Morph Corr: Final (Reused 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

Scintimammography using Miraluma (Tc-99m sestamibi) can be used as an alternative to doing a mammogram

False

When performing breast imaging with Tc-99m sestamibi the patient must be:

injected the contralateral arm (opposite the breast in question)

The patient is a 50-year-old female with dense breasts and a questionable mammogram. This examination is requested to evaluate recurrent disease. Following the intravenous administration of 22 millicuries of Tc99m Sestamibi, static images were obtained 10 minutes post injection. Which best describes what the images below are showing?

This image is concerning for a malignancy in the left breast

If cancer is suspected in both breasts, where should the radiopharmaceutical be injected?

In the foot

Why is the radiopharmaceutical injected into the arm opposite the breast lesion during scintimammography?

To prevent tracer uptake near the breast (in the lymph nodes from a bad injection)

What should you do if the injection of Tc-99m lymphoseek for a lymphatic study is subcutaneous/intradermal instead of intravenously?

proceed with the test

To visualize the axillary and apical lymph node chains for a lymphoscintigraphy study looking at lymphedema (not a sentinel lymph node study), the proper injection site would be:

medial interdigital webbing between the fingers of the hands

The physician instructs you to position the patient to visualize the cervical nodes for a lymphoscintigraphy. You should position the camera over the patient's:

neck

The ability to perform delayed images (>3 hours later) while still being able to visualize only the sentinel lymph nodes is an advantage of which radiopharmaceutical? Choose all that are correct.

Tc-99m Tilmanocept

The ability to visualize the entire lymphatic tree is an advantage of which radiopharmaceutical? Choose all that are correct.

Tc-99m unfiltered Sulfur Colloid

Tc-99m filtered Sulfur Colloid

Because of its much smaller particle size, it moves rapidly from the injection site to the sentinel lymph nodes. Choose all that are correct

Tc-99m filtered Sulfur Colloid
Tc-99m Tilmanocept

Tc-99m Tilmanocept localizes in the lymph node by:

Attaching to the mannose receptors (CD-20) on the macrophages

When performing sentinel lymph node imaging on a patient with a melanoma, what is the suggested method of performing the injection?

4 intradermal injections with each being above, below, to the left, and to the right of the melanoma

When performing a lymphoscintigram (regardless of if it is for mapping or locating a sentinel node) a Co-57 sheet source is used. What is the purpose of using the sheet source.

it allows visualization of the anatomy to better locate the lymphatic system

When performing a sentinel lymph node exam, right before surgery the patient is also inject with methyl blue. Why is this done?

the methyl blue causes the lymph nodes to turn blue making them easier to find

What is the major advantage of performing a peritumerol in the breast when doing a sentinel lymph node exam on a patient with breast cancer

It is more likely to show substernal (hilar) lymph nodes that would otherwise be missed

Using lidocaine when performing injections for lymphoscintigraphy is the preferred technique (suggested technique) because it reduces patients discomfort

False

The main disadvantage of using a large volume of fluid when performing an injection for lymphoscintigraphy is:

it causes swelling that results in slowing of the tracer to the lymph nodes

Which of the following radiopharmaceuticals may be used for brain imaging to determine if a patient is brain dead?

all of these (Tc-99m ECD, Tc-99m HMPAO, F-18 FDG, Tc-99m DTPA)

According to the American Heart Association, which exam is considered to be the exam of choice when diagnosing a hemorrhagic stroke?

A CT scan of the brain

In the previous question, not all of those exams are able to diagnose a stroke.

False

Given that a CT scan of the brain only shows the brain anatomy and not blood flow, what is the purpose of doing the exam when a patient is suspected of having an acute stroke?

it can rule out if the patient has an active brain hemorrhage, allowing treatment to begin

Both non-blood brain barrier (non-BBB) crossing and blood brain barrier (BBB) crossing radiopharmaceuticals can be used for diagnosing brain death. Which class of tracers are considered to be the most sensitive and accurate for brain death?

the BBB

Which of the following radiopharmaceuticals are considered to be BBB crossing?

Tc-99m ECD

Tc-99m HMPAO

F-18 Amyvid

F-18 FDG

In a patient with Alzheimer's disease, when performing a SPECT brain scan with Tc-99m HMPAO, the images will most likely demonstrate:

symmetric, bilateral decreased perfusion in the parietal and temporal cortex

What are the main differences between HMPAO and ECD?

both tracers are considered equally good in diagnosing changes in metabolic activity

ECD clears the blood stream quicker and can be imaged sooner after injection

ECD is a more stable tracer and has a longer shelf life after reconstituting

HMPAO shows both white and grey matter where as ECD mainly shows grey matter

When performing a brain death study using a non-BBB crossing radiopharmaceutical, the main sign of brain death is:

absence of activity flowing into the circle of Willis from the internal carotid arteries

When using a BBB crossing tracer to evaluate a patient with epilepsy, which of the following statements are true:

If injected when the seizure starts, the epileptic foci will be hot

What is the primary reason for preventing patients from eating 4 hours prior to a F-18 FDG brain image?

To ensure the brain absorbs the FDG without competition from glucose in the bloodstream

When performing the injection for evaluating rCBF for metabolic imaging, which factors are important?

the injection should occur several minutes are the IV has been placed in their arm

the patient should be kept in a dark quiet room

Until recently, the biggest challenge with doing beta amyloid imaging for Alzheimer's disease was:

you couldn't get paid because there were no treatments available

The amyloid imaging agents are able to demonstrate Alzheimer's disease because they:

attached to the plaques that cause the disease

Using beta amyloid and Tau imaging agents are currently approved for general screening exams.

False

There are no dietary restrictions or need to prevent the patient from eating when getting an F-18 Amyvid scan.

True

When a patient is undergoing a CSF scan, which of the following are true? Choose all that are correct

at 6 hours after the injection, you should see a vikings helmet sign

the patient should lay flat on their back for at least 2 hours after the injection

to image the patient on your gamma camera a medium energy collimator should be used because of the higher energy of the indium

imaging should occur at 2 hours, 6 hours, 24 hours, and 48 hours after the injection

The preferred imaging technique to evaluate normal pressure hydrocephalus is a brain PET

False

In patients who have suffered head trauma, they may be evaluated for a CSF leak. Although imaging may demonstrate this, pledgets (cotton fabric balls) are the preferred method. How are they used?

after patients are injected for a CSF study, they are inserted in the patient's nasal cavity and ears to see if they become radioactive

What is the purpose of a CSF shunt study?

to make sure that the shunt is removing the excess CSF from the patient's brain

A normal CSF shunt study will show the tracer draining down into the peritoneal space in the abdomen.

True

When performing a I-123 Ioflupane exam, what is the appropriate pretreatment?

the patient should receive Lugol's a hour before the exam

The primary purpose of I-123 Ioflupane is

to differentiate parkinsonian disease from essential tremors

The mechanism of localization for I-123 Ioflupane is

absorption by the dopamine transporter

In a patient with a parkinsonian syndrome, the I-123 Ioflupane does not deposite in the caudate nucleus and the putamen as it should. It is said that the images show a period sign instead of a comma sign.

True

How long after the injection of I-123 Ioflupane should one wait before the SPECT imaging begins?

3 hours

What would be the findings of the following image using I-123 Ioflupane?

positive for parkinson's disease

Although the majority of patients suffering from cognitive impairment suffer from Alzheimer's disease, Parkinson's disease can also cause cognitive decline.

True

The standard views performed in a lung perfusion study are _____.

anterior, posterior, laterals, and obliques

Radioxenon ventilation studies should be performed in rooms whose air pressure is _____.

lower than adjacent areas

Which of the following indicates a high probability of pulmonary embolism on a nuclear medicine ventilation/perfusion study?

unmatched segmental or larger perfusion defect

The recommended number of 99mTc MAA particles for lung perfusion scintigraphy in an adult ranges from:

200,000 - 700,000

A nebulizer is used to administer which of the following lung ventilation radiopharmaceuticals?

Tc-99m Pentetate

Why is a chest x-ray helpful in the interpretation of ventilation perfusion images?

It adds specificity to the lung scan by identifying pathologies that would alter ventilation and blood flow

Which of the following patient is considered an absolute contraindication for performing a ventilation perfusion exam?

the patient has a right to left cardiac shunt

Which of the following statements about radiolabeled aerosols used for lung ventilation imaging is true?

the particles are deposited in ventilated areas of the lungs

99mTc MAA is to be administered to a patient for a lung scan. You should

agitate the vial gently before drawing up a dose

The majority of MAA particles formulated from a kit must be within the size range of

10-90 um

The dose of 99mTc DTPA usually placed in a nebulizer for performing an aerosol study is about

30 mCi in 3 mL

Which of the following statements about the wash-in/equilibrium/wash-out method for performing xenon ventilation studies is true?

the patient rebreathes a mixture of xenon and oxygen during the equilibrium phase