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Physician Board Certification

ABIM Medical Oncology Initial Certification Examination Practice Test

Medical oncology practice requires applying cancer biology and treatment principles to patient-specific decisions. The available questions sample topics such as febrile neutropenia, tumor mismatch-repair deficiency, chemotherapy toxicity, metastatic colorectal and renal cancers, and symptom control. They call for connecting clinical findings with likely mechanisms and appropriate next steps across systemic treatment and supportive care.

Exam overview

Exam providerAmerican Board of Internal Medicine
Exam codeNot listed
CategoryPhysician Board Certification

About the ABIM Medical Oncology Initial Certification Examination Exam

Clinical oncology decisions involve matching tumor characteristics and disease extent with treatment options, while weighing prior therapy, comorbidities, and treatment intent. The practice scenarios touch on molecular interpretation, including microsatellite instability and BRAF V600E, and on selecting or adjusting therapy for metastatic disease. They also test recognition of toxicities such as cisplatin-associated kidney injury and hearing changes, and the need for cardiac assessment before potentially cardiotoxic chemotherapy. Other cases focus on urgent or supportive decisions: managing fever with severe neutropenia, evaluating jaundice in the setting of liver metastases, titrating opioids for persistent cancer pain, and approaching nausea when obstruction is not evident. These tasks require prioritizing immediate risks, identifying plausible causes, and choosing a clinically appropriate assessment or intervention rather than recalling drug facts in isolation.

Sample Practice Questions

Review a selection from this exam's published US Practice Tests practice bank.

Question 1

A 48-year-old patient receiving curative-intent chemotherapy develops a temperature of 38.6°C and has an absolute neutrophil count of 300/µL. The patient is hemodynamically stable. What is the best immediate management?

  1. AObtain blood cultures promptly and start empiric broad-spectrum antipseudomonal antibiotics
  2. BWait for culture results before giving antibiotics
  3. CGive oral antipyretics and arrange routine follow-up the next day
  4. DStart granulocyte colony-stimulating factor alone and observe
Show answerCorrect answer: A

Fever with severe neutropenia is a medical emergency because infection can progress rapidly with few localizing signs. Cultures should be obtained promptly if doing so does not delay treatment, followed by empiric broad-spectrum antibiotics with antipseudomonal coverage. Further risk assessment guides inpatient versus selected outpatient care.

Question 2

A patient with metastatic colorectal cancer is found to have high-level microsatellite instability in the tumor. Which biological defect most commonly produces this finding?

  1. AImpaired DNA mismatch repair
  2. BLoss of homologous recombination due to BRCA2 deficiency
  3. CConstitutive activation of telomerase
  4. DLoss of nucleotide excision repair
Show answerCorrect answer: A

Microsatellite instability results from deficient DNA mismatch repair, caused by abnormalities in genes such as MLH1, MSH2, MSH6, or PMS2 or by MLH1 promoter methylation. This finding has diagnostic, hereditary-risk, prognostic, and treatment implications.

Question 3

A patient receiving cisplatin develops acute kidney injury and difficulty hearing high-pitched sounds. Which adverse-effect profile most likely accounts for these findings?

  1. ANephrotoxicity and ototoxicity
  2. BHemorrhagic cystitis and cardiomyopathy
  3. CPeripheral neuropathy and pulmonary fibrosis
  4. DThyroiditis and colitis
Show answerCorrect answer: A

Cisplatin is associated with dose-related nephrotoxicity and ototoxicity, as well as nausea and peripheral neuropathy. Hydration and renal monitoring are important components of its safe administration.

Question 4

A 70-year-old man with metastatic colorectal cancer develops progressive jaundice. Imaging shows multiple liver lesions and dilation of the intrahepatic bile ducts. What is the most appropriate initial approach to clarify and address the cause of the jaundice?

  1. AAssess urgently for biliary obstruction and consider endoscopic or percutaneous drainage when appropriate
  2. BBegin the next chemotherapy cycle without further evaluation
  3. CTreat empirically with high-dose corticosteroids
  4. DRepeat tumor-marker testing and defer intervention until the next routine scan
Show answerCorrect answer: A

Jaundice with ductal dilation suggests potentially reversible biliary obstruction, which can cause hepatic dysfunction and limit treatment options. Prompt evaluation of the obstruction and multidisciplinary consideration of drainage are appropriate, alongside assessment for other causes such as diffuse hepatic replacement or drug toxicity.

Question 5

A 59-year-old patient with newly diagnosed acute myeloid leukemia is being considered for intensive induction chemotherapy. Which baseline assessment is particularly important because commonly used induction drugs can impair cardiac function?

  1. AEchocardiographic assessment of left ventricular function
  2. BBone density scan
  3. CPulmonary nodule screening CT
  4. DRoutine colonoscopy
Show answerCorrect answer: A

Anthracyclines used in AML induction can cause cardiac dysfunction. Assessment of left ventricular function, commonly by echocardiography, helps identify pre-existing impairment and informs treatment planning and monitoring.

Question 6

A 61-year-old man with newly diagnosed metastatic clear-cell renal cell carcinoma has no major comorbidities and is considering systemic therapy. Which treatment approach is commonly used as a first-line option for suitable patients?

  1. ACombination immune checkpoint inhibitor therapy
  2. BAdjuvant cisplatin after nephrectomy despite metastatic disease
  3. CTamoxifen monotherapy
  4. DImatinib monotherapy
Show answerCorrect answer: A

For many patients with metastatic clear-cell renal cell carcinoma, first-line options include immune checkpoint inhibitor combinations, such as nivolumab plus ipilimumab, or an immune checkpoint inhibitor combined with a VEGF-targeted agent. Choice depends on disease risk, comorbidities, and patient preferences.

Question 7

A patient with metastatic cancer has severe persistent pain despite appropriate use of short-acting opioid medication. The patient is alert and has no signs of opioid toxicity. What is a reasonable next step in pain management?

  1. AReassess total opioid use and convert to a scheduled long-acting opioid with breakthrough medication as appropriate
  2. BStop all opioids and use only an oral antibiotic
  3. CAvoid reassessment because pain escalation is expected in cancer
  4. DUse a long-acting opioid only as needed, without breakthrough medication
Show answerCorrect answer: A

Persistent cancer pain warrants reassessment of pain severity, function, adverse effects, and total opioid use. For a patient with stable, ongoing pain, a scheduled long-acting opioid with an immediate-release rescue option can provide baseline and breakthrough control, with individualized titration and monitoring.

How to use this practice test

Access is free. A practice session draws up to 20 random questions from the available bank of 50 and displays results when you finish. Use each case to identify the key clinical clue, explain the mechanism or treatment concern it signals, and compare your answer with the result before moving to the next topic.

Preparation tips

  • For febrile neutropenia cases, distinguish immediate infection-management priorities from later investigation, using the absolute neutrophil count, temperature, and hemodynamic status.
  • Review mismatch-repair deficiency, microsatellite instability, and actionable colorectal tumor alterations such as BRAF V600E; connect each finding to its clinical relevance.
  • Compare major chemotherapy toxicities, including cisplatin-associated nephrotoxicity and ototoxicity and anthracycline-related cardiac risk; note what baseline assessment each risk prompts.
  • Practice evaluating complications of metastatic disease, including biliary obstruction from liver involvement, and separate urgent stabilization from diagnostic clarification.
  • Work through symptom-control decisions involving opioid escalation and cancer-related nausea, accounting for toxicity, obstruction, reversible causes, and patient comfort.
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