Love Oral Boards - Nukes

Front 1

Abnormal renal activity on MDP

Back 1

AKI
- CIN
- antibiotics
- chemo
ATN
pyelo
RVT
obstruction
radiation
Multiple myeloma
iron overload

Front 2

MDP accumulation in tumors

Back 2

Osteosarcoma mets
NB
breast CA
meningioma
lung CA
mucinous liver mets
malignant effusions and ascites

Front 3

Abnormal stomach activity on MDP

Back 3

free TcO4 (check thyroid)
hyperparathyroid (check lungs)

Front 4

Breast activity on MDP

Back 4

Breast CA

Radiation

Fibrocystic dz

Mastitis

Post biopsy

Skin dz such as psoriasis

Vascular/lymphatic obstruction

Front 5

Soft tissue activity on MDP - focal

Back 5

breast or lung cancer
malignant effusions and ascites
brain and heart infarcts
fibrothorax
radiation pneumonitis

Front 6

Soft tissue activity on MDP - diffuse

Back 6

venous or lymphatic obstruction
soft tissue neoplasm
crush or thermal injury
surgery
radiation

Front 7

Muscle activity on MDP

Back 7

over use
MO
Heterotopic ossiication
hematoma
ischemia
compartment syndrome
rhabdomyolysis
electrical injury
Fe dextran injection

Front 8

Hepatic uptake on MDP - focal

Back 8

mets (mucinous colon, breast, ovary)
hepatoma
cholangiocarcinoma
necrosis
hematoma
amyloid
infarct

Peds:
hepatoblastoma
metastatic neuroblastoma

Front 9

Hepatic uptake on MDP - diffuse

Back 9

aluminum contamination
hepatic necrosis
colloid formation during preperation

Front 10

Spleen uptake on MDP

Back 10

SS
Thalassemia
hemosiderosis
hematoma
infarct

Front 11

Lung uptake on MDP

Back 11

mets
metastatic Ca+
fibrothorax
malignant effusion
lung cancer
radiation

Front 12

Superscan

Back 12

Mets
Hyperparathyroid
Pagets
Renal osteodystrophy
Osteomalacia
Myelofibrosis
Mastocytosis
Fluorosis

Front 13

Cold defect on MDP

Back 13

tumor (RCC, thyroid, leukemia, myeloma, chordoma)
hemangioma
osteomyelitis (high pressure)
AVN
radiation
attenuation (metal, BaSO4)

Front 14

Increased RAIU

Back 14

graves
TMG
early hashimotos ("Hashitoxicosis")
recovering dequivains
iodine deficiency
exogenous TSH

Front 15

Decreased RAIU

Back 15

hypothyroid
subacute thyroiditis
late hashimotos
IV contrast
meds (PTU, Lugols, Cytomel (T3), Synthroid (T4))
ectopic thyroid hormone (struma ovarii)

Front 16

Hot thyroid nodule

Back 16

adenoma
adenomatous hyperplasia
very rarely cancer

Front 17

Cold thyroid nodule

Back 17

colloid cyst
nonfunctional adenoma
carcinoma
abscess
hemorrhage
mets
lymphoma
parathyroid adenoma

Front 18

Hot liver lesion on SC

Back 18

FNH (1/3 of FNH are hot, 1/3 cold, 1/3 iso)
regenerating nodule
budd chiari (caudate lobe)
SVC obstruction (quadrate lobe)

Front 19

Cold liver lesion on SC

Back 19

mets
adenoma
abscess
cyst
hepatoma
hemangioma
FNH (1/3 of FNH are hot, 1/3 cold, 1/3 iso)

Front 20

Delayed biliary-bowel transit of HIDA

Back 20

obstruction (partial, total)
meds (narcotics)
ascending cholangitis

Front 21

Persistent nephrogram

Back 21

ATN
obstruction
RVT
RAS (MAG3)

Front 22

False positive ACEI renogram

Back 22

dehydration
ACE induced hypotension

Front 23

Panda sign

Back 23

sarcoid
sjogrens
AIDS
radiation

Front 24

Diffuse lung uptake on gallium

Back 24

sarcoid
PCP
Pneumoconioses
Drugs (bleomycin)
pneumonia
radiation
HP

Front 25

Kidney >24 hr on gallium

Back 25

obstruction
neoplasm
pyelo
vasculitis
ATN
lymphoma

Front 26

Lung >24 hr on In111 WBC

Back 26

atelectasis
CHF
pneumonia
ARDS
emboli

Front 27

Bowel activity on In111 WBC

Back 27

IBD
PMC
diverticulitis
ischemic bowel
CMV

Front 28

VQ whole lung mismatch

Back 28

large PE (unusual)
tumor
swyer james
hypoplastic or stenotic PA
prior shunt for CHD
fibrosing mediastinitis

Front 29

VQ patchy NSGM perfusion

Back 29

COPD/asthma
tumor microemboli
CHF
vasculitis
fat emboli
radiopharmaceutical problem

Front 30

Abnormally high LVEF

Back 30

IHSS and hypertrophic CM
hyperthyroidism
regurg (AI/MR/VSD)

Front 31

Technical screwups

Back 31

venous extravasation (lymphatic uptake)
arterial injection (glove like)
"hot spots" in lungs (syringe drawback)
hot liver on MDP (Al or colloid)
Fuzzy pictures (off photopeak)

Front 32

Poor image quality

Back 32

wrong photopeak
patient too far from collimator
wrong type of collimator
wroing isotope
cracked crystal
cracked PMT
tracer contamination on crystal

Front 33

PIOPED High probability

Back 33

->80% probability
->2 large (>75%) segmental mismatches or arithmetic equivalent in mod or lrg and mod defects

Front 34

PIOPED Intermediate probability

Back 34

-20-79%
-one moderate (25-75%)to 2 large segmental mismatches or arithmetic equivalent
-single matched defect with clear CXR
-triple matched defects

Front 35

PIOPED Low probability

Back 35

-20%
-nonsegmental perfusion defects
-any perfusion defect with substantially larger CXR abn
-matched VQ defects with normal CXR
-any number of small (<25%) perfusion defects with normal CXR

Front 36

VQ mismatch

Back 36

acute PE
chronic PE
tumor compression of PA
hypoplastic PA
vasculitis
sickle cell anemia
atelectasis (reverse mismatch)

Front 37

Matched VQ defects

Back 37

consolidation
COPD
atelectasis
tumor
bulla
pneumonectomy

Front 38

Stress test endpoints

Back 38

severe angina
hypotension
arrhythmias
AMI
fatigue
dyspnea
target workload achieved

Front 39

Pharmacologic stress test

Back 39

unable to exercise
use persantine or adenosine
reverse with theophylline
use dobutamine if COPD on theophylline

Front 40

Increased lung uptake on thallium

Back 40

LV failure
pulmonary venous HTN

Front 41

False negative thallium

Back 41

submaximal exercise
noncritical stenosis
small ischemic area
medications

Front 42

False positive thallium

Back 42

any cardiomyopathy
LBBB
infiltrative cardiac disease
ST attenuation

Front 43

Paradoxical septal movement

Back 43

septal ischemia
previous cardiac surgery
LBBB or pacemaker
RV overload

Front 44

Pyrophosphate uptake heart

Back 44

MI
LV aneurysm
cardiomyopathy
myocarditis
pericarditis
amyloid

Front 45

GB not visualized

Back 45

acute cholecystitis
prolonged fasting
recent meal
cholecystectomy
GB agenesis

Front 46

Biliary system not visualized

Back 46

biliary atresia
high grade bile duct obstruction (increased intrabiliary pressure)
drug induced cholestasis
- erythromycin
- tricyclics
- gold
- enalipril
- nitrofurantoin

Front 47

Low hepatic and renal activity

Back 47

severe liver disease
neonatal hepatitis

Front 48

Bowel not visulized on HIDA

Back 48

choledocholithiasis with patial or complete obstruction
ampullary stenosis
CCK given prescan
Narcotics on board

Front 49

Abnormal tracer collections on HIDA

Back 49

bile leak
choledochal cyst
carolis
duodenal diverticulum

Front 50

False negative HIDA

Back 50

duodenal diverticulum simulating GB
accessory cystic duct

Front 51

False positive HIDA

Back 51

recent meal
prolonged fasting
liver dysfunction
hyperalimentation
concomitant serious illness

Front 52

Free Tc99m pertechnatate

Back 52

can see gastric, salivary and thyroid activity

Front 53

Focal liver uptake sulfur colloid

Back 53

FNH
regenerative nodule
Budd chiari (hot caudate)
SVC or IVC obsruction

Front 54

Renal transplant uptake sulfur colloid

Back 54

rejection

Front 55

RLQ activity on meckel scan

Back 55

meckels diverticulum with ectopic gastric mucosa
other duplication cyst with ectopic gastric mucosa
renal
active bleeding sites
tumor
IBD

Front 56

Delayed gastric emptying

Back 56

diabetic gastroparesis
obstruction

Front 57

Rapid gastric emptying

Back 57

postoperative
PUD
ZE syndrome
drugs

Front 58

Focal renal cold defects

Back 58

tumor
cyst
abscess
scar
duplex collecting system
trauma
infarct
DMSA- pyelo or scar

Front 59

Focal renal hot lesions

Back 59

collecting system
leak
cross-fused ectopia
horseshoe

Front 60

Dilated ureter or collecting system

Back 60

reflux
obstructed or nonobstructed ureter

Front 61

Nonvisualized kidney

Back 61

nephrectomy
ectopic kidney
renal artery occlusion
renal vein thrombosus
hyperacute rejection in transplant (minutes to hours)
accelerated acute rejection (hours to days)

Front 62

Renal transplant complications

Back 62

ATN
cyclosporine toxicity
acute rejection
obstruction
urinoma
lymphocele
hematoma
abscess

Front 63

Decreased testicular uptake

Back 63

torsion
orchiectomy

Front 64

Increased testicular uptake

Back 64

epididymitis
orchitis
detorsion

Front 65

Ring sign testicle

Back 65

late torsion
tumor with central necrosis
abscess
trauma

Front 66

Focal hot bone lesions

Back 66

tumor
inflammation- OM, arthritis
congenital- OI, TORCH
metabolic- marrow hyperplasia, pagets, FD
trauma- fracture, stress fx, avulsion injury, AVN, RSD, THR, spondylolysis, child abuse
vascular- sickle cell
transient osteoporosis of hip
flare phenomenon

Front 67

Focal cold bone lesions

Back 67

mets- myeloma, lymphoma, renal, thyroid, neuroblastoma
primary bone lesions- SBC, ABC, EG
vascular- infarction, AVN, radiation
artifact

Front 68

MIBG scan - what is it used for, where is normal uptake?

Back 68

Used for pheochromocytoma, neuroblastoma

Normal uptake:
- areas of sympathetic innervation
- salivary glands (parotid, submandibulars)
- heart (variable)
- thyroid (free iodide)
- adrenals
- liver
- bladder

Front 69

Octreoscan
- What is the agent?
- What is it used for?
- Normal uptake?

Back 69

Octreoscan =
- 111-In pentatreotide
- Octreotide

Somatostatin analogue

Used to image neuroendocrine tumors
- Carcinoid
- Islet cell tumors (gastrinoma > glucagonoma)
- Paraganglioma
- Pheochromocytoma
- Neuroblastoma
- SCLC
- medullary thyroid
- Meningioma
- Astrocytoma
- Thymoma
- Lymphoma

Intense uptake in kidneys and spleen
Less uptake in liver and bladder
Some biliary/bowel excretion
Very little background

Front 70

Gallium 67
- Half life?
- Peak energies?
- Image at?
- Normal uptake?
- Target organ?
- Used for?

Back 70

Gallium 67

Half life = 78 hours

Peaks = 185, 300, 393 keV
(200, 300, 400)

Image at 48 and 72 hours, up to a week

Normal uptake:
- bones/marrow
- soft tissues
- liver > spleen
- bowel excretion

Target organ:
- colon

Uses:
- lymphoma (old use)
- infection (except not good for abdomen as In-111due to GI excretion)

Front 71

What tracers to use for inflammation/infection?

Back 71

111-In-oxine labeled WBC

99m-Tc HMPAO labeled WBC

67-Ga citrate

18-F FDG

Front 72

WBC scan
- What radionuclides are used?
- What does a normal scan look like?

Back 72

WBCs can be labeled with:
- 111-In oxine
- 99m-Tc HMPAO

Normal uptake in:
- Bone marrow
- Spleen > liver
- bladder (if using 99m-Tc)

Front 73

PET negative lung CA

Back 73

BAC

carcinoid

Front 74

What agents do we use for hepatobiliary scanning at UH?

Back 74

?

Front 75

Limitations or confounders in a lasix renogram

Back 75

Dehydration
Renal insufficiency
Insufficient lasix dose
Slow transit in a dilated collection system
Full bladder

Front 76

123-I:
- Half-life?
- Photopeak energy?

Back 76

123-I:
- 8 hour half-life
- 160 keV photopeak

Front 77

99m-Tc:
- half-life?
- photopeak?

Back 77

99m-Tc:
- 6 hour half-life
- 140keV photopeak

Front 78

Chance of malignancy of cold nodule on thyroid scan?

DDx?

Back 78

A cold nodule on thyroid scintigraphy has a 15-20% chance of malignancy?

Ddx:
- malignant nodule
- colloid nodule
- cyst
- scar
- hashimotos
- focal acute/chronic thyroiditis
- hematoma

Front 79

Hashimoto's thyroiditis:
- Cause?
- Appearance on scintigraphy?
- Ddx?

Back 79

Hashimoto's thyroiditis:
- caused by anti-thyroid antibodies (anti-thyroglobulin or anti-peroxidase MC)
- Variable appearance on scintigraphy. MC is decreased RAIU with patchy distribution, but can show increased uptake acutely (Hashitoxicosis).

DDx (decreased RAIU):
- subacute thyroiditis, recovering
- iodine deficiency
- Reidel infiltrating fibrosis
- Infiltrating dz (amyloid, primary CA, hemochromatosis,mets, lymphoma)
- Meds (Li+3, amiodarone)

DDx (increased RAIU):
- Graves
- MNG
- exogenous TSH

Front 80

Graves dz:
- Cause?
- Appearance?
- DDx?

Back 80

Grave's disease:
- Caused by thyroid stimulating antibodies (TSA's)

- Increased RAIU
- Diffusely enlarged gland with moderate to high uptake with high taget to background ratio

DDx:
- Grave's disease
- MNG
- early thyroiditis
- Hashitoxicosis
- exogenous TSH
- Jod Basedow phenomenon (thyrotoxicosis after administartion of iodine in iodine deficient state)

Front 81

Focal uptake in thyroid region on sestamibi scan?

Back 81

Parathyroid adenoma

Parathyroid hyperplasia

Thyroid adenoma

Metastatic disease

Lymphoma

Front 82

Periarticular activity throughout hand on MDP

Back 82

RSD (aka Sudek's atrophy)

Disuse osteopenia

Front 83

Reversal for adenosine

Back 83

Aminophylline

Front 84

Regadenoson
- binding to?
- reversal?
- t 1/2?
- contraindications?

Back 84

Adenosine analog

Binds to A2a

3 minute half-life

Reversal with aminophylline

Contraindicated in:
- Sinus node dysfunction
- 2nd or 3rd degree AV nodal block

Front 85

Dobutamine
- reversal agent?

Back 85

Dobutamine

Reversed by beta-blockers

Front 86

RBC tagging methods?

Back 86

In vivo
- inject stannous chloride
- wait 15-30 minutes
- inject 99m-Tc pertechnetate
- low binding efficiency (80%) (free pertechnetate)

Modified in vivo
- inject stannous chloride
- wait 15-30 minutes
- draw blood in closed vial containing ACD or heparin and 99m-Tc pertechnetate
- incubate 10 minutes
- infuse
- low binding efficiency (90%) (free pertechnetate)

In vitro (Ultratag)
- draw blood
- incubate with stannous chloride and sodium hypochlorite
- add 99m-Tc pertechnetate
- incubate 20 minutes
- inject
- time & cost
- 95-98% efficiency

Front 87

Causes for poor RBC 99m-Tc labeling?

Back 87

Drugs
- methydopa
- quinidine
- doxorubicin
- heparin
- hydralizine
- contrast media

Antibodies

Too much/too little stannous chloride

Front 88

Xenon 133
- Half life?
- Peak energies?
- Image at?

Back 88

Used for V/Q ventilation scans

3 phases
- Wash in
- Equlibrium
- Wash out

Photopeak = 81 kEv
- perform prior to 99m-Tc MAA

T1/2 = 5.2 days
T1/2biological = 30 seconds

Dose = 10-20 mCi

Image immdiately

Front 89

Causes of false positive WBC scan

Back 89

Poor labeling

Post operative changes
- healing operative site
- stoma
- catheter

Swallowed activity from lung or alimentary canal acitivity

Front 90

Decreased marrow uptake on 67-Ga

Back 90

Hepatic mets

Hepatic insufficiency

Chemotherapy

Front 91

False positive on tagged RBC scan for GIB

Back 91

Vascular structures

AAA

VM

Penile blood pool

Varices

Bladder

Ectopic kidney

Front 92

Low FDG uptake in brain

Back 92

Interictal focus

Low grade tumor

Radiation changes

Stroke

Front 93

Causes of hypertrophic osteoarthropathy

Back 93

Bronchognic lung CA

Mesothelioma

Lung abscess

Bronciectasis

Peds:
CV disease (cyanotic heart disease, endocarditis)
Lung disease (CF, asthma)
GI disease (UC, biliary atresia)

Front 94

111-In oxine WBC
- half life?
- target organ?
- photopeaks?
- image at?

Back 94

111-In oxine

T 1/2 = 77 hours

Target organ = spleen

Photopeaks
- 173 keV
- 273 keV

Image at 24 hours

Front 95

How do you calculate differential renal function on a MAG3 or DTPA renal scan?

Back 95

Unilateral renal cortical uptake within 1-3 minutes divided by total renal cortical uptake between 1-3 minutes

Front 96

131-I dose for hyperfunctioning adenoma?
- for MNG?
- side effects?

Back 96

20-30 mCi for hyperfuntioning nodule or MNG

Side effects include worsening of hyperthyroid sx
- tx with b-blockade and NSAIDs

Front 97

Chance of thyroid malignancy in MNG

Back 97

less than 5%

Front 98

What dose of 131-I:
- RAUI?
- Post-thyroidectomy followup?
- Tx for thyroid malignancy?

Back 98

RAIU = 10-30 microcuries

Dx scan = 4 mCi

Tx scan = 100-150 mCi

Front 99

131-I:
- photopeak?
- half life?
- other emitted particle?

Back 99

131-I:

8 day half life

364 keV photopeak

beat emitter

Front 100

123-I:
- photopeak?
- half life?

Back 100

123-I

159 keV

13 hour half life

Front 101

Doses of 131-I for:
- Grave's
- MNG
- Plummer's

Back 101

?

Front 102

Formula for therapeutic 131-I dosing for benign thyroid disease?

Back 102

(gland mass in grams/RAIU) X (dose/gram)

i.e. (60g/0.6)X(100uCi/gram) = 10mCi