Morph Corr: Cardiac (old exam questions)

Myocardial perfusion imaging is primarily performed to:

detect the location and extent of ischemia

When performing a SPECT myocardial perfusion exam, the best imaging acquisition would be:

a 180 degree acquisition around the patient starting at the right anterior oblique view and ending on the left posterior oblique view while moving around the patient's left side

Calculate the target heart rate when performing a Bruce protocol stress test on a 53-year-old male

142 BPM

For myocardial SPECT imaging, the technologist will typically position the patient:

supine with the left arm above the head

In the 1 day protocol for myocardial perfusion imaging performed with a Tc-99m-labeled tracer, the larger amount of activity is administered _____.

for the study performed second

An exercise/treadmill cardiac stress test requires the placement of how many electrodes on the patients' body?

10

The inferior wall of the heart is predominantly perfused by which artery?

Right Coronary Artery

When performing a myocardial perfusion exercise stress test, ideally the radiopharmaceutical should be injected at:

85% of anticipated maximum stress and the exercise continued for 1 to 2 minutes

Stress-rest myocardial imaging performed with Tc-99m sestamibi or Tc-99m tetrofosmin requires two administrations of the radiopharmaceutical, a low dose then a higher dose, because the tracer _____

does not redistribute once it has been taken up by the myocardium

When dual-radionuclide myocardial perfusion imaging is performed, which of the following tracers are used for stress and which for rest?

Stress - Tc-99m sestamibi

Rest - Tl-201 Thallous chloride

Treatment of the adverse effects induced by dipyridamole (persantine) involves the administration of _____

aminophylline

Which of the following drugs will reverse the effects of adenosine (adenocard)?

aminophylline

Which coronary artery primarily supplied region "D"?

Left Circumflex (LCX) artery

A patient with a history of bronchospastic disease (asthma) and wheezing arrives for a pharmacological myocardial stress test. The technologist will most likely perform the study using:

dobutamine

The advantage regadenosine has over adenosine and dipyridamole is:

it has a decreased risk of respiratory attacks because it only targets A2a receptors

After stress myocardial imaging with Tl-201 thallous chloride, a second dose of 1-3 mCi of Tl-201 thallous chloride may be administered after the stress images and before the rest myocardial images to _____

demonstrate reversible ischemia more readily or detect stunned/hibernating myocardial tissue

The image below best demonstrates

a narrowed right coronary artery

Which of the following must be discontinued for at least 24-36 hours before the administration of dipyridamole?

caffeine

To help clear the liver and bowel when performing the imaging of the stress portion of a myocardial perfusion study with Tc-99m sestamibi, a technologist should give the patient which of the following before imaging?

fatty meal

Each of the following is a (relative or absolute) contraindication for adenosine stress testing EXCEPT:

hypertension ( >160mm systolic)

What is the reason for performing a 4 hour delayed redistribution thallium image

because the tracer does not remain fixed in the myocardium, by 4 hours most of the redistribution has taken place showing viable tissue

A bull's-eye display of myocardial perfusion data is constructed by staking then flattening which reconstructed/reoriented slices?

short-axis slices

Which is a possible side effects of dobutamine?

tachycardia and tacharrhythmias

What is the standard dose for adenosine?

0.84 mg/kg given over 6 minutes

The reason why a Left Bundle Branch Block (LBBB) is a contraindication when performing an exercise stress exam is because:

it will result in a false positive diagnosis of ischemia in the septal wall

Tc-99m tetrofosmin stress and rest images indicative of an old infarction will demonstrate which of the following findings in the area of concern?

decreased stress uptake, decreased rest uptake

In a Tc-99m sestamibi or Tc-99m tetrofosmen 1 day exercise myocardial perfusion exam, which of the following is true concerning patient preparation and procedures (choose the best answer)?

nothing to eat or drink prior to doing the exam

Each of the following is considered an advantage of using Tc-99m sestamibi/tetrofosmen over Tl-201 with redistribution for the evaluation of myocardial perfusion EXCEPT:

superior at myocardial viability assessment (stunned and hibernating myocardium)

How soon should you begin imaging after the injection of Tc-99m sestamibi for the rest portion of the test?

45-90 minutes after injection

When performing an exercise stress test, what is the target heart rate goal for a 62 year old patient (in other words the minimum heart rate that should be achieved so that the injection can be performed)?

135 bpm

In myocardial perfusion imaging, after high-level stress exercise, it is recommended SPECT imaging begin when respiration has returned to normal and the heart rate has slowed down to avoid _____

upward creep of the heart during imaging

Soft tissue attenuation (such as breast artifact of diaphragmatic attenuation) may lead to

false positive studies

Acute impairment of perfusion to surrounding myocardium after an acute myocardial infarction is referred to as _____ myocardium.

stunned

The left ventricular ejection fraction on a MUGA, expressed as a percentage, for a patient with net (after background is subtracted) end-systolic counts of 29,500 and net (after background is subtracted) end-diastolic counts of 50,800 would be (to the closest 1%):

42%

When performing a gated equilibrium cardiac study, which of the following anatomical views best separates the right and left ventricles?

left anterior oblique

Which wave of the ECG is used to trigger the scintillation camera (gamma camera) to acquire counts?

R

In a amplitude analysis of a cardiac wall motion study (on a MUGA), the image represents the:

amount of change in contraction demonstrating hypokinesis

Which of the following PET cardiac tracers is a FDA-approved indicator of myocardial viability?

F-18 fluorodeoxyglucose

Clinical stress perfusion studies with Rb-82 are usually limited to pharmacologic stress because of Rb-82's _____

short half-life

Which agent is preferred for evaluating the progression of myocardial damage associated with cardiac amyloidosis?

Tc-99m pyrophosphate

When performing a PET myocardial viability study in conjunction with a myocardial perfusion stress test using Tc-99m-labeled tracers, how will hibernating or stunned tissue appear compared how the rest and stress images appear?

cold defect of the rest image, cold defect on the stress image, increased or hot uptake on the viability image

When using I-123 MIBG to evaluate the hearts sympathetic innervation, which is indicative of the highest risk of death

the ratio of the counts in the heart to the counts in the mediastinum being <1.5