100+ Free ABIM Med Oncology Practice Questions

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Question 1

Score: 0/0

A 54-year-old postmenopausal woman has a 2.2 cm, grade 2, ER 95%, PR 80%, HER2 0 by IHC, Ki-67 15% invasive ductal carcinoma with 1 of 3 sentinel nodes positive. Oncotype DX recurrence score is 18. In addition to breast-conserving therapy with whole-breast radiation, which adjuvant systemic therapy is most appropriate?

Dose-dense AC-T chemotherapy followed by endocrine therapy

Tamoxifen monotherapy for 10 years

Aromatase inhibitor (letrozole or anastrozole) for at least 5 years

Trastuzumab plus pertuzumab with endocrine therapy

to track

2026 Statistics

Key Facts: ABIM Med Oncology Exam

~$2,990

ABIM Med Onc Exam Fee

ABIM 2026

~220 MCQs

Exam Length

4 modules, ~10 hr day

3 years

Heme-Onc Fellowship

ACGME-accredited

Annual

Exam Frequency

Offered yearly

85-92%

First-Time Pass Rate

ABIM historical

4 pillars

Cancer Therapy

Chemo, targeted, IO, cellular

Medical Oncology is one of the largest ABIM subspecialties, with ~550 ACGME heme-onc fellowship graduates per year and rapidly expanding therapeutic options. The 2025-2026 exam cycle emphasizes biomarker-driven NSCLC (EGFR osimertinib FLAURA/ADAURA, ALK alectinib/lorlatinib CROWN, KRAS G12C sotorasib/adagrasib, MET exon 14, HER2 T-DXd), HER2-low breast cancer (DESTINY-Breast04), immune checkpoint inhibitor management (KEYNOTE-522 neoadjuvant TNBC, KEYNOTE-177 MSI-H CRC, EV-302 urothelial, KEYNOTE-A18 cervical), prostate ARPI intensification and Lu-PSMA VISION, HCC IMbrave150/HIMALAYA, and immune-related adverse event management (colitis, pneumonitis, hepatitis, myocarditis). Board-certified medical oncologists earn a median of ~$475K-$575K with strong demand across academic and community practice.

Sample ABIM Med Oncology Practice Questions

Try these sample questions to test your ABIM Med Oncology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 54-year-old postmenopausal woman has a 2.2 cm, grade 2, ER 95%, PR 80%, HER2 0 by IHC, Ki-67 15% invasive ductal carcinoma with 1 of 3 sentinel nodes positive. Oncotype DX recurrence score is 18. In addition to breast-conserving therapy with whole-breast radiation, which adjuvant systemic therapy is most appropriate?

A.Dose-dense AC-T chemotherapy followed by endocrine therapy

B.Tamoxifen monotherapy for 10 years

C.Aromatase inhibitor (letrozole or anastrozole) for at least 5 years

D.Trastuzumab plus pertuzumab with endocrine therapy

Explanation: RxPONDER showed that postmenopausal women with 1-3 positive nodes and Oncotype RS ≤25 derive no meaningful benefit from adjuvant chemotherapy added to endocrine therapy. In postmenopausal women with HR+/HER2- disease, an aromatase inhibitor is preferred over tamoxifen due to superior DFS (ATAC, BIG 1-98). HER2 0 disease does not receive anti-HER2 therapy. Premenopausal women with RS 0-25 and positive nodes DO benefit from chemotherapy (opposite finding).

2A 38-year-old premenopausal woman with a 3.5 cm, grade 3, ER 90%, PR 70%, HER2 0, node-positive (2/4) invasive lobular carcinoma completes AC-T chemotherapy. Based on SOFT/TEXT trials, what adjuvant endocrine therapy is most appropriate for this high-risk premenopausal patient?

A.Tamoxifen 20 mg daily for 5 years

B.Tamoxifen 20 mg daily for 10 years without ovarian suppression

C.Aromatase inhibitor (exemestane) plus ovarian function suppression (GnRH agonist) for 5 years

D.Aromatase inhibitor alone without ovarian suppression

Explanation: In the combined SOFT/TEXT analysis, exemestane + ovarian function suppression (OFS) improved DFS and OS versus tamoxifen ± OFS in high-risk premenopausal women (young age, node-positive, higher grade, received chemotherapy). AI without ovarian suppression is contraindicated in premenopausal women because intact ovarian estrogen production renders AI ineffective and may cause paradoxical HPG-axis activation.

3A 48-year-old woman with clinical stage II, ER 2%, PR 0%, HER2 0 (triple-negative) breast cancer is planned for neoadjuvant therapy. Based on KEYNOTE-522, which regimen is preferred?

A.AC followed by weekly paclitaxel, no immunotherapy

B.Carboplatin + paclitaxel followed by AC plus pembrolizumab, then adjuvant pembrolizumab

C.TCHP (docetaxel, carboplatin, trastuzumab, pertuzumab)

D.Olaparib monotherapy

Explanation: KEYNOTE-522 established neoadjuvant pembrolizumab + platinum/taxane then AC, followed by adjuvant pembrolizumab for 9 more cycles, as SOC for stage II-III TNBC regardless of PD-L1 status — improving pCR and EFS. TCHP is used for HER2+ disease. Olaparib (OlympiA) is adjuvant for gBRCA1/2 carriers after standard therapy, not a substitute for chemo-IO.

4A 62-year-old woman received neoadjuvant TCHP for clinical T2N1 HER2-positive breast cancer. Surgical pathology shows residual invasive disease in the breast (ypT1cN1). Which adjuvant therapy is most appropriate based on KATHERINE?

A.Continue trastuzumab + pertuzumab to complete 1 year

B.Trastuzumab emtansine (T-DM1) for 14 cycles

C.Trastuzumab deruxtecan (T-DXd)

D.Lapatinib plus capecitabine

Explanation: KATHERINE trial showed that in HER2+ patients with residual invasive disease after neoadjuvant HER2-directed therapy plus chemotherapy, switching to adjuvant T-DM1 for 14 cycles reduced invasive DFS events by ~50% vs continuing trastuzumab. Patients with pCR continue trastuzumab ± pertuzumab. T-DXd is approved in metastatic HER2+ and HER2-low, not adjuvant residual disease (standard remains T-DM1, though DESTINY-Breast05 is ongoing).

5A 58-year-old woman with HR+/HER2-low (IHC 1+) metastatic breast cancer has progressed after two prior lines of chemotherapy in the metastatic setting. Which therapy demonstrated OS benefit in DESTINY-Breast04?

A.Sacituzumab govitecan

B.Trastuzumab deruxtecan (T-DXd)

C.Eribulin

D.Capecitabine

Explanation: DESTINY-Breast04 (2022) established T-DXd (trastuzumab deruxtecan) as SOC for HER2-low (IHC 1+ or 2+/ISH-) metastatic breast cancer after prior chemotherapy, with PFS ~10 vs 5 months and OS benefit vs physician's choice chemo. This redefined HER2 as a spectrum. Key toxicity is interstitial lung disease/pneumonitis requiring CT monitoring.

6A 45-year-old woman with gBRCA1 mutation has metastatic triple-negative breast cancer progressing after one line of platinum-based chemotherapy. Which targeted therapy has demonstrated PFS benefit in this setting (OlympiAD)?

A.Olaparib

B.Palbociclib

C.Alpelisib

D.Elacestrant

Explanation: OlympiAD showed olaparib (PARPi) improved PFS vs TPC chemo in HER2-negative metastatic breast cancer with germline BRCA1/2 mutation. Talazoparib (EMBRACA) showed similar benefit. Palbociclib is a CDK4/6i for HR+/HER2- disease. Alpelisib (PI3Kα) is used in HR+/HER2- PIK3CA-mutant with fulvestrant (SOLAR-1). Elacestrant is an oral SERD for ESR1-mutant HR+/HER2- disease (EMERALD).

7A 67-year-old man is a never-smoker newly diagnosed with stage IV lung adenocarcinoma. Molecular testing reveals EGFR exon 19 deletion. Based on FLAURA, what is the preferred first-line therapy?

A.Carboplatin + pemetrexed + pembrolizumab

B.Erlotinib

C.Osimertinib

D.Atezolizumab monotherapy

Explanation: FLAURA established osimertinib (3rd-gen EGFR TKI with CNS penetration) as SOC 1L for EGFR exon 19 del/L858R NSCLC. Osimertinib improved PFS (~19 vs 10 months) and OS vs 1st-gen TKIs (erlotinib/gefitinib). Checkpoint inhibitors are LESS effective in EGFR-mutant NSCLC and not recommended as monotherapy. FLAURA2 now supports osimertinib + chemo as another 1L option, particularly in high-risk subgroups.

8A 58-year-old patient with EGFR exon 19 deletion NSCLC underwent complete resection of a stage II adenocarcinoma and received adjuvant chemotherapy. Based on ADAURA, what is the recommended adjuvant targeted therapy and duration?

A.Osimertinib for 3 years

B.Osimertinib for 1 year

C.Erlotinib for 2 years

D.Gefitinib indefinitely

Explanation: ADAURA showed osimertinib for 3 years after complete resection of stage IB-IIIA EGFR-mutant NSCLC significantly improved DFS and OS vs placebo. FDA-approved duration is 3 years. Starting after standard adjuvant platinum chemotherapy (when indicated) is standard.

9A 49-year-old never-smoker has metastatic lung adenocarcinoma. FISH shows ALK rearrangement. Based on CROWN, what is the preferred 1L TKI?

A.Crizotinib

B.Alectinib

C.Lorlatinib

D.Ceritinib

Explanation: CROWN trial showed lorlatinib (3rd-gen ALK TKI) had a 5-year PFS of 60% vs 8% for crizotinib in 1L ALK+ NSCLC, with superior CNS penetration. Alectinib was prior standard (ALEX trial — PFS 34 vs 10 months vs crizotinib) and remains an acceptable option. Crizotinib is now rarely used 1L. Key lorlatinib toxicities: hyperlipidemia, CNS/mood effects, weight gain.

10A 70-year-old former smoker has metastatic lung adenocarcinoma. PD-L1 TPS is 80%, all driver mutation testing is negative. What first-line therapy is preferred?

A.Carboplatin + pemetrexed alone

B.Pembrolizumab monotherapy

C.Osimertinib

D.Docetaxel + ramucirumab

Explanation: KEYNOTE-024 established pembrolizumab monotherapy as SOC 1L for metastatic NSCLC with PD-L1 TPS ≥50% (no driver mutation), with OS 26 vs 13 months vs chemo. Alternatives include cemiplimab (EMPOWER-Lung 1) and atezolizumab. Chemo-IO combinations (KEYNOTE-189 non-squamous, KEYNOTE-407 squamous) are used across all PD-L1 levels but IO monotherapy is reasonable in high expressers particularly those with poor tolerance of chemo.

About the ABIM Med Oncology Exam

The ABIM Medical Oncology subspecialty exam certifies internists who have completed an ACGME-accredited 3-year Hematology-Oncology or Medical Oncology fellowship. The exam covers solid tumor oncology including breast, thoracic, GI, GU, GYN, melanoma, CNS, sarcoma, thyroid, and CUP malignancies; targeted therapy and biomarker-driven decisions; immunotherapy and immune-related adverse events; oncologic and hematologic emergencies; cancer genetics and screening; and cellular therapy toxicities (CRS, ICANS).

Questions

220 scored questions

Time Limit

~10-hour exam day (four ~2-hour modules)

Passing Score

Criterion-referenced scaled score (pass/fail; specific cut not published)

Exam Fee

~$2,990 application + exam fee (American Board of Internal Medicine (ABIM))

ABIM Med Oncology Exam Content Outline

15%

Breast Cancer

ER/PR/HER2 subtyping; early-stage ET (tamoxifen premenopausal vs AI postmenopausal; AI + GnRH in high-risk premenopausal from SOFT/TEXT); extended ET 10 years. HER2+: TCHP neoadjuvant, adjuvant T-DM1 if residual disease (KATHERINE), T-DXd in metastatic (DESTINY-Breast03) and HER2-low (DESTINY-Breast04). TNBC: pembrolizumab KEYNOTE-522 neoadjuvant, sacituzumab govitecan, olaparib BRCA (OlympiAD).

18%

Thoracic Malignancies

NSCLC AJCC 8 staging; driver-mutation testing (EGFR exon 19 del/L858R → osimertinib 1L FLAURA and adjuvant ADAURA 3 yr; ALK alectinib/lorlatinib CROWN; ROS1 entrectinib/lorlatinib; RET selpercatinib; MET exon 14 capmatinib/tepotinib; KRAS G12C sotorasib/adagrasib; HER2 T-DXd). PD-L1 TPS ≥50 pembrolizumab monotherapy KEYNOTE-024; chemo-IO IMpower150 / KEYNOTE-189. Stage III durvalumab PACIFIC. Adjuvant ALINA alectinib. SCLC: ES platinum-etoposide + atezolizumab IMpower133 or durvalumab CASPIAN.

18%

GI Malignancies

CRC: KRAS/NRAS/BRAF testing — anti-EGFR (cetuximab/panitumumab) only in RAS wild-type left-sided; MSI-H pembrolizumab 1L KEYNOTE-177; BRAF V600E encorafenib + cetuximab (BEACON). IDEA adjuvant 3 vs 6 mo FOLFOX. Rectal TNT (RAPIDO, PRODIGE-23); watch-and-wait OPRA. Gastric: HER2 trastuzumab ToGA; nivolumab + FOLFOX CheckMate-649; zolbetuximab CLDN18.2 (2024). HCC: atezo+bev IMbrave150, durva+treme HIMALAYA, lenvatinib, sorafenib, cabozantinib 2L. Pancreas: FOLFIRINOX vs gem+nab-paclitaxel; olaparib BRCA POLO.

14%

GU Malignancies

Prostate: localized risk stratification; mHSPC ADT + ARPI (abiraterone, apalutamide, enzalutamide, darolutamide) ± docetaxel (triplet ARASENS/PEACE-1). mCRPC: enzalutamide/abi, docetaxel, cabazitaxel, Lu-PSMA-617 VISION (2021), olaparib BRCA/ATM PROfound, niraparib. RCC: 1L IO combos lenvatinib+pembro KEYNOTE-426, ipi-nivo CheckMate-214, atezo+bev IMmotion151, cabozantinib. Urothelial: EV-302 enfortumab vedotin + pembrolizumab 1L (2023); avelumab maintenance JAVELIN Bladder 100; sacituzumab govitecan; erdafitinib FGFR3.

Gynecologic Malignancies

Ovarian: primary debulking vs neoadjuvant chemo; paclitaxel + carboplatin ± bevacizumab; PARPi maintenance olaparib (SOLO-1 BRCA), niraparib (PRIMA HRD-positive), rucaparib. Cervical: KEYNOTE-A18 pembro + concurrent chemoRT locally advanced; HPV vaccine for prevention. Endometrial: RUBY dostarlimab + chemo dMMR, NRG-GY018 pembro; lenvatinib + pembro MMR-intact recurrent; HER2+ trastuzumab for uterine serous.

Melanoma and Skin Cancers

Adjuvant nivolumab or pembrolizumab stage III/IV resected; neoadjuvant pembrolizumab (SWOG S1801). Metastatic: ipi-nivo (CheckMate-067), relatlimab-nivo (RELATIVITY-047); BRAF V600E/K dabrafenib + trametinib; triplet spartalizumab-dab-tram. BCC advanced: vismodegib/sonidegib (SMO inhibitors). SCC: cemiplimab (PD-1). irAEs: colitis (infliximab, vedolizumab), pneumonitis (steroids, MMF), hepatitis (steroids → MMF), endocrinopathies (thyroiditis, hypophysitis, adrenal insufficiency), myocarditis (high-dose steroids, ATG, abatacept).

10%

CNS, Sarcoma, Thyroid, CUP

CNS: GBM Stupp regimen (TMZ + RT + TTFields); MGMT methylation; IDH1 vorasidenib 2024 for grade 2 low-grade glioma; adult LGG 1p/19q codeletion. Sarcoma: STS doxorubicin ± ifosfamide; GIST — KIT exon 11/9 imatinib, PDGFRA D842V avapritinib, ripretinib 4L; osteosarcoma MAP; Ewing VDC-IE. Thyroid: papillary/follicular DTC; medullary calcitonin + CEA, RET germline (MEN2) → vandetanib/cabozantinib/selpercatinib; anaplastic BRAF V600E dabrafenib + trametinib + pembrolizumab. CUP favorable vs unfavorable; genomic-directed therapy.

Emergencies, Genetics, Screening, Cellular Therapy

Oncologic emergencies: TLS — rasburicase + IV hydration; hypercalcemia of malignancy — IV fluids, zoledronic acid, denosumab; SVC syndrome; spinal cord compression — dexamethasone + RT/surgery; febrile neutropenia — IDSA piperacillin-tazobactam ± vancomycin; typhlitis; pericardial tamponade; leukostasis; APL differentiation syndrome — dexamethasone. TTP (ADAMTS13 < 10%), HUS, DIC. Cancer genetics: BRCA1/2, Lynch (MSH2/MSH6/MLH1/PMS2), Li-Fraumeni TP53, FAP APC, HNPCC, MEN1/2, VHL, hereditary diffuse gastric CDH1. Screening: USPSTF — mammogram 40-74 biennial (2024), HPV-based cervical, CRC 45-75, lung LDCT 50-80 20-py (2021), prostate PSA 55-69 shared decision. CAR-T: CRS tocilizumab (IL-6) + steroids; ICANS — steroids (not toci); biosimilars.

How to Pass the ABIM Med Oncology Exam

What You Need to Know

Passing score: Criterion-referenced scaled score (pass/fail; specific cut not published)
Exam length: 220 questions
Time limit: ~10-hour exam day (four ~2-hour modules)
Exam fee: ~$2,990 application + exam fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABIM Med Oncology Study Tips from Top Performers

1Master biomarker testing algorithms by tumor type before memorizing drugs. For NSCLC, know the complete panel (EGFR, ALK, ROS1, BRAF V600E, KRAS G12C, MET exon 14, RET, HER2, NTRK, PD-L1) and which findings dictate targeted vs chemo-IO vs IO-monotherapy first-line decisions.

2Learn pivotal trial names and their enrollment criteria cold — KEYNOTE-522 (neoadjuvant TNBC), KEYNOTE-177 (MSI-H CRC), FLAURA/ADAURA (osimertinib EGFR), CheckMate-067/214, CROWN (lorlatinib ALK), DESTINY-Breast03/04 (T-DXd including HER2-low), EV-302 (urothelial 1L), VISION (Lu-PSMA), IMbrave150 (HCC). Questions often test indication nuances such as line of therapy, biomarker thresholds, or residual disease status.

3Build an irAE management framework: steroids first-line for most grade 2+ toxicities, with escalation to infliximab (colitis), MMF (hepatitis if steroid-refractory), tocilizumab (CRS — not for neurotoxicity), high-dose methylprednisolone + ATG/abatacept (myocarditis). Memorize which toxicities can recur with rechallenge and which are absolute contraindications (myocarditis, pneumonitis grade 3+).

4Know oncologic emergencies algorithms by heart: TLS prevention (allopurinol, hydration) vs treatment (rasburicase for uric acid >8 or high-risk Burkitt/AML), febrile neutropenia IDSA 2018 (piperacillin-tazobactam; add vancomycin for MRSA risk, line infection, skin/soft tissue), cord compression (dexamethasone immediately then MRI and RT/surgery within 24h), APL differentiation syndrome (dexamethasone, hold ATRA only if severe).

5Memorize cancer genetics syndromes with at least one surveillance and one treatment implication each: BRCA1/2 (PARPi in ovarian/breast/prostate/pancreatic), Lynch MMR (MSI-H pembrolizumab; colonoscopy q1-2y; endometrial biopsy), Li-Fraumeni TP53 (avoid radiation when possible), FAP APC (colectomy), MEN2 RET (prophylactic thyroidectomy), VHL belzutifan HIF-2α, hereditary diffuse gastric CDH1 (prophylactic gastrectomy).

Frequently Asked Questions

Who is eligible for the ABIM Medical Oncology exam?

Candidates must hold current ABIM certification in Internal Medicine and must have satisfactorily completed an ACGME-accredited Hematology-Oncology or Medical Oncology fellowship — typically 3 years of fellowship training. A valid, unrestricted US medical license and verification of clinical competence from the program director are also required.

How is the ABIM Medical Oncology exam structured?

The exam is a single-day, computer-based test administered at Pearson VUE containing approximately 220 single-best-answer multiple-choice questions delivered in four modules of roughly two hours each, with an overall ~10-hour exam day including tutorial and breaks. It is offered annually.

What does the ABIM Medical Oncology exam cost?

The ABIM application plus exam fee for Medical Oncology is approximately $2,990 in 2026. Late fees apply after the regular deadline, and fees are subject to annual adjustment — always check the current ABIM fee schedule.

What is the pass rate for the ABIM Medical Oncology boards?

ABIM-reported first-time pass rates for Medical Oncology have historically been in the 85-92% range, reflecting a fellowship-trained candidate pool. Pass rates for repeat takers are substantially lower. See ABIM's annual pass-rate report for the most recent data.

Which topics are highest yield on the Medical Oncology boards?

Highest-yield topics include biomarker-driven NSCLC therapy (EGFR, ALK, KRAS G12C, PD-L1), breast cancer subtypes and the full HER2 spectrum including HER2-low T-DXd, colorectal biomarker testing and MSI-H pembrolizumab, prostate ARPI intensification and PARPi, immunotherapy toxicity management (colitis, pneumonitis, myocarditis), oncologic emergencies (TLS, febrile neutropenia, cord compression), and cancer genetics (BRCA, Lynch, Li-Fraumeni).

What are the best references for ABIM Medical Oncology board prep?

NCCN Clinical Practice Guidelines are essential and frequently tested verbatim. ASCO educational resources (SEP self-evaluation program, ASCO-SEP), DeVita Cancer Principles & Practice for foundational content, pivotal trial review of KEYNOTE/CheckMate/DESTINY/IMbrave/EV/PROfound/VISION, and board review courses such as the ASCO Board Review and Memorial Sloan Kettering Board Review. Practice questions with detailed rationales are critical.

How do I maintain ABIM Medical Oncology certification after passing?

ABIM offers continuous MOC via the Longitudinal Knowledge Assessment (LKA) — ~30 questions per quarter, open-book at home — or the traditional 10-year recertification exam. You must also keep your underlying Internal Medicine certification active and meet ABIM professional standing and CME requirements.

Is Medical Oncology certification required to practice?

Yes in nearly all employed settings. Most hospitals, academic centers, cancer centers, and community oncology practices require or strongly prefer ABIM board certification in Medical Oncology for credentialing, payer contracting, and NCCN member institution status. Most heme-onc fellowship graduates sit for both Hematology and Medical Oncology boards.