| Post Name | Assistant Professor in Radiotherapy - Medical Education |
|---|---|
| Question Paper Code | 032/2024/OL |
| Category Code | 346/2023 |
| Date of Test | 23 March 2024 |
| Exam Type | Online Examination |
| Total Questions | 100 |
1
46 year old premenopausal lady with ECOG PS0, underwent Left BCS (Breast Conservation Surgery) and SLNB (Sentinel Lymph Node Biopsy) for left medial quadrant breast cancer. Post-operative histopathology shows IDC, Gr2, T = 3.5 cm, SLNB - One Lymph node positive. ER + PR + Her2 Neu Negative. Metastatic work up within normal limits. She is not planned for further axillary node dissection and decided to be treated with post BCS adjuvant RT. What is the best RT schedule ?
Answer
A. Left whole breast, internal mammary and supraclavicular drainage areas 40Gy/15 Fr RT with SIB for tumour bed boost 48Gy/15fr using VMAT technique.
2
Which of the following OAR dose volume parameter for the RT plan of whole breast, is not an acceptable one ?
Answer
A. The prescription dose is 26Gy/5fr over a week. Ipsilateral lung dose V7.8Gy 18%
3
68 year old lady underwent TAH+BSO and Bilateral pelvic lymph node dissection for endometroid endometrial cancer. ECOG PS is 1, no co-morbidities. Postoperative histopathology shows Grade2 endometroid carcinoma involving >50% myometrium, ER+, P53 abnormal, cervical stromal involvement, LVSI negative, Left and right pelvic lymph nodes negative for cancer. Best treatment option for this patient among the following is
Answer
D. Either 2 or 3
4
65-year-old gentleman a diagnosed case of Adenocarcinoma of Prostate. ECOG PS0, Gleason Score 6, PSA-15ng/ml. Metastatic Work up done with a PSMA PET Scan, showed no evidence of Lymph nodal or distant Metastases. What is the best treatment option if he is not considering surgical or surveillance option ?
Answer
B. Induction treatment with Leuprolide for 3-6 months and Radical EBRT 60Gy/20fr
5
Which of the statements is TRUE about DNA repair processes ?
Answer
C. The most common types of DNA damage induced by ionizing radiation are repaired through base excision repair
6
Equal doses of densely-and sparsely-ionizing radiations, produce diļ¬erent levels of biological damage. Which of the following is the best explanation of the diļ¬erence in biological eļ¬ectiveness ?
Answer
D. Densely ionizing radiations produces more ionizations per unit length of the track
7
A patient with a diagnosis of oral cavity cancer was planned for Radical Radiation treatment. The dose prescription was 70Gy/35 fraction over a period of 7 weeks with 5 fractions a week. After 5 week of treatment he defaulted and lost the whole week of radiation. He is now ready for continuation of the treatment. He has no contraindication for continuing it. After the gap, treatment resumes on the Monday of the seventh week of the schedule. As a radiation oncologist you wish to give a correction for the gap. What will be the best option among the following ?
Answer
A. Ideally these ten fractions should be delivered over the ļ¬ve remaining treatment days so as not to extend the treatment. The missed dose can therefore be compensated for by delivering the remainder of the treatment as twice-daily fractions (minimum of six hours apart) in each weekday of the ļ¬nal week
8
58 year old gentleman ECOG PS1 with a diagnosis of Left Parietal Glioblastoma Multiforme, is planned postoperative adjuvant Radiotherapy with concomitant Temozolamide. He was planned 60Gy/30 fraction as convention fractionation schedule along with daily Temozolamide 75 mg/ and also Co- Trimoxazole as PCP prophylaxis. His routine blood is done every week during the course of treatment. Which of the following is not acceptable decision in this treatment plan ?
Answer
A. Second week of treatment his Platelet count is 48,000/microliter. All other blood counts and general condition is normal. He needs interruption of Temozolamide till recovery of platelet to 1,00,000/microliter but he can continue RT.
9
A tumour has a cell cycle time of 10 days, a growth fraction of 0.5 and a cell loss factor of 1.0. Considering these kinetic parameters remain constant over a period of one month, how much would the tumour volume have increased during that time ?
Answer
B. Remain the same
10
A Radiation schedule of 60 Gy in once-daily 2 Gy fractions was planned for the patient. If the fraction size is decreased to 1.3 Gy in an attempt to reduce the incidence of late eļ¬ects, approximately what total dose should be delivered to maintain the same level of tumor control ? (Assume an equal eļ¬ect per fraction, no repopulation, and an / ratio for the tumour of 10 Gy.)
Answer
B. 64 Gy
11
Carboplatin along with Paclitaxel was planned for the ovarian cancer patient as adjuvant chemotherapy. While calculating the dose of carboplatin using the Calvert formula (GFR+25) X target AUC, the consultant asked the resident why 25 is added to GFRF ? Resident gave the correct explanation and she was congratulated. What would have been her explanation to this question ?
Answer
B. 25 ml/minute is a constant which measures the non-GFR clearance of Carboplatin
12
52 year chronic smoker ECOG PS 1, history of migraine attacks, newly diagnosed as a case of Non-Small cell lung cancer, Adeno carcinoma stage IV liver metastases. EGFR, ALK, ROS1 mutations were all wild type. PDL1 69%. He was started on immunotherapy with Pembrolizumab. He completed 3 cycles of the treatment fairly well. On day 10 of the third cycle of Pembrolizumab he reported to the emergency department with tiredness, severe headache and blurred vision. On examination he was afebrile, BP 98/62 mm of Hg. Otherwise he is conscious oriented and no other symptoms. What is the best initial management for him ?
Answer
C. Start on IV Methyl prednisolone 1mg/kg, analgesics after sending blood for Serum Cortisol, ACTH, TSH
13
A patient treated with combination chemotherapy with Docetaxel and Cyclophosphamide for metastatic breast cancer reports to the emergency department with tiredness and sore throat on day of chemotherapy. On clinical examination he is afebrile, Respiratory rate-25/minute, pulse rate 100/minute. Oxygen saturation 90%. BP 90 systolic. Management options include some or all of the following. a. Intravenous line b. IV antibiotics with Piperacillin and Tazobactum c. Blood for complete blood count, Biochemistry, S. lactate, Culture and sensitivity d. Intravenous ļ¬uid with normal saline e. Oxygen inhalation. What is the correct sequence of the immediate management for the clinical condition ?
Answer
A. a, c, d, e, b without waiting for blood results
14
What is false about Sacituzumab Govitecan ?
Answer
D. Inhibition of topoisomerase I results in single-strand DNA breaks, apoptosis, and ultimately cell death and termination of cellular replication
15
What is false about phases of Clinical Trials ?
Answer
D. Phase 3 is post-marketing surveillance
16
Which among the following is incorrectly matched with regards to chemotherapy extravasation ?
Answer
D. Mitomycin C- Hyaluronidase is an antidote
17
Which is false regarding imaging in Oncology ?
Answer
A. The basic principle of PET is that proton-rich radionuclides decay by emitting positrons ( +), which subsequently travel a short distance and annihilate with an electron ( ā) to create two, 255 KeV photons that arise almost exactly 180Ā° apart
18
Which among the following is false with respect to 'RadScopal' eļ¬ect ?
Answer
C. An interesting phenomenon that local radiation may exert a systemic antitumor immune response and lead to the regression of non-irradiated distant tumors
19
Below is the axial CT slice at the level of upper thorax. Which of the following is not correctly matched regarding this CT slice ?
Answer
A. Arrow labelled 3- represent Right internal jugular vein
20
50-year-old male is undergoing Stereotactic Body Radiation Therapy (SBRT) for an unresectable cholangiocarcinoma of the common bile duct. The duodenum is a major Organ at Risk. With regards to the relations of the duodenum identify the false statement.
Answer
B. Left ureter, left renal vessels, left adrenal gland forms posterior relation
21
You are contouring the target volumes on a 53-year-old male with a T3N0M0 adenocarcinoma of the low rectum. The tumour extends below the dentate line. The lymph node groups that this lesion could potentially drain are bilateral inguinal, bilateral external iliac, bilateral internal iliac, bilateral obturator, mesorectal, presacral lymph node groups. In the same patient, if the primary rectal cancer was above the dentate line, which nodal groups would you remove from your list above ? Give the best answer.
Answer
C. Bilateral Inguinal and Bilateral external iliac
22
Hodgkin's lymphoma one of the pathological hall mark is presence of Reed Sternberg in microscopy. Which among the following is not true about Reed Sternberg cell ?
Answer
B. Basophilic inclusion like nucleoli with Owl's eye appearance
23
Superior pulmonary sulcus tumors, also called Pancoast tumors, arise from the apical pleuropulmonary groove located superior to the ļ¬rst rib. When these tumors involve the surrounding structures such as the brachial plexus, cervical paravertebral sympathetic nervous system, and stellate ganglion, they cause a group of signs and symptoms that are collectively called Pancoast syndrome. In this context which is false regarding this scenario ?
Answer
C. Contraindications to surgical resection include presence of metastases, involvement of ipsilateral or contralateral mediastinal nodes or supraclavicular nodes, involvement of vertebral bodies greater than 50%, involvement of esophagus and trachea, involvement of brachial plexus below T1 nerve root
24
Pain management is an integral part of cancer treatment. Oral morphine are very commonly used in pain management. There are scenarios where we need to switch morphine to other opioids. In this context of switching oral morphine to below mentioned opiods the ratio followed is correct except
Answer
B. To oral hydromorphone 1:3
25
Which is true regarding radioisotopes used in pain management ?
Answer
C. is a pure beta emitter with long physical half life (50 days)
26
Regarding emesis management which is false ?
Answer
D. Netupitant is a less selective NK1 receptor antagonist that targets serotonin and substance Pāmediated pathways
27
65 year old lady ECOG PS0 is planned for combination adjuvant chemotherapy for Ovarian cancer. Following is the blood investigation report prior to the start of chemotherapy. Junior Resident has multiple queries prior to start of chemotherapy based on this report. Being a consultant you have cleared all the queries. Which among the below is the best advice ?
Answer
A. Paclitaxel dose needs to be modiļ¬ed from 175 mg/mĀ² to 135 mg/mĀ² , carboplatin needs no dose modiļ¬cation
28
Which is false in the management of Gastro Intestinal Stromal Tumour (GIST) ?
Answer
B. The presence and type of KIT and PDGFRA mutations are strongly correlated with prognosis
29
Which of the following is a prodrug ?
Answer
B. Dacarbazine
30
Which is false regarding the basic principles in chemotherapy and radiotherapy ?
Answer
D. Dose Maximum is a measure of dose per unit of time and thus allows comparisons between protracted and compacted dosing schedules
31
Nucleus of an atom contains
Answer
D. Protons and neutrons
32
Curie is the unit of
Answer
C. Radioactivity
33
Oxygen enhancement ratio decreases as
Answer
B. LET increases and RBE increases
34
One curie a unit of activity is equal to
Answer
C. 3.7 disintegrations per sec.
35
The S.I. unit for roentgen. Is
Answer
A. Coulomb/kg
36
Pair production is possible only with photon having energy more than
Answer
A. 1.02 MeV
37
A ļ¬ssion product of uranium is
Answer
C. Cesium ā 137.
38
The unit-of-dose equivalent that is used to express radiation exposure to living tissue is the
Answer
C. Rem.
39
In photo electric eļ¬ect, the x-ray interact with
Answer
C. Bound electrons
40
In the ortho-voltage range of radiation therapy, which of the following interactions predominates ?
Answer
B. Photoelectric eļ¬ects
41
Percentage depth dose increase with increases in
Answer
B. SSD
42
In a ļ¬xed SSD technique, the dose is routinely normalized at
Answer
A. Dmax
43
Concept of fractionated radiotherapy was given by
Answer
D. Henri Coutard and Claude Regau
44
When parallel opposed 6MV photon beams are used in a 22 cm thick patient, the maxium dose will occur at
Answer
B. The dose will be uniform throughout the patient
45
The attenuation of Cerrobend is
Answer
B. About 15 percent less than lead
46
True about stochastic eļ¬ect are all except
Answer
C. Has a threshold of dose
47
Half life of Cobalt-60 is
Answer
B. 5.3 years
48
Increasing the distance from 80 to 90 cm. causes the dose rate to change by
Answer
D. 0.7901
49
Which of the following is not a part of gantry of modern LINAC ?
Answer
D. 6DOF (Degree of Freedom) movement
50
The central axis percentage depth dose of various energies should be deļ¬ned at
Answer
C. 10 cm
51
The technique employed in radiotherapy to counteract the eļ¬ect of tumor motion due to breathing is known as
Answer
C. Gating
52
The term GTV as deļ¬ned by ICRU, means
Answer
B. The gross palpable or visible/demonstrable tumor extent to be irradiated to a speciļ¬ed dose
53
Film badge reports are stated in quantities of
Answer
B. Rems or millirems.
54
The commonest wedge used for treatment of carcinoma maxilla is
Answer
B. 45Ā° wedge
55
Tangential ļ¬elds are used in the treatment of
Answer
B. Carcinoma breast
56
Wedge ļ¬lters are useful because
Answer
C. Dose distributions become uniform
57
Which of the following is not a immobilization device ?
Answer
D. Front pointer
58
The minimize the risk of cold and hot spot in the junction between two photon ļ¬elds, the gap should
Answer
A. Be moved several times during the treatment course
59
All of the following except are various methods used for in-vivo dosimetry in Radiotherapy
Answer
C. Port Films
60
Which of the following is not true about Dose-Volume Histogram (DVH) ?
Answer
B. DVH clearly shows where within a structure a dose is received
61
The higher the energy of an electron beam
Answer
Question Cancelled
62
Which of the following is not true ?
Answer
A. Electron beam energy selected should cover the target volume completely within 100% isodose curve
63
When the ļ¬eld is reduced below that required for lateral scatter equilibrium
Answer
Question Cancelled
64
The minimum thickness of lead required to block a 12MeV electron beam is approximately
Answer
C. 7 mm
65
What is the primary standard for electron dosimetry ?
Answer
B. Graphite calorimeter
66
At photon-electron ļ¬eld matching
Answer
B. Beams should abut each other, there are cold spots in electron side and hotspots in photon side
67
As the beam obliquity increases, the following would happen except
Answer
D. Penumbra increases for surface close to source
68
Which is not true regarding total skin electron therapy ?
Answer
A. Surface to Skin Dose (SSD) is 120 cm
69
Which of the following is not true with respect to TSET ?
Answer
D. Eye shields are usually not recommended
70
Regarding IORT, which of the following is not true ?
Answer
D. Not suitable in recurrent setting
71
Which of the following is true about Ir-192 brachytherapy source ?
Answer
C. Half-life~73.8 days
72
Which of the following brachytherapy radioisotopes has the greatest HVL ?
Answer
B. Ra-226 (average energy 0.83 MeV)
73
Which of the following is used for LDR brachytherapy source calibration ?
Answer
B. Well type ionisation chamber
74
Which one of the following is said to be the biological advantage of LDR brachytherapy when compared to HDR ?
Answer
B. Low dose rate is biologically similar to fractionated radiotherapy and results in sublethal damage repair of the normal tissues
75
What is the maximum depth of the tumor for which surface mould brachytherapy can be used for cure ?
Answer
B. 5mm
76
Which of the following is not true about after loading in brachytherapy ?
Answer
C. Plaque brachytherapy involves manual after loading technique
77
Which of the following is not an implantation technique used in intestitial brahytherapy ?
Answer
D. Stockholm
78
Which among the following is not true about ideal placement of intracavitary brachytherapy applicator in carcinoma cervix treatment ?
Answer
D. Unacceptable geometry will result in unacceptable normal tissue toxicity, but patient's survival is not aļ¬ected
79
Which among the following is not a radio pharmaceutical drug used for palliative treatment of bone metastasis ?
Answer
D. Pd-103
80
Which of the following is not true about Ir-192 brachytherapy facility ?
Answer
D. The primary barrier thickness should be 70 cm and secondary barrier thickness is 50 cm in order to ensure safety in the console
81
Which among the following does not contribute to background radiation ?
Answer
C. External radiation from nuclear reactors and other equipment
82
Out of the limits for occupational workers laid down by AERB listed below, which one is similar to those advised by ICRP ?
Answer
Question Cancelled
83
For an absorbed dose of 2 Gy during a TBI treatment using a LINAC, the equivalent dose received will be
Answer
C. 2 Sv
84
The half value layer thickness of lead for is
Answer
B. 3 mm
85
TLD badges in India consist of following compound
Answer
D. Calcium sulphate
86
Neutrons are produced with X-ray beam energy exceeding
Answer
C. 10 MV
87
For quality assurance of beam ļ¬atness for photon beams, how much dose variation is considered acceptable ?
Answer
A. +3% to ā3%
88
The ampliļ¬cation of charge in a Gieger-Muller counter is INDEPENDENT of
Answer
C. Type of radiation being detected
89
In ļ¬uoroscopic simulation, if an image is acquired with the subject at a distance shorter than SSD (=100cm) while keeping the imager at the same distance, the subject will appear
Answer
A. Magniļ¬ed in size
90
Peak scatter factor denotes
Answer
A. Tissue-air ratio speciļ¬c for depth of peak dose
91
As per ICRU report 50, which of the following statements is NOT true ?
Answer
B. A hot spot represents a volume outside the PTV which receives a dose larger than 107% speciļ¬ed PTV dose
92
The ICRU report 62 introduced the following aspects of 3D treatment planning in addition to the ones already explained in ICRU report 50, EXCEPT
Answer
C. Irradiated volume
93
Which of the following statements is NOT TRUE for inverse planning for IMRT ?
Answer
D. Beam direction is assigned arbitrarily
94
In dynamic MLC delivery of IMRT, intensity modulation is achieved if parallel MLC leaves are moving
Answer
C. In same direction with diļ¬erent velocities
95
As per HyTec are commendations, metastatic brain lesions should be considered for SRT instead of SRS if their maximum diameter exceeds
Answer
B. 20 mm
96
Which of the following mechanisms have been attributed to tumor cell death by SRS ?
Answer
D. All of the above
97
A dedicated gantry based isocentric linear accelerator for SRS/SBRT has which of the following ? 1. Flattening ļ¬lter free beam 2. Reduced leaf width MLC 3. Motion management systems 4. 6D robotic couch table
Answer
C. 1, 2, 3 and 4
98
Which step in the installation and commissioning process of a new radiotherapy facility involves verifying the accuracy of beam delivery by comparing calculated and measured dose distributions in a phantom ?
Answer
A. Dosimetric veriļ¬cation of treatment planning systems
99
What is a key procedural step in the installation and commissioning of a teletherapy radiotherapy facility that involves the veriļ¬cation of beam characteristics using water phantoms and ionization chambers ?
Answer
C. Calibration of beam output using dosimetry techniques
100
In the calibration process of a new radiotherapy unit, what procedure ensures accurate delivery of prescribed radiation doses by establishing the relationship between monitor units and absorbed dose ?
Answer
B. Measurement of treatment machine output factors
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