ESMO Examination - Sample Questions Explained

Below you will find a selection of sample questions from the ESMO examination.

A Questions

An A question has five answers, of which only one is correct.

Example:

Which anti-emetic schedule is the most appropriate for a patient receiving 70 mg/m*2 cisplatin in combination with gemcitabine 1250 mg/m*2 at day 1?

A.  Metoclopramide in combination with dexamethasone at day 1
B.  5-HT3 receptor antagonist (e.g. ondansetron, granisetron) and dexamethasone at day 1
C.  5-HT3 receptor antagonist in combination with lorazepam at day 1
D.  5-HT3 receptor antagonist, aprepitant or fosaprepitant at day 1
E.  5-HT3 receptor antagonist, aprepitant or fosaprepitant, dexamethasone at day 1

Explanation:

The correct answer is E. This chemotherapy schedule is classified as a highly emetic schedule and the standard of care in this situation is a combination of 5-HT3 receptor antagonists, aprepitant or fosaprepitant  and dexamethasone. All other schedules mentioned are less effective.

Literature

ESMO Clinical Practice Guidelines, all cancer handbooks, www.uptodate.com

B Questions

In B questions, you have to link two of five terms (A to E) to the most appropriate of the following two answers (1 and 2).

Example:

Associate supportive care agents with their potential adverse events:
 
A. dexamethasone
B. granulocyte colony stimulating factor
C. megestrol acetate
D. oxycodone
E. zoledronic acid
1. osteonecrosis of the jaw
2. constipation

Explanation:

In the above example five common supportive agents are listed ( A to E). These terms are followed by two side effects (1. and 2.). Correct answer: E1 D2.

It is recommended looking first to the two answers, here 1. osteonecrosis of the jaw and 2. constipation. Then you associate respectively the 1. and 2. answer to one of the terms (A to E). Osteonecrosis of the jaw is a typical side effect of bisphosphonates (e.g. zoledronic acid), so the right answer is E1. Constipation is a typical side effect from morphine therapy (e.g. oxycodone), so the right answer is D2. A side effect from dexamethasone may be osteoporosis, from G-CSF bone pain, from megestrol acetate thrombosis. These answers are not mentioned, so terms A, B and C are not right.

E Questions

E questions test the ability of a candidate to logically link two separate statements in a cause-effect relationship. The best way to approach an E question is first to analyze the two statements separately, secondly to see if they are linked together.

A. (+ because +) Both statements are correct as is the relationship between the two
B. (+ / +)           Both statements are correct, but there is no causal relationship
C. (+ / -)            The first statement is correct, the second statement is incorrect
D. (- / +)            The first statement is incorrect, the second statement is correct
E. (- / -)             Both statements are incorrect

Example:

Positron emission tomography with 18-fluorodeoxyglucose (18-FDG) is recommended as a preoperative staging tool in early stage NSCLC
because:
18-FDG uptake is highly specific for malignant disease involvement in mediastinal lymph nodes in NSCLC.

Explanation:

In this specific case the first statement is correct since FDG-PET is recommended in the staging of all cases of potentially resectable NSCLCs. In fact, it allows a more accurate definition of mediastinal nodal status and has great relevance for detecting occult distant disease. However, its specificity is 85%, and abnormal PET findings in the mediastinum always need confirmation by histology or cytology. Therefore, the first statement is correct, while the second is wrong. As a consequence, there is no link between the two statements, and the correct answer is C.

References:

Crinò L, Weder W, van Meerbeeck J, Felip E; ESMO Guidelines Working Group. Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 2010; 21 (Suppl 5):v103-15.

K Questions

A K question has four possible answers, each of which may be true or false.

Example:

Which statements apply to the estrogen receptor?

A. It is a good predictive marker for response to endocrine treatment in patients with breast cancer
B. The expression of the estrogen receptor is confined to breast tissue
C. It is located on the outer cell surface of breast cells
D. Estrogen receptor status is associated with specific sites of metastatic spread in breast cancer patients
A: true
B: false
C: false
D: true

Explanation:

A: The estrogen receptor status strongly predicts the response to hormonal treatment in patients with breast cancer, both in the adjuvant ( absolute risk reduction of 10-15% with regard to breast cancer mortality) and metastatic setting (approximately 50-60% response in first line treatment).
B: Estrogen expression is not confined to breast tissue. E.g.: Also endometrial cells, ovarian cancer cells can express the receptor.
C: The estrogen receptor belongs to the nuclear  hormone receptor family, is located at the nuclear membrane in the cytosol of the cell ( not on the outer membrane)
D: ER positive breast cancers are more likely to cause apparent metastatic disease in bones, genital tract and soft tissue than ER negative tumours. (Insa et al. Breast Cancer Res Treat. 1999;56:67)

Literature:

All cancer handbooks, www.uptodate.com