Free Specialty Certificate Examination in Medical Oncology Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Specialty Certificate Examination in Medical Oncology practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1An oncology MDT in England reviews a woman with newly diagnosed invasive breast cancer. Pretreatment axillary ultrasound shows a morphologically abnormal node. What should be arranged to establish its status?

   1. A.Ultrasound-guided needle samplingCorrect answer: A
   2. B.Contrast-enhanced breast MRI
   3. C.Sentinel lymph node scintigraphy
   4. D.Whole-body bone scintigraphy

   Explanation: NICE states: "if abnormal lymph nodes are identified, perform ultrasound-guided needle sampling." The abnormal axillary node requires tissue sampling; the other imaging procedures do not establish its pathological status.

   Reference: NICE NG101: Early and locally advanced breast cancer, professional society-hosted original — 1.1.1, pp. 6–7

2. 2A woman presents with adenocarcinoma in an axillary node and no primary identified on standard breast assessment. Which tumour-marker panel should be included in initial pathological evaluation?

   1. A.AFP, beta-hCG and LDH
   2. B.PSA, PSMA and androgen receptor
   3. C.Chromogranin, synaptophysin and Ki-67
   4. D.ER, PR and HER2Correct answer: D

   Explanation: NCI states: "Initial pathological studies should include estrogen-receptor, progesterone-receptor, and human epidermal growth factor (HER2) status" The occult breast paradigm calls for breast predictive receptors; the other panels investigate germ-cell, prostate or neuroendocrine differentiation.

   Reference: NCI PDQ: Cancer of Unknown Primary Treatment — Health Professional Version — Axillary Lymph Node(s) With Adenocarcinoma Histology

3. 3A patient is to receive perioperative FLOT for resectable gastric adenocarcinoma. Which taxane is part of this regimen?

   1. A.Paclitaxel
   2. B.Cabazitaxel
   3. C.Nab-paclitaxel
   4. D.DocetaxelCorrect answer: D

   Explanation: NCI states: "perioperative docetaxel, oxaliplatin, and 5-FU/leucovorin (FLOT)" Docetaxel is the taxane in FLOT; all choices are taxane formulations or drugs.

   Reference: NCI PDQ: Gastric Cancer Treatment — Health Professional Version — Perioperative chemotherapy, FLOT4

4. 4A woman taking tamoxifen develops postmenopausal bleeding. Which investigation is needed to assess a possible treatment-associated malignancy?

   1. A.Serum CA-125 alone
   2. B.Vaginal microbiology alone
   3. C.Endometrial tissue biopsyCorrect answer: C
   4. D.Cervical cytology alone

   Explanation: NCI states: "patients who are receiving tamoxifen and experiencing abnormal uterine bleeding have follow-up examinations and biopsy of the endometrial lining." Tamoxifen increases endometrial risk; bleeding requires tissue investigation rather than a screening smear or serum marker.

   Reference: NCI PDQ: Endometrial Cancer — Risk factors

5. 5A specialist sarcoma MDT plans diagnostic sampling of a deep thigh mass. Which method normally provides adequate tissue while allowing a planned definitive resection?

   1. A.Skin punch biopsy
   2. B.Excisional biopsy
   3. C.Image-guided core-needle biopsyCorrect answer: C
   4. D.Fine-needle aspiration cytology

   Explanation: NCI states: "Adequate tissue should be obtained via either image-guided core-needle biopsy or planned incisional biopsy (for select cases)." Planned core biopsy provides tissue without an unplanned excision.

   Reference: NCI PDQ: Soft Tissue Sarcoma — Diagnostic evaluation

6. 6A woman requires definitive radiotherapy for locally advanced cervical carcinoma and is fit for concurrent chemotherapy. Which agent forms the established radiosensitising backbone?

   1. A.Irinotecan
   2. B.Gemcitabine
   3. C.CisplatinCorrect answer: C
   4. D.Oxaliplatin

   Explanation: NCI states: "Concurrent cisplatin-based chemotherapy with radiation therapy is the standard of care for women who require radiation" Concurrent cisplatin is the established backbone in this setting.

   Reference: NCI PDQ: Cervical Cancer Treatment — Health Professional Version — Treatment of Stages IIB, III, and IVA

7. 7A patient with high-risk clear-cell renal carcinoma after nephrectomy asks which immunotherapy was studied as one year of adjuvant treatment in KEYNOTE-564. Which drug was used?

   1. A.Nivolumab
   2. B.Atezolizumab
   3. C.Avelumab
   4. D.PembrolizumabCorrect answer: D

   Explanation: NCI states: "A double-blind, randomized, placebo-controlled trial (KEYNOTE-564 [NCT03142334]) studied the impact of 1 year of pembrolizumab after nephrectomy." This identifies the trial intervention rather than asserting identical approval or access across jurisdictions.

   Reference: NCI PDQ: Renal Cell Cancer Treatment — Health Professional Version — Adjuvant therapy, KEYNOTE-564

8. 8A lung biopsy in a woman previously treated for breast cancer shows cells matching the breast primary. How should this lesion be classified?

   1. A.Primary pleural mesothelioma
   2. B.Metastatic breast cancerCorrect answer: B
   3. C.Primary lung carcinoma
   4. D.Synchronous lung sarcoma

   Explanation: NCI states: "Metastatic cancer has the same name and the same type of cancer cells as the original, or primary, cancer." The site of spread does not change the lineage of the primary malignancy.

   Reference: NCI: What Is Cancer? — Metastatic Cancer

9. 9An early oncology trial escalates doses in small cohorts to assess tolerability and identify a tolerable dose. Which trial phase best matches that principal purpose?

   1. A.Phase 2
   2. B.Phase 3
   3. C.Phase 4
   4. D.Phase 1Correct answer: D

   Explanation: NCI states: "In a phase 1 clinical trial, researchers figure out whether a new treatment is safe, what its side effects are, whether people can tolerate it, and the highest dose that people can tolerate." The dose-and-safety objective identifies phase 1.

   Reference: NCI: What Are Clinical Trials? — Clinical trial phases

10. 10During a peripheral SACT infusion, pain, swelling and leakage raise concern for extravasation. Which immediate sequence is specified before specialist management?

    1. A.Pause the infusion, change the tubing and resume treatment
    2. B.Stop the infusion, retain the device and attempt aspirationCorrect answer: B
    3. C.Stop the infusion, remove the device and apply pressure
    4. D.Pause the infusion, flush the device and restart slowly

    Explanation: UKONS states: "If the patient is receiving an active infusion STOP the infusion immediately" and "Leave the vascular access device in place." The retained device permits aspiration; flushing or restarting could worsen tissue exposure.

    Reference: UKONS Acute Oncology Initial Management Guidelines — Guideline 34, p. 42