The area of the cerebrum responsible for sensory and association is the:
The sense of smell is conveyed by the:
A glioma spreads by means of:
____________ brain tumors are known to spread via the CSF.
__________ brain tumors are seen more frequently in adults.
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:
The primary management modality for primary brain tumors is:
Uncontrolled diabetes, visual disturbances & sinus pressure are all symptoms of __________.
Incontinence/impotence and radiating pain down the legs may indicate a primary spinal cord tumor located in the __________ region.
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:
The TD 5/5 for the optic nerve or optic chiasm is:
Involvement of cranial nerve ______ may manifest as dysphagia.
Cranial nerve IX (glossopharyngeal)
During primary brain tumor irradiation, normal brain tissue should be kept below:
The Clark method for classifying melanoma is based on:
Depth of invasion
Melanocytes are found in the ______ layer of the skin.
The cells most sensitive to radiation are located in the ________ layer of the epidermis.
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:
Removal of WBC's for re-infusion:
Coal based chemical:
_____ rods are associated with leukemia
Alfred velpeau documented the first case of _________.
List the different white blood cells:
The most important diagnostic factor for detecting CML is:
Bone marrow depression nadir can occur within _____ days in patients that have received methotrexate .
A clinical spleen set-up requires a ____cm margin around the organ.
Patients with ____ leukemia always exhibit lymphocytosis.
______ leukemia has the worst prognosis.
_____ leukemia appears to have a hereditary component.
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.
The spleen is located in the ______ quadrant.
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 _________.
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?
The thoracic duct is the main collecting duct of the lymphatic system and begins in the _______.
75% of all Hodgkin disease will have
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
Name the corresponding Organ for each letter when using the lymphoma staging system.
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?
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
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
In the tx of fields of Waldeyer ring for non Hodgkin lymphoma the fields delineation closely resembles that of carcinoma of the
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?
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
T or F
NHL is most likely to spread randomly, rather than orderly like HD does
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
The most favorable of the 4 subtypes of HD is
NHL may arise in
In NHL, lymphocytes pathologically arrange themselves in patterns called
Follicular and nodular
The optimal dose to the mantle field is
which nodes are included in the inverted Y field
Radiation carditis is a chronic side effect after irradiation to the mantle field; this is inflammation of the
What is an acute side effect after radiation for Hodgkin's?
When txg the tumor bed for Wilm's tumor, care should be taken to include the entire width of the spine to prevent
Which of the following is not an assoc risk factor for pediatric solid tumors?
c. ionizing radiation
d. prenatal factors
The most common symptom of Wilm's tumor is
Nephroblastomas met most commonly to the
Neuroblastomas originate in the
neural crest tissue
What primary brain tumor typically spreads to the CSF
The most common symptom of Ewing sarcoma is
The most frequent orbital malignancy in children is
Wilm's tuor originate from what cell type?
(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:
Syngeneic donor self compatible match identical twin
Allogenic= compatible match
syngeneic= identical twin
The most important latent side effects from radiation therapy to the pediatric patient include
impaired bone growth
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
Primary osseous tumors met to the lung via
___________ surgery would include intralesional incision, wide margin excision with bone grafting, and marginal margin excision with internal fixation.
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
A natural barrier for regional spread of primary bone tumors is the
Compact bone is arranged in concentric circle patterns known as
The area of spongy bone is found in the
A solitary multiple myeloma tumor is known as a
Which bone cancer has an onion skin appearance on an xray
A common symptom for soft tissue tumors is
The most common childhood bone cancer is
The most common primary bone cancer overall is
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
What is the most common primary orbital malignancy of childhood
Do regional lymph nodes have to be included in tx ports for primary bone tumors
What area of the brain would you expect to find involved if a patient had vision problems
What is the average survival for patients with brain mets
Distinguish between osteolytic and osteoblastic lesions as they may appear on a conventional xray
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
Which radionuclide may be used in treating met bone disease
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?
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
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
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
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
Bremsstrahlung radiation &
The positive side of the basic x-ray tube is know as the _______
The ratio of xray to heat during xray production is variable depending on the __________ of electrons transversing the tube.
An _________ collision is one in which the incoming electron gives all of its energy to the electrons it encounters.
Name the photon interactions
Name the electron interactions
Regarding isotopes, isotopes are an element that have the same # of ____ but a different # of neutrons
___isotopes___isobars___isotones___isomerA. IR192m IR192m
B. 27Fe59, 27Fe58
C. 28NI60, 31Ga60
D. 11Na22, 10Ne21
If using a tungsten target, the fx of 4 MeV electrons converted to photons is
.1036 or 10.36%
The probability of photoelectric interaction_______ with increasing energy and ________ with the atomic # of the medium.
A neutral atom that loses an electron by ionization is called a
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 ____
An atom is neutral if the # of its electron is = to its
The photons produced during the orbital transitions of electrons from a higher to lower energy are called
2 or more chemicals with the same chemical formula, but having difference nuclear states are known as
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
The wavelength of xrays are measured in
The photoelectric process is essentially an interaction between a photon and a ______ electron
A deutron is the nucleus of an isotope of H2. Which of the following is true?
A. it has a mass # of 2
B.it has an atomic # of 2
C. it has a positive charge of 2
D. is has an energy of 2 MeV
The probability that a photon interacts with a material is _____ to the attenuation coefficient
Out of Alpha, Beta, Proton and Neutrons, which is produced during natural radioactive decay
Out of Alpha, Beta, Proton and Neutrons, which can carry a + or - charge
Out of Alpha, Beta, Proton and Neutrons, which has helium nucleus
Out of Alpha, Beta, Proton and Neutrons, which has hydrogen nucleus
Out of Alpha, Beta, Proton and Neutrons, which has greatest internal hazard
Out of Alpha, Beta, Proton and Neutrons, which cannot ionize directly and interacts with only the nucleus
Out of Alpha, Beta, Proton and Neutrons, which may be referred to as an electron or positron
Out of Q- Quantity, H-quality, and B for both, which is affected by altering time of exposure
Out of Q- Quantity, H-quality, and B for both, which is affected by altering tube current
Out of Q- Quantity, H-quality, and B for both, which is affected by altering target material
Out of Quantity, quality, or both, which is affected by altering distance
Out of Q- Quantity, H-quality, and B for both, which is affected by altering filtration
Out of Q- Quantity, H-quality, and B for both, which is affected by altering kVp
Out of Q- Quantity, H-quality, and B for both, which is affected by altering generator type
I131 and I125 have different #s of
Neutron decay ______ (is/is not) a type of nuclear decay.
The radioactive decay of a radioisotope is characterized by its:
The energy of an electromagnetic radiation is _________ proportional to its wavelength.
energy <inversely> wavelength
The energy of an electromagnetic radiation is _________ proportional to its frequency.
Cobalt 60 decays by ______.
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:
When a long-lived radionuclide decays to a short-lived daughter, it is known as ________ equilibrium.
________ implies the removal of an electron from the atom.
When a radionuclide decays, radiation is emitted from the ________.
IMRT does not require port film verification
Form of breast immobilization that has best reproducibility:
When looking up PDD or TMR use(effective square/equivalent square) when there are blocks or MLCs:
Pros and cons of SSD setup:
1)more clearance between pt and gantry
2)larger field size possible
3)less collimator scatter
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)?
Standard wedges can have a beam hardening effect when the radiation is MONOENERGETIC.
Dmax for 18 MV:
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.
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:
Au 198seeds imbedded into the tongue are considered:
Formula for calculating an exposure at a specific distance for a particular isotope:
When planning a gyn implant it is calculated to point____.
When an element has an excessive number of neutrons it it likely to undergo _____decay.
LDR isotopes deliver a dose rate of between ___ and ____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
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
4)fluid cytology(body secretions)
5) surgical biopsy
Define prophylactic cancer treatment:
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.
Any substance or gent that produces or incites cancer is called:
The seven warning signs include all the follwing except:
1)thickening or lump
4)change in bowel habits
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:
(don't be tricked into saying something like; lymphoreticuloma or lymphosarcoma :) )
When more than one cancer modality is used simultaneously, it is known as:
The cancer warning signal most likely indicating colon/rectal cancer is:
a change in bowel habits
Which cytotoxic drug may produce heart failure?
A tumor classified as T3, N2, MO is likely a stage:
The tissue of a malignant carcinoma is:
The method used to establish definitive malignancy is:
A malignant tissue of striated muscle is called a/n:
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:
The highest incidence of malignancy for adult males in the US occurs in the _____. For females it is the _______.
(overall male and female it's LUNG)
The most common side effect associated with cytotoxic drugs is:
Most cancers are: (sporadic/familial).
The removal of cells by scraping is called:
The____of a tumor is an evaluation of the degree of cellular differentiation.
According to B & T, factors that may influence the sensitivity of a group of cells to ionizing radiation is:(pick any or all)
2)time of cell division
4)Length of mitotic activity
2)time of cell division (NO!!)
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
One of the characteristics of benign tumors are that they are never fatal.
The term for transmission of disease from one original site to one or more sites elsewhere in the body is metastasis.
Oncogenes are also known as tumor- suppressor genes.
In general, children have the highest rates of cancer.
Surgery is never used prophylactically.
Which of the following is not a possible side effect of cytotoxic drugs:
5)None of the above
None of the above
(all are possible side effects of chemo)
The oldest cancer management modality is:
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:
4)All of the above
All of the above
A tumor marker for detection of germ cell tumors is:
The ACS reccomends ______for men beginning at age 45.
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
surgical removal of prostate
surgical removal of breast and pecs
Modified radical mastectomy
removal of breast with fewer muscles than with radical
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?
Hippocrates is credited with:
Identifying the disease we know as cancer
The youngest modality used in the treatment of cancer is:
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)
Actinomycin D is an:
Generally, a lesion classified T1 NO MO is a stage __:
Which of the following is not recognized as a carcinogen:
A patient receiving RT to the brain is expected to experience:
A likely symptom of testicular cancer is:
a painless lump
The most widely used staging system is known as the ____system.