Simulation of Real Life
Testing Conditions

Available on our partner site, BoardVitals, this course contains questions written exclusively by experienced physicians certified in medical oncology and hemepath. Structured questions and cases mirror the content and format of the exam. Answer questions in review or timed mode in simulated exam conditions.

Measure Your
Performance

Percent correct provided on most questions to compare your performance against the national average.

Learn While You Earn

Earn up to 27.00 AMA PRA Category 1 CME Credit(s)TM  and up to 27.00 ABIM MOC Credits quickly and easily.


Identify Your Strengths
& Weaknesses

Enables you to recognize knowledge gap through detailed dashboards that track your progress and identify strengths and weaknesses.

Detailed Questions
& Explanations

Test your knowledge by answering questions targeted to the ABIM initial certification exam for medical oncology with over 800 questions total (which include 181 hematology and 286 oncology exam questions). Correct your answers as you go with evidence-based rationales for the correct answers.

Leading Faculty

Developed by top faculty and practicing clinicians, BoardVitals helps thousands of doctors, advanced practice nurses, and other health professionals prepare for board certification exams and complete their CME/CE requirements. BoardVitals is trusted by leading medical and nursing institutions including Harvard, Yale, Mt. Sinai, and Duke.


Convenient Access

Whether testing from your iPad in the hospital between cases, or at home on your couch, you have twenty-four hours a day access for 3 months.


ClinicIan Feedback:

We've needed a HemOnc question bank for a while... glad it's finally here. The topics in your question bank are similar to the HemOnc board exam and I'm grateful for the resource

Ben Steuben, MD, Pathology, Hematology, MD Anderson Cancer Center


Medical Oncology Sample Questions:

Question 1

A 32-year-old overweight woman presents with persistent right knee pain. She denies trauma, swelling, fever, rash, or general unwellness. She has never had anything like this before. She has no significant past medical history. She leads an active but stressful life as a woman's clothing store owner. Knees appear symmetrical with no swelling, effusion, erythema, or warmth. Distal femur is tender on palpation. Range of movement is decreased on the right. On x-ray, there is a lucent, lytic lesion over the disease femur. What is the most likely diagnosis?

A) Osteoarthritis
B) Osteogenic sarcoma
C) Ewing's sarcoma
D) Giant cell tumor of bone
E) Chondrosarcoma

Answer
D) Giant cell tumor of bone


Explanation
Correct: (D) Giant cell tumor of bone. Explanation: Giant cell tumors (GCT) are usually benign but complex bone tumors. They have a propensity to be locally destructive and to metastasize to lung or lymph nodes years after the initial diagnosis. Local recurrence after treatment is a challenge in approximately 10% of cases. Although GCTs account for <10% of all primary tumors, they tend to affect younger adults (ages 25-40 years) and women more than other populations. The slow development of worsening pain at the site of the tumor is a chief complaint. In 15% of cases, a pathological fracture leads to diagnosis. On examination, there may be a palpable swelling with warmth, tenderness, or decreased range of movement. Radiographs are characterized by a well-circumscribed lucent "soap bubble" appearance. Surgery is the mainstay of treatment, specifically intralesional excision by "extended" curettage. Local recurrence is common. Denosumab was FDA-approved in June 2013 for unresectable giant cell tumors. Pulmonary metastases may receive surgery, chemotherapy, and/or radiotherapy. A. FALSE: Osteoarthritis is a degenerative joint disease. Risk factors are obesity, previous joint injury, female gender, and older age. The main symptom is a pain. Typical x-ray findings include joint space narrowing, sclerosis of subchondral bone, subchondral cyst formation, and osteophytes. B. FALSE: Osteogenic sarcoma is a type of bone malignancy that primarily affects people <20 years of age. The primary complaint is pain that is worst at night. There may be a swelling on the proximal end of the affected tibia or humerus or distal femur. Characteristic x-ray findings are a lytic tumor with irregular margins and extension into soft tissue surrounded by "Codman's Triangle," which refers to reactive periosteal formation of new bone. C. FALSE: Ewing's sarcoma is a malignancy of bone or soft tissue. It usually occurs in children or adults <20 years of age and may occur anywhere in the body. The pelvis and long bones are frequently affected. The presenting complaint is often pain with fever, anemia, and elevated white cell count, indicating an inflammatory process. Radiographs show lytic lesions with a periosteal reaction that is typically referred to as an "onion skin" reaction. E. FALSE: Chondrosarcoma is a cancer that forms from cartilage and is typically found in the pelvis, shoulders, and ribs or at the ends of long bones. Pain, especially at night, is a common presenting complaint. Calcified cartilage and areas of demineralized areas may be seen on radiographs.

Reference
http://www.bonetumor.org/tumors-bone/giant-cell-tumor 2. Lewis VO. Giant cell tumor workup. Medscape. 2013. Available from: http://emedicine.medscape.com/article/1255364-workup.


Question 2

A 27-year-old female Jamaican immigrant, at 28 weeks gestation presented to the emergency room with a week long history of progressive altered mental status. Upon physical examination she had multiple lesions on her hands and face, along with chest and shoulder pains. As part of her work up a chest x-ray and peripheral smear was performed (below). Her lab workup revealed a calcium level of 18.5 mg/dl (normal range 8.3-10.2 mg/dl). What additional stain on immunohistochemistry should you order to help establish the diagnosis?


A) CD 25
B) CD 10
C) CD 15
D) CD 30
E) CD 7

Answer
A) CD 25


Explanation
Correct: (A) CD25. Explanation: Adult T-cell leukemia/lymphoma (ATLL) is a post-thymic lymphoproliferative neoplasm of helper T lymphocytes caused by human T-cell lymphotrophic virus, type 1 (HTLV-1). HTLV-1 is a single-stranded RNA virus that integrates into host DNA. HTLV-1 encodes several structural and regulatory genes, such as tax, a potent HTLV-1 transcription activator thought to have a role in HTLV-1 induced transformation and resistance to apoptosis. Most cases of ATLL occur in endemic areas where a significant proportion of the population is infected with HTLV-1. These areas include southwestern Japan, the Caribbean basin, Trinidad, Africa, Brazil, Iran, and the southeast portion of the United States. Affected individuals are usually exposed early in life; it may be transmitted through sexual intercourse, blood or blood products, breastfeeding, and vertical transmission. ATLL develops in only 2% to 4% of carriers, typically after a prolonged latency period which is usually around 25 years. The median age of affected patients is around 55 years. The disease manifests in 75% of cases with leukemia and in the remaining as pure lymphomatous form. ATLL is essentially a disease of adults, characterized by the presence of small to large leukemic cells with highly convoluted nuclei and deep nuclear indentations which have been described as "flower-like cells", lymphadenopathy that spares the mediastinum, hepatosplenomegaly, skin lesions, hypercalcemia associated with lytic bone lesions, and generalized bone resorption. Four clinical variants have been described including acute, lymphomatous, chronic and smoldering. The neoplastic lymphocytes express T-cell associated antigens including CD2, CD3, CD4, and CD5. CD25 is strongly expressed in the majority of cases. The neoplastic cells usually lack CD7 which distinguishes ATLL from other peripheral T-cell proliferations, such as T-cell prolymphocytic leukemia (CD4+, CD7+, CD8+/- , and CD25+/-) and mycoses fungicides/Sezary syndrome (CD4+, CD7-, and CD25-). The prognosis of ATLL is poor, clinical form, age, performance status, elevation of lactate dehydrogenase, high beta-2 microglobulin, high serum level of CD25, high serum neuron-specific enolase, the presence of hypercalcemia and a high proliferative rate are the main prognostic factors. The median survival is less than one year for the acute and lymphoma forms and the projected 4-year survival is estimated to be around 5% for these two clinical variants. Chronic and smoldering ATLL have better prognosis, with projected 4-year survival of 26.9% and 62% respectively.

References
Stueben, Benjamin, et al. Adult T-Cell Lymphoma in Pregnancy. Case Reports in Oncological Medicine, Article ID 631825. Matutes, E. Adult T-cell leukemia/lymphoma. Journal of Clinical Pathology 2007; 60:1373-1377.

Dahmous, L., Hijazi, Y., et al. Adult T-cell leukemia/lymphoma. A Cytopathologic, Immunocytochemical, and Flow cytometric study. Cancer Cytopathology. 2002;6-2:110-116. Matsuoka Retrovirology 2005 2:27 doi:10.1186/1742-4690-2-27

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