Principles and Practice of Radiation Therapy 4th Edition Test Bank

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Chapter 01: Cancer: An OverviewWashington & Leaver: Principles and Practice of Radiation Therapy, 4th EditionMULTIPLE CHOICE1.Knowledge of cancer dates back to which of the following?a.1600BCEgyptb.1600ADEnglandc.400BCGreeced.1900ADGermanyANS:AThe first known observations of cancer date back to 1600BCEgypt.REF:p. 32.Which of the following isnota term for genes involved in the cancer process?a.Anti-oncogenesb.Oncogenesc.Proto-oncogenesd.Somato-oncogenesANS:DAnti-oncogenes, oncogenes, and proto-oncogenes have all been identified as playing a part inthe development of tumors. Somato-oncogenes do not exist.REF:p. 33.Tumor-suppressor genes are also known as ___________.a.anti-oncogenesb.oncogenesc.proto-oncogenesd.somato-oncogenesANS:AAlthough more commonly called tumor-suppressor genes, these genes are also known asanti-oncogenes.REF:p. 34.Which of the following isnota phase of the mammalian cell cycle?a.G0b.G1c.G2d.G3ANS:DG0 is a resting phase where cells do not enter mitosis. G1 and G2 are growth phases duringthe mammalian cell cycle. Although some algae species demonstrate a relatively long phasebetween nuclear division and cleavage of the cell termed G3, this phase is not part of themammalian cell cycle.

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REF:pp. 3-45.Which phase of the mammalian cell cycle is composed of functional cells not preparing forDNA replication?a.G0b.G1c.G2d.Se.MANS:AG0 is typically depicted outside the cell cycle because cells in this phase are not preparing forDNA synthesis.REF:pp. 3-46.In which phase of the mammalian cell cycle does DNA synthesis occur?a.G0b.G1c.G2d.Se.MANS:D“S”is representative of synthesis and is the phase in which DNA synthesis occurs.REF:p. 47.Identify the correct order for the phases of the mammalian cell cycle.a.G1, G2, M, Sb.G1, G2, S, Mc.G1, M, G2, Sd.G1, S, G2, MANS:DThe typical mammalian cell will move from G1 to S, followed by G2, and then M. Some cellswill eventually pause in G0 after M.REF:pp. 3-48.Which of the following is true of anaplastic tumors?a.Closely resemble the cells of originb.Maintain some resemblance of the cells of originc.Do not resemble the cells of originANS:CAnaplastic tumors are also known as undifferentiated tumors. Undifferentiated cells do notresemble the normal cells of origin.REF:p. 4

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9.Which of the following is (are) true of benign tumors?a.Well differentiatedb.Do not metastasizec.Encapsulatedd.All of the aboveANS:DBenign tumors typically are well differentiated, do not metastasize, and are encapsulated.REF:p. 410.Which of the following factors doesnotaffect the incidence of tumor sites?a.Informationalb.Environmentalc.Technologicald.GeographicANS:ATumor site incidence is affected by environmental factors such as sun exposure. It is alsoaffected by technological factors such as the advent of more precise imaging modalities.Additionally, tumor site incidence is affected by geographic factors, as exemplified bygastrointestinal cancers in Japan.REF:pp. 5-611.What is defined as the “study of the cause of disease”?a.Etiologyb.Etymologyc.Epidemiologyd.EntomologyANS:AEtiology is defined as the “study of the cause of disease.” Etymology is the “study of wordorigins,” epidemiology is the “study of disease incidence,” and entomology is the “study ofinsects.”REF:p. 512.What is the “study of disease incidence”?a.Etiologyb.Etymologyc.Epidemiologyd.EntomologyANS:CEpidemiology is defined as the “study of disease incidence.” Etiology is the “study of thecause of disease,” etymology is the “study of word origins,” and entomology is the “study ofinsects.”REF:p. 613.Which of the following make(s) for an effective screening examination?

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a.Specificb.Sensitivec.Cost-effectived.Accuratee.All of the aboveANS:EFor a screen tool to be effective, it must be specific, sensitive, accurate, and cost effective.REF:p. 614.What is the “workup”?a.The initial nursing visitb.The initial physician visitc.A series of diagnostic examinationsd.A physical assessment of the patientANS:CAlthough the termworkupmay be used by different radiation oncology departments invarious ways, the generally accepted definition of this term is a series of diagnosticexaminations performed after a patient has been diagnosed with a disease or condition. Thismay be done at the time of the initial physician or nurse visit and may include a physicalassessment, but these are only portions of the entire workup.REF:p. 615.Which of the following isnottypically part of the workup?a.Patient demographicsb.Type, location, and size of tumorc.Normal tissue invasiond.Presence of metastasesANS:AThe workup includes information about the tumor such as type, size, and location, amount ofnormal tissue invasion, and presence of metastases. Typically, demographic information iscollected at a time other than during the workup by support staff.REF:pp. 6-716.Which imaging modality is beneficial for distinguishing between recurrent disease and othertissue changes post treatment?a.CTb.PETc.Plain filmsd.MRANS:BAlthough a CT or MR scan may be used as part of the diagnostic process for ruling outrecurrent disease, PET is the only imaging modality listed that can differentiate recurrencefrom other tissue changes.REF:p. 7

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17.What is the most common tumor staging system?a.AJCCb.FIGOc.TNMd.UICCANS:CTNM is the most commonly used staging system. This system has been adopted by AJCC andUICC. FIGO is the staging system used for gynecologic tumors but has no application to themajority of tumors.REF:p. 718.A T1N0MXtumor has how many positive lymph nodes?a.0b.1c.2d.UnknownANS:AN0is an indication of no positive lymph nodes.REF:p. 719.Tumors are the result of which of the following?a.Black bileb.Necrotic tissuec.Abnormal cellular proliferationd.Traumatic injuryANS:COnce thought to be the result of black bile or traumatic injuries, tumors are now known to bethe result of abnormal cellular proliferation. Tumor growth may result in a large central areaof necrosis, but this is an effect rather than a cause.REF:p. 320.Tumor grade is a measure of ________.I.aggressivenessII.differentiationIII. spreada.I and IIb.I and IIIc.II and IIId.I, II, and IIIANS:ATumor grade is a measure of both aggressiveness and differentiation. Staging is used todescribe the tumor’s spread.REF:pp. 7-8

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21.Which of the following biopsy methods results in the removal of the entire tumor?a.Fine needle aspirationb.Core needlec.Incisionald.ExcisionalANS:DDuring a fine needle aspiration, only a few cells of the tumor are removed. The same is true ofcore needle biopsies. Incisional biopsies remove more tumor than either fine needle aspirationor core needle biopsy, but some of the tumor remains. During an excisional biopsy, the entiretumor is removed en bloc.REF:pp. 8-922.Which of the following biopsy methodscannotevaluate tumor architecture?a.Fine needle aspirationb.Core needlec.Incisionald.ExcisionalANS:AFine needle aspiration removes cells from a tumor but cannot retain the architecture of thetumor.REF:pp. 8-923.Factors that may exclude a patient from having surgery include allexceptwhich of thefollowing?a.Preexisting medical conditionsb.Tumor locationc.Patient preferenced.ClassificationANS:DThe invasive nature of surgical procedures for cancer removal may exclude some patientswith preexisting conditions. In addition, the location of some tumors (such as base of skulllesions) may eliminate surgery as a possible treatment option. Furthermore, surgery may beexcluded in an attempt to preserve function, as in the treatment of anal cancers. Tumorclassification alone is not a contraindication for surgery.REF:pp. 9-1024.When compared with surgery, benefits of radiation therapy include allexceptwhich of thefollowing?a.Instantaneous cureb.Better cosmetic resultsc.Preservation of functiond.NoninvasiveANS:A

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Individual results will vary based on tumor type and other factors but, as a general rule,radiation therapy provides patients with better cosmetic results than surgery. In addition,radiation therapy is noninvasive and can often preserve function not possible with surgery.However, only surgery can provide an instantaneous cure via total resection.REF:p. 1025.Which of the following treatment techniques uses radioactive sources?a.External beamb.Intraoperativec.Brachytherapyd.IMRTANS:CTypically, brachytherapy treatments require a radioactive source, although advances innanotechnology have resulted in some brachytherapy procedures using miniature x-ray tubes.In times past, radioactive cobalt was used in external beam radiation therapy, but this processis now antiquated.REF:p. 1126.Which of the following isnotused for brachytherapy treatments?a.Cesiumb.Cobaltc.Iodined.IridiumANS:BAlthough some reports document the use of cobalt for brachytherapy, it is traditionally usedfor external beam radiation therapy.REF:p. 1127.High-dose after loading equipment is used in association with which treatment technique?a.External beamb.Intraoperativec.Brachytherapyd.IMRTANS:CHigh-dose after loading equipment is used during brachytherapy treatments to reduce staffexposure to high doses of radiation.REF:p. 1128.Pancreatic cancer may be treated using which technique?a.Intraluminalb.Intravascularc.Intracavitaryd.IntraoperativeANS:D

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Although pancreatic cancer can be treated with radiation therapy by a number of differenttechniques, including 3D conformal, IMRT, and IGRT, it can also be treated using anintraoperative technique. Intraluminal, intravascular, and intracavitary are brachytherapytechniques not used for the treatment of pancreatic cancer.REF:pp. 10-1129.Which of the following is a systemic treatment?a.Surgeryb.Radiation therapyc.Chemotherapyd.All of the aboveANS:CRadiation therapy and surgery are localized treatments, whereas chemotherapy is a systemictreatment.REF:p. 1130.Which of the following routes of administration is used when treating bladder cancer withchemotherapy?a.Oralb.Intra-arterialc.Intracavitaryd.IntrathecalANS:CAs described in the text, bladdercancer may be treated by instilling the chemotherapy agentdirectly into the bladder via a catheter. This process is known as intracavitary chemotherapy.REF:p. 1231.Which classification of chemotherapy agents was the first to be identified as having anticanceractivities?a.Alkylating agentsb.Antimetabolitesc.Antibioticsd.Hormonal agentse.Nitrosoureasf.Vinca alkaloidsANS:AThe first chemotherapy agent was nitrous mustard, an alkylating agent.REF:p. 1232.Which of the following arenotcell cycles specific?I.Alkylating agentsII.AntimetabolitesIII. AntibioticsIV. Hormonal agentsV.Nitrosoureas

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VI. Vinca alkaloidsa.I and IIb.I and IIIc.I, III, and Vd.II, IV, and VIe.II, III, and VIANS:CAlkylating agents are not cell cycle specific. Neither are anticancer antibiotics (although theyare more effective during certain phases) nor nitrosoureas.REF:p. 1233.Which classification of chemotherapy agents is derived from the periwinkle plant?a.Alkylating agentsb.Antimetabolitesc.Antibioticsd.Hormonal agentse.Nitrosoureasf.Vinca alkaloidsANS:FPeriwinkle plants are part of the genusVincaand are sometimes called vinca. It is from theseplants that vinca alkaloids are derived.REF:p. 1234.In which classification are the chemotherapy agent’s lipids soluble and capable of crossing theblood-brain barrier?a.Alkylating agentsb.Antimetabolitesc.Antibioticsd.Hormonal agentse.Nitrosoureasf.Vinca alkaloidsANS:ENitrosoureas are the only classification of chemotherapy agents that are both lipid soluble andcapable of passing through the blood-brain barrier.REF:p. 1235.Which of the following is a radiosensitizing chemotherapy agent?a.Cyclophosphamideb.5-Fluorouracilc.Doxorubicind.CisplatinANS:CDoxorubicin, also known as Adriamycin, acts a radiosensitizer. Cyclophosphamide,5-fluorouracil, and cisplatin are not known to enhance the effects of radiation.

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REF:p. 1436.Which of the following acts as a radioprotector?a.Amifostineb.Actinomycin Dc.Adriamycind.EtoposideANS:AAmifostine acts to protect normal tissue against the effects of radiation and is, therefore,considered a radioprotector. Adriamycin is a radiosensitizer. Actinomycin and etoposide arenot known to be radioprotectors.REF:p. 1437.Injecting monoclonal antibodies is an example of which type of treatment?a.Surgeryb.Radiation therapyc.Chemotherapyd.ImmunotherapyANS:DInjection of monoclonal antibodies is an example of immunotherapy.REF:p. 1438.Which of the following best describes tumor spread?a.Exophyticb.Multicentricc.Disseminationd.UlcerationANS:CDissemination is defined as the act of spreading or diffusion and is most closely associatedwith cancer spread. Exophytic is used to describe tumors that grow outward. Multicentricdescribes tumors with more than one focus. Ulceration is the development of an ulcer and isunassociated with cancer spread.REF:p. 1539.Which of the following factors isnotconsidered when determining a prognosis?a.Tumor stageb.Nodal statusc.Genderd.All are consideredANS:DMany factors are considered when a physician determines a prognosis, including tumor site,grade, stage, size, and histology; lymph node status; performance status; and the patient’s age,gender, and race.REF:pp. 15-16

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40.Randomized studies are, by definition, which phase?a.Ib.IIc.IIId.IVANS:CPhase III studies are used to compare an experimental treatment to a standard treatment usinga randomized sample.REF:p. 1641.Which staff member is most responsible for designing the patient’s treatment plan?a.Medical physicistb.Radiation oncologistc.Dosimetristd.Radiation therapistANS:CSpecific duties will vary between specific departments, but as a general rule the medicaldosimetrist is responsible for designing the patient’s treatment plan. The medical physicist orradiation oncologist may oversee this process. In some departments, radiation therapistsparticipate in the treatment planning process.REF:pp. 16-1742.Which staff member is most responsible for the quality assurance to the treatment equipment?a.Medical physicistb.Radiation oncologistc.Dosimetristd.Radiation therapistANS:AAlthough all members of the cancer treatment team are responsible for quality assurance andthe radiation therapists and medical dosimetrists may perform some of the duties specific totreatment equipment quality assurance, the person most responsible is the medical physicist.REF:pp. 16-1743.Which of the following is an example of an etiologic factor?a.Genderb.Sexc.Raced.Social habitsANS:DAn etiologic factor would be one associated with the cause of cancer. Social habits such assmoking and alcohol use have been linked to the cause or elevation of the risk of certaincancers.REF:pp. 5-6

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44.A cancer designated with an N1 classification using the TNM staging system likely indicateswhich of the following?a.No positive lymph nodes are involved.b.Positive lymph nodes are involved at distant sites.c.Positive lymph nodes are involved near the site.d.Lymph nodes cannot be accessed.ANS:CThe N category describes the status of lymph node involvement. Nx, N0-N4 are often used.N1 likely indicates that one or more positive lymph nodes are involved close to the originalsite of malignancy.REF:p. 7

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Chapter 02: The Ethics and Legal Considerations of Cancer ManagementWashington & Leaver: Principles and Practice of Radiation Therapy, 4th EditionMULTIPLE CHOICE1.What is the study of ethical issues in medicine?a.Biometricsb.Bioethicsc.Macro ethicsd.Micro ethicsANS:BBioethics is defined as the application of ethics to medicine, nursing, and health care.Biometrics is a branch of biology that studies biological phenomena and observations bymeans of statistical analysis. Micro ethics consider individuals and internal relations of thespecific situations, whereas macro ethics applies to the collective social responsibility and tosocietal decisions.REF:p. 252.Which of the following isnota sanctionable offence by the American Registry of RadiologicTechnologists (ARRT)?a.Failure to participate in professional activities, share knowledge with colleagues,and investigate new aspects of professional practiceb.Impersonation of a candidate for the examinationc.Failure to perform radiation therapy procedures with reasonable skill and safetyd.Knowingly assisting, aiding, or allowing a person without a current certificateofregistration with the ARRT to engage in the practice of radiologic technology, in ajurisdiction that requires such registrationANS:AAlthough participation in professional activities, sharing knowledge, and researching newaspects of professional practice result in professional growth and other benefits, failure to beinvolved in any of these activities is not a sanctionable offense by the ARRT.REF:pp. 23-243.Which of the following is a theory of ethics developed by Immanuel Kant?a.Virtue ethicsb.Communitarianismc.Contextual ethicsd.DeontologyANS:DIn its purest form, deontology was developed by Immanuel Kant.REF:p. 264.Who is most closely associated with the stages of grief?a.Nel Noddings

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b.Elisabeth Kübler-Rossc.John Milld.Immanuel KantANS:BIn 1969, in her book titledOn Death and Dying, Dr. Elisabeth Kübler-Ross described severalstages a patient passes through while dealing with grief.REF:p. 315.Which group is responsible for producing the rules of ethics for radiation therapists?a.American Registry of Radiologic Technologists (ARRT)b.American Society of Radiologic Technologists (ASRT)c.American Medical Association (AMA)d.American Hospital Association (AHA)ANS:AThe rules of ethics are part of the ARRT’s standards of ethics document. The ASRT has acode of ethics for radiation therapists but no rules of ethics. The AMA and AHA do not haveany documents specific to radiation therapists.REF:p. 216.Utilitarianism is an example of which broad group of ethical theories?a.Teleologyb.Deontologyc.Virtue ethicsANS:AUtilitarianism is one of the two major divisions of teleology (with egoism).REF:pp. 26-277.Jeremy Bentham and John Mill are most closely associated with which ethical theory?a.Communitarianismb.Egoismc.Natural law ethicsd.UtilitarianismANS:DBentham and Mill are typically held to be the founders of utilitarianism as an ethical theory.REF:pp. 26-278.What occurs when the obvious solution to a problem is prohibited by institutional constraints?a.Ethical dilemmab.Ethical dilemma of justicec.Ethical distressd.Locus of authorityANS:CEthical distress occurs when a problem has an obvious solution, but institutional constraintsprohibit the application of the solution.

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REF:pp. 26-279.Allocation of scarce resources is an example of which ethical category?a.Ethical dilemmab.Ethical dilemma of justicec.Ethical distressd.Locus of authorityANS:BEthical dilemmas of justice are problems associated with the distribution of benefits andburdens, such as the allocation of scarce resources.REF:p. 2710.Which patient/provider relationship model is best represented by the informed consentprocess?a.Engineeringb.Priestlyc.Collegiald.Contractuale.CovenantANS:DThe contractual model is based on a business relationship model and includes a “contract,”such as the informed consent form.REF:p. 2711.Which patient/provider relationship model devalues autonomy?a.Engineeringb.Priestlyc.Collegiald.Contractuale.CovenantANS:BThe priestly model assumes that the caregiver knows what is best for the patient and does notallow for the patient to provide input into the decision-making process.REF:p. 2712.Which of the following isnota source from which values are derived?a.Moneyb.Experiencec.Religiond.ScienceANS:AAlthough money may factor into many aspects of decisions, values are not derived frommoney. Values are instead the result of culture, experience, religion, and science.

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