10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The NO exam has 200 questions and runs 4 hours.
These 10 free NO questions are organized by exam domain, so you can see how each part of the Neuro-Oncology Certification (NO) blueprint is tested. Reveal the answer and explanation under each question.
Resection of a nonenhancing frontal tumor shows a diffusely infiltrating astrocytic neoplasm with sparse mitoses and no necrosis or microvascular proliferation. Testing identifies an IDH1 R132H mutation, loss of ATRX expression, intact chromosome arms 1p and 19q, and homozygous deletion of CDKN2A/B. What is the integrated diagnosis?
Correct answer: C - Astrocytoma, IDH-mutant, CNS WHO grade 4
Eight weeks after completing radiotherapy with concurrent temozolomide for glioblastoma, a patient has increased enhancement around the resection cavity compared with the first post-radiotherapy MRI. All enhancement lies within the treated field. Neurologic function is unchanged, dexamethasone has been discontinued, and there are no new lesions outside the radiation field. Adjuvant temozolomide has begun. Which response best follows RANO 2.0 principles?
Correct answer: B - Continue temozolomide and obtain a confirmatory MRI in 4-8 weeks
Primary CNS lymphoma is suspected in a 68-year-old with subacute cognitive slowing and two deeply situated, homogeneously enhancing periventricular lesions that restrict diffusion. Edema is mild, with no hydrocephalus, midline shift, or declining consciousness. Corticosteroids have not been given, and stereotactic biopsy can be performed the next morning. Which diagnostic plan best preserves the chance of obtaining an interpretable specimen?
Correct answer: C - Obtain stereotactic tissue before administering corticosteroids
A 10-year-old has undergone gross-total resection of a WNT-activated medulloblastoma. Contrast-enhanced brain and spine MRI shows no metastatic deposits. An adequate lumbar CSF specimen obtained 21 days after surgery contains unequivocal tumor cells. Under conventional clinical risk stratification, which staging and treatment-risk assignment is appropriate?
Correct answer: A - M1 disease; high-risk therapy despite the favorable molecular subgroup
An unresectable hypothalamic pilocytic astrocytoma has progressed in a 7-year-old despite carboplatin and vincristine. Molecular testing shows a KIAA1549-BRAF fusion, with no BRAF V600 mutation. Further systemic treatment is needed. Which targeted therapy has a U.S. FDA indication that specifically accommodates this alteration and treatment history?
Correct answer: D - Tovorafenib
Serial MRI dimensions of a chiasmatic optic-pathway glioma have barely changed in a 6-year-old with neurofibromatosis type 1. However, best-corrected visual acuity in the right eye has declined from 20/30 to 20/80 on two reliable examinations. Refraction and examination identify no alternative ocular explanation. The tumor has not previously been treated. Which finding should determine the next management decision?
Correct answer: A - The reproducible visual decline supports initiating systemic tumor therapy
Three weeks after complete resection of a solitary lung-adenocarcinoma brain metastasis, MRI shows a 2.6-cm surgical cavity without residual enhancement or other intracranial disease. The patient is neurologically independent, extracranial disease is controlled, and there has been no prior cranial irradiation. The cavity is suitable for stereotactic treatment. She places a high priority on preserving memory and can attend regular MRI follow-up. Which postoperative strategy best balances intracranial control and cognitive risk?
Correct answer: D - Stereotactic radiation to the resection cavity without whole-brain radiotherapy
A patient with renal-cell carcinoma has an L3 vertebral metastasis. Pain worsens with standing and twisting and improves when supine. CT shows a lytic lesion, 30% vertebral-body collapse, normal alignment, and tumor involvement of the left pedicle only. MRI shows no epidural neural compression, and the neurologic examination is normal. Which Spinal Instability Neoplastic Score (SINS) and management interpretation are supported by these findings?
Correct answer: B - 10, potentially unstable; obtain a spine surgical assessment
At an urgent visit after lomustine treatment, a patient with glioma has an oral temperature of 38.7°C, a leukocyte count of 1,500/µL, segmented neutrophils of 16%, and bands of 8%. Neutropenia is expected to persist for another 10 days, and painful oral mucositis prevents reliable medication intake. Blood pressure is normal, and there is no beta-lactam allergy. Which paired absolute neutrophil count and initial management plan is correct?
Correct answer: B - ANC 360/µL; obtain cultures and admit for intravenous cefepime
A woman with lung cancer and two brain metastases treated by radiosurgery nine months ago develops an acute proximal femoral DVT and a segmental pulmonary embolism. She is hemodynamically stable. Brain MRI performed yesterday shows stable lesions without hemorrhage. Platelets are 162,000/µL, renal function is normal, and there is no recent surgery, active bleeding, or other anticoagulation contraindication. How should the thromboembolism be treated?
Correct answer: A - Start therapeutic low-molecular-weight heparin
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