1. Which of the following is the most common site of breast cancer metastases?
a) Liver
b) Lungs
c) Brain
d) Bone
2. Positron emission tomography (PET) uses a radioactive drug to identify which of the following in suspected cancer sites?
a) Oxygen usage
b) Glucose metabolism
c) Blood flow
d) Protein expression
3. Which imaging test is considered the gold standard for detecting liver metastases?
a) CT scan
b) MRI
c) PET scan
d) Ultrasound
4. Identify the circulating tumor cells (CTCs) in blood samples is important for which of the following?
a) Prognosis
b) Monitoring treatment response
c) Detecting early relapse
d) All of the above
5. Liquid biopsy analyzing circulating tumor DNA (ctDNA) in blood is useful for which of the following?
a) Identifying driver mutations for targeted therapy
b) Detecting resistance mutations
c) Monitoring treatment response
d) All of the above
6. Metastatic workup for a breast cancer patient should include which imaging modality?
a) PET-CT
b) Chest X-ray
c) Bone scan
d) Liver ultrasound
7. What percentage of colorectal cancer patients will eventually develop metastases?
a) 30-50%
b) 50-70%
c) 70-90%
d) Over 90%
8. The most common sites of colorectal cancer metastases are:
a) Liver and lungs
b) Liver and bone
c) Lungs and bone
d) Brain and liver
9. Which biomarker is not commonly evaluated in lung adenocarcinoma to guide treatment decisions?
a) EGFR mutations
b) KRAS mutations
c) BRAF mutations
d) HER2 amplification
10. Initial imaging workup for suspected breast cancer metastasis should include which modalities?
a) Bone scan, chest X-ray, liver ultrasound
b) PET-CT, liver MRI, bone scan
c) Chest CT, liver MRI, PET-CT
d) Mammogram, breast MRI, PET-CT
11. What percentage of prostate cancer patients eventually develop metastases?
a) 30-40%
b) 40-50%
c) 50-60%
d) Over 70%
12. The most common sites of prostate cancer metastasis are:
a) Liver and lungs
b) Bone and lymph nodes
c) Brain and lungs
d) Adrenal glands and kidneys
13. Recent evidence suggests circulating tumor cells are detected in around what percentage of patients with metastatic cancer?
a) 50-60%
b) 60-70%
c) 70-80%
d) Over 90%
14. Which biomarker mutation would guide the use of osimertinib as the first-line treatment in metastatic EGFR mutated NSCLC?
a) T790M mutation
b) Exon 19 deletion
c) Exon 21 L858R mutation
d) All of the above
15. Recent studies show ctDNA analysis can detect relapse earlier than imaging in which cancer type?
a) Breast cancer
b) Colorectal cancer
c) Lung cancer
d) Prostate cancer
16. Biomarker testing of which tissue is preferred for guiding targeted therapy in metastatic cancer?
a) Primary tumor tissue
b) Metastatic tissue
c) Circulating tumor cells
d) ctDNA
17. Advanced breast cancer patients with which biomarker would benefit from CDK4/6 inhibitor therapies?
a) HER2 positive
b) Triple negative
c) HR positive
d) EGFR overexpression
18. ALK rearrangements are commonly detected in which type of lung cancer guiding targeted therapy?
a) Small cell lung cancer
b) Squamous cell lung cancer
c) Large cell lung cancer
d) Adenocarcinoma
19. Multigene panels from ctDNA analysis can identify acquired resistance mutations in which cancer?
a) Lung cancer
b) Breast cancer
c) Colorectal cancer
d) Prostate cancer
20. The recommended initial imaging for suspected melanoma metastases includes which modalities?
a) Chest X-ray, abdominal ultrasound, bone scan
b) Chest CT, PET-CT scan, brain MRI
c) Chest X-ray, liver MRI, whole body MRI
d) Mammogram, chest X-ray, abdominal X-ray
21. Which type of lung cancer frequently harbors ROS1 rearrangements guiding targeted therapy?
a) Squamous cell carcinoma
b) Small cell carcinoma
c) Large cell neuroendocrine carcinoma
d) Adenocarcinoma
22. CEA levels are commonly monitored to detect recurrence or metastases in which cancer?
a) Ovarian cancer
b) Lung cancer
c) Colorectal cancer
d) Pancreatic cancer
23. How long after surgical resection of the primary tumor is the peak period of risk for development of metastases in colorectal cancer?
a) 1-2 years
b) 2-3 years
c) 3-5 years
d) Over 5 years
24. Which biomarker overexpression would guide anti-HER2 therapies like trastuzumab in metastatic breast cancer?
a) ER+
b) HER2+
c) Triple negative
d) Progesterone receptor+
25. Biomarkers in favor of immunotherapy include which of the following?
a) PD-L1 expression
b) Microsatellite instability-high
c) High tumor mutational burden
d) All of the above
26. Multigene NGS panels from liquid biopsies are helping to detect acquired resistance mechanisms in which type of lung cancer?
a) NSCLC harboring EGFR mutations
b) SCLC
c) Squamous cell lung cancer
d) NSCLC with ALK fusions
27. The FIRST-Line Study showed osimertinib was more effective than other EGFR-TKIs as first-line treatment of stage IV EGFR mutated NSCLC. True or False?
a) True
b) False
28. Genomic assays of cell-free circulating tumor DNA can monitor treatment response and detect recurrence earlier than imaging in which cancer?
a) Breast cancer
b) Prostate cancer
c) Colorectal cancer
d) Lung cancer
29. Mutations in BRAF are commonly found in which cancers guiding targeted therapy?
a) Lung cancer
b) Colorectal cancer
c) Melanoma
d) Prostate cancer
30. Features favoring multikinase inhibitors over monotherapy EGFR-TKI as first-line treatment in EGFR mutated advanced NSCLC include all except:
a) Multiple EGFR mutations
b) CNS metastases
c) Prior response to EGFR-TKI therapy
d) Indolent clinical course
31. Initial workup of suspected pancreatic cancer metastasis would include which tests?
a) CEA, CA 19-9, CT scan of chest/abdomen/pelvis
b) Alpha fetoprotein, CT scan, bone scan
c) Chest x-ray, colonoscopy, mammogram
d) PSA, testosterone levels, rectal exam
32. The recommended treatment approach for BRAF V600 mutated metastatic melanoma is:
a) Surgery if resectable
b) Single agent BRAF inhibitor
c) Anti-PD1 immunotherapy
d) BRAF+MEK inhibitor combination
33. Circulating tumor cell counts have been shown useful in which scenario in metastatic breast cancer?
a) Predicting prognosis
b) Monitoring chemotherapy response
c) Detecting early relapse
d) All of the above
34. The use of multigene panels from liquid biopsy has shown promise in overcoming resistance to 3rd generation EGFR-TKI therapy in NSCLC harboring which specific resistance mutation?
a) EGFR T790M mutation
b) MET amplification
c) KRAS mutation
d) BRAF mutation
35. Which biomarker predicts lack of benefit from anti-EGFR therapies like cetuximab in mCRC?
a) KRAS mutations
b) BRAF mutations
c) HER2 overexpression
d) Microsatellite instability
36. Features favoring use of multikinase inhibitors over 3rd generation EGFR-TKI as first-line therapy in EGFR advanced NSCLC include:
a) High tumor volume c) Brain metastases
b) Poor performance status d) Multiple extra-CNS metastases
37. Sequential targeting of drivers and resistance mutations informed by liquid biopsies is a promising strategy in which type of lung cancer?
a) SCLC
b) Squamous cell carcinoma
c) Large cell neuroendocrine carcinoma
d) EGFR mutant NSCLC
38. Recommended monitoring for early detection of resistance includes which of the following in EGFR mutant NSCLC treated with osimertinib?
a) Chest x-ray every 3 months
b) PET-CT every 6 months
c) Plasma EGFR mutation testing every 3 cycles
d) All of the above