, bladder, and head and neck cancer?
A. Moderate physical activity
B. Tobacco use
C. Adequate hydration
D. Regular sleep patterns
27. Chemoprevention with tamoxifen may be considered for which patient population?
A. Postmenopausal women with no breast cancer risk factors
B. Women at high risk for breast cancer based on validated risk assessment models
C. Men with prostate cancer
D. Patients with active deep vein thrombosis, without additional consideration
28. Prostate-specific antigen (PSA) screening decisions should primarily involve:
A. Automatic screening of all men starting at age 40 without discussion
Study Guide
1. Which of the following best describes the function of a tumor suppressor gene?
A. Promotes uncontrolled cell division when activated
B. Normally inhibits cell proliferation and its loss of function contributes to carcinogenesis
C. Repairs damaged mitochondrial DNA exclusively
D. Encodes structural proteins of the cytoskeleton only
2. A patient with a germline BRCA1 mutation has an increased lifetime risk of which cancers?
A. Colorectal and gastric cancer
B. Breast and ovarian cancer
C. Renal cell and bladder cancer
D. Thyroid and adrenal cancer
3. Lynch syndrome is most strongly associated with which genetic mechanism?
A. Defective DNA mismatch repair genes
B. Amplification of the HER2 oncogene
C. Loss of the RB1 tumor suppressor gene
D. Trinucleotide repeat expansion
4. The proto-oncogene HER2/neu, when amplified, contributes to carcinogenesis primarily by:
A. Silencing tumor suppressor transcription
B. Driving excessive growth factor receptor signaling and cell proliferation
C. Inhibiting angiogenesis
D. Increasing apoptosis of malignant cells
5. Which statement about the cell cycle checkpoint at G1/S is most accurate?
A. It allows repair of DNA damage before replication proceeds
B. It occurs only in postmitotic neurons
C. It is regulated exclusively by telomerase
D. It has no relationship to p53 function
6. A mutation in the p53 gene is significant in oncogenesis because p53 normally:
A. Promotes unregulated cell growth
B. Arrests the cell cycle to allow DNA repair or triggers apoptosis in damaged cells
C. Synthesizes new telomeres
D. Suppresses immune surveillance of tumor cells
7. Which of the following is an example of an oncogenic virus associated with a specific malignancy?
A. Human papillomavirus and cervical cancer
B. Influenza virus and lung cancer
C. Rhinovirus and laryngeal cancer
, D. Rotavirus and colorectal cancer
8. Telomerase reactivation in cancer cells contributes to malignant transformation by:
A. Shortening telomeres to trigger apoptosis
B. Preventing telomere shortening, allowing cells to bypass replicative senescence
C. Increasing chromosomal fragility
D. Blocking DNA replication entirely
9. Angiogenesis is important in tumor progression primarily because it:
A. Provides the tumor with blood supply for oxygen and nutrients, enabling growth beyond 1-2
mm
B. Prevents metastasis
C. Increases apoptosis in the tumor core
D. Blocks the epithelial-mesenchymal transition
10. Which inheritance pattern is typical of most hereditary cancer syndromes, such as Li-Fraumeni
syndrome?
A. Autosomal recessive
B. Autosomal dominant
C. X-linked recessive
D. Mitochondrial
11. The process by which malignant cells lose adhesion, invade the basement membrane, and spread to
distant sites is called:
A. Apoptosis
B. Metastasis
C. Differentiation
D. Senescence
12. Epithelial-mesenchymal transition (EMT) contributes to cancer progression by:
A. Increasing cell adhesion and preventing invasion
B. Allowing epithelial tumor cells to acquire migratory, invasive mesenchymal characteristics
C. Restoring normal apoptotic pathways
D. Reducing angiogenic signaling
13. A patient with familial adenomatous polyposis (FAP) has a germline mutation in which gene?
A. APC
B. BRCA2
C. MLH1
D. RET
14. Which of the following best characterizes a driver mutation in cancer biology?
A. A mutation that confers no growth advantage
B. A mutation that confers a selective growth advantage and contributes directly to oncogenesis
C. A silent mutation with no phenotypic effect
, D. A mutation only found in noncoding DNA
15. Multiple endocrine neoplasia type 2 (MEN2) is associated with germline mutation of which gene?
A. RET proto-oncogene
B. TP53
C. PTEN
D. VHL
16. The Warburg effect in cancer cells refers to:
A. Increased reliance on aerobic glycolysis for energy production even in the presence of oxygen
B. Complete shutdown of glucose metabolism
C. Exclusive use of oxidative phosphorylation
D. Enhanced fatty acid oxidation as the primary energy source
17. Which of the following is a hallmark of cancer as originally described by Hanahan and Weinberg?
A. Increased sensitivity to growth-inhibitory signals
B. Sustained proliferative signaling and evasion of growth suppressors
C. Enhanced contact inhibition
D. Obligatory anchorage dependence
18. A tumor with high microsatellite instability (MSI-H) is most relevant clinically because it:
A. Predicts poor response to immunotherapy
B. Is associated with defective mismatch repair and may respond well to immune checkpoint
inhibitors
C. Indicates a low tumor mutational burden
D. Rules out a diagnosis of Lynch syndrome
19. Which factor is most important in determining whether a genetic cancer risk assessment referral is
indicated?
A. Patient age alone
B. Family history pattern suggestive of hereditary cancer syndrome (early onset, multiple
affected relatives, bilateral/multiple primaries)
C. Presence of any first-degree relative with any cancer at any age
D. Patient's personal preference regardless of history
20. Loss of heterozygosity (LOH) is a key concept in tumor suppressor gene inactivation because:
A. Both alleles of a tumor suppressor gene typically must be inactivated for loss of function
(Knudson two-hit hypothesis)
B. A single mutated allele is always sufficient to cause cancer
C. LOH only occurs in oncogenes, not tumor suppressors
D. LOH prevents cancer development
21. According to current general screening guidelines, average-risk adults should begin colorectal cancer
screening at what age?
A. Age 30
, B. Age 45
C. Age 60
D. Age 65
22. Low-dose CT lung cancer screening is recommended for which population?
A. All adults over age 40 regardless of smoking history
B. Adults aged 50-80 with a significant smoking history (e.g., 20 pack-year) who currently
smoke or quit within the past 15 years
C. Only never-smokers with a family history of lung cancer
D. Adults under age 30 with occupational asbestos exposure
23. A woman with average risk for breast cancer is typically advised to begin mammographic screening
at:
A. Age 25
B. Age 40
C. Age 55
D. Age 65
24. The primary purpose of the Pap test in cervical cancer screening is to detect:
A. Invasive cervical cancer only
B. Precancerous cervical cellular changes before progression to invasive cancer
C. HPV vaccination status
D. Ovarian cancer cells
25. HPV vaccination is most effective when administered:
A. After the onset of sexual activity
B. Before exposure to HPV, ideally in preadolescence
C. Only to individuals already diagnosed with cervical dysplasia
D. Only to female patients
26. Which lifestyle factor has the strongest evidence for increasing risk of multiple cancer types,
including lung, bladder, and head and neck cancer?
A. Moderate physical activity
B. Tobacco use
C. Adequate hydration
D. Regular sleep patterns
27. Chemoprevention with tamoxifen may be considered for which patient population?
A. Postmenopausal women with no breast cancer risk factors
B. Women at high risk for breast cancer based on validated risk assessment models
C. Men with prostate cancer
D. Patients with active deep vein thrombosis, without additional consideration
28. Prostate-specific antigen (PSA) screening decisions should primarily involve:
A. Automatic screening of all men starting at age 40 without discussion
