Radiotherapy Practice Set

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Practice Set of Radiotherapy

1. Cancer histology is derived from the embryological remnant of the urachus
(1) Transitional Cell
(2) Adenocarcinoma
(3) Squamous cell carcinoma
(4) Pheochromocytoma

2. The most validated pain intensity scale is known as the
(1) Visual analogue scale
(2) Faces scale
(3) Visual rating scale
(4) Visual number scale

3. Opioid treatment fits best on which step of the WHO analgesic ladder?
(1) Step One
(2) Step Two
(3) Step Three
(4) Step Four

4. What is opiophobia ?
(1) Fear of opioid plant
(2) Fear of drugs
(3) Dear of prescribing opioid drugs
(4) Fear of anaesthesia

5. A 60-year-old woman with locally advanced cancer of the left breast presented with recent-onset lymphedema of her left arm. She is not a candidate for radical resection, and due to her pulmonary co morbidities, she is unable to tolerate radiotherapy. Her examination shows a very swollen left arm, elbow and wrist associated with ischaemic changes in the fingers of her left hand. There is no radial pulse and Doppler ultrasound scan shows no thrombus in any of the veins however reduced flow within her brachial arteries. What is the most appropriate initial management of her lymphedema ?
(1) Compression sleeve
(2) Manual lymphatic drainage
(3) Frusemide and spironolactone
(4) Surgical debulking

6. A 70-year-old male with metastatic prostate cancer with multiple bony lesions complains of sudden onset right hip pain. A CT scan shows a large lytic lesion with cortical thinning within the upper third of the femur. What is the most appropriate management for this patient ?
(1) Densoumab/ Bisphosphonates
(2) Radiotherapy
(3) Surgical Fixation
(4) Non-weight bearing status

7. Signs of opioid toxicity include :
(1) Hypertension, aggression
(2) Irritability and restlessness
(3) Drowsy
(4) Sleepiness, respiratory depression, pinpoint pupils

8. The highest success rate with nerve blocks is seen with:
(1) Coeliac plexus block
(2) Intrathecal block
(3) Cryotherapy
(4) Brachial block

9. Which of the following most accurately describes “breakthrough” pain ?
(1) Associated with pathological fractures
(2) Refers to a new psychological or spiritual insight
(3) Can occur as end-of-dose failure
(4) An aspect of opioid pseudo-addiction

10. Which of the following is an example of nociceptive pain ?
(1) Chemotherapy induced paraesthesia
(2) Post herpetic neuralgia
(3) Colic from subacute intestinal obstruction
(4) Right arm pain from brachial plexopathy

11. Principles of palliative care are :
(1) Psycho-social care, symptom control & disease management
(2) Providing adequate analgesic, disease management and place to die
(3) Disease management, intensive care and symptom control
(4) Religious/ spiritual support and psychosocial care

12. Which of the following pairs of cancer type and corresponding genetic alterations in that cancer is FALSE ”
(1) Pancreatic-K-RAS
(2) Lung adenocarcinoma-ALK
(3) Colon-PTCH
(4) Thyroid-RET

13. A 64 years old male has been recently diagnosed with non-small cell lung cancer, stage IIIB. He has an ECOG performance status of 0. He presents acutely to the emergency department with upper limb swelling conjunctival suffusion, stridor and significant dyspnoea. What is the most appropriate diagnosis matched with treatment strategy ?
(1) Superior vena cava syndrome, surgical stent insertion
(2) Superior vena cava syndrome, chemotherapy
(3) Superior vena cava syndrome, chemotherapy and radiotherapy
(4) Pulmonary embolism, therapeutic unfractionated heparin

14. What is the most common cause of superior vena cava obstruction syndrome ?
(1) Small cell lung cancer
(2) Lymphoma
(3) Non-small cell lung cancer
(4) Metastatic deposits

15. What is the RT dose and fractionation for prophylaxis against heterotopic ossification ?
(1) 30 Gy * 10 Fraction
(2) 10 Gy * 5 Fraction
(3) 5 Gy * 1 Fraction
(4) 7 Gy * 2 Fraction

16. A 68 year old male has been recently diagnosed with prostate malignancy. He presents acutely to the radiotherapy department with severe pain in right side peritrochanteric region. His x-ray pelvis shows lytic destruction peritrochanteric region and the Mirels scoring system is twelve. What is the most appropriate treatment strategy ?
(1) Radiotherapy
(2) Radiotherapy + Internal fixation
(3) Internal fixation prior to RT
(4) Internal Fixation

17. What is the optimal total radiation dose required for immunosuppression and tumoral cell eradication in fractionated TBI regimens ?
(1) 2-4 Gy
(2) 4-6 Gy
(3) 6-8 Gy
(4) 8-12 Gy

18. What is an advantage of a cross-over study ?
(1) Carry-over effect
(2) Increased drop-out
(3) Efficiency increase
(4) Slow recruitment

19. What is the correct interpretation of hazard ratio (HR) ?
(1) HR = hazard in the control group / hazard in the intervention group
(2) HR of 0.5 means that twice as many patients in the treatment group are experiencing an event compared to the control group
(3) HR of 1.0 means that at any particular time the event rates are the same for both groups
(4) HR of 2.0 means that at any particular time, half as many patients in the treatment group are experiencing and event compared to the control group

20. What is the primary goal of a Phase IV trial ?
(1) Determine MTD
(2) Obtain FDA approval
(3) Post approval assessment of safety and effectiveness
(4) Investigate off-label indications

21. What is the MOST common radiation dose for treatment of Graves’ ophthalmophathy ?
(1) 8 Gy in 1 fx
(2) 20 Gy in 5 fx
(3) 20 Gy in 10 fx
(4) 30 Gy in 15 fx

22. What is FDA approved treatment to minimize acute radiation syndrome in the event of a radiation emergency ?
(1) Amifostine
(2) Sargramostim
(3) Cisplatin
(4) Gefitinib

23. The overall RBE factor of a proton therapy beam is :
(1) 1.0
(2) 1.1
(3) 1.3
(4) 1.8

24. How does hyperthermia enhance radiation-induced tumor growth delay ?
(1) Decreases tumor oxygenation
(2) Decreases formation of DNA lesions
(3) Inhibits repair of DNA damage
(4) Inhibits the blood supply to the tumor

25. For which one of the following would a BIRADS 6 classification be most appropriate ?
(1) Post procedure mammogram for marker placement
(2) Prior treated breast cancer
(3) Recent biopsy proven breast cancer
(4) Suspicious abnormality; needs biopsy

26. Spinal cord compression is optimally treated by:
(1) SBRT
(2) RT alone
(3) Surgical decompression/ stabilization + RT
(4) Surgical decompression/ stabilization alone

27. Protons are preferred for therapeutic treatments of some anatomical sites. What is the principal justification for this ?
(1) DNA damage is irreparable
(2) Hypoxic cells are sensitive to photons
(3) Limit dose to normal tissue
(4) The OER for protons is above 4

28. Cells in which phase of the cell cycle are MOST resistant to hyperthermia induced cell killing ?
(1) Gl
(2) S
(3) G2
(4) M

29. What is the MOST dose limiting side effect of TBI ?
(1) Cardiac failure
(2) Pancreatitis
(3) Pneumonitis
(4) Enteritis

30. What change is incorporated in the 2018 AJCC staging guidelines for soft tissue sarcoma ?
(1) Histologic grade is no longer included
(2) NI is Stage group III
(3) Retroperitoneal location is staged separately
(4) T3 includes tumors from 10-20 cm

31. Based on the National Lung Cancer Screening Trial (NLLST), which of the following parameters from smoking history is NOT a risk factor to select patients for lung cancer screening ?
(1) 230 pack-year smoking history
(2) Smoking cessation <15 years
(3) Age 55-74 years
(4) Second-hand smoking history

32. The lifetime of an OH radical is approximately :
(1) 1015 Second
(2) 10-9 second
(3) 10-1 second
(4) 1 second

33. Which phase trial is used to determine maximum tolerated dose (MTD) ?
(1) Phase I
(2) Phase II
(3) Phase III
(4) Phase IV

34. What is the typical maximum energy of protons accelerated in a modern cyclotron used for therapeutic proton radiotherapy ?
(1) 75 MeV
(2) 125 MeV
(3) 250 MeV
(4) 500 MeV

35. Which is correct for double-blind Phase III clinical trial ?
(1) Both investigators and participants do not know the treatment.
(2) The investigators know the treatment, but the participants do not.
(3) The participants know the treatment, but the investigators do not.
(4) Both investigators and participants know the treatment.

36. Regarding pair production and annihilation, which of the following is true ?
(1) The incident photon is scattered with reduced energy
(2) Annihilation photons always have an energy of 0.511 MeV each
(3) A pair of orbital electrons are ejected from the atom
(4) It cannot occur if the photon energy is above 1.02 MeV

37. Following total thyroidectomy for papillary thyroid carcinoma, which of the following is an indication for radioactive iodine (RAT) therapy ?
(1) Multifocal disease
(2) High risk histologic subtypes
(3) Microscopically positive margins (RI)
(4) Postoperative unstimulated thyroglobulin levels > 5-10

38. Which of the following matches is not correct for ICRU reports ?
(1) ICRU 38-brachytherapy
(2) ICRU 78-proton therapy
(3) ICRU 71-electron therapy
(4) ICRU 72-external therapy

39. In adults, where does the spinal cord typically end ?
(1) L1
(2) L3
(3) LS
(4) SI

40. Which action improves the dose homogeneity when treating with same energy, parallel-opposed photon treatment fields ?
(1) Using uneven beam weighting
(2) Increasing the treatment volume separation
(3) Decreasing the treatment field Size
(4) Increasing the photon beam energy

41. There is no transfer of energy to atoms so ionization does not occur. This type of photon-matter interaction is called:
(1) Coherent scattering
(2) Photelectric effect
(3) Compton effect
(4) Photodisintegration

42. Which phase of the cell cycle is most sensitive to hyperthermia induced cell killing ?
(1) GI
(2) S
(3) G2
(4) G0

43. For an open, flattening filter free beam, at what location within the photon beam, dose rate is the highest ?
(1) Central beam axis
(2) Off axis
(3) Penumbra region
(4) Bragg peak

44. What is a factor that should be considered in a CTV to PTV expansion ?
(1) Microscopic Invasion into surrounding tissue
(2) Dose fractionation
(3) Serial or parallel nature of the CTV
(4) Patient immobilization

45. For a low energy, poly-energetic X-ray beam, the second half-value layer (HVL) as compared to the first HVL is :
(1) Smaller
(2) the same
(3) larger
(4) larger only for small field sized