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47 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Question 1
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page 103
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Which of the following describes the activity on delayed static images in a patient with testicular torision?
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decreased
normal increased variable |
decreased
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Clearance of 99-mTc MAG3 is by
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active transport
tubular secretion glomerular filtration none of the above |
tubular secretion
Tc-99m MAG3 is cleared by the proximal tubules. DTPA is cleared by glomerular filtration rate (GFR) 99m-Tc DMSA binds to proximal renal tubules, and is useful for imaging the renal parenchyma and clears very slowly int the urine...... 99-Tc GH is clreared by both glomerular filtration and the renal tubules and is also useful for imaging the renal cortex |
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Which renal imaging agent allows imaging at 6 hours after injection
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99m-Tc MAG3
99m-Tc DTPA 99m-Tc GH 99m-Tc DMSA |
99m-Tc DMSA
Injected 99m-Tc DMSA will remain concentrated in the renal cortex for many hours after injection.....delayed imaging is often necessary to have sufficient activity in the kidneys relative to the background if the patient has impaired renal function |
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A patient with Cushing's syndrome might receive a dose of
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I 131 NP-59 to study the adrenal cortex
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A patient who receives an injection of II 131 MIBG for the detection of pheochromocytoma should also receive
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potassium perchlorate
dipyridamole Lugol's Solution cimetidine |
Lugol's solution
page 258 Lugol's solution will block some of the uptake of I131 by the thyroid |
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Which of the following is used to image the adrenal cortex?
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131-I MIBG
131 I-NP-59 |
131 I-NP-59
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99Tc DMSA delivers a relatively high radiation dose to the kidneys becasues
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20 mCi are normally inkected in renal studies
there is a long effective half life in the kidneys there is a long physical half life in the kidneys a high energy photon is emited |
there is a long effective half life in the kidneys
Although the dose can be lower than other 99Tc renal imaging agents...... the radiation dose to the kidneys is higher than other agents due DMSA remains fixed in the kidney s for many hours |
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Which of the following is excreted through glomerular filtration?
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99m-Tc DTPA
99m-Tc DMSA 99m-Tc MAG3 99m-Tc GH |
99m-Tc DTPA
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Indications for renal scanning with radionuclides include?
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assess blood flow to transplanted kidneys
allergy to iodinated contrast assess function of native kidneys evaluation of space occupying lesions - all of the above |
all of the above
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Normal glomerular filtration rate is
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25 mL/min
50mL/min 100mL/min 125mL/MIM |
125mL/min
Glomerular filtration is the process that removes excess water, salts and urea from the blood....this filtration takes place in the glomeruli following which the filtered blood flows into Bowman's capsule. GFR varies according to age, race and gender but the average value is 120-125 ml/min for both kidneys in young and middle ages adults. |
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For visualizing intraparenchymal lesions in the kidneys, the radiopharmaceutical of choice from the list below is:
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99Tc-DMSA
99Tc-DTPA 99Tc- MAG3 131OIH |
99Tc-DMSA
DMSA binds to the proximal renal tubules....is useful for imaging the renal parenchyma and clears very slowly in the urine |
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What is the preparation for renal functioning imaging what 99m-Tc MAG3?
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- NPO for at least 4 hours
-patient must be well hydrated -patient must void at least one our before imaging -patient must drink nothing for 2 hours prior to the examination -all patient must be cathetrtized |
patient must be well hydrated
Patients undergoing renal imaging with 99 Tc MAG3 should be well hydrated and should void before the exam.....The renogram may show delayed peak activity and delayed clearance of radopharm. if the patient is dehydrated...... |
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30 minutes after injection of 8 mCi of 99-Tc MAG3, there is significant activity remaining in the renal pelvis.....what will most likely follow?
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- patient will be asked to void before re-imaging
- a diuretic will be administered -imaging will be extended for 20 minutes - all of the above |
all of the above
If an obstruction is suspected, a diuretic can be administered....the patient should be asked to void or be catherized....and further imaging may be carried out |
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IF AFTER administration of furosemide, a patient still has activity in the renal calyces there is possibility
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poor renal function
renal artery occulusion renal infarction collecting system obstruction |
collecting system obstruction
Diuretic renography, usally performed using 99m-Tc MAG3 with furosemide can help differentiate between functional abnormalities and anatomic obstruction. Furosemide will increase the pressure in the renal pelvis causing the tracer to move from the collecting system, unless the obstruction is anatomic....in this case there would be little change in the distribution of the tracer |
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Performing an evaluation of a renal transplant includes the following consdiderations
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detector face should be centered over the right or left iliac fossa
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Imaging of transplants is performed anteriorly with the detector centered over the relevant iliac fossa.
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The left kidney is usally lower then the right because of the spleen
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true
falsw |
false
The right kidney is often, but not always, lower than the left....probably because of its proximity to the liver...... |
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Setting up for a scrotal scan includes
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elevating the scotum with towels or a sling fashioned from tape across the thighs
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Torsion of the testicle
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is a surgical emergency
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Testicular Torsion is a painful condition in which the spermatic cord is twisted and is usally requires surgical correction within 5-6 hours......It often follows trauma......but may also be caused by a congenital abnormality.... or may be spontaneous...... the involved testicles is always swollen
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The adult dose of 99m-Tc for imaging of the testicles
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10-20 mCi
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The kidneys are normally perfused via the illiac artery
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true
false |
false
The blood supply to the kidneys comes from the renal arteries which arise from the descending aorta |
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Radionuclide cystography is most often performed
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detect vesicoureteral reflux
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Radionuclide cystopraphy is performed to evaluate patients for vesicoureteral reflux. The radiopharm. is introduced into the bladder with saline..... and the patient is imaged during bladder filling and voiding to detect reflux of activity from the bladder into the ureters.
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The expected bladder capacity for a 6 year old is
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240 ml
formula: age + 2 x 30 ml |
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The reason for calculation of of expected bladder capacity before radionuclide cystography:
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to have an idea of when maximum bladder filling will be reached
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Quantitative information can only be obtained by comparing counts in the bladder pre and post voiding...... and by using regions of interest in the ureters
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A tech. is performing a radionuclide cystography on a 4 year old girl. During bladder filling with Tc-99 in saline there is a leakage from around the catheter. What impact will this have?
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quantitative information will be not accurate
the detector may become contaominated if it has not been properly protected with plastic-backed absorbent paper |
The possibility to image any reflux will not be lost....but there is danger that the detector will be contaminated and some quantitative information may be unreliable
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Which of the following describes normal images from radionuclide cystohgraphy during bladder filling?
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-increasing activity over time in bladder
-homogeneous activity in both ureters -decreasing activity in the kidneys over time - none of the above |
increasing activity in the bladder over time
Normal cystopgraphy will show an increase in activity in the bladder during filling and decreasing activity during voiding with no activity in the ureters or kidneys |
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Preparation for pediatric radionuclide cystography includes
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-patient catheterization
-calculation of expected bladder capacity -taking measures to prevent contamination of equipment etc emptying the patient's bladder - all of the above |
all of the above
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In normal patients, a volume of up to 1.5 m: may reflux into the ureters and kidneys at maximum bladder filling?
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true
false |
false
any reflux into the ureters or kidneys is abnormal......small volumes of reflux into the distal ureters may be difficult to detect |
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Voiding images taking during radionuclide cystography should be:
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-dynamic images
- acquired based on information density - 5 minute images - taken for 500 k |
dynamic images
- filling and voiding images should be dynamic images |
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Which of the following is NOT true regarding glomerular filtration rate?
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-it usually becomes abnormal before serum creatinine levels become abnormal
-it is typically obtained through the use of DTPA - it can be determined only by taking blood or urine - it is a measure of the ability of the kidneys to clear insulin from the plasma -all except b |
it can be determined only by taking blood or urine samples
GFR is the amount of fluid filtered from glomerular capillaries to Bowman's capsule in a given amount of time, normally expressed as ml/min..... It is defined as the ability of the kidneys to clear insulin from plasma; insulin is a substance that is filtered by the glomeruli and is not secreted or reabsorbed by the tubules. Significant kidney function may be lost before serum creatinine becomes abnormal so GFR is an important measurement. 99-mTc DTPA is cleared by the glomeruli and is used for measuring glomerular filtration rate |
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Which radiopharmaceutical can be used to determine effective renal plasma flow?
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MAG3
131 I OIH DTPA a and b |
a and b only
MAG3 131 I OIH Renal Plasma Flow is defined as the clearance of para-aminohippurate (PAH) which is secreted and filtered by the renal tubules from plasma Effective Renal Plasma Flow (ERPF) has been measured using I131 OIH in the past and more recently 99-Tc MAG3. It is termed effectivce because it does not equal the clearance of PAH, but approixmates it |
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An advantage of GFR and ERPF measurements over other indicators of renal function such as BUN and creatinine is that the function of each kidney can be determined seperately
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true
false |
true
Blood tests with implications for renal function, like BUN and creatinine only capture information about overall renal function..... Quantitative studies of GFR and ERPF can provide information about individual kidney function |
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Which saline bottle would be sufficient to fill the bladder of an 8 year old during radionuclide?
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age (8yrs) + 2 x 30mL
300 |
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Which renal imaging agent requires the highest dose?
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DTPA
I 131 OIH MAG3 DMSA c and d |
MAG3 and DMSA
DMSA is usually adm. in lower doses because of its retention in the kindey I 131 OIH with its beta emissions and long half life also has a lower dosage MAG3 and DTPA have similar dosages |
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A tech. prepares a radiopharm. for renal imaging at 8:00am. The patient arrives late at 12:15 pm and therefore a new kit has to be made. The radiopharm. being used is:
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DTPA
MAG3 GH DMSA |
DMSA
DMSA should be disgarded after 4 hrs |
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On a normal renal scan, the gallbladder activity is noted.....this indicated that the scan was performing using:
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99-TcMAG3
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A small % of 99m-Tc MAG3 may be taken up in the liver and GB in normal patients..... and this may be more pronounced in patients with poor renal function
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Following the injection of 131I NP-59 imaging for adrenal lesions is performed
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5-7 days later
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The adrenal glands
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superior to the kidneys
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Which of the following is a tuft of capillaries?
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loop of henle
the glomerulus renal pyramid collecing tubule |
the glomerulus
The glomerulus is a tuft or a group/bunch of capillaries within the nephron. The loop of Henle is the hairpin loop that the tubules makes. Distal tubules from several nephrons join to form the collecting duct. The renal pyramids are part of the renal medulla which empty into the renal pelvis. |
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What percentage of cardiac output is directed to the kidneys?
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10%
25% 40% 50% |
25%
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ON A normal static image of the kidneys, the lower poles of the kidneys appear slightly decreased in intensity relative to the upper poles. Why is that?
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the lower poles of the kidneys are situated slightly anterior to the upper poles
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If the images are obtained posteriorly, the lower poles may appear to have slightly less activity than the upper poles because lower the poles are often situated slightly anterior to the upper poles
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In a patient with renal artery stenosis
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a post captopril study will show decreased GFR
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Patients who have renal artery stenosis.....when given an ACE (angiotensin converting enzyme) inhibitor will show decrease in GFR. Therefore, captopril renpgraphy is an effective examination to determine whether renal artery stenosis is the cause of hypertension
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When performing captopril renography, captopril should be administered
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ONE HOUR PRIOR TO THE INJECTION OF THE RADIOPHARM
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Preparation for captopril renography includes
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-ACE inhibitors
-fasting to enhance absorption of oral captopil - all of the above - none of the above |
all of the above
The patient should be well hydrated... fasting and off..... ACE inhibtors before the study begins. The length of time that the medication should be held depends on the type of medication; typically 3 days for captopril and one week for some other medications |
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Captopril is used when
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the patient is suspected of having renovascular hypertension
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Captopril renography is used when the patient is suspected of having renovascular hypertension.....but since only 1-4% of hypertension is due to renovascular hypertension....it is not used as a screening test in all cases of hypertension
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Question 46
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page 113
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The renogram shown indicates poor renal function....There appears to be a no excretion so a diuretic could be adm. in the hope of inducing excretion
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The adrenal glands sit on top of the ___________
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kidneys
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