Nuc Med

Front 1

Gamma camera QC check with collimator? What type of source?

Back 1

1) extrinsic uniformity (flood)
2) cobalt sheet source

Front 2

Gamera camera QC check without collimator? What type of source?

Back 2

1) intrinsic uniformity (flood)
2) Tc-99m point source

Front 3

DDx for "tram track" in the cortex on bone scan?

Back 3

1) hypertrophic osteoarthropathy
2) shin splints
3) venous insufficiency

Front 4

How do you look for free Tc-99m in a dose?

Back 4

thin layer chromatography

Front 5

When do you decrease the dose of MAA in a VQ scan?

Back 5

1) pregnant women
2) suspected R to L shunt
3) children
4) pulm HTN
5) known PE?

Front 6

DDx for a superscan?

Back 6

1) metastatic disease (prostate)
2) renal failure (secondary hyperparathyroidism)
3) Paget's disease
4) osteopetrosis
5) myelofibrosis

Front 7

Increased activity and osseous expansion on bone scan ddx (children)?

Back 7

1) Ewing's
2) fibrous dysplasia
3) lymphoma

Front 8

Increased activity and osseous expansion on bone scan ddx (adults)

Back 8

1) Paget's
2) mets

Front 9

DDx for positive 3 phase bone scan?

Back 9

1) fracture
2) infection
3) bone tumor (including osteoid osteomas)
4) RSD

Front 10

DDx for non-visualization of gallbladder on biliary scan?

Back 10

1) acute cholecystitis
2) hepatocellular disease
3) high grade biliary obstruction
4) inadequate pt preparation (recent meal, prolonged fasting)

Front 11

What 3 drugs can be given before a Meckel's scan to increase sensitivity?

Back 11

1) pentagastrin
2) cimetidine
3) glucagon

Front 12

DDx for a positive Meckel's scan?

Back 12

1) Meckel tic
2) urinary tracer excretion
3) intra-abdominal infectious/inflammatory processes

Front 13

What is the dose of phenobarbitol before a biliary scan to look for biliary atresia?

Back 13

5 mg/kg for 5 days

Front 14

False positive on a parathyroid sestamibi scan?

Back 14

thyroid adenoma/cancer

Front 15

Preferred method for RBC tagging on bleeding scan?

Back 15

in vitro

Front 16

Benefit of sulfur colloid over tagged RBC for bleeding scan?

Back 16

shorter preparation time

Front 17

Frontal lobe hypometabolism on brain PET ddx?

Back 17

1) Pick's disease
2) depression
3) schizophrenia

Front 18

DDx for unilateral absent lung perfusion?

Back 18

1) massive PE
2) tumor
3) fibrosing mediastinitis
4) post-surgical or congenital

Front 19

What medication can cause a false-positive b/l renal impairment curve on MAG-3 imaging?

Back 19

calcium channel blockers

Front 20

Most sensitive cancer found with ostreoscan?

Back 20

gastrinoma

Front 21

False positives found with ostreoscan?

Back 21

1) granulomatous disease (most common)
2) lymphoma
3) meningioma
4) astrocytoma
5) breast cancer

Front 22

"Trident sign" found on Tc99m HMPAO brain scan?

Back 22

Normal!

Front 23

What is the purpose of pre-therapy I-123 or I-131 whole body scanning?

Back 23

1) identify residual thyroid tissue
2) look for mets

Front 24

What is the physiologic pattern of I-123 or I-131?

Back 24

1) salivary glands
2) stomach
3) intestines
4) urinary bladder
5) esophagus (from swallowed radioactive saliva)

Front 25

Diffuse lung activity on a gallium scan indicates what disease?

Back 25

PCP

Front 26

Which cancer is typically negative on gallium imaging?

Back 26

Kaposi sarcoma

Front 27

DDx for hot spot on sulfur colloid hepatic imaging?

Back 27

1) FNH
2) regenerating nodules
3) Budd-Chiari syndrome

Front 28

DDx for cold spot on sulfur colloid hepatic imaging?

Back 28

1) hemangioma
2) adenoma/HCC
3) mets
4) abscess
5) FNH (1/3 are photopenic)

Front 29

What is sincalide used for in biliary imaging?

Dose?

Back 29

1) to induce GB contraction so that it empties, allowing agent to fill in.

2) 0.02 mcg/kg, infused SLOWLY

Front 30

What are some processes that will cause increased FDG on PET?

Back 30

1) tumor
2) infection
3) post-operative inflammation
4) post-radiation changes (3-4 months)
5) granulomatous diseases (sarcoid, fungal, etc)

Front 31

What are 4 characteristic uptake patterns of Galium imaging?

Back 31

1) bone
2) soft tissue
3) liver > spleen
4) bowel

Front 32

What do you give to block thyroid uptake on I-123 MIBG scans?

Back 32

Lugol's solution

Front 33

What types of tumors can be imaged with octreoscan?

Back 33

1) carcinoid
2) islet cell tumors
3) neuroblastoma
4) paraganglioma (pheo)

Front 34

What is one caveat to using In tagged WBCs to look for IBD?

Back 34

Must image early. Peristalsis can make localization inaccurate.

Front 35

On cardiac imaging, when is a reversible defect not related to ischemia?

Back 35

Septal defect in patients with LBBB, stressed with exercise.

That's why people with LBBB are stressed only pharmacologically.

Front 36

What presents with "tram track" uptake diffusely on bone scan?

Back 36

hypertrophic osteoarthropathy

Front 37

Which tumors can create "cold" lesions on bone scan?

Back 37

1) myeloma
2) thyroid mets
3) renal cell ca mets

Front 38

What agent can show tubular back perfusion on renal transplant imaging?

Back 38

DTPA.

sign of ATN

Front 39

What is the dose limit to the public?

Back 39

1 mSv

Front 40

How many mSv are in 1 rem?

Back 40

10 mSv = 1 rem

Front 41

What procedure do you follow for a minor spill?

Back 41

1) clean up spill with absorbent paper and gloves on.
2) survey the area
3) remove contaminated clothing
4) wash clothes
5) report spill to RSO

Front 42

What procedure do you follow for a major spill?

Back 42

1) call RSO
2) Do not clean up. Clear and secure the area.
3) Potentially shield/decontaminate personnel

Front 43

What is the dose to the thyroid during radioactive iodine ablation?

Back 43

10,000 rad (100 Gy)

Front 44

What is the mechanism of action of MIBG?

Back 44

incorporates itself into the norepinephrine synthesis pathway.

Front 45

What part of the RBC is "tagged" in a bleeding scan?

Back 45

beta chain of hemoglobin

Front 46

How long does a patient need to stop breastfeeding after receiving 2 mcCi of I-131?

Back 46

forever

Front 47

What is the normal distribution of ostreotide scans?

Back 47

1) liver
2) spleen
3) kidneys
4) bowel (early)