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ABIM Med Oncology study materials
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ABIM Med Oncology practice questions

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Question 1Breast Cancer

A 52-year-old postmenopausal woman has an estrogen receptor-positive, HER2-negative invasive ductal carcinoma. Which adjuvant endocrine strategy is most appropriate for a woman with an intact uterus?

  1. Ovarian suppression alone
  2. Trastuzumab with endocrine therapy
  3. Tamoxifen for 5 to 10 years Correct answer.
  4. Aromatase inhibitor monotherapy

Explanation

Tamoxifen is the standard adjuvant endocrine agent for premenopausal women and for postmenopausal women with a contraindication to aromatase inhibitors. Aromatase inhibitors are generally reserved for postmenopausal status because they do not suppress ovarian estrogen production.

Question 2Breast Cancer

Which biomarker is used to determine candidacy for anti-HER2 therapy in breast cancer?

  1. HER2 receptor overexpression or gene amplification Correct answer.
  2. Estrogen receptor
  3. Progesterone receptor
  4. Ki-67 proliferation index

Explanation

Anti-HER2 agents require documentation of HER2 overexpression by immunohistochemistry or gene amplification by in situ hybridization. The other markers guide endocrine therapy or prognosis but not HER2-directed treatment.

Question 3Breast Cancer

A woman with newly diagnosed breast cancer undergoes staging. Which finding would most strongly suggest metastatic disease requiring systemic staging?

  1. Ductal carcinoma in situ on biopsy
  2. Bone pain with an elevated alkaline phosphatase Correct answer.
  3. A single axillary node that is mobile
  4. A 1.5 cm tumor with no palpable nodes

Explanation

Bone pain with an elevated alkaline phosphatase is a classic presentation of osseous metastases and warrants imaging. Small tumors without nodal involvement and in situ disease have low metastatic risk and do not require routine systemic staging.

Question 4Breast Cancer

Which chemotherapy regimen is a standard neoadjuvant option for a patient with HER2-positive early breast cancer?

  1. High-dose methotrexate
  2. Single-agent capecitabine
  3. Taxane plus trastuzumab and pertuzumab Correct answer.
  4. Cyclophosphamide monotherapy

Explanation

Dual HER2 blockade with trastuzumab and pertuzumab combined with a taxane is a standard neoadjuvant backbone for HER2-positive disease. Single-agent and non-breast regimens are not appropriate neoadjuvant choices.

Question 5Breast Cancer

A premenopausal woman with hormone receptor-positive metastatic breast cancer is started on tamoxifen. Which adverse effect most warrants counseling about endometrial risk?

  1. Peripheral neuropathy
  2. Osteoporosis
  3. Endometrial carcinoma Correct answer.
  4. Hyperkalemia

Explanation

Tamoxifen has partial agonist activity on the endometrium and increases the risk of endometrial proliferation and carcinoma. Bone density is generally preserved or improved, and electrolyte or neurologic effects are not characteristic.

Question 6Breast Cancer

A patient with hormone receptor-positive, HER2-negative metastatic breast cancer has progressed on an aromatase inhibitor. Which targeted combination is appropriate if a PIK3CA mutation is detected?

  1. Trastuzumab plus paclitaxel
  2. Olaparib plus carboplatin
  3. Alpelisib plus fulvestrant Correct answer.
  4. Pembrolizumab monotherapy

Explanation

Alpelisib, an alpha-selective PI3K inhibitor, combined with fulvestrant is approved for PIK3CA-mutated hormone receptor-positive, HER2-negative advanced disease after endocrine progression. The other options target different pathways or biomarkers.

Question 7Breast Cancer

Which germline mutation confers eligibility for single-agent olaparib in metastatic HER2-negative breast cancer?

  1. BRCA1 or BRCA2 Correct answer.
  2. BRAF V600E
  3. KRAS
  4. EGFR

Explanation

PARP inhibitors such as olaparib are indicated for patients with germline BRCA1 or BRCA2 mutations, exploiting synthetic lethality in homologous recombination-deficient tumors. The other mutations are not established biomarkers for PARP inhibitor use in breast cancer.

Question 8Breast Cancer

A postmenopausal woman with node-positive hormone receptor-positive breast cancer is being considered for extended adjuvant endocrine therapy. Which strategy is supported by trial evidence?

  1. Adding trastuzumab for 5 additional years
  2. Continuing an aromatase inhibitor beyond 5 years in selected high-risk patients Correct answer.
  3. Stopping all endocrine therapy at 5 years regardless of risk
  4. Switching to tamoxifen after 5 years of an aromatase inhibitor

Explanation

Extended aromatase inhibitor therapy beyond 5 years can reduce recurrence risk in selected high-risk postmenopausal patients. Switching back to tamoxifen or stopping unconditionally ignores risk stratification, and trastuzumab has no role in HER2-negative disease.

Question 9Breast Cancer

Which finding on a breast biopsy most strongly indicates a need for HER2-directed therapy?

  1. Immunohistochemistry 3+ for HER2 Correct answer.
  2. Immunohistochemistry 1+ for HER2
  3. Estrogen receptor positivity of 90%
  4. Immunohistochemistry 2+ without in situ hybridization

Explanation

An immunohistochemistry score of 3+ is a positive HER2 result and qualifies the patient for anti-HER2 therapy. Scores of 1+ and 2+ without amplification are negative, and estrogen receptor status is unrelated to HER2 targeting.

Question 10Breast Cancer

A patient with triple-negative breast cancer has a germline BRCA1 mutation and early-stage disease after neoadjuvant chemotherapy. Which adjuvant oral agent improves outcomes in this setting?

  1. Olaparib Correct answer.
  2. Trastuzumab
  3. Palbociclib
  4. Letrozole

Explanation

Adjuvant olaparib improves invasive disease-free survival in patients with germline BRCA-mutated, high-risk early breast cancer after local therapy and chemotherapy. Endocrine and HER2 agents are ineffective in triple-negative disease, and palbociclib is not used adjuvantly.

Question 11Breast Cancer

Which CDK4/6 inhibitor combination is a standard first-line option for hormone receptor-positive, HER2-negative metastatic breast cancer?

  1. Palbociclib plus capecitabine
  2. Palbociclib plus trastuzumab
  3. Palbociclib plus an aromatase inhibitor Correct answer.
  4. Palbociclib monotherapy

Explanation

CDK4/6 inhibitors combined with endocrine therapy improve progression-free survival and are standard first-line therapy in hormone receptor-positive, HER2-negative metastatic disease. Combining with anti-HER2 therapy or chemotherapy, or using monotherapy, is not the established approach.

Question 12Breast Cancer

A 45-year-old woman has a 2 cm hormone receptor-positive, node-negative breast cancer. Which genomic assay can help decide whether adjuvant chemotherapy adds benefit beyond endocrine therapy?

  1. Oncotype DX recurrence score Correct answer.
  2. Peripheral blood karyotype
  3. Echocardiogram
  4. Serum CA 27.29

Explanation

The Oncotype DX recurrence score quantifies recurrence risk and predicts chemotherapy benefit in hormone receptor-positive, HER2-negative early breast cancer. Karyotype, tumor markers, and echocardiography do not inform adjuvant chemotherapy decisions.

Question 13Breast Cancer

Which toxicity is most characteristic of trastuzumab and requires baseline and periodic monitoring?

  1. Hemorrhagic cystitis
  2. Cardiomyopathy with left ventricular dysfunction Correct answer.
  3. Pulmonary fibrosis
  4. Nephrotoxicity

Explanation

Trastuzumab can cause reversible left ventricular dysfunction, so baseline and serial cardiac function assessment is recommended, especially with anthracyclines. The other toxicities are not characteristic of trastuzumab.

Question 14Breast Cancer

A patient with HER2-positive metastatic breast cancer progresses on first-line trastuzumab, pertuzumab, and a taxane. Which agent is an appropriate next-line HER2-directed option?

  1. Olaparib
  2. Everolimus
  3. Tamoxifen
  4. Trastuzumab deruxtecan Correct answer.

Explanation

Trastuzumab deruxtecan, an antibody-drug conjugate, is effective after progression on prior HER2-directed therapy. The other agents do not target HER2 and are used in different biomarker-defined settings.

Question 15Breast Cancer

Which patient with early breast cancer is most appropriately offered breast-conserving surgery followed by radiation rather than mastectomy?

  1. A patient with extensive multicentric disease
  2. A patient with a 2 cm unifocal tumor and no contraindications Correct answer.
  3. A patient with inflammatory breast cancer
  4. A patient with prior chest wall radiation

Explanation

Breast-conserving surgery with radiation is standard for unifocal disease of appropriate size without contraindications. Multicentric disease, prior chest wall radiation, and inflammatory breast cancer are contraindications to breast conservation.

Question 16Breast Cancer

Which statement about sentinel lymph node biopsy is correct for clinically node-negative early breast cancer?

  1. It is contraindicated in all patients with invasive disease
  2. It identifies the first draining node to stage the axilla with less morbidity than axillary dissection Correct answer.
  3. It requires removal of all axillary lymph nodes
  4. It is used only after neoadjuvant chemotherapy

Explanation

Sentinel lymph node biopsy samples the first draining node and provides accurate axillary staging with lower lymphedema risk than full dissection. It is widely used in clinically node-negative disease and is not limited to the post-neoadjuvant setting.

Question 17Breast Cancer

A patient with hormone receptor-positive metastatic breast cancer develops disease progression on tamoxifen. Which endocrine approach is reasonable if she is postmenopausal?

  1. Observation without further therapy
  2. An aromatase inhibitor with or without a CDK4/6 inhibitor Correct answer.
  3. Carboplatin plus paclitaxel as first endocrine step
  4. Trastuzumab monotherapy

Explanation

In postmenopausal hormone receptor-positive disease, switching to an aromatase inhibitor, often combined with a CDK4/6 inhibitor, is a standard next endocrine step after tamoxifen progression. Anti-HER2 therapy and chemotherapy are reserved for different indications.

Question 18Breast Cancer

Which adverse effect is most characteristic of fulvestrant?

  1. Cataracts
  2. Injection-site reactions Correct answer.
  3. Pulmonary hypertension
  4. Hemolytic anemia

Explanation

Fulvestrant is administered intramuscularly and commonly causes injection-site reactions. The other listed effects are not characteristic of this selective estrogen receptor degrader.

Question 19Breast Cancer

A patient with HER2-positive early breast cancer achieves a pathologic complete response after neoadjuvant chemotherapy plus trastuzumab. Which adjuvant strategy is standard?

  1. Omit all further HER2 therapy
  2. Switch to capecitabine
  3. Add pertuzumab only after surgery
  4. Continue trastuzumab to complete one year of therapy Correct answer.

Explanation

Patients with HER2-positive disease who receive neoadjuvant trastuzumab continue anti-HER2 therapy to complete approximately one year. Escalation with additional agents is reserved for residual disease, and omitting HER2 therapy increases recurrence risk.

Question 20Breast Cancer

Which clinical feature most suggests inflammatory breast cancer?

  1. A firm, mobile, well-circumscribed nodule
  2. Diffuse erythema and peau d'orange of rapid onset Correct answer.
  3. Nipple inversion present for many years
  4. Clear nipple discharge

Explanation

Inflammatory breast cancer presents with rapid-onset diffuse erythema, edema, and peau d'orange due to dermal lymphatic involvement. A well-circumscribed nodule or long-standing nipple inversion suggests benign or other processes.

Question 21Breast Cancer

Which chemotherapy agent used in breast cancer requires monitoring for cumulative dose-related cardiomyopathy?

  1. Cyclophosphamide
  2. Methotrexate
  3. Doxorubicin Correct answer.
  4. Paclitaxel

Explanation

Anthracyclines such as doxorubicin cause cumulative dose-dependent cardiomyopathy, requiring monitoring of cardiac function. The other agents do not share this characteristic cumulative cardiotoxicity.

Question 22Breast Cancer

A patient with metastatic triple-negative breast cancer has tumor cells expressing PD-L1. Which therapy is supported in this setting?

  1. Pembrolizumab plus chemotherapy Correct answer.
  2. Trastuzumab plus pertuzumab
  3. Letrozole plus palbociclib
  4. Tamoxifen plus everolimus

Explanation

Immune checkpoint inhibitors such as pembrolizumab combined with chemotherapy improve outcomes in PD-L1-positive metastatic triple-negative breast cancer. The other combinations target hormone receptor or HER2 pathways absent in triple-negative disease.

Question 23Breast Cancer

Which laboratory abnormality is most consistent with bone metastases in breast cancer?

  1. Low serum calcium
  2. Elevated alkaline phosphatase Correct answer.
  3. Elevated lipase
  4. Isolated hyperkalemia

Explanation

Bone metastases often cause elevated alkaline phosphatase due to increased osteoblastic activity. Hypercalcemia, not hypocalcemia, may occur from osteolysis, and electrolyte or pancreatic abnormalities are unrelated.

Question 24Breast Cancer

A premenopausal woman with hormone receptor-positive metastatic breast cancer is treated with ovarian suppression plus an aromatase inhibitor. Which combination achieves ovarian suppression?

  1. Capecitabine
  2. Trastuzumab
  3. A GnRH agonist such as goserelin Correct answer.
  4. Tamoxifen

Explanation

GnRH agonists suppress ovarian estrogen production and enable use of aromatase inhibitors in premenopausal women. Tamoxifen, trastuzumab, and capecitabine do not suppress ovarian function.

Question 25Thoracic and Head/Neck Cancers

A 62-year-old with resected stage IIB non-small cell lung cancer is being considered for adjuvant therapy. Which finding makes adjuvant osimertinib appropriate?

  1. An activating EGFR exon 19 deletion Correct answer.
  2. A KRAS G12C mutation
  3. Absence of any driver alteration
  4. High PD-L1 expression of 80%

Explanation

Adjuvant osimertinib is indicated after complete resection of stage IB-IIIA NSCLC harboring sensitizing EGFR mutations such as exon 19 deletion or L858R. Driver-negative tumors and KRAS-mutant tumors are not treated with adjuvant EGFR inhibitors, and PD-L1 status does not select adjuvant targeted therapy.

Question 26Thoracic and Head/Neck Cancers

A 58-year-old with metastatic lung adenocarcinoma has a ROS1 rearrangement. Which oral agent is approved first-line for this alteration?

  1. Dabrafenib
  2. Larotrectinib
  3. Erlotinib
  4. Crizotinib Correct answer.

Explanation

Crizotinib and other ROS1 inhibitors (e.g., entrectinib, repotrectinib) are active against ROS1-rearranged NSCLC. EGFR inhibitors, BRAF inhibitors, and NTRK inhibitors do not target ROS1 fusions.

Question 27Thoracic and Head/Neck Cancers

A patient with newly diagnosed extensive-stage small cell lung cancer is planned for first-line systemic therapy. Which regimen is standard?

  1. Platinum plus etoposide with a PD-L1 inhibitor Correct answer.
  2. Pemetrexed plus carboplatin alone
  3. Single-agent paclitaxel
  4. Pembrolizumab monotherapy

Explanation

First-line extensive-stage SCLC standard is a platinum-etoposide backbone combined with an immune checkpoint inhibitor (atezolizumab or durvalumab). Pemetrexed has minimal activity in SCLC, and checkpoint monotherapy is not used as initial therapy.

Question 28Thoracic and Head/Neck Cancers

A 66-year-old with stage IIIA NSCLC is treated with concurrent chemoradiation followed by consolidation durvalumab. What is the most characteristic immune-related toxicity requiring monitoring during durvalumab?

  1. Peripheral neuropathy
  2. QT prolongation
  3. Hemorrhagic cystitis
  4. Immune-mediated pneumonitis Correct answer.

Explanation

Checkpoint inhibitors cause immune-related adverse events, and in patients with prior thoracic radiation pneumonitis is a particularly important concern. Hemorrhagic cystitis, neuropathy, and QT prolongation are not characteristic class effects of PD-L1 blockade.

Question 29Thoracic and Head/Neck Cancers

A patient with advanced NSCLC and no actionable driver alteration has a PD-L1 tumor proportion score of 60%. Which first-line approach is most appropriate?

  1. Osimertinib
  2. Carboplatin plus paclitaxel without immunotherapy
  3. Crizotinib
  4. Pembrolizumab monotherapy Correct answer.

Explanation

For driver-negative NSCLC with PD-L1 TPS of 50% or greater, single-agent pembrolizumab is a standard first-line option. Targeted agents require the corresponding driver alteration, and chemotherapy alone is less preferred when high PD-L1 expression is present.

Question 30Thoracic and Head/Neck Cancers

A 55-year-old with metastatic ALK-rearranged NSCLC has progressed on crizotinib. Which next-generation ALK inhibitor is appropriate second-line therapy?

  1. Alectinib Correct answer.
  2. Trastuzumab
  3. Gefitinib
  4. Vemurafenib

Explanation

Second-generation ALK inhibitors such as alectinib, brigatinib, and ceritinib have activity after crizotinib failure and are also used first-line. EGFR, BRAF, and HER2-directed agents do not target ALK.

Question 31Thoracic and Head/Neck Cancers

A patient with resected stage II NSCLC is being evaluated for adjuvant chemotherapy. Which regimen is standard?

  1. Pemetrexed plus radiation
  2. Pembrolizumab monotherapy for one year
  3. Single-agent carboplatin for six cycles
  4. Cisplatin plus vinorelbine for four cycles Correct answer.

Explanation

Adjuvant platinum-based doublet chemotherapy, such as cisplatin with vinorelbine, is standard for resected stage II-IIIA NSCLC. Single-agent platinum is inadequate, and immunotherapy alone is not a substitute for adjuvant chemotherapy in this setting.

Question 32Thoracic and Head/Neck Cancers

A 70-year-old with limited-stage small cell lung cancer is being planned for definitive therapy. Which approach offers the best chance of long-term control?

  1. Palliative carboplatin monotherapy
  2. Thoracic radiotherapy alone
  3. Surgery alone
  4. Concurrent thoracic radiotherapy with platinum-etoposide Correct answer.

Explanation

Limited-stage SCLC is treated with concurrent chemoradiation using a platinum-etoposide backbone, often with prophylactic cranial irradiation. Surgery alone or radiotherapy alone is inadequate, and palliative single-agent chemotherapy is not definitive treatment.

Question 33Thoracic and Head/Neck Cancers

A patient with metastatic NSCLC has a BRAF V600E mutation. Which targeted combination is approved for this alteration?

  1. Lapatinib plus capecitabine
  2. Osimertinib plus crizotinib
  3. Dabrafenib plus trametinib Correct answer.
  4. Sorafenib plus sunitinib

Explanation

The BRAF inhibitor dabrafenib combined with the MEK inhibitor trametinib is approved for BRAF V600E-mutant NSCLC. The other combinations are not approved for this indication and target unrelated pathways.

Question 34Thoracic and Head/Neck Cancers

A 60-year-old with locally advanced head and neck squamous cell carcinoma of the oropharynx is planned for definitive radiation. Which systemic agent is added to radiotherapy to improve survival?

  1. Doxorubicin
  2. Cisplatin Correct answer.
  3. Cetuximab plus cisplatin
  4. Pembrolizumab

Explanation

Concurrent high-dose cisplatin with radiotherapy is the standard radiosensitizing regimen for locally advanced head and neck squamous cell carcinoma. Adding cetuximab to cisplatin increases toxicity without proven survival benefit, and doxorubicin is not a radiosensitizer in this setting.

Question 35Thoracic and Head/Neck Cancers

A patient with recurrent/metastatic head and neck squamous cell carcinoma has PD-L1 combined positive score of 25. Which first-line regimen is appropriate?

  1. Bleomycin plus vincristine
  2. Cetuximab monotherapy
  3. Methotrexate monotherapy
  4. Pembrolizumab with platinum and fluorouracil Correct answer.

Explanation

For recurrent or metastatic head and neck squamous cell carcinoma with PD-L1 CPS of 1 or greater, pembrolizumab combined with platinum and fluorouracil is a standard first-line option. Cetuximab or methotrexate monotherapy is reserved for later lines, and bleomycin-vincristine is not a regimen for this disease.

Question 36Thoracic and Head/Neck Cancers

A patient with nasopharyngeal carcinoma has an Epstein-Barr virus-associated tumor. Which finding most influences use of EBV-directed monitoring?

  1. CA 19-9 level
  2. Plasma EBV DNA level Correct answer.
  3. Serum alpha-fetoprotein
  4. CEA level

Explanation

Plasma EBV DNA is a validated tumor marker for nasopharyngeal carcinoma used for monitoring response and detecting recurrence. AFP, CA 19-9, and CEA are markers for other malignancies and are not used for EBV-associated nasopharyngeal carcinoma.

Question 37Thoracic and Head/Neck Cancers

A patient with locally advanced laryngeal cancer is deciding between total laryngectomy and organ-preservation chemoradiation. Which factor most strongly favors the surgical approach?

  1. Absence of nodal disease
  2. Extensive cartilage destruction with airway compromise Correct answer.
  3. Desire to preserve voice
  4. Small T2 tumor with mobile vocal cord

Explanation

Extensive cartilage destruction or airway compromise makes organ-preservation chemoradiation unsafe or ineffective, favoring laryngectomy. Small tumors, voice preservation goals, and node-negative disease are features that support non-surgical larynx preservation.

Question 38Thoracic and Head/Neck Cancers

A patient with head and neck cancer receiving concurrent cisplatin and radiation develops severe mucositis limiting oral intake. Which supportive measure is most appropriate?

  1. Continuation of oral intake without modification
  2. Discontinuation of all anticancer therapy permanently
  3. Placement of a feeding tube for nutritional support Correct answer.
  4. Initiation of high-dose corticosteroids alone

Explanation

Severe mucositis with inadequate oral intake during chemoradiation is managed with enteral nutritional support, often via a feeding tube. Permanent cessation of therapy is not indicated, and corticosteroids alone do not address nutritional compromise.

Question 39Thoracic and Head/Neck Cancers

A patient with malignant pleural mesothelioma has unresectable disease. Which first-line systemic regimen is standard?

  1. Etoposide plus ifosfamide
  2. Pemetrexed plus cisplatin Correct answer.
  3. Gemcitabine plus docetaxel
  4. Paclitaxel plus bevacizumab

Explanation

Pemetrexed combined with a platinum agent is the standard first-line chemotherapy for unresectable malignant pleural mesothelioma. The other regimens are not established standards for this disease.

Question 40Thoracic and Head/Neck Cancers

A patient with metastatic NSCLC has an NTRK1 fusion and has progressed on platinum chemotherapy. Which agent is appropriate?

  1. Dabrafenib
  2. Larotrectinib Correct answer.
  3. Osimertinib
  4. Alectinib

Explanation

Larotrectinib and entrectinib are TRK inhibitors approved for NTRK fusion-positive solid tumors, including NSCLC. Osimertinib, alectinib, and dabrafenib target EGFR, ALK, and BRAF respectively, not NTRK fusions.

Question 41Thoracic and Head/Neck Cancers

A 68-year-old with stage IV NSCLC treated with pembrolizumab develops fatigue, nausea, and hyponatremia. Which workup is most important to identify an immune-related cause?

  1. Bone marrow biopsy
  2. Serum alpha-fetoprotein
  3. Echocardiography
  4. Adrenal and thyroid function testing Correct answer.

Explanation

Immune-related endocrinopathies such as adrenal insufficiency and hypothyroidism can present with fatigue, nausea, and hyponatremia, so adrenal and thyroid function should be assessed. Echocardiography, AFP, and bone marrow biopsy do not evaluate these common immune-related endocrine toxicities.

Question 42Thoracic and Head/Neck Cancers

A patient with extensive-stage small cell lung cancer achieves a good response to first-line therapy. Which intervention improves survival in this setting?

  1. Routine whole-brain radiation regardless of response
  2. Prophylactic cranial irradiation Correct answer.
  3. Maintenance pemetrexed
  4. Adjuvant osimertinib

Explanation

Prophylactic cranial irradiation reduces brain metastases and improves survival in patients with extensive-stage SCLC who respond to initial therapy. Maintenance pemetrexed is ineffective in SCLC, and osimertinib is irrelevant without an EGFR mutation.

Question 43Thoracic and Head/Neck Cancers

A patient with RET fusion-positive metastatic NSCLC is being considered for targeted therapy. Which agent is appropriate?

  1. Selpercatinib Correct answer.
  2. Crizotinib
  3. Vemurafenib
  4. Erlotinib

Explanation

Selpercatinib and pralsetinib are selective RET inhibitors approved for RET fusion-positive NSCLC. Crizotinib, erlotinib, and vemurafenib target ALK/ROS1, EGFR, and BRAF respectively.

Question 44Thoracic and Head/Neck Cancers

A patient with head and neck cancer treated with high-dose cisplatin develops a rising creatinine. Which nephroprotective measure should have been emphasized before each dose?

  1. Vigorous intravenous hydration Correct answer.
  2. Oral potassium supplementation alone
  3. Fluid restriction
  4. High-dose loop diuretics alone

Explanation

Cisplatin nephrotoxicity is mitigated by vigorous intravenous hydration before and after administration. Fluid restriction worsens renal injury, and diuretics alone or potassium alone do not provide adequate protection.

Question 45Gastrointestinal Cancers

A 62-year-old man with metastatic colorectal cancer has a tumor that is wild-type for KRAS, NRAS, and BRAF. Which targeted antibody is appropriate to add to first-line chemotherapy in this setting?

  1. Trastuzumab
  2. Ramucirumab
  3. Pembrolizumab
  4. Cetuximab Correct answer.

Explanation

Anti-EGFR antibodies such as cetuximab or panitumumab benefit patients with RAS wild-type, BRAF wild-type colorectal cancer and are used with chemotherapy. Their efficacy depends on the absence of downstream activating mutations in the MAPK pathway.

Question 46Gastrointestinal Cancers

Which laboratory marker is used to monitor response and recurrence in colorectal cancer after resection?

  1. CEA Correct answer.
  2. Alpha-fetoprotein
  3. CA 19-9
  4. CA 125

Explanation

Carcinoembryonic antigen (CEA) is the standard serum tumor marker for colorectal adenocarcinoma and is checked at baseline and serially after resection. Rising CEA can prompt imaging to detect recurrence.

Question 47Gastrointestinal Cancers

A 55-year-old woman has a 2.5 cm rectal adenocarcinoma with no lymph node involvement and no distant metastases. What is the T category?

  1. T4
  2. T3
  3. T2 Correct answer.
  4. T1

Explanation

In colorectal TNM staging, T2 denotes invasion into the muscularis propria, and T1 is limited to submucosa. Tumors larger than 2 cm that invade muscularis propria without extending through it are T2.

Question 48Gastrointestinal Cancers

A 60-year-old man with locally advanced esophageal adenocarcinoma is being planned for perioperative therapy. Which regimen is a standard option based on the FLOT trial?

  1. Carboplatin and paclitaxel
  2. Fluorouracil, leucovorin, irinotecan, and oxaliplatin
  3. Cisplatin and etoposide
  4. Fluorouracil, leucovorin, oxaliplatin, and docetaxel Correct answer.

Explanation

The FLOT regimen combines 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel and improved outcomes compared with ECF/ECX in resectable esophagogastric adenocarcinoma. It is a preferred perioperative regimen.

Question 49Gastrointestinal Cancers

Which chronic infection is the strongest established risk factor for gastric adenocarcinoma of the intestinal type?

  1. Human papillomavirus
  2. Epstein-Barr virus
  3. Hepatitis B virus
  4. Helicobacter pylori Correct answer.

Explanation

Helicobacter pylori infection drives chronic gastritis and is the strongest established risk factor for intestinal-type gastric adenocarcinoma. Eradication reduces but does not eliminate risk.

Question 50Gastrointestinal Cancers

A 68-year-old man with metastatic pancreatic adenocarcinoma has a good performance status. Which first-line combination is standard?

  1. Gemcitabine plus cisplatin
  2. FOLFIRINOX Correct answer.
  3. Irinotecan plus cetuximab
  4. Single-agent capecitabine

Explanation

FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin) improves survival over gemcitabine in fit patients with metastatic pancreatic cancer. Gemcitabine plus nab-paclitaxel is an alternative.