The area of the cerebrum responsible for sensory and association is the:
Parietal area
The sense of smell is conveyed by the:
Olfactory nerve
A glioma spreads by means of:
Local Invasion
____________ brain tumors are known to spread via the CSF.
Medulloblastoma
__________ brain tumors are seen more frequently in adults.
Glioma
Single dose radiosurgery would be appropriate for a ____________ brain tumor.
Solitary 2 cm primary brain tumor
Headache, increased intra-cranial pressure (ICP) & Seizures are symptoms of:
Intracranial tumors
The primary management modality for primary brain tumors is:
Surgery
Uncontrolled diabetes, visual disturbances & sinus pressure are all symptoms of __________.
pitutary adenomas
Incontinence/impotence and radiating pain down the legs may indicate a primary spinal cord tumor located in the __________ region.
Lumbosacral
Facial pain could be associated with a primanry CNS tumor near cranial nerve ______.
Cranial nerve VII (facial)
The TD 5/5 for the lense of the eye is:
5-10 Gy
The TD 5/5 for the optic nerve or optic chiasm is:
50 Gy
Involvement of cranial nerve ______ may manifest as dysphagia.
Cranial nerve IX (glossopharyngeal)
During primary brain tumor irradiation, normal brain tissue should be kept below:
60 Gy
The Clark method for classifying melanoma is based on:
Depth of invasion
Melanocytes are found in the ______ layer of the skin.
Basal
The cells most sensitive to radiation are located in the ________ layer of the epidermis.
Stratum Basale
Lentigo maligna is a histologic type of melanoma characterized by growth in a _______ pattern with ______ or black color.
Radial pattern with tan or black color
Causing fetal damage:
Teratogenic
Removal of WBC's for re-infusion:
Leukopheresis
Coal based chemical:
Benzene
_____ rods are associated with leukemia
Auer rods
Alfred velpeau documented the first case of _________.
Leukemia
List the different white blood cells:
(6)
Basophils
Neutrophils
Eosinophils
Monocytes
Lymphocytes
Platelets
The most important diagnostic factor for detecting CML is:
Philadelphia chromosome
Bone marrow depression nadir can occur within _____ days in patients that have received methotrexate .
10-14 days
A clinical spleen set-up requires a ____cm margin around the organ.
1 cm
Patients with ____ leukemia always exhibit lymphocytosis.
CLL
______ leukemia has the worst prognosis.
CML
_____ leukemia appears to have a hereditary component.
CLL
A _________ biopsy is needed for the diagnosis of ALL.
Bone marrow aspiration biopsy
The layers of the ________ include the dura mater, pia mater & the arachnoid mater.
Meninges
The spleen is located in the ______ quadrant.
LUQ
In the _____ & _____ phases of the cell cycle the undifferentiated cells have a decreased proportion of blast cells compared to normal bone marrow blast cells in regards to the pathology of AML.
S & M phases
B cells mature in the _________.
Bone Marrow
Lymph nodes are usually ___ to ___ mm in length.
1 to 25 mm
Which type of lymphoma spreads randomly, originates in lymph nodes or extra nodal tissue and commonly arises in the GI tract?
Non-Hodgkin's lymphoma
The thoracic duct is the main collecting duct of the lymphatic system and begins in the _______.
cisterna chyli
75% of all Hodgkin disease will have
nodular sclerosis
The most common presenting symptom for Hodgkin disease
Painless cervical node enlargement
A large binucleate or polynucleate cell present for a dx of Hodgkin is referred to as
Reed Sternberg Cell
Classification for staging of lymphoma is traditionally
Ann Arbor
Name the corresponding Organ for each letter when using the lymphoma staging system.
SHLMPOD
Marrow
Lung
Liver
Spleen
Osseous
Skin
Pluera
M-Marrow
L-Lung
H-Liver
S-Spleen
O-Osseous
D-Skin
P-Pleura
A 21 yr old male pt has an enlarged cervical lymph node. Diagnostic work up reveals a mediastinal and axillary nodes as well. What stage is this pt?
II
Staging for Hodgkins also includes AB grouping. Which symptom is not one of the classical B symptoms?
A. Profuse night sweats
B. weight loss greater than 10% of body weight
C. unexplained fever above 38 degrees
D unexplained pruritus
Unexplained pruritus
In Hodgkin disease, involvement of several nodal regions of both sides of the diaphragm accompanied by localized involvement of an extra lymphatic site is stage
III E
In the tx of fields of Waldeyer ring for non Hodgkin lymphoma the fields delineation closely resembles that of carcinoma of the
nasopharynx
Which lymphnode groups are treated in a mantle field
mediastinal and axillary
Which of the following are common side effects of RT of the abdomen?
Nausea
vomiting
fatigue
All of the above
T or F
Non Hodkin Lymphoma differs in a couple of ways from Hodgkins disease, one is that it occurs primarily in older persons
True
T or F
NHL is most likely to spread randomly, rather than orderly like HD does
True
A young woman has swelling in her lower neck for suspected HD. A chest xray also revealed mediastinal adenopathy. She had not experienced any fever, night sweats, or weight loss. Staging would be
IIA
The most favorable of the 4 subtypes of HD is
Nodular Sclerosis
NHL may arise in
(3)
Lymph nodes
gastrointestinal tract
Waldyer ring
In NHL, lymphocytes pathologically arrange themselves in patterns called
Follicular and nodular
The optimal dose to the mantle field is
35-44 Gy
which nodes are included in the inverted Y field
(3)
retroperitoneal
common iliac
inguinal
Radiation carditis is a chronic side effect after irradiation to the mantle field; this is inflammation of the
heart
What is an acute side effect after radiation for Hodgkin's?
dysphagia
When txg the tumor bed for Wilm's tumor, care should be taken to include the entire width of the spine to prevent
scoliosis
Which of the following is not an assoc risk factor for pediatric solid tumors?
a. parasites
b. environment
c. ionizing radiation
d. prenatal factors
parasites
The most common symptom of Wilm's tumor is
abdominal mass
Nephroblastomas met most commonly to the
lung
Neuroblastomas originate in the
neural crest tissue
What primary brain tumor typically spreads to the CSF
medulloblastoma
The most common symptom of Ewing sarcoma is
Pain
The most frequent orbital malignancy in children is
retinoblastoma
Wilm's tuor originate from what cell type?
nephroblasts
(Wilm's tumor aka nephroblastoma)
Which type of childhood cancer is mostly assoc with prophylactic irradiation of the CNS
Acute Lymphocytic Leukemia
dose approx 18 Gy
Match these bone marrow transplants:
Allogeneic donor
Autologous donor
Syngeneic donor self compatible match identical twin
Allogenic= compatible match
autologous= self
syngeneic= identical twin
The most important latent side effects from radiation therapy to the pediatric patient include
impaired bone growth
secondary cancers
An aggressive mgmt for retinoblastoma is an enucleation. An enucleation is
surgical removal of the orbit
Soft tissue sarcomas usually spread
locally, along the longitudinal muscle place
Sarcomas originate in the _____ tissue layer
mesoderm
Primary osseous tumors met to the lung via
blood
___________ surgery would include intralesional incision, wide margin excision with bone grafting, and marginal margin excision with internal fixation.
Limb salvaging
What feature would be present on an xray image of a lytic primary bone tumor
decreased density in the region of the tumor
(lytic = less dense)
What is the likely explanation for weight loss and fever in the pt suspected to have primary bone cancer
presence of the tumor causes hypercalcemia
Rad to the abdomen for soft tissue sarcomas in the peritoneum is limited by low tolerance organs such as the kidneys. The TD 5/5 for the whole kidney is
23GY
A natural barrier for regional spread of primary bone tumors is the
periosteum
Compact bone is arranged in concentric circle patterns known as
haversian systems
The area of spongy bone is found in the
epiphysis
A solitary multiple myeloma tumor is known as a
plasmacytoma
Which bone cancer has an onion skin appearance on an xray
Ewing sarcoma
A common symptom for soft tissue tumors is
painless mass
The most common childhood bone cancer is
Ewing Sarcoma
The most common primary bone cancer overall is
Osteosarcoma
The variable that are used for staging soft tissue sarcomas are
a. histologic grade
b. tumor size
c. regional lymph node involvement
d. presence of distant mets
Histologic grade & Presence of distant mets
Are soft tissue sarcomas common or rare
rare
What is the most common primary orbital malignancy of childhood
rhabdomyosarcoma
Do regional lymph nodes have to be included in tx ports for primary bone tumors
no
What area of the brain would you expect to find involved if a patient had vision problems
parietal
What is the average survival for patients with brain mets
3 mos
Distinguish between osteolytic and osteoblastic lesions as they may appear on a conventional xray
Lytic-moth eaten
Blastic- dense abnormal growth
Compare/contrast palliative doses of radiation for brain mets to curative doses for primary brain malignancy
palliative- 300 cGy per fraction total of 30-40GY
Primary- 180-200 cGy per fraction total of 60GY
What is superior vena cava syndrome
compression of the SVC by tumors in the apex of the lung or mediastinum
What is laminectomy
Removal of a portion of the lamina to decrease or prevent compression of spinal cord
Compression of the cauda equina will likely manifest as
incontinence
Which radionuclide may be used in treating met bone disease
strontium 89
In spinal cord compression and SVC syndrome, high doses of radiation are given in the 1st few txs. What is a typical dose
300-400 cGy per fraction
Is the humerus a likely site of bony mets?
No
Met brain disease differs from primary brain malignancy in that
met is usually multi focal and primaries are solitary at the time of dx and spread locally
When txg a pt who has spinal cord compression in the cervical spine, the best position among the following would be
prone with the chin and forehead in a horizontal plane and arms at the side
A typical field size for the tx of thoracic vertebrae 5-10 would be
8x15 cm
single posterior flds are not usually adequate for lower lumbar or sacral bone met because
This region of the spine has lordotic curvature
A T-shaped radiation tx field would likely be seen in the tx of
spinal cord compression in the lower lumbar or sacral region
A common symptom of liver mets is
jandice
Regional lymphatics are not usually included in rad flds for palliation because
disease spread is assumed to have already taken place
Daily tx charges for a single fld spine with no field shaping or beam modifiers would be
simple
What are the differences between electrons and protons
Electrons are light, negatively charged particles that collide and interact with other particles.
Protons are heavy, positive charge particles that only interact with electrons.
During xray production, the resulting xray beam comes from electrons colliding with the target causing interactions such as
characteristic radiation
Bremsstrahlung radiation &
Auger electrons
The positive side of the basic x-ray tube is know as the _______
Anode
The ratio of xray to heat during xray production is variable depending on the __________ of electrons transversing the tube.
Maximum energy
An _________ collision is one in which the incoming electron gives all of its energy to the electrons it encounters.
Elastic
Name the photon interactions
photon disentintegration
coherent scattering
photelectric effect
compton effect
pair production
Name the electron interactions
bremsstrahlung
characteristics
Regarding isotopes, isotopes are an element that have the same # of ____ but a different # of neutrons
protons
Match these
___isotopes___isobars___isotones___isomerA. IR192m IR192m
B. 27Fe59, 27Fe58
C. 28NI60, 31Ga60
D. 11Na22, 10Ne21
A. isomer
B. isotope
C. isobar
D. isotone
If using a tungsten target, the fx of 4 MeV electrons converted to photons is
.1036 or 10.36%
F=3.5X10^-4(74)(4MeV)
F=.1036
The probability of photoelectric interaction_______ with increasing energy and ________ with the atomic # of the medium.
decreases
increases
A neutral atom that loses an electron by ionization is called a
positive ion
A certain atom has binding energies of 70eV in the L shell and 10eV in the M shell. During an M shell to L shell transition, the photon emitted will have the energy of ____
60ev
An atom is neutral if the # of its electron is = to its
protons
The photons produced during the orbital transitions of electrons from a higher to lower energy are called
characteristic radiation
2 or more chemicals with the same chemical formula, but having difference nuclear states are known as
isomers
How many disintegration per min are there in 1 Ci?
3.7 X 1010 dpm
On Jan 1, we receive 80 mCi of an isotpe with a 1/2 life of 8 days. The activity remaining on Jan 25 would be
10 mCi
A=80(.5)^(24/8)=
A=80 (.5)^3)
A=80 (.125)
A=10
The wavelength of xrays are measured in
angstroms
The photoelectric process is essentially an interaction between a photon and a ______ electron
bound
A deutron is the nucleus of an isotope of H2. Which of the following is true?
A.
The probability that a photon interacts with a material is _____ to the attenuation coefficient
proportional
Out of Alpha, Beta, Proton and Neutrons, which is produced during natural radioactive decay
Alpha
Out of Alpha, Beta, Proton and Neutrons, which can carry a + or - charge
Beta
Out of Alpha, Beta, Proton and Neutrons, which has helium nucleus
Alpha
Out of Alpha, Beta, Proton and Neutrons, which has hydrogen nucleus
Proton
Out of Alpha, Beta, Proton and Neutrons, which has greatest internal hazard
Alpha
Out of Alpha, Beta, Proton and Neutrons, which cannot ionize directly and interacts with only the nucleus
neutron
Out of Alpha, Beta, Proton and Neutrons, which may be referred to as an electron or positron
beta
Out of Q- Quantity, H-quality, and B for both, which is affected by altering time of exposure
Quantity
Out of Q- Quantity, H-quality, and B for both, which is affected by altering tube current
Quantity
Out of Q- Quantity, H-quality, and B for both, which is affected by altering target material
Quality
Out of Quantity, quality, or both, which is affected by altering distance
Both Q/B
Out of Q- Quantity, H-quality, and B for both, which is affected by altering filtration
Both H/B
Out of Q- Quantity, H-quality, and B for both, which is affected by altering kVp
Quality
Out of Q- Quantity, H-quality, and B for both, which is affected by altering generator type
Both
I131 and I125 have different #s of
neutrons
Neutron decay ______ (is/is not) a type of nuclear decay.
is not
The radioactive decay of a radioisotope is characterized by its:
Decay constant
The energy of an electromagnetic radiation is _________ proportional to its wavelength.
Inversely
energy <inversely> wavelength
The energy of an electromagnetic radiation is _________ proportional to its frequency.
Directly
energy<directly>frequency
Cobalt 60 decays by ______.
Beta minus
To interact by photoelectric effect, the interacting photon must have energy equal or greater than the :
Binding energy of the orbiting electron
Carbon 14 and Nitrogen 14 are:
Isobars
(same mass)
When a long-lived radionuclide decays to a short-lived daughter, it is known as ________ equilibrium.
Secular
________ implies the removal of an electron from the atom.
Ionization
When a radionuclide decays, radiation is emitted from the ________.
nucleus
TRUE/False
IMRT does not require port film verification
F
Form of breast immobilization that has best reproducibility:
NOTHING
When looking up PDD or TMR use(effective square/equivalent square) when there are blocks or MLCs:
effective square
Pros and cons of SSD setup:
PROS:
1)more clearance between pt and gantry
2)larger field size possible
3)less collimator scatter
CONS:
pt must be moved between fields
When an extended distance is required for a nonisocentric treatment, what changes and additions are needed in the calculations;(name 3)
1)Include maynoerd factor in denominator
2)change inverse square to reflect new SSD
3)find new PDD for field size at a new distance
What is not an advantage of using a multifield approach?
increases the integral dose
Field size determinations should be done (dosimetrically/geomtrically)?
dosimetrically
T/F
Standard wedges can have a beam hardening effect when the radiation is MONOENERGETIC.
F
Dmax for 18 MV:
3.5 cm
A pt is delivered a dose of 150 cGy at a depth of 13 cm with 10 MV photos at 100 SSD. The PDD is 60%. Calculate dose delivered to the depth of maximum dose.
150/.60=250cGy
Electron arc therapy has what effect on Dmax position, as compared to a stationary electron field of the same energy?
Moves Dmax away from the surface
A prostate seed implant is considered:
interstitial
Au 198seeds imbedded into the tongue are considered:
interstitial
Formula for calculating an exposure at a specific distance for a particular isotope:
activity(decay constant)/distance2
When planning a gyn implant it is calculated to point____.
A
When an element has an excessive number of neutrons it it likely to undergo _____decay.
negatron
LDR isotopes deliver a dose rate of between ___ and ____cGy/min
0.5-2.0 cGy/min
Your pt has been in hospital for blood transfusions and has missed 3 wks of treatments. Upon the pts return what should therapist do?
remeasure, relocalize, remark, and ask for BED adjustments in fx or total dose
Spinal cord compression of T5-6 is likely to be treated with:
a single posterior low energy photon field
A primary brain tumor located in the rt temporal lobe will likely be treated with:
a wedged pair consisting of a rt lateral and vertex fields
Figure gap:
100 SSD
depth 5 cm
field 1: 8x 20
field 2: 8x 25
10(.05)+ 12.5(.05)= 1.1 cm
Isocenter x =-1.0 cm
Shift should be ____to the patient's ____.
1 cm to pts right
Compare and contrast benign and malignant tumors:
Benign: do not metastasize, not usually lethal unless can cause local damage, encapsulated
Malignant:metastasizes, lethal if left untreated, NOT encapsulated
List and describe 5 different methods of tissue sampling/biopsy.
1)Fine needle aspiration
2)core needle
3)dermal punch
4)fluid cytology(body secretions)
5) surgical biopsy
Define prophylactic cancer treatment:
Prevention
i.e. radiation to tumor bed, PCI, chemo used before mets
Compare and contrast hyperplasia, metaplasia, and anaplasia:
hyperplasia=↑ # of cells (benign or malignnt
metaplasia= replacement of cells by cells not normally present (malignant)
anaplasia=loss of differentiation (malignant and benign)
Mortality rates are based on persons per ______population.
100,000
Any substance or gent that produces or incites cancer is called:
carcinogen
The seven warning signs include all the follwing except:
1)thickening or lump
2)nagging cough
3)pain
4)change in bowel habits
pain
The TNM staging system evaluates:(pick any or all)
a)the size and extent of tumor
b)whether the tumor has metastasized
c)the grade of the tumor
a)the size and extent of tumor
b)whether the tumor has metastasized
TNM does NOT evaluate GRADE!!
Malignant neoplasms that originate in the lymphoreticular tissues are called:
lymphomas
(don't be tricked into saying something like; lymphoreticuloma or lymphosarcoma :) )
When more than one cancer modality is used simultaneously, it is known as:
concurrent therapy
The cancer warning signal most likely indicating colon/rectal cancer is:
a change in bowel habits
Which cytotoxic drug may produce heart failure?
Adriamycin
A tumor classified as T3, N2, MO is likely a stage:
III
The tissue of a malignant carcinoma is:
epithelial
The method used to establish definitive malignancy is:
histopathologic screening
A malignant tissue of striated muscle is called a/n:
rhabdomyosarcoma
A surgical procedure in which an incision is made through the abdominal wall to examine lymph nodes to establish the extent of disease is called a/n:
laparoscopy (book answer)
mock test answer is:
exploratory laparotomy
The highest incidence of malignancy for adult males in the US occurs in the _____. For females it is the _______.
prostate
breast
(overall male and female it's LUNG)
The most common side effect associated with cytotoxic drugs is:
myelosupression
Most cancers are: (sporadic/familial).
sporadic
The removal of cells by scraping is called:
curettage
The____of a tumor is an evaluation of the degree of cellular differentiation.
grade
According to B & T, factors that may influence the sensitivity of a group of cells to ionizing radiation is:(pick any or all)
1)mitotic activity
2)time of cell division
3)cellular differentiation
4)Length of mitotic activity
1)mitotic activity
2)time of cell division (NO!!)
3)cellular differentiation
4)Length of mitotic activity
Law of Bergonie and Tribondeau" states "the radiosensitivity of a tissue is directly proportional to the reproductive activity and
inversely proportional to the degree of differentiation"
What difference would you expect to see between larngeal tumors classified as T2 and T4?
The T4 would be larger
TRUE/FALSE:
One of the characteristics of benign tumors are that they are never fatal.
FALSE
TRUE/FALSE:
The term for transmission of disease from one original site to one or more sites elsewhere in the body is metastasis.
TRUE
TRUE/FALSE:
Oncogenes are also known as tumor- suppressor genes.
FALSE
TRUE/FALSE:
In general, children have the highest rates of cancer.
FALSE
TRUE/FALSE:
Surgery is never used prophylactically.
FALSE
Which of the following is not a possible side effect of cytotoxic drugs:
1)nausea
2)Cardiac toxicity
3)Myelosuppression
4)Alopecia
5)None of the above
None of the above
(all are possible side effects of chemo)
The oldest cancer management modality is:
surgery
One of the unique characteristics of substitute ureas is:
They can cross the blood-brain barrier
The incidence of cancer in a given area may be affected by:
1)Race
2)envioronmental exposures
3)cultural practices
4)All of the above
All of the above
A tumor marker for detection of germ cell tumors is:
beta HCG
The ACS reccomends ______for men beginning at age 45.
colonoscopy (baseline)
Who is at greater risk for lung cancer: A person who has smoked 1 pack/day for the past year or someone who has smoked 1 pack/day for the past 25 years?
The longer exposure has more risk
Define:
prostatectomy
surgical removal of prostate
Define:
radical mastectomy
surgical removal of breast and pecs
Define:
Modified radical mastectomy
removal of breast with fewer muscles than with radical
Define:
Exentertion
total removal of multiple organs
Prophylactic therapy is intended to:
sterilize areas of microscopic disease
Curative therapy is intended to:
totally eradicate disease
If cytotoxic drugs poison both normal and cancer cells, how is it that we continue using this modality and expect to treat cancer and return patient to a healthy state?
normal cells have the capacity for repair, cancer cells don't
Because both chemo and RT rely on adequate vascular supply, what is it's significance concerning the effectiveness of both modalities?
Blood vessels re necessary to deliver chemo to tumor, and oxygen(delivered via blood through vasculature) sensitizes cancer cells to radiation.
When tumors outgrow their blood supply, they become necrotic and much more difficult to treat.
When cure rates using systemic chemo and RT are similar for early stage cervix, glottic larynx, and BCC of he skin, why would RT be preferable?
For quality of life issues (it is less invasive-for instance with larynx: keeping the voice)
We generally report survival rates in 5 yr increments. Breast cancer survival rates are reported at a different time interval. What is it and why?
Survival is usually reported at 10 and 20 yrs because so much progress has been made in treating breast cancer but it still can come back after many years(not considered "cured" at 5 yrs out)
Most cytotoxic drugs cannot cross blood/brain barrier. Explain how certain drugs or combinations of drugs, unable to cross the barrier, are effectively used in the management of certain CNS malignancies today.
By LOCAL administration: direct injection into the tissue so that it does not need to cross the blood/brain barrier
Which of the following modalities, used alone, would best treat a patient with metastatic disease?
1)Surgery
2)Radiation
3)Chemo
4)hormone therapy
Chemo
Hippocrates is credited with:
Identifying the disease we know as cancer
The youngest modality used in the treatment of cancer is:
chemotherapy
The following is true regarding excisional biopsy:(pick any or all)
1)Involves a removal of a portion of the tumore
2)Generally appropriate for cure of a relatively small tumor
3)provides a definitive diagnosis
1)Involves a removal of a portion of the tumor
2)Generally appropriate for cure of a relatively small tumor
3)provides a definitive diagnosis
Possible routes for administration of chemo are:(pick any or all)
1)intravenous
2)topical
3)enteral
intravenous
topical
enteral
Actinomycin D is an:
antitumor antibiotic
Generally, a lesion classified T1 NO MO is a stage __:
I
Which of the following is not recognized as a carcinogen:
1)ionizing radiation
2)asbestos
3)ultraviolet light
4)crude oil
crude oil
A patient receiving RT to the brain is expected to experience:
1)epilation
2)diarrhea
3)dysuria
4)dysphagia
epilation
A likely symptom of testicular cancer is:
a painless lump
The most widely used staging system is known as the ____system.