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MRCP PART 1 · ONCOLOGY

Oncology questions
for MRCP Part 1.

Clinora has 188 oncology single best answer questions covering 176 topics. Every question explains all five options, separates the key clue from what it means and what to do next, and links to its source. Try the 5 sample questions below, then practise more for free.

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FREE SAMPLE QUESTIONS

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Choose your answer, then open the explanation.

Question 1ECOG performance statusEasy

A 61-year-old man with metastatic colorectal cancer remains fully ambulatory and independent. Cancer-related fatigue prevents strenuous exercise, but he continues his office job and does light housework. What is his ECOG performance status?

  1. AECOG 1
  2. BECOG 0
  3. CECOG 2
  4. DECOG 3
  5. EECOG 4
Show answer and explanation

Answer: A ECOG 1

ECOG performance status describes how much a cancer limits someone's daily life, on a scale from 0 to 5. 0: fully active, no restriction. 1: restricted in strenuous activity but walking and able to do light or desk work. 2: walking and able to care for themselves but unable to work, and up and about more than half of waking hours. 3: capable of only limited self-care and in bed or a chair more than half of waking hours. 4: completely disabled and confined to bed or chair. 5: dead. He cannot do strenuous exercise but still works in an office and does light housework, so he is ECOG 1. The grade matters clinically because it predicts tolerance of treatment and survival. Most chemotherapy decisions and clinical trial eligibility depend on it, with many trials requiring ECOG 0–1 or 0–2. Grade function, not the diagnosis: two people with the same cancer can have very different performance status.

Key clue
Unable to exercise strenuously but ambulatory, independent and continuing office work
What it means
Light work is preserved despite restriction of strenuous activity
What to do
ECOG 1

Why the other options are less appropriate

  • B ECOG 0 means fully active with no restriction. His fatigue limits strenuous activity.
  • C ECOG 2 means unable to work. He still works in an office.
  • D ECOG 3 means limited self-care and more than half the day in a bed or chair.
  • E ECOG 4 means completely disabled and confined to bed or chair.

Source: ECOG-ACRIN Cancer Research Group: ECOG Performance Status Scale

Question 2Metastatic malignancy — tissue diagnosisMedium

A 67-year-old man has weight loss, multiple liver lesions and a 3 cm left supraclavicular node on CT. There is no obvious primary tumour and no immediate organ-threatening complication. Which is the most appropriate next step before tumour-specific systemic therapy?

  1. AStart empirical colorectal chemotherapy because liver metastases are common
  2. BMeasure a broad panel of serum tumour markers and treat the highest result
  3. CBiopsy the accessible supraclavicular node for histology and immunohistochemistry
  4. DArrange upper and lower gastrointestinal endoscopy before obtaining diagnostic tissue
  5. EBiopsy a deep liver lesion rather than the safer superficial node
Show answer and explanation

Answer: C Biopsy the accessible supraclavicular node for histology and immunohistochemistry

Weight loss, multiple liver lesions and an enlarged left supraclavicular node (Virchow's node) strongly suggest metastatic cancer, but imaging cannot show what kind of cancer it is. Treatment depends on the tissue type and sometimes on molecular markers, so histology comes first. NICE CG104 on cancer of unknown primary advises taking a biopsy from the safest, most accessible site that will give enough tissue. Here that is the supraclavicular node, sampled by ultrasound-guided core biopsy or excision. Fine-needle aspiration alone often gives too little tissue. The pathologist uses immunohistochemistry to find the lineage (for example carcinoma, lymphoma, melanoma or germ cell tumour) and the likely primary site, such as CK7/CK20 and CDX2 for gastrointestinal origin or TTF-1 for lung. This guides further tests, including molecular testing. A left supraclavicular node often comes from an abdominal or gastric primary, so endoscopy may follow if the pathology points that way. The patient should be managed by the CUP team.

Key clue
Metastatic pattern without known histology plus a safely accessible enlarged node
What it means
Tissue lineage must be established using the least burdensome suitable biopsy before site-specific treatment
What to do
Biopsy the accessible supraclavicular node for histology and immunohistochemistry

Why the other options are less appropriate

  • A Liver metastases have many possible primaries. Starting colorectal chemotherapy without tissue risks treating the wrong cancer.
  • B Most tumour markers are not specific enough to choose treatment. NICE advises against a broad, unselected marker panel.
  • D Endoscopy without symptoms or pathology pointing to the gut delays diagnosis. It may follow once the biopsy suggests a GI primary.
  • E Liver biopsy carries more risk of bleeding. The superficial node gives equally useful tissue more safely.

Source: NICE CG104: Metastatic malignant disease of unknown primary origin in adults — recommendations

Question 3Familial breast cancer — genetics referralEasy

A healthy 36-year-old woman asks about inherited cancer risk. Her mother developed breast cancer at 43 and her sister developed breast cancer at 46. Both are alive. What is the most appropriate next step?

  1. ARefer her to a specialist genetic clinic for counselling and a family testing strategy
  2. BReassure her because neither relative was younger than 40
  3. COrder a direct-to-consumer BRCA test without counselling
  4. DOffer risk-reducing bilateral mastectomy before formal risk assessment
  5. EWait until she develops a breast symptom before reviewing family history
Show answer and explanation

Answer: A Refer her to a specialist genetic clinic for counselling and a family testing strategy

Her mother and sister had breast cancer at 43 and 46, an average age of 44.5. NICE CG164 recommends referral to a specialist genetic clinic for women with two first- or second-degree relatives diagnosed with breast cancer at an average age under 50, at least one of them a first-degree relative. Other referral criteria include one first-degree relative diagnosed under 40, male breast cancer, bilateral breast cancer, and breast and ovarian cancer in the same family. In the clinic, family history is checked and her risk estimated with a validated tool such as BOADICEA. NICE offers genetic testing when the combined BRCA1/BRCA2 carrier probability is 10% or more. Because both relatives are alive, testing should start with one of them where possible. A pathogenic variant then allows reliable predictive testing for her. Depending on her risk category she may be offered more frequent mammography from her forties, annual MRI if risk is high, chemoprevention, or discussion of risk-reducing surgery. Counselling about the implications of testing is essential before any test.

Key clue
Mother and sister both developed breast cancer before age 50
What it means
Two first-degree relatives diagnosed at an average age below 50 meet specialist genetics referral criteria
What to do
Refer her to a specialist genetic clinic for counselling and a family testing strategy

Why the other options are less appropriate

  • B The NICE criterion for two relatives is an average age under 50, not under 40. Their average of 44.5 meets it.
  • C Testing without counselling or family context risks a misleading negative result and harm. Testing should start with an affected relative where possible.
  • D Risk-reducing mastectomy is considered only after formal risk assessment, counselling and multidisciplinary discussion.
  • E Assessing inherited risk aims to allow surveillance and prevention before cancer develops. Waiting for symptoms misses that chance.

Source: NICE CG164: Familial breast cancer — recommendations

Question 4Brain metastasis — symptomatic vasogenic oedemaHard

A 63-year-old woman with metastatic breast cancer develops a progressive headache and new left arm weakness. Emergency CT shows a right frontal mass with substantial surrounding vasogenic oedema and no intracranial haemorrhage. She is alert and protecting her airway. What is the most appropriate immediate plan?

  1. AGive mannitol as the only treatment and discharge when the headache improves
  2. BStart whole-brain radiotherapy immediately without specialist imaging review
  3. CWait for histological proof from a brain biopsy before treating the oedema
  4. DStart levetiracetam despite no seizure and defer dexamethasone until after MRI
  5. EStart dexamethasone and arrange urgent brain MRI with neuro-oncology assessment
Show answer and explanation

Answer: E Start dexamethasone and arrange urgent brain MRI with neuro-oncology assessment

New headache and arm weakness with a frontal mass and marked surrounding oedema mean the symptoms are caused by mass effect from vasogenic oedema around a likely breast cancer metastasis. Tumour vessels leak plasma into the white matter. Corticosteroids reduce this leak and often improve headache and weakness within hours to days. Start dexamethasone now, at the lowest dose that controls symptoms. Higher doses are used for marked symptoms, then taper as soon as definitive treatment allows. Monitor glucose. Arrange urgent contrast-enhanced MRI, which is more sensitive than CT for counting lesions and showing oedema. Refer to the neuro-oncology or brain metastasis multidisciplinary team. Definitive options depend on the number, size and site of lesions, performance status and control of systemic disease. They include surgery for a single large lesion causing mass effect, stereotactic radiosurgery for limited disease, and systemic treatment, for example HER2-directed drugs. Prophylactic antiseizure drugs are not recommended if she has not had a seizure.

Key clue
Focal neurological deficit and headache with a cerebral mass and extensive vasogenic oedema
What it means
Symptomatic tumour-associated oedema needs immediate corticosteroid treatment plus definitive neuro-oncology characterisation
What to do
Start dexamethasone and arrange urgent brain MRI with neuro-oncology assessment

Why the other options are less appropriate

  • A Mannitol is a short-term bridge for impending herniation. She is alert, and discharge without steroids or MRI leaves the oedema and tumour untreated.
  • B Whole-brain radiotherapy is now used less often and depends on MRI lesion count and MDT review. Starting it blind may be the wrong treatment.
  • C Symptomatic oedema needs treatment now. With known metastatic breast cancer, biopsy is often unnecessary and should never delay steroids.
  • D She has had no seizure, so prophylaxis is not indicated. Delaying dexamethasone leaves her symptomatic mass effect untreated.

Source: EANO-ESMO Clinical Practice Guideline: Neurological and vascular complications of primary and secondary brain tumours

Question 5Cisplatin nephrotoxicity preventionEasy

A patient with normal baseline renal function is due to receive a cisplatin-containing regimen. Which supportive plan best reduces predictable renal and electrolyte toxicity?

  1. AUse protocol-based saline hydration, check renal function and electrolytes, and replace magnesium as indicated
  2. BGive protocol saline hydration but omit electrolyte and magnesium surveillance when baseline results are normal
  3. CUse routine forced diuresis with mannitol or a loop diuretic while minimising saline hydration
  4. DReplace magnesium routinely but omit protocol hydration and pre-treatment renal assessment
  5. ERely on urine output and defer renal and electrolyte tests until the next cycle
Show answer and explanation

Answer: A Use protocol-based saline hydration, check renal function and electrolytes, and replace magnesium as indicated

Cisplatin is concentrated in the proximal tubule, where it is taken up by the organic cation transporter OCT2 and causes dose-related tubular injury. This leads to a rise in creatinine and, very commonly, renal magnesium wasting; hypomagnesaemia in turn worsens hypokalaemia and hypocalcaemia. The eviQ guidance on preventing cisplatin nephrotoxicity rests on three measures: protocol-specified intravenous 0.9% sodium chloride hydration before and after each dose, magnesium (with potassium as needed) given with the hydration, and measurement of renal function and electrolytes before each cycle, with dose modification when creatinine clearance falls. Forced diuresis with mannitol or a loop diuretic is not a substitute for adequate hydration. Other nephrotoxins such as aminoglycosides, NSAIDs and iodinated contrast should be avoided around treatment. Other cisplatin toxicities worth knowing are ototoxicity with high-frequency hearing loss, peripheral neuropathy and severe emesis, which needs prophylaxis with an NK1 antagonist, a 5-HT3 antagonist and dexamethasone.

Key clue
Planned cisplatin exposure with known renal and magnesium-wasting risk
What it means
Prevention requires protocol hydration plus renal and electrolyte surveillance rather than reactive treatment alone
What to do
Use protocol-based saline hydration, check renal function and electrolytes, and replace magnesium as indicated

Why the other options are less appropriate

  • B Normal baseline results do not predict on-treatment magnesium wasting or kidney injury, so surveillance is still needed before each cycle.
  • C Diuretics without adequate saline hydration risk volume depletion, which increases cisplatin nephrotoxicity rather than preventing it.
  • D Magnesium replacement treats one consequence of tubular injury, but without hydration and renal assessment the kidney injury itself is not prevented.
  • E Urine output can stay normal despite falling GFR and electrolyte loss, and renal function must be checked before each dose is given.

Source: eviQ: Prevention and management of cisplatin-induced nephrotoxicity

That is 5 of 188. Carry on with oncology in the practice bank, with progress tracking, flashcards and timed sessions.

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Topics covered

Show all 176 oncology topics
  • A central line alone does not mandate a glycopeptide
  • A normal radiograph in cord compression
  • Abiraterone
  • Advanced breast cancer
  • An age-specific CA125 threshold
  • Anthracycline cardiotoxicity surveillance
  • Anthracycline extravasation
  • Aromatase inhibitor
  • Asparaginase thrombosis
  • Avoiding automatic aminoglycoside addition
  • Axillary nodal adenocarcinoma
  • Barrett oesophagus
  • Basal cell carcinoma
  • Bisphosphonate jaw complication
  • Bladder cancer
  • Bleomycin pulmonary toxicity
  • Bone metastasis
  • Brain mass presenting with a seizure
  • Brain metastases
  • Brain metastasis
  • BRCA-mutated platinum-sensitive ovarian cancer
  • Breast cancer
  • Breast cancer bone metastases
  • Breast lump
  • Cancer biology
  • Cancer cachexia
  • Cancer complications
  • Cancer diagnosis
  • Cancer pain
  • Cancer therapeutics
  • Cancer treatment
  • Cancer-associated non-bacterial thrombotic endocarditis
  • Cancer-associated thrombosis
  • Cancer-related fatigue assessment
  • Capecitabine hand-foot syndrome
  • CAR-T therapy
  • Carcinoma of unknown primary
  • Central-line management during initial empiric care
  • Cervical cancer
  • Checkpoint inhibitor colitis
  • Checkpoint inhibitor hepatitis
  • Checkpoint inhibitor myocarditis
  • Checkpoint inhibitor pneumonitis
  • Checkpoint inhibitor thyroiditis
  • Chemotherapy oral mucositis prevention
  • Chest radiography in neutropenic sepsis
  • Cisplatin nephrotoxicity prevention
  • Cisplatin ototoxicity
  • Colon cancer
  • Colorectal cancer
  • Dabrafenib plus trametinib
  • Daily review of high-risk neutropenic sepsis
  • dMMR or MSI-high metastatic cancer
  • Doxorubicin extravasation response
  • ECOG performance status
  • EGFR inhibitor
  • EGFR-mutated metastatic NSCLC
  • Endometrial cancer
  • Enlarging soft-tissue lump
  • Enzalutamide
  • ER-positive early breast cancer
  • Established tumour lysis syndrome while G6PD testing is pending
  • Extravasation during chemotherapy
  • Familial adenomatous polyposis clue
  • Familial breast cancer
  • FDG PET-CT
  • Febrile neutropenia escalation
  • Febrile-neutropenia prevention
  • Fertility counselling before treatment
  • FIT as a gatekeeper
  • Fluoropyrimidine cardiotoxicity
  • Fluoropyrimidines
  • Gastric cancer
  • Germ-cell tumour marker interpretation
  • GIST
  • Glioblastoma
  • Grade 3 immune checkpoint inhibitor colitis
  • Haematological malignancy
  • Haemoptysis and a reassuring infection label
  • Head-and-neck cancer airway bleeding
  • Head-and-neck cancer nutrition
  • Hepatocellular carcinoma
  • High-dose methotrexate
  • Highly emetogenic chemotherapy
  • Hormonal therapy thrombosis
  • HPV-related oropharyngeal cancer
  • Hypercalcaemia of malignancy
  • Ifosfamide
  • Immune checkpoint inhibitor myocarditis
  • Immune-checkpoint diabetes
  • Immune-checkpoint hypophysitis
  • Immune-checkpoint pneumonitis
  • Immunotherapy toxicity
  • Intravenous-to-oral switch after reassessment
  • iRECIST response classification
  • Irinotecan
  • Irinotecan delayed diarrhoea
  • Iron-deficiency anaemia
  • Leptomeningeal metastases presentation
  • LHRH agonists
  • Li-Fraumeni syndrome clue
  • Lynch syndrome colorectal surveillance
  • Malignant ascites
  • Malignant bowel obstruction
  • Malignant central-airway obstruction
  • Malignant pericardial effusion
  • Malignant pleural effusion
  • Malignant spinal cord compression first action
  • Malignant ureteric obstruction
  • Medullary thyroid carcinoma
  • Melanoma
  • Melanoma histology
  • Merkel cell carcinoma
  • Mesothelioma
  • Metabolic emergency
  • Metastatic colorectal cancer
  • Metastatic malignancy
  • Nasopharyngeal cancer
  • Nasopharyngeal cancer presentation
  • Neck mass adult principle
  • Neutropenic enterocolitis without perforation
  • Neutropenic sepsis
  • Neutrophil count and stopping empiric antibiotics
  • NSCLC
  • Oesophageal cancer
  • Oncological emergency
  • Oral cancer non-healing ulcer
  • Oropharyngeal cancer red flag
  • Osteonecrosis of jaw prevention
  • Ovarian cancer
  • Ovarian cancer symptoms
  • Oxaliplatin acute neurotoxicity
  • Paraneoplastic cerebellar degeneration
  • Paraneoplastic dysphagia
  • Paraneoplastic SIADH
  • Paraneoplastic syndromes
  • Penile cancer
  • Persistent fever without deterioration
  • Persistent unilateral hoarseness
  • Positive FIT without anaemia
  • Possible metastatic cord compression
  • Post-radiotherapy xerostomia
  • Postcoital bleeding
  • Postmenopausal bleeding
  • Progressive focal deficit
  • Prostate cancer
  • PSA testing
  • Radiation cystitis presentation
  • Radiation pneumonitis
  • Raised CA125
  • Rectal cancer
  • Renal cell carcinoma
  • Renal-cell carcinoma
  • Rituximab
  • Severe hypercalcaemia of malignancy
  • Social safety in outpatient neutropenic sepsis care
  • Steroid timing in MSCC
  • Superior vena cava obstruction
  • Suspected lymphoma or myeloma: avoiding steroids before biopsy
  • Suspected melanoma
  • Suspicious pigmented lesion
  • Tamoxifen
  • Taxane acute hypersensitivity
  • Testicular cancer
  • Testicular mass
  • Thyroid lump and hoarseness
  • Timing and method of septic-complication risk assessment
  • TNM staging
  • Trastuzumab
  • Treatment toxicity
  • Tumour lysis syndrome
  • VEGF inhibitor
  • Vincristine neuropathy
  • Visible haematuria
  • Vulval cancer
  • When compression is excluded

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