Prometric Exam Questions for Oncology Specialists 2026: 20 MCQs with Answers on Breast, Colorectal, Lung and Prostate Cancer, Chemotherapy Toxicity, Oncological Emergencies, Immunotherapy and Palliative Care

The specialist medical oncology paper (ONC5900 at DHA, with ONC6100 for consultants, and the equivalents at SCFHS, QCHP and NHRA) is 100 to 150 single-best-answer questions in up to three hours with a pass mark of about 60%. The Gulf is building cancer centres quickly, and the paper reflects a modern practice: molecular subtyping, immunotherapy and its toxicities, and the emergencies a ward oncologist handles at night. The consultant paper covers the same ground with more judgement questions. This set covers the themes that recur.

Breast and gynaecological cancer

Question 1

A 48-year-old premenopausal woman has a 2.5 cm invasive ductal carcinoma, one positive axillary node, oestrogen receptor positive, HER2 negative, grade 2. After surgery, the standard adjuvant endocrine therapy includes:

1. Tamoxifen for one year
2. Tamoxifen for 5 to 10 years, or ovarian function suppression plus an aromatase inhibitor in higher-risk premenopausal disease, with adjuvant chemotherapy decided by risk and genomic assay where available
3. An aromatase inhibitor alone without ovarian suppression
4. No endocrine therapy because a node is positive

Answer: B. Aromatase inhibitors are ineffective in premenopausal women unless the ovaries are suppressed; extended endocrine therapy reduces late recurrence.

Question 2

A patient with HER2-positive early breast cancer receives trastuzumab. The monitoring required is:

1. Monthly liver function tests
2. Baseline and periodic (about three-monthly) left ventricular ejection fraction assessment, holding treatment for a significant asymptomatic fall or symptomatic heart failure
3. Audiometry
4. Pulmonary function tests

Answer: B. Trastuzumab cardiotoxicity is usually reversible, unlike anthracycline cardiotoxicity, which is dose-dependent and cumulative.

Question 3

A 60-year-old woman with high-grade serous ovarian cancer achieves a complete response to platinum-based chemotherapy after debulking surgery. She carries a germline BRCA1 mutation. The maintenance therapy with the strongest evidence is:

1. Tamoxifen
2. A PARP inhibitor such as olaparib, which substantially prolongs progression-free survival in BRCA-mutated disease
3. Continued carboplatin for two years
4. Observation only

Answer: B. Germline testing in ovarian cancer has treatment implications for the patient and cascade testing for relatives, a topic Gulf papers favour given consanguinity rates.

Question 4

A 45-year-old woman has a stage IIB cervical squamous carcinoma. Standard treatment is:

1. Radical hysterectomy alone
2. Concurrent chemoradiotherapy with weekly cisplatin and brachytherapy
3. Chemotherapy alone
4. Observation

Answer: B. Locally advanced cervical cancer is treated with chemoradiation; HPV vaccination and screening are the prevention questions that accompany it.

Gastrointestinal and thoracic cancer

Question 5

A 58-year-old man has a resected stage III (node-positive) colon adenocarcinoma. The standard adjuvant treatment is:

1. No further treatment
2. Fluoropyrimidine plus oxaliplatin (FOLFOX or CAPOX) for three to six months depending on risk, started within about eight weeks of surgery
3. Radiotherapy to the abdomen
4. Bevacizumab monotherapy

Answer: B. Oxaliplatin causes cumulative peripheral neuropathy and cold-induced dysaesthesia; DPD deficiency testing before fluoropyrimidines is increasingly standard.

Question 6

A patient with metastatic colorectal cancer is being considered for an anti-EGFR antibody (cetuximab or panitumumab). Which result excludes benefit?

1. HER2 negativity
2. A RAS (KRAS or NRAS) mutation, and in practice BRAF V600E and right-sided primaries also predict poor response
3. Microsatellite stability
4. Low CEA

Answer: B. Mismatch repair-deficient (MSI-high) metastatic colorectal cancer, by contrast, responds to immune checkpoint inhibitors in the first line.

Question 7

A 55-year-old never-smoker woman from South Asia has metastatic lung adenocarcinoma. Before starting systemic therapy, the essential step is:

1. Start platinum doublet chemotherapy immediately
2. Molecular testing for EGFR, ALK, ROS1, BRAF, KRAS G12C, MET, RET and NTRK alterations plus PD-L1 expression, because a targeted oral agent (for example osimertinib for EGFR) is first line when a driver is present
3. Whole-brain radiotherapy prophylactically
4. Immunotherapy regardless of markers

Answer: B. EGFR mutations are found in up to half of never-smoker Asian patients with adenocarcinoma; immunotherapy performs poorly in EGFR-mutant disease.

Question 8

A patient with limited-stage small cell lung cancer has a complete response to concurrent chemoradiotherapy. The next recommended step is:

1. Surgical resection
2. Prophylactic cranial irradiation or MRI brain surveillance, given the high rate of brain metastases
3. Maintenance chemotherapy for two years
4. No follow-up

Answer: B. Extensive-stage disease is treated with platinum-etoposide plus an anti-PD-L1 antibody.

Genitourinary and haematological tumours

Question 9

A 72-year-old man has newly diagnosed metastatic hormone-sensitive prostate cancer with bone metastases and a PSA of 150 ng/mL. Standard first-line systemic therapy is:

1. Androgen deprivation therapy alone
2. Androgen deprivation therapy combined with an androgen receptor pathway inhibitor (abiraterone, enzalutamide, apalutamide or darolutamide) and, in high-volume disease, docetaxel; with bone health protection
3. Radical prostatectomy
4. Observation

Answer: B. Treatment intensification improves survival; a GnRH agonist should be covered with an anti-androgen initially to prevent flare in patients with spinal metastases.

Question 10

A 25-year-old man has a painless testicular mass. Ultrasound confirms a solid intratesticular lesion. The correct sequence is:

1. Transscrotal biopsy
2. Serum AFP, beta-hCG and LDH before surgery, then radical inguinal orchidectomy, followed by staging CT and risk-based management
3. Chemotherapy before diagnosis
4. Observation for three months

Answer: B. Transscrotal biopsy risks seeding; a raised AFP excludes pure seminoma. Sperm banking is offered before treatment.

Question 11

A 30-year-old has painless cervical lymphadenopathy, night sweats and weight loss. Excision biopsy shows Reed-Sternberg cells. The standard initial chemotherapy for classical Hodgkin lymphoma is:

1. R-CHOP
2. ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), with PET-adapted de-escalation such as omitting bleomycin after a negative interim PET; brentuximab-based regimens are an alternative in advanced disease
3. FOLFOX
4. Cisplatin and etoposide

Answer: B. Bleomycin pulmonary toxicity and doxorubicin cardiotoxicity are the monitored risks; late second cancers follow radiotherapy.

Oncological emergencies

Question 12

A patient on day 10 after chemotherapy for breast cancer has a temperature of 38.5 °C and a neutrophil count of 0.3 × 10⁹/L. The correct action is:

1. Oral antibiotics and review in 48 hours
2. Blood cultures from peripheral blood and any central line, then empirical broad-spectrum intravenous antibiotics with anti-pseudomonal cover (such as piperacillin-tazobactam) within one hour, risk-stratified with the MASCC score
3. G-CSF alone
4. Wait for culture results

Answer: B. Febrile neutropenia is a medical emergency; low-risk patients may be stepped down to oral therapy after assessment.

Question 13

A patient with Burkitt lymphoma starting chemotherapy develops potassium 6.4 mmol/L, phosphate 2.8 mmol/L, calcium 1.7 mmol/L, urate 900 micromol/L and a rising creatinine. The diagnosis and the key treatments are:

1. Hypercalcaemia; bisphosphonates
2. Tumour lysis syndrome; aggressive intravenous hydration, rasburicase for established hyperuricaemia, correction of hyperkalaemia, cardiac monitoring and early renal replacement therapy if needed
3. Sepsis; antibiotics
4. Adrenal crisis; hydrocortisone

Answer: B. Prophylaxis with hydration and allopurinol or rasburicase is given before treatment of high-risk bulky, rapidly proliferating tumours; rasburicase is contraindicated in G6PD deficiency, which is common in the Gulf.

Question 14

A man with metastatic prostate cancer develops new back pain, leg weakness and urinary retention over 24 hours. The immediate management is:

1. Analgesia and outpatient MRI in two weeks
2. High-dose dexamethasone immediately, urgent whole-spine MRI within 24 hours, and urgent radiotherapy or surgical decompression, because neurological outcome depends on function at the time of treatment
3. Physiotherapy
4. Bisphosphonate infusion

Answer: B. Metastatic spinal cord compression is a time-critical emergency; patients still walking at treatment usually stay walking.

Question 15

A patient with squamous cell lung cancer is confused and dehydrated with a corrected calcium of 3.4 mmol/L. After intravenous fluids, the next treatment is:

1. Oral calcium supplements
2. An intravenous bisphosphonate such as zoledronic acid (or denosumab if refractory or renal function prohibits), with calcitonin for rapid short-term effect in severe cases
3. Thiazide diuretics
4. Vitamin D

Answer: B. Hypercalcaemia of malignancy is usually PTH-related peptide mediated; thiazides worsen it, and the underlying cancer must be treated.

Systemic therapy and toxicity

Question 16

A patient on pembrolizumab for melanoma develops eight episodes of watery diarrhoea a day with abdominal pain. The appropriate management is:

1. Loperamide and continue immunotherapy
2. Hold the checkpoint inhibitor, exclude infection, and start systemic glucocorticoids (prednisolone 1 to 2 mg/kg or intravenous methylprednisolone), escalating to infliximab or vedolizumab if there is no response within 72 hours
3. Reduce the pembrolizumab dose by half
4. Antibiotics only

Answer: B. Immune-related adverse events (colitis, pneumonitis, hepatitis, endocrinopathies including hypophysitis and thyroiditis) are graded and treated with immunosuppression, not dose reduction; endocrine toxicities are usually permanent and managed with hormone replacement.

Question 17

A patient scheduled for cisplatin has a creatinine clearance of 45 mL/min. The most appropriate action is:

1. Give full-dose cisplatin with extra hydration
2. Substitute carboplatin dosed by the Calvert formula to a target AUC, or reduce the cisplatin dose per protocol, with hearing and renal monitoring
3. Omit platinum entirely
4. Give cisplatin without hydration

Answer: B. Cisplatin is nephrotoxic, ototoxic and highly emetogenic, requiring a three-drug antiemetic regimen (5-HT3 antagonist, NK1 antagonist and dexamethasone, with olanzapine as an option).

Question 18

Which chemotherapy agent requires lifetime cumulative dose tracking because of dose-dependent cardiomyopathy?

1. Paclitaxel
2. Doxorubicin, with cumulative doses kept generally below 400 to 450 mg/m² and baseline cardiac assessment
3. Capecitabine
4. Gemcitabine

Answer: B. Bleomycin (pulmonary fibrosis) and vincristine (neuropathy, never intrathecal) are the other classic cumulative or route-specific toxicities tested.

Screening and palliative care

Question 19

Which cancer screening recommendation is correct for an average-risk adult?

1. Annual whole-body CT from age 40
2. Colorectal cancer screening from age 45 to 50 with colonoscopy or stool-based testing, mammography from age 40 to 50 depending on the programme, and cervical screening with HPV testing from age 25 to 30
3. PSA testing for all men from age 30
4. Annual chest radiograph for smokers

Answer: B. Low-dose CT lung screening is for high-risk smokers of 50 to 80; Gulf national programmes are expanding breast, cervical and colorectal screening, and papers test the age thresholds.

Question 20

A patient with metastatic pancreatic cancer has severe pain uncontrolled on regular paracetamol and codeine. The next step is:

1. Add another weak opioid
2. Switch to a strong opioid such as oral morphine, titrated with regular and breakthrough doses, a laxative and antiemetic prescribed alongside, and early referral to palliative care with coeliac plexus block considered for refractory pain
3. Refuse opioids because of addiction risk
4. Non-steroidal drugs only

Answer: B. Controlled drug prescribing rules in the Gulf (special prescriptions, quantity limits) sit alongside the clinical principles in this domain; reduce opioid doses in renal failure and consider fentanyl or buprenorphine.

How to practise

• Learn the molecular markers that change treatment: ER/PR/HER2, RAS/BRAF/MSI, EGFR/ALK/PD-L1, BRCA, and when to test.
• Know the emergencies as protocols: febrile neutropenia, tumour lysis, cord compression, hypercalcaemia, SVC obstruction, immunotherapy colitis and pneumonitis.
• Learn toxicities by drug: anthracyclines, trastuzumab, platinum, taxanes, bleomycin, vincristine, fluoropyrimidines, checkpoint inhibitors.
• Practise under time in the Oncology bank or the Consultant Oncology bank, using the error-log method.

Related sets: internal medicine, gastroenterology and urology. Specialist title recognition is in recognised qualifications.

Frequently asked questions

How many questions are in the Prometric oncology specialist exam?

Typically 100 to 150 single-best-answer MCQs in up to three hours, with a pass mark of about 60%, varying by authority.

Which oncology topics come up most?

Breast, colorectal, lung and prostate cancer management, molecular testing, oncological emergencies, chemotherapy and immunotherapy toxicity, and palliative care.

Is the consultant oncology paper different?

It covers the same blueprint with more judgement and management questions; the pass mark and format are similar.

Does the exam include radiation and surgical oncology?

At the level a medical oncologist needs: indications for radiotherapy and surgery within multidisciplinary pathways, not technique.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.