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WorksheetsRT_4110 Exam II
Total questions: 100
Worksheet time: 52mins
The most common malignant pediatric brain tumor is:
Astrocytoma
Ependymoma
Medulloblastoma
Craniopharyngioma
A benign, slow-growing glioma in the cerebellum of children is:
Anaplastic astrocytoma
Pilocytic astrocytoma
Oligodendroglioma
Glioblastoma
The most common primary adult brain tumor is:
Medulloblastoma
Glioblastoma multiforme
Meningioma
Astrocytoma Grade II
A KPS score of 50 indicates a patient who:
Is fully active
Needs constant nursing care
Needs assistance but can live independently
Is bedridden > 50 % of time
Which structure is a serial organ in the CNS?
Brain stem
Spinal cord
Pituitary
Optic chiasm
TD 5/5 for the spinal cord is approximately:
35 Gy
45 Gy
55 Gy
60 Gy
Common symptom of increased intracranial pressure (ICP):
Epistaxis
Dysphagia
Headache and nausea
Hematuria
Best imaging for defining soft-tissue brain lesions:
CT
MRI
PET
Ultrasound
Most common metastatic sites to brain are from:
Lung, breast, melanoma, colon, kidney
Prostate, thyroid, pancreas, ovary, testis
Skin, muscle, bone, cartilage, tendon
Liver, spleen, gallbladder, stomach, intestine
Tolerance dose for optic chiasm (TD 5/5):
40 Gy
50 Gy
60 Gy
70 Gy
Whole-brain RT inferior field border should extend to:
C2
Bottom of C1 / through zygomatic arch
Foramen magnum
Top of C3
Primary CNS lymphomas occur most in patients with:
Children
Smokers
Immunosuppression / HIV
Diabetes
CNS tumor that commonly calcifies on imaging:
Medulloblastoma
Oligodendroglioma
Astrocytoma
Ependymoma
Best beam arrangement for whole-brain RT:
Opposed laterals
Opposed laterals (yes—standard)
Vertex field
Oblique
Late effect after CNS irradiation:
Myelosuppression
Cognitive decline and necrosis
Skin erythema
Alopecia only
Most common symptom of pancreatic head cancer: ________
Painless jaundice
Abdominal distension
Hematuria
Cough
Most pancreatic adenocarcinomas arise in the: ________
Head of the pancreas
Tail of the pancreas
Body of the pancreas
Uncinate process
Surgery for pancreatic head cancer: ________
Whipple procedure
Billroth I procedure
Hartmann's procedure
Sleeve gastrectomy
Pancreatic tumor marker: ________ Rationale: Used for monitoring.
CA 19-9
AFP
CEA
PSA
Most common site of esophageal cancer: ________
Lower third
Upper third
Middle third
Cervical esophagus
Most common histology of esophageal cancer worldwide: ________
Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma
Sarcoma
Best imaging for staging esophageal cancer: ________
PET/CT
Chest X-ray
Barium swallow
Ultrasound
Typical RT dose for esophageal cancer: ________ Gy
50–50.4 Gy
60–66 Gy
40–45 Gy
70–75 Gy
Common chemo with RT for esophagus: ________
Cisplatin and 5-FU
Paclitaxel and Carboplatin
Methotrexate and Vincristine
Gemcitabine and Docetaxel
5-year survival rate for pancreatic CA: ________
< 10 %
20-30 %
40-50 %
60-70 %
Tolerance dose for liver (TD 5/5): ________ Gy Rationale: Above this risk of radiation hepatitis.
30–35 Gy
45–50 Gy
10–15 Gy
60–65 Gy
Tolerance dose for kidneys (TD 5/5): ________ Gy (bilateral)
23 Gy (bilateral)
15 Gy (bilateral)
30 Gy (bilateral)
40 Gy (bilateral)
Most common metastatic site for pancreatic CA: ________
Liver
Lung
Bone
Brain
Cause of radiation enteritis: ________
Small-bowel exposure
Liver dysfunction
Renal artery stenosis
Pancreatic insufficiency
Best position to reduce small-bowel dose in pelvic fields: ________ Rationale: Displaces bowel superiorly.
Prone on belly board
Supine with knee support
Lateral decubitus
Sitting upright
Most common histology of bladder CA: ________
Transitional (urothelial) cell carcinoma
Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma
#1 risk factor for bladder CA: ________ Accounts for half of cases.
Smoking
Alcohol consumption
Obesity
High salt intake
Common symptom of bladder CA: ________ Earliest presentation.
Hematuria
Dysuria
Urinary retention
Nocturia
Radiosensitizer for bladder preservation: ________
Cisplatin
Methotrexate
Vincristine
Cyclophosphamide
Intravesical immunotherapy drug: ________ Stimulates immune response.
BCG
Methotrexate
Cisplatin
Cyclophosphamide
Bladder tolerance dose (TD 5/5): ________ Gy
Avoids contracture / fibrosis.
65 Gy
45 Gy
75 Gy
80 Gy
Prostate is typically treated to approx.: ________
76–80 Gy
60–64 Gy
50–54 Gy
86–90 Gy
Most radioresistant structure near bladder: ________ Can receive higher dose.
Prostate
Rectum
Seminal vesicle
Ureter
Pelvic lymph nodes included for T3 bladder CA: ________ Regional spread.
External & internal iliac, obturator
Inguinal & para-aortic
Axillary & mediastinal
Cervical & supraclavicular
Most common metastatic site of bladder CA: ________ Via hematogenous spread.
Lung and bone
Liver and spleen
Brain and skin
Kidney and adrenal gland
Imaging for initial bladder staging: ________ Shows wall invasion and nodes.
CT abdomen/pelvis
Ultrasound KUB
X-ray abdomen
IVP
Common late effect after pelvic RT: ________
Cystitis and rectal bleeding
Pulmonary fibrosis
Hepatic encephalopathy
Thyroid dysfunction
When two photon fields match at skin, what occurs at depth? ________
Hot spot
Cold spot
No change
Increased scatter
Technique to avoid field junction hot spots: ________ Moves junction periodically.
Feathering the gap
Backhand welding
Spot welding
Tack welding
Purpose of full bladder during pelvic RT: ________
Displace small bowel superiorly
Increase radiation dose to bladder
Reduce bladder volume
Enhance tumor sensitivity
Most common solid tumor of childhood (excluding CNS): ________ From adrenal medulla.
Neuroblastoma
Wilms tumor
Retinoblastoma
Hepatoblastoma
Most common renal tumor in children: ________ Occurs ages 2–5.
Wilms tumor
Renal cell carcinoma
Angiomyolipoma
Oncocytoma
Wilms tumor metastasizes primarily to: ________
Lungs
Liver
Bone
Brain
Most common pediatric soft-tissue sarcoma: ________ Embryonal type dominant.
Rhabdomyosarcoma
Liposarcoma
Synovial sarcoma
Fibrosarcoma
Common site of rhabdomyosarcoma: ________ Rapidly growing mass.
Head and neck / orbit
Liver
Kidney
Pancreas
Retinoblastoma gene: ________ Tumor-suppressor on chromosome 13.
RB1
BRCA1
TP53
APC
Typical presentation of retinoblastoma: ________ (white pupil reflex)
Leukocoria
Glaucoma
Cataract
Strabismus
Most common pediatric bone tumor: ________ Metaphysis of long bones.
Osteosarcoma
Ewing's sarcoma
Chondrosarcoma
Fibrosarcoma
Second most common bone tumor in children: ________
Ewing sarcoma
Osteosarcoma
Chondrosarcoma
Fibrosarcoma
Common RT late effect in children: ________ Due to damage to growth plates.
Growth retardation
Cataract formation
Pulmonary fibrosis
Hearing loss
Late effect after cranial RT: ________
Cognitive impairment and hormone imbalance
Improved vision and hearing
Increased muscle strength
Enhanced immune response
Which pediatric tumor is most radiosensitive?
Wilms tumor
Neuroblastoma
Osteosarcoma
Ewing's sarcoma
Typical dose range for Wilms tumor: ________
10–30 Gy
40–60 Gy
1–5 Gy
60–80 Gy
Common chemotherapy for Wilms: ________
Vincristine + Actinomycin-D ± Doxorubicin
Methotrexate + Leucovorin
Cisplatin + Etoposide
Cyclophosphamide + Bleomycin
Late secondary malignancy risk in pediatrics is due to: ________
Higher cell division rates and long lifespan
Lower metabolic activity and short lifespan
Decreased DNA repair mechanisms only
Reduced exposure to environmental carcinogens
Diagnostic cell of Hodgkin’s: ________ Owl-eye cell pathognomonic.
Reed–Sternberg
Plasma cell
Langerhans cell
Kupffer cell
Subtype of Hodgkin’s most common: ________ Young adults, mediastinum.
Nodular sclerosis
Lymphocyte-rich
Mixed cellularity
Lymphocyte-depleted
Classic B symptoms: ________
Fever, night sweats, weight loss
Cough, chest pain, hemoptysis
Headache, photophobia, neck stiffness
Polyuria, polydipsia, polyphagia
Chemo for Hodgkin’s: ________
ABVD
CHOP
FOLFOX
MOPP
Chemo for Non-Hodgkin’s: ______ ± Rituximab. Cyclophosphamide, Doxorubicin, Vincristine, Prednisone.
CHOP
ABVD
FOLFOX
MOPP
Typical RT dose for HL involved sites: ______ Gy. After chemo response.
30–36
10–14
45–50
60–66
Most common extranodal site for NHL: ______. MALT lymphoma.
Stomach
Liver
Lung
Brain
Virus linked to Burkitt lymphoma: ______. EBV DNA found in tumors.
Epstein–Barr virus
Human papillomavirus
Hepatitis B virus
Cytomegalovirus
Burkitt lymphoma cells show: ______ pattern. Macrophages among lymphoid cells.
Starry-sky
Onion-skin
Rosette
Homer Wright
HL spreads contiguously; NHL spreads ______. Key difference in pattern.
Non-contiguously / extranodally
Contiguously
Only within lymph nodes
Via the bloodstream only
Primary RT field for HL in neck and mediastinum: ______. Modern reduced field size.
Involved-site technique
Mantle field
Extended field technique
Total nodal irradiation
Common late effect of mediastinal RT: ______. Pericarditis or CAD risk.
Cardiac toxicity
Pulmonary embolism
Renal failure
Hepatic cirrhosis
Second malignancy after HL RT: ______. From scatter and field exposure.
Breast CA or lung CA
Colon CA
Prostate CA
Thyroid CA
Which type has better prognosis? ______. Highly curable with combined modality.
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
Multiple myeloma
Chronic lymphocytic leukemia
Typical presentation of Burkitt lymphoma in U.S.: ______. Sporadic form.
Abdominal mass
Jaw mass
Skin lesion
Mediastinal mass
Which imaging sequence best distinguishes tumor edema from recurrence?
T1-weighted MRI
PET scan
T2/FLAIR MRI
CT with contrast
Which chemotherapy crosses the BBB and is commonly used in glioblastoma?
Cisplatin
Temozolomide
5-FU
Bleomycin
What is the typical dose for SRS to a solitary brain metastasis?
20 Gy
25 Gy
18–24 Gy single fraction
10 Gy
Which late effect is unique to pediatric brain RT?
Hair loss
Dermatitis
Growth hormone deficiency
Esophagitis
Pancreatic cancer commonly invades which vessel?
IVC
Superior mesenteric vein
Portal vein
Celiac trunk
Which organ is dose-limiting in pancreatic RT?
Stomach
Liver
Duodenum / small bowel
Pancreas
Respiratory motion in pancreas RT is best managed with:
Cone-beam only
4D CT and breath-hold gating
MRI fusion
Ultrasound tracking
Classic triad for pancreatic head tumor includes:
Fatigue, nausea, vomiting
Diarrhea, jaundice, cough
Jaundice, weight loss, back pain
Abdominal distention
Intravesical BCG acts by:
Direct tumor necrosis
Immune activation of bladder mucosa
Radiation sensitization
DNA repair inhibition
Which phase of treatment uses a full bladder?
Initial whole-pelvis
Boost phase to tumor bed
All phases
None
Which chemo regimen is often paired with RT for bladder preservation?
CHOP
Cisplatin + 5-FU ± Mitomycin C
ABVD
Gemcitabine alone
The primary lymphatic drainage for bladder includes:
Para-aortic
Inguinal
Internal and external iliac nodes
Axillary
What is the most common route of retinoblastoma spread?
Hematogenous
Lymphatic
Along the optic nerve to brain
Direct bone invasion
Plaque brachytherapy for retinoblastoma uses which isotope?
I-131
Cs-137
I-125
Ir-192
Lens-sparing external beam techniques are used to prevent:
Nystagmus
Cataract formation
Ptosis
Diplopia
Which genetic translocation is associated with alveolar rhabdomyosarcoma?
t(11;14)
t(8;14)
t(2;13)
t(9;22)
What margin is typically used around gross disease in pediatric RMS RT?
1 cm
2 cm
3 cm
5 cm
Which modern RT technique replaces the historical “mantle field”?
Whole-body RT
ISRT (Involved-Site Radiation Therapy)
IFRT
Extended field
Oophoropexy is performed during mantle RT to:
Prevent lymphedema
Preserve fertility by moving ovaries out of field
Fix uterine prolapse
Decrease cardiac dose
The “pain after alcohol ingestion” sign is associated with:
Non-Hodgkin’s
Hodgkin’s lymphoma
Leukemia
Multiple myeloma
Plaque brachytherapy for retinoblastoma uses which isotope?
I-131
I-125
Cs-137
Ir-192
What is the most common route of retinoblastoma spread?
bone invasion
along optic nerve
lymphatic
hematogenious
The most common presenting symptom of bladder cancer is
(a)
The genetic mutation associated with hereditary retinoblastoma occurs in the (a) gene.
The most common pediatric soft-tissue sarcoma is (a) .
