Thyroid Parathyroid And Salivary Gland

Front 1

Question 1 & 2
static testicular torrsion

Back 1

page 124
decreased activity on delayed images

Front 2

What will the effect be if a tech. places the uptake probe over the proximal thigh when counting background in the patient?

Back 2

the background will be falsely elevated
the background will be falsely decreased
the calculated uptake will decrease
a and c

Hint 2

a and c

Front 3

Which of the following dietary supplements will affect thyroid uptake?

Back 3

vitamin A
vitamin B
St. John's wort
kelp tablets
lacotbacillus

Hint 3

kelp tablets
- kelp tablets contain iodine and therefore may affect measured uptake value of thyroid uptake

Front 4

Thyrotropin is also known as

Back 4

TRH
TSH
T3
T4

Hint 4

TSH = thyroid stimulating hormone = thyrotropin is secreted by the anterior pituitary and causes the thyroid to release hormone thyroxine (T4)

Front 5

WHICH OF THE following will not affect thyroid uptake?

Back 5

iodinated contrast media
propylthiourcil
thyroid hormones
beta blockers

Hint 5

beta blockers

Front 6

Which of the following statements is not true?

Back 6

- TRH stimulates the release of TSH by the anterior pituitary
- release of T3 is inhibited by elevation of T4
-T3 and T4 are both hormones which are manufactured and released by the thyroid
- TRH is synthesized in the hypothalmus

Hint 6

release of T3 is inhibited by elevation of T4

TRH = is thyrotropin releasing hormone which is secreted by the hypothalamus and stimulates the secrection of TSH BY THE anterior pituitary. The thyroid releases the hormones T3 (triiodothyronine) and T4

Front 7

Most people have 4 parathyroid glands

Back 7

true
false

Hint 7

true
a small % of people may have more or less

Front 8

The salivary glands include

Back 8

the partoid glands
sublingual salivary glands
submaxillary glands
all of the above

Hint 8

all of the above
there are also minor glands in the cheeks, lips, mouth and throat

Front 9

Which of the following are used to image the parathyroid?

Back 9

99m-Tc
99m-Tc sestamibi
201Tl- chloride
a and b
b and c

Hint 9

b and c
99m-Tc sestamibi
201Tl- chloride

sometimes one of these imaging agents is paired with Tc-99m imaging to create images that will allow subtraction of thyroid

Front 10

The collimator attached to a thyroid uptake probe is

Back 10

converging
diverging
pinhole
flat field
low energy all purpiose

Hint 10

flat field
the pinhole is used for imaging but the flat field IS USED FOR UPTAKE

Front 11

Which of the following are part of the preparation for a thyroid uptake?

Back 11

NPO from midnight
administer Lugol's solution
have the patient void before injection
withhold caffeine containing beverages for 24 hours prior to examination
none of the above

Hint 11

NPO from midnight

Front 12

When performing a thyroid scan the tech. neglects to count the capsule before it is adm. to the patient. What are the impications?

Back 12

- it will not be possible to calculate the uptake values
- an identical capsule must be counted in a neck phantom in order to obtain uptake values.
- no decay factor will be used in the calculation of uptake values

Hint 12

- an identical capsule must be counted in a neck phantom in order to obtain uptake values.
- no decay factor will be used in the calculation of uptake values

THIS IS WHAT WE DID AT RAHWAY HOSPITAL....WE ALWAYS ORDERED A 2ND CAPSULE

Front 13

What is the method of localization of 99m-Tc pertechnetate in the thyroid?

Back 13

sequestration
active transport
receptor binding
diffusion
phagocytosis

Hint 13

active transport
99m-Tc localizes in the thyroid by active transport; it is trapped in the gland, but unlike iodine not organified

Front 14

Image of the thyroid takes place

Back 14

approximately 20 minutes after injection of 99m-Tc
6 hours after adm. of an I123 sodium iodide capsule
24 hours after adm. of an I123 sodium iodide capsule
all of the above

Hint 14

approximately 20 minutes after injection of 99m-Tc
6 hours after adm. of an I123 sodium iodide capsule
24 hours after adm. of an I123 sodium iodide capsule
all of the above

Images taken at 6 hours will have a higher background relative to 24 hrs and those obtained at 24 hours will have a lower count rate...... but images may be superior due to the decrease boday background

Front 15

Which of the following will not optimize images of the thyroid?

Back 15

use of a pinhole collimator
having the patient avoid swallowing during images
hyper extending the neck
placing a radioactive marker on the xiphoid process

Hint 15

placing a radioactive marker on the xiphoid process

the xiphoid process will likely not be the the FOV

Front 16

A linear area of activity in the esophagus is seen on a thyroid image taken using 99-m Tc. What does it represent?

Back 16

pertechetate that was secreted by the salvary glands and swallowed

the artifact can be distinguished by having the patient drink

Front 17

The use of I131 thyroid imaging

Back 17

is typically only used when scanning the whole body

Whole Body I 131 is to rule out metastatic disease is often performed after thyroidectomy. The dose is 3-5 mCi...... thyroid uptake and scanning is performed using I 123

Front 18

Question 20

Back 18

page 128

Front 19

The salivary glands may be images using

Back 19

5 mCi of 99m-Tc
often to evaluate function or rule out mass

Front 20

Which of the following describes delayed images at 2-3 hrs after injection of 99-mTc sestamibi?

Back 20

persistent activity in parathyroid adenomas, and decreased activity in the thyroid relative to early images

Hint 20

99 Tc sestamibi washes out of the thyroid over time and paraythyroid adenomas, whuch may appear more intense than the thyroid on early images......often retain activity on delayed image

Front 21

A hot nodule on a thyroid image will most likely be benign

Back 21

true
false

Hint 21

true
the majority of hot nodules seen on thyroid scans are benign

Front 22

Which of the following are symptoms of hyerthyroidsm?

Back 22

exophythalmus = or protrusion of the eyeballs may be seen in hyperthyroid patients
bradycardia = slow heart rate
cold intolerance = symtom of hypothyroidism
all of the above
b and c

Hint 22

bradycardia

Front 23

The highest doses of therapeutic I131 are given to patients with

Back 23

Grave's Disease
toxic multinodular goiter
thyroid cancer
chronic thyroiditis

Hint 23

thyroid cancer
thy therapeutic dose of radio iodine for thyroid cancer is 150-200 mCi and may be higher is distant metastases are being targeted

Front 24

A patient with a 45% uptake of I 123 sodium iodine at 24 hours ij

Back 24

euthyroid
hyperthyroid
hyopthyroid
athyroid

Hint 24

hyperthyroid

Front 25

The part of the thyroid that lies anterior to the trachea and is often not seen on thyroid imaging is the:

Back 25

right lobe
left lobe
isthmus
parathyroid
superior thyroid notvh

Hint 25

isthmus
the thyroid appears as a butterfly shape on imaging, with the isthmus often not visualized or displaying decreased activity relative to the right and left lobes. A slightly larger right lobe is commonly seen and is usually a normal finding

Front 26

On a thyroid imaging taken using I 131 sodium iodine, the right lobe appears to be larger than the left. The explanation for this is

Back 26

a right hemigoiter
a hypo-functioning left lobe
a normal finding
the patient's head was turned slightly to the left
the patient's head was turned slightly to the right

Hint 26

a normal finding

Front 27

Iodine is needed for the thyroid gland to synthesize T3 and T4

Back 27

true
false

Hint 27

true
Ingested iodine is absorbed in the small intestine and transported to the thyroid where it is needed for the synthesis of T3 and T4

Front 28

About 90% of the thyroid hormone secreted into the blood is a form of

Back 28

thyroxine
triiodothyronine
thyroglobulin
thyrotropin
iodotyrosine

Hint 28

thyroxine
THE thyroid secretes much more thyroxin (T4) than triiodothyronine (T3). Both are secreted by the folicular cells of the gland.......if to little T4 is secreted......myxedema will result

Front 29

A patient with hyperparathyroidism will have

Back 29

myxedema
exopthalmus
cold nodules in the thyroid
increased fracture risk
more than 4 parathyroid glands

Hint 29

increased fracture risk
Hyperparathyroidism caused by hyperplasia of the glands.....or by a tumor and will result in increased PTH secretion. This causes an increase of bone fractures because PTH, when elevated will foster the removal of calcium from bone......the high PTH can also effect the nervous system

Front 30

Why is a 6 hour thyroid uptake obtained?

Back 30

to detect hyperthyroidism when the turnover is so rapid that the 24 hour uptake may be normal

Hint 30

in cases of extremely rapid iodine turnover....... only a 6 hour uptake may be abnormal....such as in Grave's Disease

Front 31

Which patient will have the longest wait before an an accurate thyroid uptake with 123I can be obtained?

Back 31

a patient with a myelogram
a patient who took synthroid
a patient who had an IVP
a patient who was given Lugol's solution
a patient who took kelp tablets

Hint 31

a patient with a myelogram
SNM = wait 2-4 weeks after exams using iodinated contrast....
Many places wait 6 weeks
If Pantopaque was used.....2 years delay is required

Front 32

To stimulate secretion during salivary glands sctintigraphy, which of the following if often used?

Back 32

99-Tc sestamibi
lemon juice
Lugol's solution
captropril
furosemide

Hint 32

lemon juice

Front 33

Ectopic tissue may occur

Back 33

in the pelvis
in the neck
in the mediastinum
at the base of the tongue
all of the above

Hint 33

all of the above
ectopic tissue may be present in many places....I 131 imaging may be helpful.....it is not taken up by the salivary glands....the long half life allows imaging after the target to backfround ratio has become higher and there has been urinary excretion of much of the dose

Front 34

If the salivary glands are not seen on a thyroid scan obtained with the use of 99m-Tc pertechnetate, it may mean

Back 34

that the thyroid is hyperfunctionig, and trapped the majority of the tracer
that the salivary gland function is compromised

Hint 34

It is typically to see salivary glands superior to the thyroid on images using straight Tc--99m.........if they are not seen..... it may be because the patient Grave's disease or because salivary gland function is compromised.

Front 35

When would a low energy all purpose collimator be used for thyroid examinations?

Back 35

- during uptake counting
- when searching for ectopic thyroid with I 131 sodium iodide
- when performing whole body with I 131 sodium iodide scanning after thyoidectomy
-when obtaining a blood pool image of the thyroid with 99m-Tc to differentiate cystic and solid masses
- all except a

Hint 35

-when obtaining a blood pool image of the thyroid with 99m-Tc to differentiate cystic and solid masses

THE LEAP collimator is ideal for imaging with 99-mTc if magnification is not needed. This is what we did at Rahway.......Images with a pinhole collimator may follow.......UPTAKE COUNTING REQUIRES A FLAT FIELD COLLIMATOR, AND medium or high energy may be used for 131I

Front 36

Radio-active iodine and 99-mTc cross the placenta

Back 36

-true
-false

Hint 36

true
Boh radioiodine and straight Tc-99m will cross the placenta

Front 37

Question 39

Back 37

page132

Front 38

AN indication for a thyroid uptake is for use in calculation of the amount of radioactive theraphy for hyperthyroidism

Back 38

true
false

Hint 38

true