Free CGRA Practice Questions

Question 1

A woman with breast cancer has a BRCA2 variant of uncertain significance. Her mother, who also had breast cancer, carries the same variant. After reviewing this family information, the laboratory retains the uncertain classification. The patient asks whether her unaffected sister should have predictive testing for this variant. What is the appropriate recommendation?

Accepted Answer

Assess the sister using her own history and the pedigree; do not use this VUS for predictive testing.

Answer

Offer targeted testing because finding the variant in two affected relatives establishes its usefulness for predicting risk.

Answer

Treat the sister as a BRCA2 carrier until testing shows that she does not carry the familial variant.

Answer

Postpone the sister's cancer-risk assessment until the laboratory can classify the variant as pathogenic or benign.

Question 2

An unaffected 36-year-old woman seeks testing after her mother develops high-grade serous ovarian cancer. Her mother is available and willing to be tested. Both have Ashkenazi Jewish ancestry. The mother's earlier negative BRCA report examined only three founder variants. Which strategy would provide the most informative initial evaluation of this family's inherited cancer risk?

Accepted Answer

Offer the mother a germline breast/ovarian cancer panel with sequencing and deletion/duplication analysis.

Answer

Begin with a comprehensive germline panel in the daughter, using her result to guide the mother's testing.

Answer

Obtain tumor-only sequencing in the mother instead of further germline testing for the family.

Answer

Test the daughter for the three founder variants before considering more extensive testing in either woman.

Question 3

While constructing a pedigree, a clinician learns that the patient's sister with breast cancer shares the same biological father but has a different mother. Their father died in an accident at 32, and his mother died at 29. An earlier assessment counted the sister as a first-degree relative and described the remaining paternal history as reassuring. How should these two entries be corrected?

Accepted Answer

Second-degree relative; the remaining paternal history is limited rather than reassuring.

Answer

First-degree relative; the remaining paternal history is limited rather than reassuring.

Answer

Second-degree relative; the absence of other paternal cancers is reassuring.

Answer

First-degree relative; the absence of other paternal cancers is reassuring.

Question 4

A woman has an estimated 4% risk of invasive breast cancer over five years and a 28% remaining lifetime risk. Her clinician estimates that a preventive medication would reduce her five-year risk by 50% relative to taking no medication. She asks, "How many women like me would actually avoid a breast cancer diagnosis during those five years?" Which explanation translates the expected benefit correctly?

Accepted Answer

About 2 fewer women out of 100 would develop breast cancer during those five years.

Answer

About 4 fewer women out of 100 would develop breast cancer during those five years.

Answer

About 14 fewer women out of 100 would develop breast cancer during those five years.

Answer

About 50 fewer women out of 100 would develop breast cancer during those five years.

Question 5

At a U.S. breast-risk clinic, a postmenopausal woman with atypical ductal hyperplasia and a five-year breast-cancer risk of 4.8% wants to consider endocrine prevention. She had an unprovoked pulmonary embolism three years ago. Her bone density is normal, and she has no fragility-fracture history. Which option best accommodates her medical history?

Accepted Answer

Discuss anastrozole, including its off-label prevention use and the need to monitor bone health.

Answer

Discuss raloxifene because its lower thromboembolic risk than tamoxifen makes a prior embolism acceptable.

Answer

Discuss tamoxifen because the thromboembolic contraindication applies to treatment of cancer, not prevention.

Answer

Avoid all endocrine prevention because a prior pulmonary embolism contraindicates both SERMs and aromatase inhibitors.

Question 6

An endometrial tumor has absent MLH1/PMS2 expression and retained MSH2/MSH6 expression. Internal controls are adequate. Which additional finding most strongly supports a tumor-acquired mismatch-repair defect?

Accepted Answer

MLH1 promoter hypermethylation in the tumor.

Answer

An activating BRAF V600E tumor variant.

Answer

A microsatellite-instability-high result on a validated tumor assay.

Answer

The same MLH1/PMS2 loss confirmed in another block of the tumor.

Question 7

Before hereditary-cancer testing, a patient says, "I understand GINA protects me, so a future life-insurance application cannot be affected by the result." The discussion concerns federal GINA protections, not any additional state law. Which response accurately corrects her understanding?

Accepted Answer

GINA addresses genetic discrimination in health insurance and employment, but not life, disability, or long-term-care insurance.

Answer

GINA protects life-insurance applicants who have a pathogenic variant but have not yet developed the associated cancer.

Answer

GINA extends to life insurance when testing was ordered by a clinician rather than purchased directly by the patient.

Answer

GINA covers genetic-test results in life insurance, although insurers may still consider the same risk from family history.

Question 8

At a breast-risk visit, an asymptomatic 45-year-old has a Gail five-year invasive breast-cancer estimate of 3.8% and a Tyrer-Cuzick remaining lifetime estimate of 27%, driven substantially by family history. She has no personal breast cancer or high-penetrance pathogenic variant. Under USPSTF medication guidance and ACS high-risk screening recommendations, how should these results be used?

Accepted Answer

Discuss medication using five-year risk; add annual MRI to mammography using lifetime risk.

Answer

Discuss medication using lifetime risk; add MRI only after identifying a pathogenic germline variant.

Answer

Start annual MRI using five-year risk; discuss medication eligibility using lifetime risk.

Answer

Replace mammography with annual MRI; discuss medication only if germline testing is positive.

Question 9

A 40-year-old woman tests negative on an adequate targeted assay for the pathogenic BRCA2 variant identified in her father. Separately, her mother had ovarian cancer at 46 and a maternal aunt had breast cancer at 39; neither maternal relative has had genetic testing. Which interpretation preserves the distinction between the two sides of her family?

Accepted Answer

She is a true negative for the paternal BRCA2 variant; the maternal cancer history remains unexplained.

Answer

Her result is uninformative for the paternal variant because unexplained cancers remain on the maternal side.

Answer

She is a true negative for hereditary breast and ovarian cancer risk because the known familial variant is absent.

Answer

She should be managed as a BRCA2 carrier because the maternal cancers are compatible with that syndrome.

Question 10

A core breast biopsy documented atypical ductal hyperplasia. Subsequent excision showed no residual atypia or malignancy; review confirmed that the original core diagnosis was correct. The patient's intake summary now lists only "benign biopsy." Which entry should be carried forward into her breast-risk history?

Accepted Answer

A history of atypical ductal hyperplasia, even though the excision contained no residual atypia.

Answer

A nonproliferative benign biopsy, because the final surgical specimen contained no atypical cells.

Answer

A history of ductal carcinoma in situ, because the original core contained atypical ductal cells.

Answer

Biopsy history with atypia status unknown, because the core and excision had different findings.

Free CGRA Practice Questions

Domain 1: Collect and document pertinent patient and family history 15% of exam

Question 1

Question 2

Domain 2: Perform personalized cancer risk assessment 18% of exam

Question 3

Question 4

Domain 3: Interpret relevant genetic test results 32% of exam

Question 5

Question 6

Question 7

Domain 4: Determine medical management options based on genetic test results and risk factors 10% of exam

Question 8

Domain 5: Effectively communicate with and counsel patients 25% of exam

Question 9

Question 10

That's 10 of 1,030