CNS cancer

All of the following are parts of the anatomy of the brain except: a. Ethmoids b. Cerebrum c. Cerebellum d. Pons

A. Ethmoid is a bone that forms the roof of the nasal cavity

Landmarks around the mouth are generally not very accurate due to: a. Extreme flexibility in the area b. Daily variations in skin texture in the area c. Extreme hyperpigmentation in the area d. Occasional occurrence of contagious mouth sores

A. Extreme flexibility in the area

The spinal cord proper in adults extends from the: a. Foremen magnum to the second lumbar spine b. Pons to the fifth lumbar spine c. Foremen magnum to the fifth lumbar spine d. Hypothalamus to the second lumbar spine

A. Foremen magnum to the second lumbar spine

A glioma spreads primarily by way of: a. Local invasion b. Cerebrospinal fluid c. Lymph nodes d. Blood

A. Local invasion

What is the most common CNS tumor in children? a. Medulloblastoma b. Metastatic lesion c. Astrocytoma d. Craniopharyngioma

A. Medulloblastoma

A common subacute post radiation syndrome following total CNS radiation is: a. Myelitis b. Hypersomnia c. Low wbc d. Esophagitis

A. Myelitis

The sense of smell conveyed by the: a. Olfactory nerve b. Oculomotor nerve c. Abductees nerve d. Facial nerve

A. Olfactory nerve I

A glioma spreads by means of: a. Local invasion b. Cerebrospinal fluid c. Lymph nodes d. Blood

A. Primary brain tumors spread by local invasion; glioma tend to remain local

Which of the following is the dose at which radiation necrosis of brain tissue is most likely to occur? a. 6,000cGy b. 4,500cGy c. 4,000 cGy d. 2,000 cGy

A. Radiation tolerance for normal tissues within the CNS include 5,000cGy for whole brain, 6,000 cGy for partial brain, and 4,500 to 5,000cGy for the spinal cord.

The primary management modality for primary brain tumors is: a. Surgery b. Radiation c. Chemotherapy d. Hormonal therapy

A. Whenever possible, total resection is the primary mode of management for primary brain tumors

At what vertebral body does the spinal cord end? a. T12 b. L2 c. L4 d. S2

B

Cerebrospinal fluid is contained within the ___________ space a. Subdural b. Subarachnoid c. Epidural d. Arachnoid

B

Ependymomas typically spread via: a. Lymphatic spread b. Seeding through CNS c. Invasion into the cerebellum d. Extension through base of skull

B

Glioblastoma multiforme has a prognosis of: a. Less than 1 month b. Less than 1 year c. 5 years d. Almost always curable

B

Margins of _________are typically added to the tumor and edema when planning 3D conformal radiation therapy for a primary brain tumor a. 0.5 cm b. 2 cm c. 4 cm d. 6 cm

B

On CT scan, the texture of this structure resembles that of cauliflower, and is gray in color a. Frontal lobe b. Cerebellum c. Hypothalamus d. Pituitary gland

B

The cribiform plate is a structure of this bone: a. Frontal b. Ethmoid c. Sphenoid d. Parietal

B

What covering of the brain is closest to the skull? a. Arachnoid mater b. Dura mater c. Pia mater d. Epi mater

B

What is the most common age of diagnosis for malignant glioma? a. 35-45 years B. 25-55 years c. 55-65 years d. 65-75 years

B

What structure in the brain is (are) horn shaped? a. Pons b. Lateral ventricles c. Cerebral aquaduct d. Infundibulum

B

Which of the following beam arrangements is most typical for treatment of a malignant primary brain tumor? a. Parallel opposed whole brain fields b. Small fields with 1-3 cm margins c. Oblique fields to include the Supra orbital ridge d. Large fields with 5-10 cm margins

B.

What is the 5-year survival rate for all CNS tumors combined? a. 20% b. 35% c. 50% d. 75%

B. 35%

Another term for the pituitary gland is the: a. Hypothalamus b. Hypophysis c. Pineal gland d. Neurotic fascia

B. Hypophysis

Which of the following is a late effect of brain irradiation in children? a. Leukemia b. Decreased IQ c. Gigantism d. Chronic fatigue

B. Late effects after CNS treatment in children include decreased mean intelligent quotient (IQ) scores and the regrowth of hair

What is the most common source of brain metastasis among the following? a. Colon b. Lung c. Breast d. Melanoma

B. Lung

The area of the cerebrum responsible for sensory and association is the: a. Frontal area b. Parietal area c. Temporal area d. Occipital area

B. Parietal area

Which of the following cells is responsible for myelin production? a. Neurons b. Schwann cells c. Astrocytes d. Ependymal cells

B. Schwann cells, in addition to oligodendrocytes, produce a fatty insulating substance called myelin, which insulates and protects nerves outside the CNS

What is the inferior border of the spine field when treating a patient with craniospinal irradiation (CSI)? a. C2 b. T12 c. L2 d. S2

D

What lobe in the cerebrum is the most posterior? a. Frontal b. Parietal c. Temporal d. Occipital

D

What structure within the brain is responsible for supplying arterial blood to the cerebrum? a. Thalamus b. Corpus callosum c. Hypothalamus d. Circle of willis

D

Which of the following is not a common chronic effect of external beam radiation to the brain? a. Alopecia b. Necrosis c. Vision changes d. Headache

D

Which of the following factors can limit the usefulness of surgery for CNS neoplasms? a. Tumor location and extent b. Patient status c. Risk of causing neurological damage d. All of the above

D. All of the above

Which of the following would be important to consider in the initial work up for a diagnosis of CNS malignancy? a. Family history b. Environmental exposures c. Changes in behavior or personality d. All of the above

D. All of the above

Which of the following conditions is a contraindication for stereotactic radio surgery (SRS)? a. Spherical tumor b. 2-cm tumor c. Brain metastases d. Five lesions

D. Five lesions

Which of the following brain tumors is seen more frequently in the adult? a. Medulloblastoma b. Ependymoma c. Pituitary adenoma d. Glioma

D. Majority of primary brain tumors in adults are gliomas

What is the most common type of brain tumor? a. GBM b. Astrocytoma c. Meningioma d. Metastatic brain lesions

D. Metastatic brain lesions

The lymphatics included in radiation treatment fields for a glioblastoma multiforme in the right temporal lobe would include: a. Retropharyngeal b. Preauricular c. Parotid D. None of the above

D. None of the above there is no lymphatic drainage in the central nervous system. No lymph nodes are included in radiation fields for tumors of the brain

Which of the following is NOT a symptom of intracranial tumors? a. Headache b. ICP c. Seizures D. Nocturia

D. Symptoms of intracranial tumors would not include nocturia (urination at night)

What defines the inferior radiation field border for the treatment of the whole brain for palliation? a. 1-cm flash b. Superior orbital ridge c. External auditory meatus d. Both b and c

D. The inferior margin of the field intersects the superior orbital ridge and external auditory meatus

A triangular-shaped surface landmark often used in radiation therapy that partially covers the external auditory meatus is known as the: a. Helix b. Glabella c. Canthus d. Tragus

D. Tragus is the triangular shaped cartilage of the external auditory meatus

Which of the following is MOST significant to the prognosis of brain tumors? a. Tumor size b. Lymph node involvement c. Metastases d. Grade

D. Tumor grade rather than size is the primary factor involved with prognosis

Radiation therapy treatment fields often conform to primary brain tumors with about a 2-cm margin. Metastatic brain disease calls for whole brain radiation therapy. Explain.

Metastatic brain disease is usually multi-focal. Even if not demonstrated as multi-focal at the time of detection, it is accepted that there is likely microscopic disease throughout the brain. Primary tumors are usually solitary and tend to grow radially from the primary location

A 270-degree rotational arc will be used to treat a pituitary adenomatous through coronal plane. The starting angle is 225-degree gantry position. What is the finishing angle? for the above 270-degree rotation, the calculated monitor units for the arc is 280 MU. What is the calculated MU/degree?

135 degree 1.04 MU/degree

From which cells to medulloblastomas arise? a. Primitive neuroectodermal tumor(PNET) b. Primitive neuroectodermal cells C. Astrocytes d. Lymphocytes

A

Local hair loss and erythema are the expected side effects from cranial irradiation. Patients should be advised to: a. Use mild shampoo or water only for washing b. Use a razor to shave the head before the hair begins to thin c. Apply keratosis cream to scalp daily d. Apply hot towels daily to rest insulate hair growth

A

Simulation for patients with brain tumors would include immobilization via: a. Thermoplastic immobilization device b. Vacuum bag immobilization c. Chemical mold d. Abdominal compression

A

Symptoms of brain tumors commonly include dizziness, diplopia, and seizures. Patients should be advised to: a. Come accompanied to each therapy session b. Take an analgesic before therapy c. Take an anti diuretic before therapy d. Apply cold towels to the forehead after each treatment

A

The __________lobe of the brain has a role in a persons a. Frontal b. Parietal c. Temporal d. Occipital

A

The most inferior portion of the brain stem is: a. Medulla oblongata b. Midbrain c. Pons d. Spinal cord

A

The preferred imaging modality for the diagnosis of brain tumors is: a. MRI b. CT c. PET d. Radiographs

A

The tolerance dose TD 5/5 for the lens of the eye is: a. 5-10 Gy b. 10-20 Gy c. 20-30 Gy D. 30-40 Gy

A

The tolerance dose TD 5/5 for the optic nerve or chiasm is: a. 50 Gy b. 60 Gy c. 70 Gy d. 80 Gy

A

This bone contains the dorsal sellae: a. Sphenoid b. Occipital c. Temporal d. Frontal

A

Which of the following may be included in a patients treatment plan for a glioblastoma multiforme? Choose all correct answers. A. Temozolomide b. External beam radiation therapy c. Surgery d. Interferon e. Corticosteroids

A, b, c, e

Patients treated to the cranium should be advised to protect their heads from direct sunlight because the sun______________ a. Enhances radiation-induced side effects b. Causes lower white blood cell counts c. Enhances feelings of nausea d. Lowers tolerance to anti-inflammatory medications

A.

What is the current 5-year survival of patients with glioblastoma mutliforme (GBM) a. 35% b. 55% c. 75% d. 95%

A. 35%

The lateral ventricles are located within the: a. Cerebral hemispheres b. Brainstem c. Sella turnica d. Flax cerebri

A. Cerebral hemispheres

A common area of spread for medulloblastoma is: a. Cerebrospinal fluid b. Lung c. Liver d. Bone

A. Cerebrospinal fluid

Which portion of the brain is the site of intelligence and judgement? a. Cerebrum b. Cerebellum c. Brain stem D. Thalamus

A. Cerebrum

Involvement of cranial nerve_______may manifest as dysphagia a. IX b. VII c. VI d. V

A. Cranial nerve IX controls swallowing and secretion of saliva

Adult tumors in the central nervous systems are typically located: a. In the spinal cord b. In the brain stem c. Supratentorial d. Infratentorial

C

During primary brain tumor irradiation, dose to normal brain tissue should be kept below: a. 45 Gy b. 50 Gy c. 60 Gy d. 75 Gy

C

Patients with a tumor in the cerebrum may present with any of the following signs and symptoms except: a. Headaches B. Visual changes c. Deferred pain in the thorax d. Nausea and vomiting

C

The most common malignancy in the brain is: a. Astrocytoma b. Glioma c. Metastatic disease d. Oligodendroglioma

C

What extension of the dura mater separates the cerebellum from the cerebrum? a. Falx cerebelli b. Falx cerebri c. Tentorium cerebelli d. Tentorium cerebri

C

Facial pain could be associated with a primary CNS tumor near cranial nerve: a. I b. III c. VII d. XI

C. Cranial nerve VII controls movement and sensory of the face

The lobes of the thyroid gland are separated by the: a. Parathyroids b. Ilets of langerhans c. Isthhmus d. Hyoid

C. Isthmus is a thin, peaked structure separating the bilateral lobes of the thyroid gland

Which tumors spread through the cerebral spinal fluid? a. Astrocytoma b. Oligodendroglioma c. Medulloblastoma d. Schwannoma

C. Medulloblastoma and PNET

Which of the following brain tumors have the tendency to spread via the CSF? a. Glioma b. Astrocytoma c. Medulloblastoma d. Oligodendroglioma

C. Medulloblastoma, ependymomas, pineal gland tumors have high potential to spread throughout CSF

Which class of chemotherapy drugs has the ability to cross the blood-brain barrier? a. Antimetabolites b. Plant alkaloids c. Nitrosoureas D. Hormonal agents

C. Nitrosoureas are lipid soluble, allowing them to cross the blood-brain barrier

Luteinizing hormone (LH) stimulates sexuality and some reproductive function. LH is secreted by the _______gland a. Pineal b. Adrenal c. Pituitary D. Prostate

C. Pituitary

The blood-brain barrier: a. Protects the brain from radiation b. Prevents lipid soluble substances from passing into the brain c. Protects the brain from potentially toxic substances d. Nourishes the brain with oxygen

C. Protects the brain from potentially toxic substances

Single dose stereotactic radio surgery is most appropriate for: a. Multi focal metastatic brain tumors B. Recurrent 5-cm brain tumors c. Solitary 2-cm primary brain tumors d. Solitary 5-cm primary brain tumors

C. SRS is reserved for small solitary primary tumors small metastatic tumors or small solitary recurrent tumors

The pituitary gland secretes which reproductive hormones? a. TSH, ACTH, LTH b. LH, estrogen, progestrone c. FSH, LH, LTH d. Progesterone and estrogen

C. The pituitary gland secretes follicle stimulating, lutenizing and luteotropic (prolactin) hormones

In a single-fraction stereotactic radio surgery: a. The target margins are generous b. The fields conform to the target with a margin of 2 cm c. There are generally no target margins d. Fields are shaped using cerrobend blocks

C. There are generally no target margins. SRS has no margins. Doses are high

A primary spinal cord tumor located in the lumbosacral region may demonstrate by: a. Tingling sensation in the lower abdomen b. Pain radiating along the flank c. Incontinence, impotence d. Radiating pain down the legs e. C and d only

E. A tumor compressing the lumbosacral region of the spine could cause incontinence, impotence, and pain down the legs

Which of the following are symptoms of pituitary adenomatous? a. Uncontrolled diabetes b. Visual disturbances c. Sinus pressure d. A and b only e. All of the above

E. Pituitary adenomatous may show symptoms associated with hormonal imbalance as in diabetes or visual disturbance or sinus pressure due to anatomical location and extension of tumor

If manual calculation was performed, what information would be required for the final monitor unit calculation

Field size output field size factor attenuating factors (if any) average TAR/TMR prescribed dose to tumor

Noncoplanar beam arrangements are useful in treating pituitary adenomatous. What is the advantage of this treatment strategy over traditional coplanar field arrangements?

Noncoplanar beam arrangements allow for smaller doses from each field with more conforming dose distribution than with traditional fields traversing a single plane and exposing normal tissues to higher total dose

Several primary tumors metastasize to the brain. However, primary brain tumors do not spread outside of the central nervous system. Briefly explain

One theory is since the central nervous system is central station for all bodily functions it is self-contained for protection from systemic, pathogenic disability. It therefore sets strict limits regarding what comes in and out. Permeation is uniquely controlled in either direction. Non-CNS primaries more readily make their way to the CNS (especially brain) via the blood route than CNS tumors through common vasculature