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RT_4110 Exam II

Total questions: 100

Worksheet time: 52mins

Name
Class
Date
1.

The most common malignant pediatric brain tumor is:

a)

Astrocytoma

b)

Ependymoma

c)

Medulloblastoma

d)

Craniopharyngioma

2.

A benign, slow-growing glioma in the cerebellum of children is:

a)

Anaplastic astrocytoma

b)

Pilocytic astrocytoma

c)

Oligodendroglioma

d)

Glioblastoma

3.

The most common primary adult brain tumor is:

a)

Medulloblastoma

b)

Glioblastoma multiforme

c)

Meningioma

d)

Astrocytoma Grade II

4.

A KPS score of 50 indicates a patient who:

a)

Is fully active

b)

Needs constant nursing care

c)

Needs assistance but can live independently

d)

Is bedridden > 50 % of time

5.

Which structure is a serial organ in the CNS?

a)

Brain stem

b)

Spinal cord

c)

Pituitary

d)

Optic chiasm

6.

TD 5/5 for the spinal cord is approximately:

a)

35 Gy

b)

45 Gy

c)

55 Gy

d)

60 Gy

7.

Common symptom of increased intracranial pressure (ICP):

a)

Epistaxis

b)

Dysphagia

c)

Headache and nausea

d)

Hematuria

8.

Best imaging for defining soft-tissue brain lesions:

a)

CT

b)

MRI

c)

PET

d)

Ultrasound

9.

Most common metastatic sites to brain are from:

a)

Lung, breast, melanoma, colon, kidney

b)

Prostate, thyroid, pancreas, ovary, testis

c)

Skin, muscle, bone, cartilage, tendon

d)

Liver, spleen, gallbladder, stomach, intestine

10.

Tolerance dose for optic chiasm (TD 5/5):

a)

40 Gy

b)

50 Gy

c)

60 Gy

d)

70 Gy

11.

Whole-brain RT inferior field border should extend to:

a)

C2

b)

Bottom of C1 / through zygomatic arch

c)

Foramen magnum

d)

Top of C3

12.

Primary CNS lymphomas occur most in patients with:

a)

Children

b)

Smokers

c)

Immunosuppression / HIV

d)

Diabetes

13.

CNS tumor that commonly calcifies on imaging:

a)

Medulloblastoma

b)

Oligodendroglioma

c)

Astrocytoma

d)

Ependymoma

14.

Best beam arrangement for whole-brain RT:

a)

Opposed laterals

b)

Opposed laterals (yes—standard)

c)

Vertex field

d)

Oblique

15.

Late effect after CNS irradiation:

a)

Myelosuppression

b)

Cognitive decline and necrosis

c)

Skin erythema

d)

Alopecia only

16.

Most common symptom of pancreatic head cancer: ________

a)

Painless jaundice

b)

Abdominal distension

c)

Hematuria

d)

Cough

17.

Most pancreatic adenocarcinomas arise in the: ________

a)

Head of the pancreas

b)

Tail of the pancreas

c)

Body of the pancreas

d)

Uncinate process

18.

Surgery for pancreatic head cancer: ________

a)

Whipple procedure

b)

Billroth I procedure

c)

Hartmann's procedure

d)

Sleeve gastrectomy

19.

Pancreatic tumor marker: ________ Rationale: Used for monitoring.

a)

CA 19-9

b)

AFP

c)

CEA

d)

PSA

20.

Most common site of esophageal cancer: ________

a)

Lower third

b)

Upper third

c)

Middle third

d)

Cervical esophagus

21.

Most common histology of esophageal cancer worldwide: ________

a)

Squamous cell carcinoma

b)

Adenocarcinoma

c)

Small cell carcinoma

d)

Sarcoma

22.

Best imaging for staging esophageal cancer: ________

a)

PET/CT

b)

Chest X-ray

c)

Barium swallow

d)

Ultrasound

23.

Typical RT dose for esophageal cancer: ________ Gy

a)

50–50.4 Gy

b)

60–66 Gy

c)

40–45 Gy

d)

70–75 Gy

24.

Common chemo with RT for esophagus: ________

a)

Cisplatin and 5-FU

b)

Paclitaxel and Carboplatin

c)

Methotrexate and Vincristine

d)

Gemcitabine and Docetaxel

25.

5-year survival rate for pancreatic CA: ________

a)

< 10 %

b)

20-30 %

c)

40-50 %

d)

60-70 %

26.

Tolerance dose for liver (TD 5/5): ________ Gy Rationale: Above this risk of radiation hepatitis.

a)

30–35 Gy

b)

45–50 Gy

c)

10–15 Gy

d)

60–65 Gy

27.

Tolerance dose for kidneys (TD 5/5): ________ Gy (bilateral)

a)

23 Gy (bilateral)

b)

15 Gy (bilateral)

c)

30 Gy (bilateral)

d)

40 Gy (bilateral)

28.

Most common metastatic site for pancreatic CA: ________

a)

Liver

b)

Lung

c)

Bone

d)

Brain

29.

Cause of radiation enteritis: ________

a)

Small-bowel exposure

b)

Liver dysfunction

c)

Renal artery stenosis

d)

Pancreatic insufficiency

30.

Best position to reduce small-bowel dose in pelvic fields: ________ Rationale: Displaces bowel superiorly.

a)

Prone on belly board

b)

Supine with knee support

c)

Lateral decubitus

d)

Sitting upright

31.

Most common histology of bladder CA: ________

a)

Transitional (urothelial) cell carcinoma

b)

Squamous cell carcinoma

c)

Adenocarcinoma

d)

Small cell carcinoma

32.

#1 risk factor for bladder CA: ________ Accounts for half of cases.

a)

Smoking

b)

Alcohol consumption

c)

Obesity

d)

High salt intake

33.

Common symptom of bladder CA: ________ Earliest presentation.

a)

Hematuria

b)

Dysuria

c)

Urinary retention

d)

Nocturia

34.

Radiosensitizer for bladder preservation: ________

a)

Cisplatin

b)

Methotrexate

c)

Vincristine

d)

Cyclophosphamide

35.

Intravesical immunotherapy drug: ________ Stimulates immune response.

a)

BCG

b)

Methotrexate

c)

Cisplatin

d)

Cyclophosphamide

36.

Bladder tolerance dose (TD 5/5): ________ Gy
Avoids contracture / fibrosis.

a)

65 Gy

b)

45 Gy

c)

75 Gy

d)

80 Gy

37.

Prostate is typically treated to approx.: ________

a)

76–80 Gy

b)

60–64 Gy

c)

50–54 Gy

d)

86–90 Gy

38.

Most radioresistant structure near bladder: ________ Can receive higher dose.

a)

Prostate

b)

Rectum

c)

Seminal vesicle

d)

Ureter

39.

Pelvic lymph nodes included for T3 bladder CA: ________ Regional spread.

a)

External & internal iliac, obturator

b)

Inguinal & para-aortic

c)

Axillary & mediastinal

d)

Cervical & supraclavicular

40.

Most common metastatic site of bladder CA: ________ Via hematogenous spread.

a)

Lung and bone

b)

Liver and spleen

c)

Brain and skin

d)

Kidney and adrenal gland

41.

Imaging for initial bladder staging: ________ Shows wall invasion and nodes.

a)

CT abdomen/pelvis

b)

Ultrasound KUB

c)

X-ray abdomen

d)

IVP

42.

Common late effect after pelvic RT: ________

a)

Cystitis and rectal bleeding

b)

Pulmonary fibrosis

c)

Hepatic encephalopathy

d)

Thyroid dysfunction

43.

When two photon fields match at skin, what occurs at depth? ________

a)

Hot spot

b)

Cold spot

c)

No change

d)

Increased scatter

44.

Technique to avoid field junction hot spots: ________ Moves junction periodically.

a)

Feathering the gap

b)

Backhand welding

c)

Spot welding

d)

Tack welding

45.

Purpose of full bladder during pelvic RT: ________

a)

Displace small bowel superiorly

b)

Increase radiation dose to bladder

c)

Reduce bladder volume

d)

Enhance tumor sensitivity

46.

Most common solid tumor of childhood (excluding CNS): ________ From adrenal medulla.

a)

Neuroblastoma

b)

Wilms tumor

c)

Retinoblastoma

d)

Hepatoblastoma

47.

Most common renal tumor in children: ________ Occurs ages 2–5.

a)

Wilms tumor

b)

Renal cell carcinoma

c)

Angiomyolipoma

d)

Oncocytoma

48.

Wilms tumor metastasizes primarily to: ________

a)

Lungs

b)

Liver

c)

Bone

d)

Brain

49.

Most common pediatric soft-tissue sarcoma: ________ Embryonal type dominant.

a)

Rhabdomyosarcoma

b)

Liposarcoma

c)

Synovial sarcoma

d)

Fibrosarcoma

50.

Common site of rhabdomyosarcoma: ________ Rapidly growing mass.

a)

Head and neck / orbit

b)

Liver

c)

Kidney

d)

Pancreas

51.

Retinoblastoma gene: ________ Tumor-suppressor on chromosome 13.

a)

RB1

b)

BRCA1

c)

TP53

d)

APC

52.

Typical presentation of retinoblastoma: ________ (white pupil reflex)

a)

Leukocoria

b)

Glaucoma

c)

Cataract

d)

Strabismus

53.

Most common pediatric bone tumor: ________ Metaphysis of long bones.

a)

Osteosarcoma

b)

Ewing's sarcoma

c)

Chondrosarcoma

d)

Fibrosarcoma

54.

Second most common bone tumor in children: ________

a)

Ewing sarcoma

b)

Osteosarcoma

c)

Chondrosarcoma

d)

Fibrosarcoma

55.

Common RT late effect in children: ________ Due to damage to growth plates.

a)

Growth retardation

b)

Cataract formation

c)

Pulmonary fibrosis

d)

Hearing loss

56.

Late effect after cranial RT: ________

a)

Cognitive impairment and hormone imbalance

b)

Improved vision and hearing

c)

Increased muscle strength

d)

Enhanced immune response

57.

Which pediatric tumor is most radiosensitive?

a)

Wilms tumor

b)

Neuroblastoma

c)

Osteosarcoma

d)

Ewing's sarcoma

58.

Typical dose range for Wilms tumor: ________

a)

10–30 Gy

b)

40–60 Gy

c)

1–5 Gy

d)

60–80 Gy

59.

Common chemotherapy for Wilms: ________

a)

Vincristine + Actinomycin-D ± Doxorubicin

b)

Methotrexate + Leucovorin

c)

Cisplatin + Etoposide

d)

Cyclophosphamide + Bleomycin

60.

Late secondary malignancy risk in pediatrics is due to: ________

a)

Higher cell division rates and long lifespan

b)

Lower metabolic activity and short lifespan

c)

Decreased DNA repair mechanisms only

d)

Reduced exposure to environmental carcinogens

61.

Diagnostic cell of Hodgkin’s: ________ Owl-eye cell pathognomonic.

a)

Reed–Sternberg

b)

Plasma cell

c)

Langerhans cell

d)

Kupffer cell

62.

Subtype of Hodgkin’s most common: ________ Young adults, mediastinum.

a)

Nodular sclerosis

b)

Lymphocyte-rich

c)

Mixed cellularity

d)

Lymphocyte-depleted

63.

Classic B symptoms: ________

a)

Fever, night sweats, weight loss

b)

Cough, chest pain, hemoptysis

c)

Headache, photophobia, neck stiffness

d)

Polyuria, polydipsia, polyphagia

64.

Chemo for Hodgkin’s: ________

a)

ABVD

b)

CHOP

c)

FOLFOX

d)

MOPP

65.

Chemo for Non-Hodgkin’s: ______ ± Rituximab. Cyclophosphamide, Doxorubicin, Vincristine, Prednisone.

a)

CHOP

b)

ABVD

c)

FOLFOX

d)

MOPP

66.

Typical RT dose for HL involved sites: ______ Gy. After chemo response.

a)

30–36

b)

10–14

c)

45–50

d)

60–66

67.

Most common extranodal site for NHL: ______. MALT lymphoma.

a)

Stomach

b)

Liver

c)

Lung

d)

Brain

68.

Virus linked to Burkitt lymphoma: ______. EBV DNA found in tumors.

a)

Epstein–Barr virus

b)

Human papillomavirus

c)

Hepatitis B virus

d)

Cytomegalovirus

69.

Burkitt lymphoma cells show: ______ pattern. Macrophages among lymphoid cells.

a)

Starry-sky

b)

Onion-skin

c)

Rosette

d)

Homer Wright

70.

HL spreads contiguously; NHL spreads ______. Key difference in pattern.

a)

Non-contiguously / extranodally

b)

Contiguously

c)

Only within lymph nodes

d)

Via the bloodstream only

71.

Primary RT field for HL in neck and mediastinum: ______. Modern reduced field size.

a)

Involved-site technique

b)

Mantle field

c)

Extended field technique

d)

Total nodal irradiation

72.

Common late effect of mediastinal RT: ______. Pericarditis or CAD risk.

a)

Cardiac toxicity

b)

Pulmonary embolism

c)

Renal failure

d)

Hepatic cirrhosis

73.

Second malignancy after HL RT: ______. From scatter and field exposure.

a)

Breast CA or lung CA

b)

Colon CA

c)

Prostate CA

d)

Thyroid CA

74.

Which type has better prognosis? ______. Highly curable with combined modality.

a)

Hodgkin’s lymphoma

b)

Non-Hodgkin’s lymphoma

c)

Multiple myeloma

d)

Chronic lymphocytic leukemia

75.

Typical presentation of Burkitt lymphoma in U.S.: ______. Sporadic form.

a)

Abdominal mass

b)

Jaw mass

c)

Skin lesion

d)

Mediastinal mass

76.

Which imaging sequence best distinguishes tumor edema from recurrence?

a)

T1-weighted MRI

b)

PET scan

c)

T2/FLAIR MRI

d)

CT with contrast

77.

Which chemotherapy crosses the BBB and is commonly used in glioblastoma?

a)

Cisplatin

b)

Temozolomide

c)

5-FU

d)

Bleomycin

78.

What is the typical dose for SRS to a solitary brain metastasis?

a)

20 Gy

b)

25 Gy

c)

18–24 Gy single fraction

d)

10 Gy

79.

Which late effect is unique to pediatric brain RT?

a)

Hair loss

b)

Dermatitis

c)

Growth hormone deficiency

d)

Esophagitis

80.

Pancreatic cancer commonly invades which vessel?

a)

IVC

b)

Superior mesenteric vein

c)

Portal vein

d)

Celiac trunk

81.

Which organ is dose-limiting in pancreatic RT?

a)

Stomach

b)

Liver

c)

Duodenum / small bowel

d)

Pancreas

82.

Respiratory motion in pancreas RT is best managed with:

a)

Cone-beam only

b)

4D CT and breath-hold gating

c)

MRI fusion

d)

Ultrasound tracking

83.

Classic triad for pancreatic head tumor includes:

a)

Fatigue, nausea, vomiting

b)

Diarrhea, jaundice, cough

c)

Jaundice, weight loss, back pain

d)

Abdominal distention

84.

Intravesical BCG acts by:

a)

Direct tumor necrosis

b)

Immune activation of bladder mucosa

c)

Radiation sensitization

d)

DNA repair inhibition

85.

Which phase of treatment uses a full bladder?

a)

Initial whole-pelvis

b)

Boost phase to tumor bed

c)

All phases

d)

None

86.

Which chemo regimen is often paired with RT for bladder preservation?

a)

CHOP

b)

Cisplatin + 5-FU ± Mitomycin C

c)

ABVD

d)

Gemcitabine alone

87.

The primary lymphatic drainage for bladder includes:

a)

Para-aortic

b)

Inguinal

c)

Internal and external iliac nodes

d)

Axillary

88.

What is the most common route of retinoblastoma spread?

a)

Hematogenous

b)

Lymphatic

c)

Along the optic nerve to brain

d)

Direct bone invasion

89.

Plaque brachytherapy for retinoblastoma uses which isotope?

a)

I-131

b)

Cs-137

c)

I-125

d)

Ir-192

90.

Lens-sparing external beam techniques are used to prevent:

a)

Nystagmus

b)

Cataract formation

c)

Ptosis

d)

Diplopia

91.

Which genetic translocation is associated with alveolar rhabdomyosarcoma?

a)

t(11;14)

b)

t(8;14)

c)

t(2;13)

d)

t(9;22)

92.

What margin is typically used around gross disease in pediatric RMS RT?

a)

1 cm

b)

2 cm

c)

3 cm

d)

5 cm

93.

Which modern RT technique replaces the historical “mantle field”?

a)

Whole-body RT

b)

ISRT (Involved-Site Radiation Therapy)

c)

IFRT

d)

Extended field

94.

Oophoropexy is performed during mantle RT to:

a)

Prevent lymphedema

b)

Preserve fertility by moving ovaries out of field

c)

Fix uterine prolapse

d)

Decrease cardiac dose

95.

The “pain after alcohol ingestion” sign is associated with:

a)

Non-Hodgkin’s

b)

Hodgkin’s lymphoma

c)

Leukemia

d)

Multiple myeloma

96.

Plaque brachytherapy for retinoblastoma uses which isotope?

a)

I-131

b)

I-125

c)

Cs-137

d)

Ir-192

97.

What is the most common route of retinoblastoma spread?

a)

bone invasion

b)

along optic nerve

c)

lymphatic

d)

hematogenious

98.

The most common presenting symptom of bladder cancer is

(a)  

99.

The genetic mutation associated with hereditary retinoblastoma occurs in the (a)   gene.

100.

The most common pediatric soft-tissue sarcoma is (a)   .