Specialty Certificate Examination in Medical Oncology Sample Questions

Specialty Certificate 

Examination 

in Medical Oncology Sample Questions 

Question 1. 
 
A 28-year-old woman was found to have stage IV Burkitt’s lymphoma. Her renal function was 
normal and a staging CT scan had shown no abnormality of the renal tract. Three days later, 
when she was about to start chemotherapy, she developed a temperature of 39.0°C with 
rigors and was treated with imipenem. 
 
Investigations (the following day): 
 
 

serum sodium 

138 mmol/L (137–144) 

serum potassium 

6.2 mmol/L (3.5–4.9) 

 serum 

creatinine 

215 

μ

mol/L (60–110) 

serum corrected calcium 

1.60 mmol/L (2.20–2.60) 

serum phosphate 

1.52 mmol/L (0.8–1.4) 

serum lactate dehydrogenase 

1238 U/L (10–250) 

serum urate 

0.69 mmol/L (0.19–0.36) 

 
What is the most likely cause of the renal impairment? 
 
A imipenem 

toxicity 

B intravenous 

contrast 

toxicity 

C kidney 

infiltration 

D septic 

shock 

E  tumour lysis syndrome 
 

Question 2. 
 
A 44-year-old woman presented with post-coital bleeding. Investigation revealed a 2-cm 
grade 1, stage IB1 squamous cell carcinoma of the cervix. There was no evidence of 
lymphovascular space invasion. She had completed her family. 
 
What is the most appropriate treatment? 
 
A brachytherapy 
B chemo-radiotherapy 
C  excision cone biopsy only 
D radical 

hysterectomy 

E vaginal 

trachelectomy 

Question 3. 
 
A 43-year-old man presented with vomiting and 4-kg weight loss. His performance status was 
1. He was found to have a pre-pyloric gastric carcinoma gastric outlet obstruction. A CT scan 
showed no metastases. 
 
What is the most appropriate next step? 
 
A chemo-radiation 
B neoadjuvant 

chemotherapy 

C palliative 

bypass 

D radical 

resection 

E self-expanding 

stent 

Question 4. 
 
A 72-year-old man was found to have an anterior rectal cancer at 2 cm from the anal verge. A 
CT scan of chest, abdomen and pelvis showed no evidence of metastatic disease. An MR 
scan of pelvis showed an anterior tumour abutting the prostate gland, radiologically staged as 
a T3, N1, M0 cancer. 
 
What is the most appropriate next step in management? 
 
A abdominoperineal 

resection 

B chemotherapy 
C long-course 

chemoradiation 

D short-course 

radiotherapy 

E  total mesorectal excision 
 

Question 5. 
 
A 42-year-old man presented with a 1-month history of altered personality and increased 
seizure frequency. An MR scan of brain demonstrated an enhancing lesion in the right frontal 
lobe. Histology revealed a grade 3 oligodendroglioma, with loss of heterozygosity of 1p/19q. 
 
What is the most appropriate treatment? 
 
A  chemoradiation with temozolomide  
B cranial 

irradiation 

C  craniospinal irradiation  
D  procarbazine, vincristine and lomustine (PCV) 
E temozolomide 
 

Question 6. 
 
A 50-year-old woman with early breast cancer presented with fatigue to the accident and 
emergency department on day 7 of her first adjuvant chemotherapy cycle. On examination, 
her temperature was 38.5°C, her pulse was 110 beats per minute and her blood pressure was 
110/70 mmHg. A full blood count was requested. 
 
What is the most appropriate next step? 
 
A  await full blood count result 
B  intravenous broad-spectrum antibiotics 
C  intravenous broad-spectrum antibiotics and granulocyte colony-stimulating factor (G-CSF) 
D  oral broad-spectrum antibiotics 
E  oral broad-spectrum antibiotics and G-CSF  
 
 

Question 7. 
 
A 35-year-old man sought advice about the increased risk of cardiac complications following 
chemotherapy. Eight years previously, he had been successfully treated for Hodgkin’s 
disease with six cycles of doxorubicin, bleomycin, vinblastine and dacarbazine, and 
mediastinal radiotherapy. 
 
For how many years from the end of treatment will this increased risk persist?  
 
A 1–5 

B 6–10 

C 11–15 

D 16–20 

E >20 
 

Question 8. 
 
A 52-year-old woman presented with hot flushes. Her last menstrual period had been 1 year 
previously. She was treated with ethinylestradiol and medroxyprogesterone acetate. 
 
Which potential consequence of oestrogen therapy is most reduced by co-prescription of a 
progestogen? 
 
A breast cancer 
B breast pain 
C endometrial cancer 
D mood changes 
E weight gain 
 
 

Question 9. 
 
A 59-year-old man was referred because of a change in bowel habit. He had noticed no 
alteration in stool calibre, gastrointestinal bleeding or unintended weight loss. There was no 
family history of colonic polyps or gastrointestinal malignancy. 
 
Physical examination was normal. A rectal examination revealed no masses. A 
sigmoidoscopy revealed a 4-mm polyp in the mid-rectum, which was removed with forceps, 
and histology revealed a tubular adenoma. 
 
What is the most appropriate next step in management? 
 
A  barium enema now 
B  colonoscopy in 3 years 
C  colonoscopy in 5 years 
D colonoscopy now 
E  sigmoidoscopy in 1 year 
 

Question 10. 
 
A 58-year-old man presented with haemoptysis, weight loss and worsening breathlessness. 
He was a lifelong heavy smoker. His chest X-ray was abnormal. A CT scan of chest and 
abdomen demonstrated a large mass in the right lower lobe invading into the mediastinum 
and pericardium, extensive mediastinal lymphadenopathy, and bone metastasis (T4, N3, 
M1b). Bronchoscopy and biopsy confirmed a squamous cell carcinoma. Mutation analysis 
revealed that EGFR and K-ras

genes were both wild type. 

 
What is the most appropriate first-line therapy? 
 
A docetaxel 
B erlotinib 
C gefitinib 
D  gemcitabine and cisplatin 
E  pemetrexed and cisplatin 
 
 

Question 11. 
 
A 55-year-old man underwent resection of a T2 clear cell renal carcinoma. 
 
What is the most likely pathogenesis? 
 
A  activating mutations of the VHL gene 
B  MET oncogene activity 
C  mutation of p53 
D up-regulated 

expression 

of HIF-controlled genes 

E  von Hippel–Lindau syndrome 
 

Question 12. 
 
A 30-year-old man presented with a swelling in the testis and an ultrasound scan confirmed 
the presence of a malignant mass. Following orchidectomy, he was found to have a 40-mm 
seminomatous germ cell tumour without non-seminomatous components. There was 
evidence of vascular invasion within the testis. 
 
Investigations: 
 
 

serum lactate dehydrogenase (LDH) 

1250 U/L (10–250) 

 serum 

α

-fetoprotein  

normal 

 serum 

β

-human chorionic gonadotrophin (HCG)  700 U/L (<5) 

 
A CT scan of body showed retroperitoneal lymphadenopathy of up to 7 cm in size, a 3-cm 
mediastinal lymph node and over 30 pulmonary metastases. There were no signs of liver, 
brain or bone metastases. 
 
What is the most appropriate International Germ Cell Cancer Collaborative Group 
classification? 
 
A  good prognosis because of the absence of liver, bone and brain metastases 
B  good prognosis because of the raised HCG and LDH 
C  intermediate prognosis because of the presence of lung metastases 
D  intermediate prognosis because of the raised serum HCG and LDH 
E  poor prognosis because of the raised serum HCG and LDH 
 

Question 13. 
 
A 29-year-old woman had a 2.5-mm Breslow thickness melanoma removed from her right 
shin. She was referred for wide local excision of the scar and consideration of sentinel node 
biopsy.  
 
In what proportion of patients with a negative sentinel node biopsy does nodal recurrence 
subsequently develop in the same lymph node basin? 
 
A <1% 
B 1–4% 
C 5–9% 
D 10–14% 
E 15–25% 
 
 

Answer keys: 
 
1. 

E

2. 

D

3. 

D 

4. 

C 

5. 

B 

6. 

B 

7. 

E 

8. 

C 

9. 

D 

10. 

D 

11. 

D 

12. 

A 

13. 

B