Rad Pharm 3 Practice Exam

What is the GENERIC name of Choletec?

Mebrofenin

What is the BRAND name of Tc-99m Mertiatide?

MAG3

What is the GENERIC name of Pulmotec?

Tc-99m MAA (Macroaggregated Albumin)

What is the GENERIC name of Cardiolite?

Sestamibi

What is the GENERIC name of Myoview?

Tetrofosmin

What is the GENERIC name of Lymphoseek?

Tilmanocept

What is the GENERIC name of DMSA?

Succimer

Tc-99m Sulfur Colloid is best described as:

A generic drug with no specific brand name

Technegas is the brand name for:

Tc-99m Carbon (graphite-based ventilation agent)

DTPA is the abbreviation for Tc-99m:

Pentetate

PYP stands for:

Pyrophosphate

What is the GENERIC name for PYP?

Tc-99m Pryophosphate

Xenon-133 is:

A generic name - supplied as 5% Xe with 95% CO2

Which of the following drugs do you BOIL during kit prep?

Sulfur Colloid, MAG3, Cardiolite (Sestamibi)

The cardiac PET drugs are:

Rb-82 Chloride and N-13 Ammonia

What is the minimum acceptable radiochemical purity (RCP) for all Tc-99m agents on this exam?

>90%

Choletec (Mebrofenin) QC uses which solvent and paper?

20% Saline or distilled water / SA and SG

Lymphoseek (Tilmanocept) QC uses which solvent and paper?

Acetone / Whatman

MAG3 QC is unique because it uses:

Sep-Pak C18 reverse-phase mini-column chromatography with HCl and 50/50 EtOH/H2O

DTPA QC uses which solvents and papers?

0.9% NaCl and Acetone / SG and Whatman (also Sep-Pal C18)

DMSA (Succimer) QC uses which solvent and paper?

Acetone / SG

Pulmotec (MAA) QC uses which solvent and paper?

0.9% Saline / SG

Both Cardiolite (sestamibi) AND Myoview (testrofosmin) QC use which solvent and paper?

Ethyl acetate / saturation paper

PYP (Tc-99m Pyrophosphate) QC uses which solvents and papers?

0.9% NaCl and Acetone / SG and Whatman

What is the UNIQUE QC consideration for MAA particles?

Particles are measured under a microscope - if any single particle is larger than 150 um or if the field is larger than a 3×3 grid, the kit CANNOT be used

DMSA has a shelf life of how long after compounding?

4 hours

Cardiolite (sestamibi) storage - both the cold kit and hot kit are stored at:

room temp

Myoview (tetrofosmin) storage - the cold kit is stored:

In the refrigerator; hot kit at room temp

Pulmotec (MAA) - both cold and hot kits are stored:

In the fridge (2-8 degrees C)

What is the maximum volume (ml) that the MAA vial can hold?

10 ml

Sulfur Colloid kit preparation requires boiling for how long, and what happens if you exceed the boiling time?

6 min ; particles clump into larger particles, altering biodistribution

After boiling Sulfur Colloid for 6 min, the next step is:

remove vial, place in lead shield, then in freezer for 3 min to cool

The valence of Tc-99m in sulfur colloid is:

+7

MAG3 kit preparation requires which two unique steps?

pull back 5ml syringe plunger to vent 2-5ml argon gas and introduce air; then boil kit for 10 min

Why is air (oxygen) deliberately introduced into the MAG3 kit - making it an exception to most Tc-99m kits?

to oxidize excess stannous ion, which might otherwise further reduce the oxidation state of Tc and create impurities

MAG3 is a complex of Tc(V) and :

mercaptoacetyl-triglycine

About what percentage of Tc-99m MAG3 is bound to plasma protein after IV injection?

89-90%

Cardiolite (sestamibi) kit prep requires:

boiling water bath for 15-20 min

Myoview (tetrofosmin) kit prep requires:

do NOT boil; inject at least 10 ml of 0.9% NaCl, then inject Tc-99m. do NOT add Tc-99m before dilution (radiolysis risk)

What happens if Tc-99m is added to the Myoview vial before adequate dilution with saline?

Myoview can double-bind Tc-99m, causing radiolysis that will break the drug apart in under 1 hour

The spleen RBC labeling procedure uses Ultratag. The water bath step is:

49-50 degrees C for 20 min

In the spleen RBC labeling procedure, how much Tc-99m is added to the vial?

22 mCi

MAA (Pulmotec) particles consist of:

Aggregated human albumin; size 10-90 microns; no particle larger than 150 microns

MAA (Pulmotec) should be used within how many hours of compounding per the package insert?

12-18 hours

Technegas particle size is:

5-30 nanometers

Choletec (Mebrofenin) is indicated for imaging which organs?

Liver and gallbladder

Visualization of the hepatic duct and gallbladder occurs within how many minutes post-injection in a healthy patient?

10-15 minutes

What patient preparation is required before a Choletec (HIDA) scan?

Fast for 4 hours to encourage bile excretion and gallbladder visualization

Normal gallbladder ejection fraction (GBEF) is between:

30-70%

Sulfur Colloid is indicated for imaging which of the following?

Liver, spleen, bone marrow, lymphoscintigraphy, and gastric emptying

The Tc-99m application for the spleen study is used to:

Access if splenunculi are present, using heat-denatured RBCs tagged with Ultratag, overlaid with CT

A splenunculus is:

an accessory spleen formed during fetal development, trauma, or incomplete surgical removal

Lymphoseek (Tilmanocept) is indicated for:

Primary sentinel lymph node biopsy or removal in cancer staging

A key advantage of Lymphoseek over Sulfur Colloid for sentinel node mapping is:

Lymphoseek only sees sentinel (primary) nodes, allows delayed imaging up to 15 hours, and has faster transit due to its small 7 nm size

Tc-99m DTPA is indicated for which two major organ systems?

Kidneys (GFR/perfusion) and lungs (ventilation/V-Q scan)

DTPA peak concentration in the kidneys occurs how many min post-injection?

3-4 min

DMSA (Succimer) is used primarily in which patient population for clinical evaluation of kidney function?

Children and premature babies, because nephronogenesis continues until 34-36 weeks of gestation

What percentage of an injected DMSA dose is retained in the renal cortex at 6 hours?

42%

Pulmotec (MAA) is used for which of the following applications?

Evaluating pulmonary perfusion and diagnosing PE; right-to-left shunt quantification; liver mapping for Sirspheres therapy

When performing MAA injecion, which three patient/technique requirements must be followed?

Patient supine; agitate syringe gently before injection; do NOT draw blood back into the syringe (will cause clumping)

MAA is contraindicated or requires reduced particle dose in which conditions?

Severe pulmonary hypertension or hypersensitivity; reduced dose for pregnancy. COPD, emphysema, right-to-left shunt, split lung study, peds

Cardolite (Sestamibi) and Myoview (Tetrofosmin) are both used for:

Testing for CAD and myocardial perfusion imaging

For Cardiolite (sestamibi) dosing, the stress dose is always ____ times the rest dose

3x

PYP is indicated for:

Cardiac imaging- adjunct diagnosis of transthyretin cardiac amyloidosis and acute myocardial infarction; shows characteristic doughnut-hole pattern in amyloid

Tc-99m Pertechnetate is used for cardiac studies to:

Tag RBSs for gated cardiac scan to assess ejection fraction, stroke volume, and cardiac output

Sincalide (CCK) is the drug of choice for evaluating gallbladder ejection fraction (GBEF). It:

stimulates gallbladder contraction and relaxes the sphincter of Oddi

The dose of Sincalide (CCK) is:

0.02 mcg/kg IV over 60 min; normal GBEF is >=38%

When is Morphine Sulfate used during a hepatobiliary (Choletec) scan?

When acute cholecystitis is suspected but the gallbladder is not visualized within 30-60 min of injection

Morphine Sulfate works in hepatobiliary imagin by:

Inducing temporary spasm of the sphincter of Oddi, increasing biliary pressure, and facilitating bile flow into the gall bladder if the cystic duct is patent

The dose of Morphine Sulfate for hepatobiliary studies is:

0.04 mg/kg or a flat 2 mg dose IV over 2-3 min

It is critically important NOT to give CCK and Morphine at the same time because:

Morphine seals the sphincter of Oddi while CCK causes the gallbladder to contract - bile would be forced into the sealed common hepatic duct

When CCK (Sincalide) is unavailable, which oral substitutes can be used?

Boost or Ensure- oral fatty meal substitutes containing fats/lipids that stimulate endogenous CCK release

Lasix (Furosemide) is used as a conjunction drug in renal imaging to:

Inhibit sodium reabsorption in the proximal and distal tubules- differentiate mechanical obstruction from functional stasis (dilated pelvis)

ACE inhibitors (Captopril or Enalapril) are used to renal imaging to:

Identify renal artery stenosis as the cause of hypertensions; patients must be off ACE inhibitors AND diuretics for one week before the test

Which of the following is the vasodilator used in pharmacologic cardiac stress testing that is a manufactured variation of adenosine, activating only A2a receptors?

Regadenosine (Lexiscan)

Adenosine (Adenocard) activates which receptors, and why is this a problem?

Both A2a and A2b receptors - A2b activation can cause bronchospasms

The general mechanism of all vasodilators (Adenosine, Persantine, Regadenosine) in cardiac stress testing is:

Cause coronary vasodilation- increase blood flow everywhere EXCEPT where there is a stenosis, creating a perfusion difference