AOCNP Advanced Oncology Certified Nurse Practitioner 2 — Questions and Answers
Question 1: A patient receiving FOLFOX chemotherapy develops grade 3 peripheral neuropathy. What is the most appropriate management?
- Continue FOLFOX at full dose
- Dose reduce oxaliplatin by 25%
- Discontinue oxaliplatin permanently (Correct answer)
- Switch to FOLFIRI
Correct answer: Discontinue oxaliplatin permanently
Grade 3 peripheral neuropathy from oxaliplatin warrants permanent discontinuation of oxaliplatin to prevent irreversible nerve damage.
Question 2: Which tumor suppressor gene is most commonly mutated in hereditary breast-ovarian cancer syndrome?
- TP53
- BRCA1/BRCA2 (Correct answer)
- MLH1
- APC
Correct answer: BRCA1/BRCA2
BRCA1 and BRCA2 mutations account for the majority of hereditary breast-ovarian cancer syndrome cases.
Question 3: A patient with metastatic melanoma is started on ipilimumab and develops colitis with diarrhea >7 stools/day above baseline. What is the first-line treatment?
- Loperamide 4 mg PO
- Oral prednisone 1 mg/kg/day
- IV methylprednisolone 1-2 mg/kg/day (Correct answer)
- Infliximab 5 mg/kg IV
Correct answer: IV methylprednisolone 1-2 mg/kg/day
Grade 3-4 immune-related colitis requires high-dose IV corticosteroids as initial therapy.
Question 4: What is the mechanism of action of venetoclax in hematologic malignancies?
- Inhibits BCR-ABL tyrosine kinase
- Blocks BCL-2 anti-apoptotic protein (Correct answer)
- Inhibits Bruton's tyrosine kinase
- Targets CD20 on B-cells
Correct answer: Blocks BCL-2 anti-apoptotic protein
Venetoclax is a selective BCL-2 inhibitor that restores apoptosis in cancer cells that overexpress this anti-apoptotic protein.
Question 5: A postmenopausal woman with ER+/HER2- early breast cancer completes 5 years of tamoxifen. What is the recommended next step?
- Discontinue all hormonal therapy
- Continue tamoxifen for 5 more years
- Switch to an aromatase inhibitor for up to 5 additional years (Correct answer)
- Start trastuzumab
Correct answer: Switch to an aromatase inhibitor for up to 5 additional years
Extended adjuvant therapy with an aromatase inhibitor for up to 5 additional years after tamoxifen reduces late recurrence in postmenopausal patients.
Question 6: Which laboratory finding is most consistent with tumor lysis syndrome?
- Hypernatremia, hypophosphatemia, hypercalcemia
- Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia (Correct answer)
- Hypokalemia, hypophosphatemia, hypercalcemia
- Hyponatremia, hyperchloremia, hypercalcemia
Correct answer: Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia
Tumor lysis syndrome is characterized by hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia from massive cell death.
Question 7: A patient with newly diagnosed AML has FLT3-ITD mutation. Which targeted agent should be added to induction chemotherapy?
- Imatinib
- Midostaurin (Correct answer)
- Ibrutinib
- Venetoclax
Correct answer: Midostaurin
Midostaurin, a FLT3 inhibitor, is added to standard 7+3 induction chemotherapy for FLT3-mutated AML to improve outcomes.
AOCNP Advanced Oncology Certified Nurse Practitioner 2
A patient receiving FOLFOX chemotherapy develops grade 3 peripheral neuropathy.
What is the most appropriate management?