P2 COMPLETE

1. Which of the following is boiled during preparation?

a. MAA

b. Sulfur colloid

c. Albumin colloid

d. Diphosphonates

2. The presence of 12 μg Al+3 in 1 ml of 99Tc eluate is:

a. An example of radionuclidic impurity

b. An example of chemical impurity

c. An example of radiochemical impurity

d. Acceptable since it is less than 15 μg/ml

3. Which body decides on the acceptable levels of radionuclidic impurity?

a. DEP

b. NRC

c. FDA

d. USP

4. Which of the following is an example of radionuclidic impurity?

a. Presence of free 99mTc in a preparation of 99mTc sulfur colloid

b. Presence of 99

Mo in 99mTc eluate

c. Presence of aluminum ions in 99mTc eluate

d. Presence of pyrogens in eluate

5. Which of the following is an example of radiochemical impurity?

a. Presence of free 99mTc in a preparation of 99mTc sulfur colloid

b. Presence of 99 Mo in 99mTc eluate

c. Presence of aluminum ions in 99mTc eluate

d. Presence of pyrogens in eluate

6. Which radiopharmaceutical, when correctly prepared, will have the smallest particle size?

a. 99mTc sulfur colloid

b. 99mTc albumin colloid

c. 99mTc human serum albumin

d. 99mTc macroaggregated albumin

7. A 99Mo/99mTc generator exists in ________ equilibrium and the parent isotope has a________ physical half-life than the daughter isotope.

a. Transient, longer

b. Transient, shorter

c. Static, longer

d. Static, shorter

8. Which of the following is the most commonly used radionuclide in nuclear medicine imaging?

a. Iodine-131

b. Technetium-99m

c. Fluorine-18

d. Gallium-67

9. What is the ideal gamma energy range for gamma cameras?

a. 50–100 keV

b. 100–200 keV

c. 300–500 keV

d. 600–800 keV

10. Which radionuclide is most commonly used for PET imaging?

a. Technetium-99m

b. Iodine-131

c. Fluorine-18

d. Thallium-201

11. Which of the following refers to the process of removing Tc-99m from the Mo-99/Tc-99m

generator?

a. Decay

b. Fission

c. Elution

d. Activation

12. Compare the advantages of dry and wet Mo-99/Tc-99m generator systems in nuclear medicine applications.

a. Dry systems are more cost-effective

b. Wet systems allow for immediate elution

c. Dry systems provide better purity

d. Wet systems require less maintenance

13. Which of the following refers to the half-life of In-111?

a. 2.8 hours

b. 36 days

c. 2.8 days

d. 5.2 days

14. A type of radiopharmaceutical mechanism of localization which describes the movement of a cell such as a leukocyte in response to a chemical stimulus:

a. Chemotaxis

b. Passive diffusion

c. Capillary blockade

d. Receptor binding

15. A nuclear medicine quality control test where absence of microorganisms and pyrogens are checked:

a. Physical purity

b. Chemical purity

c. Radiochemical purity

d. Biological purity

16. Radiochemical purity issues can arise due to all of the following factors EXCEPT:

a. Temperature changes

b. Presence of unwanted oxidizing or reducing agents

c. Proper storage and handling

d. Autoradiolysis

17. Which of the following is an example of a PET radiopharmaceutical?

a. Technetium-99m MDP

b. Iodine-123

c. Fluorodeoxyglucose (FDG) F-18

d. Gallium-67

18. Which quality control test is performed to check for Mo-99 contamination in Tc-99m eluate?

a. Molybdenum breakthrough test

b. Radionuclide purity test

c. Radiochemical purity test

d. pH test

19. What is the most common method used for radiochemical purity testing?

a. Spectroscopy

b. Electrophoresis

c. Thin-layer chromatography (TLC)

d. Gamma counting

20. Point out why Mo-99 is an undesirable contaminant in the $^{99m}Tc$ eluate.

I. It emits high energy beta particles.

II. It emits gamma rays with energy of 740 keV and 780 keV.

III. It has a short half-life.

IV. The gamma rays emitted are not efficiently detected by the scintillation detector.

a. I, II, and IV

b. II and III

c. I, II, and III

d. II and IV

21. Point out the radiopharmaceuticals that can be used as receptor-binding agents.

a. C-11 methionine

b. N-13 ammonia

c. C-11 carfentanil

d. Rb-82 chloride

22. Which of the following radiopharmaceuticals are used for myocardial perfusion imaging?

a. Rubidium-82

b. Xenon-133

c. Iodine-123

d. Iodine-131

23. Which type of nuclear reaction is responsible for the production of Molybdenum-99

(Mo-99)?

a. Nuclear fusion

b. Alpha decay

c. Isomeric transition

d. Nuclear fission

24. A specific radiolabeled molecule that resembles the in vivo behavior of a natural molecule and can be used to provide information about a specific biological process is called:

a. Isotope

b. Radiotracer

c. Ligand

d. Pharmaceutical

25. The quality control procedure known as survey meter calibration is usually performed by:

a. The physicist

b. The technologist

c. The lead technologist

d. The radiation safety officer

26. Phosphorus-32, Copper-67, Iodine-131, and Yttrium-90 are examples of:

a. Alpha-particle emitters

b. Beta-particle emitters

c. Alpha- and beta-particle emitters

d. Pure gamma emitters

27. It refers to the decay mode of Gallium-67.

a. Beta minus decay

b. Isomeric transition

c. Beta plus decay

d. Electron capture

28. The name given when the parent radionuclide is very long-lived compared to the daughter.

a. Secular equilibrium

b. Transient equilibrium

c. Regular equilibrium

d. Static equilibrium

29. Point out the radiopharmaceutical that can be used for inflammatory disease and infection.

a. Xe-133 (inert gas)

b. I-131 sodium iodide

c. In-111 ibritumomad (Zevalin)

d. In-111 oxine leukocytes

30. Point out the radionuclide which emits principal photon energies of 172 and 245 keV.

a. Iodine-131

b. Iodine-133

c. Indium-111

d. Technetium-99m

31. Point out the major disadvantages of thallium as a radioactive imaging agent:

I. Absence of an ideal photopeak for imaging.

II. The gamma emissions (135 and 167 keV) occur in low abundance.

III. It emits beta particles which don’t contribute to diagnosis.

IV. The emitted mercury characteristic x-rays in the range of 69 to 83 keV are acquired, as sometimes are the 167 keV gamma emissions.

a. I, II, and IV

b. I, II, and III

c. II and IV

d. IV only

32. Which of the following refers to a biomolecule (typically a protein) that is capable of inducing the production of, and binding to, an antibody in the body?

a. Antibody

b. Antigen

c. Antimony

d. Antiseptic

33. What mechanism of radiopharmaceutical localization involves red blood cells being withdrawn from the patient, labeled with Tc-99m, and slightly damaged by in vitro heating in a boiling water bath for approximately 30 min?

a. Phagocytosis

b. Passive diffusion

c. Physiochemical adsorption

d. Cell sequestration

34. Point out the characteristics of a desired radiopharmaceutical:

I. Should ensure that it will localize in the organ or tissue of interest.

II. Should be free of any toxicity or physiological effects.

III. Should rapidly and specifically localize according to the intended application.

IV. Should not contain particulate radiation.

a. I, II, and III

b. I, III, and IV

c. I, II, III, and IV

d. II and IV

35. Which of the following patients undergoing diagnostic medical procedures are considered a radioactive source?

a. Patient undergoing MRI study with gadolinium administration

b. Patient undergoing CT scan with iodine administration

c. Patient undergoing NM study with radiopharmaceutical administration

d. Patient undergoing X-ray study

36. The form of targeted radionuclide therapy that uses a monoclonal antibody to deliver localized radiation is called:

a. Radioimmunotherapy

b. Radiochemotherapy

c. Radiation therapy

d. Antibody therapy

37. Which of the following radiopharmaceuticals is used for hepatobiliary scintigraphy?

a. Tc-99m iminodiacetic acid (HIDA)

b. Tc-99m exametazime (HMPAO)

c. Tc-99m macroaggregated albumin (MAA)

d. Tc-99m sodium pertechnetate

38. Which of the following radiopharmaceuticals is used for lymphoscintigraphy?

a. Tc-99m diethylenetriamine-pentaacetic acid (DTPA)

b. Tc-99m dimercaptosuccinic acid (DMSA)

c. Tc-99m sulfur colloid

d. Tc-99m bicisate (ECD)

39. The first radiopharmaceutical of importance in clinical nuclear medicine:

a. Iodine-133

b. Iodine-131

c. Xenon-133

d. Indium-111

40. Point out the advantages of Iodine-123 over Iodine-131:

I. It has a shorter half-life (13.2 hours).

II. Principal photon energy (159 keV) is better suited to imaging with the gamma camera.

III. It decays by electron capture, and the dosimetry is favorable compared with that of I-131.

IV. Long half-life (8 days).

a. I and II

b. II and IV

c. I, II, and III

d. I, II, III, and IV

41. Point out the advantages of Krypton-81m:

I. High principal gamma emission (190 keV).

II. Generator must be replaced daily.

III. Short half-life (13 seconds).

IV. Allowing for postperfusion imaging and multiple-view acquisition without concern for

retained activity or radiation dose.

a. I, II, and III

b. I and IV

c. I, II, and IV

d. I, III, and IV

42. Which of the following is true regarding pregnancy in nuclear medicine procedures?

a. It is an absolute contraindication to performing a nuclear medicine study.

NUCMED P2

b. Radioiodine examination on pregnant women should be done before 10 to 12 weeks of

gestation.

c. Risk-to-benefit ratio of ventilation-perfusion scintigraphy is high and considered an

acceptable procedure in this circumstance.

d. Tc-99m MAA does not cross the placenta while xenon and radioiodine crosses the

placenta.

43. What is the principal mode of decay for I-123?

a. Alpha decay

b. Electron capture

c. Beta minus

d. Isomeric transition

44. Which of the following refers to the half-life of Indium-111?

a. 2.8 days

b. 78.3 hours

c. 6 hours

d. 272 days

45. What particle is bombarded to Uranium-235 to produce Molybdenum-99?

a. Proton

b. Electron

c. Triton

d. Neutron

46. What is the most common type of generator system used for regional clinics, which

comes with a reservoir of normal saline?

a. Molytech generator

b. Pellets

c. Wet generator

d. Dry generator

47. All of the following are radionuclides used in single-photon emission computed tomography (SPECT) EXCEPT:

a. Cobalt-57

b. Thallium-201

c. Iodine-123

d. Xenon-133

48. Point out how the Nuclear Regulatory Commission (NRC) regulations define a medical

event:

I. Administered dose differing from the prescribed dose when the effective dose equivalent to

the patient exceeds 5 rem to the whole body or 50 rem to any individual organ.

II. Radiopharmaceutical dose administration involving the wrong patient.

III. Wrong route of administration.

IV. Wrong radiopharmaceutical.

*Note: Corrected values for NRC "Medical Event" are typically 5 rem (0.05 Sv) whole body or 50 rem (0.5 Sv) to an organ.*

a. I, II, and III

b. II, III, and IV

c. II and III

d. II and IV

49. Which of the following refers to the introduction of the radiopharmaceutical into a

well-defined anatomic compartment?

a. Compartmental localization

b. Cell sequestration

c. Perfusion

d. Chemotaxis

50. In a Molybdenum-99/Technetium-99m generator, which of the following is the standard

for radionuclide purity?

a. < 0.15 μCi Mo-99 / mCi Tc-99m at time of administration

b. < 0.015 μCi Mo-99 / mCi Tc-99m at time of administration

c. < 0.15 mCi Mo-99 / mCi Tc-99m at time of administration

d. < 0.105 μCi Mo-99 / mCi Tc-99m at time of administration

51. Point out the radionuclides used in Positron Emission Tomography (PET):

I. Nitrogen-13

II. Rubidium-82

III. Iodine-123

IV. Gallium-68

a. I, II, and IV

b. II and III

c. I, II, and III

d. II only

52. The presence of Mo-99 contamination in the Tc-99m eluate is called:

a. Molybdenum breakout

b. Molybdenum breakthrough

c. Molybdenum breaking

d. Alumina breakthrough

53. In a Molybdenum-99/Technetium-99m generator, which of the following is the standard value for chemical purity?

a. < 0.1 μg/mL (fission generator)

b. < 10 mg/mL (fission generator)

c. < 10 μg/mL (fission generator)

d. < 100 μg/mL (fission generator)

54. In the context of radiation accident spills, for I-131, which of the following is considered to be a minor spill?

a. Incidents involving less than 1 μCi

b. Incidents involving less than 1 mCi

c. Incidents involving more than 1 mCi

d. Incidents involving less than 0.1 mCi

55. In the event of a major spill involving radioactive materials, which of the following actions should NOT be taken to ensure safety and minimize radiation exposure?

a. Attempts are made to prevent further spread with absorbent pads, and, if possible, the radioactivity is shielded.

b. The radiation safety officer directs how to proceed with cleanup and decontamination.

c. The room should be kept open.

d. Radiation safety officer is notified immediately.

56. Which of the following radiopharmaceuticals is a skeletal imaging agent used to demonstrate areas of hyper or hypo osteogenesis and/or osseous blood flow?

a. Tc-99m Pentetate

b. Tc-99m Pyrophosphate

c. Tc-99m Red Blood Cells

d. Tc-99m Bicisate

57. Which of the following radiopharmaceuticals is used for the diagnosis of myocardial ischemia and infarct?

a. Tc-99m Sulfur Colloid

b. Tc-99m Sestamibi

c. Tc-99m Tetrofosmin

d. Tc-99m Sodium Pertechnetate

58. Which of the following radiopharmaceuticals is used for the identification and semiquantitative assessment of myocardial ischemia and infarction?

a. Tc-99m Tetrofosmin

b. Tl-201 Thallous Chloride

c. Xe-133 Xenon Gas

d. Y-90 Microspheres

59. Which of the following radiopharmaceuticals is a radioimmunotherapeutic monoclonal antibody used for the treatment of relapsed or refractory low-grade, follicular or transformed B-cell non-Hodgkin's Lymphoma?

a. Y-90 Zevalin

b. Y-90 Microspheres

c. Tc-99m Bicisate

60. Tc-99m Disofenin, also known as HIDA (iminodiacetic acid), is used as a hepatobiliary imaging agent. What method of administration is used to localize this radiopharmaceutical?

a. Inhalation

b. Oral

c. Intracavitary

d. Intravenous

61. Which of the following radiopharmaceuticals is a radioimmunotherapeutic monoclonal antibody for the treatment of chemotherapy-refractory low-grade or transformed low-grade Non-Hodgkin's lymphoma?

a. I-131 Tositumomab

b. In-111 Capromab

c. In-111 Pentetreotide

d. P-32 Chromic Phosphate

62. Point out the radiopharmaceutical that is used for the treatment of polycythemia vera (PCV), myelocytic leukemia, and chronic lymphocytic leukemia.

a. In-111 White Blood Cells

b. Kr-81m Krypton Gas

c. P-32 Sodium Phosphate

d. P-32 Chromic Phosphate Colloid

63. Point out the radiopharmaceuticals that can be used for radionuclide therapy only:

I. Sm-153 EDTMP (Quadramet)

II. Sr-89 Chloride (Metastron)

III. Tc-99m DMSA (dimercaptosuccinic acid)

a. I, II, and III

b. I and II

c. I and III

d. II and III

64. Y-90 Microspheres is used for the treatment of unresectable hepatocellular carcinomas with beads. Point out the method of localization to localize this radiopharmaceutical.

a. Radioembolization

b. Phagocytosis

c. Passive diffusion

d. Active transport

65. Point out the radiopharmaceutical that is considered a glucose analogue and used to assess recurrence and to differentiate between recurring tumor and necrotic tissue, and for the localization of epileptogenic focus and evaluation of dementias.

a. Cr-51 Sodium Chromate

b. Co-57 Vitamin B12

c. I-123 Metaiodobenzylguanidine (MIBG)

d. F-18 Fluorodeoxyglucose (FDG)

66. Point out the radiopharmaceuticals that can be used for renal scintigraphy:

I. Tc-99m diethylenetriamine-pentaacetic acid (DTPA)

II. Tc-99m diphosphonate

III. Tc-99m mercaptoacetyltriglycine (MAG3)

IV. Tc-99m dimercaptosuccinic acid (DMSA)

a. I, III, and IV

b. I, II, and III

c. I, II, and IV

d. I, II, III, and IV

67. A type of generator system that is common in imaging clinics where a volume-calibrated saline charge is placed on the entry port and a vacuum vial is placed on the collection port.

a. Wet system

b. Dry system

c. Wetting system

d. Dryer system

68. Approximately how many hours does the 99Mo generator take to reach equilibrium?

a. 23 hours

b. 24 hours

c. 25 hours

d. 26 hours

69. Point out the radiopharmaceuticals that can be used for pulmonary ventilation scintigraphy:

I. Krypton-81m

II. Xenon-133

III. Xenon-127

IV. Indium-111

a. I, II, and III

b. II and IV

c. I, II, and IV

d. III and IV

70. Point out the radiopharmaceutical that is used to detect neuroendocrine tumors.

a. In-111 oxine leukocytes

b. I-123 sodium iodide

c. In-111 pentetreotide (OctreoScan)

d. I-131 tositumomab

71. All of the following are used as perfusion agents in nuclear medicine EXCEPT:

a. Oxygen-15 water

b. Nitrogen-13 ammonia

c. Carbon-11 acetate

d. Rubidium-82 chloride

72. What is the expected valence state of the Tc-99m eluted from the generator?

a. +8

b. +7

c. +6

d. +9

73. Which of the following best describes chemical purity in radiopharmaceutical preparations?

a. The fraction of total radioactivity in the desired chemical form.

b. The ratio of the desired radionuclide to other radionuclides.

c. The absence of microorganisms and pyrogens.

d. The fraction of wanted vs. unwanted chemicals in a preparation.

74. A nuclear medicine technologist is measuring the particle size distribution in a Tc-99m MAA preparation. This measurement assesses which type of purity?

a. Chemical purity

b. Physical purity

c. Radiochemical purity

d. Biological purity

75. Sterility testing of a radiopharmaceutical preparation is primarily done to ensure:

a. Radiochemical purity

b. Radionuclide purity

c. Physical purity

d. Biological purity

76. What could be a consequence of low radionuclide purity in a radiopharmaceutical preparation?

a. Increased radiation exposure from unintended isotopes.

b. Presence of large, undissolved particles in the preparation.

c. Reduced sterility leading to infections.

d. Unstable binding of the radiopharmaceutical to target tissues.

77. A patient with a suspected hepatic hemangioma requires imaging. Which radiopharmaceutical is the best choice?

a. Tc-99m sestamibi

b. Tc-99m macroaggregated albumin (MAA)

c. Tc-99m red blood cells

d. Tc-99m sulfur colloid

78. If a clinician wants to assess a patient's glomerular filtration rate (GFR) dynamically, which radiopharmaceutical should be selected?

a. Tc-99m DMSA

b. Tc-99m MAG3

c. Tc-99m DTPA

d. Tc-99m sestamibi

79. A patient presents with possible bone metastases. Which radiopharmaceutical is most appropriate?

a. Tc-99m sestamibi

b. Tc-99m diphosphonate (e.g., MDP)

c. Tc-99m ECD

d. Tc-99m HMPAO

80. Which radiopharmaceutical is preferred for evaluating liver and spleen function?

a. Tc-99m sestamibi

b. Tc-99m sulfur colloid

c. Tc-99m DMSA

d. Tc-99m tetrofosmin

81. What makes Tc-99m MAA useful in pulmonary perfusion scans?

a. It binds selectively to lung tumors.

b. It gets trapped in pulmonary capillaries due to particle size.

c. It has a longer half-life than other agents.

d. It accumulates in myocardial tissue for perfusion studies.

82. A nuclear medicine physician needs to assess a patient's brain perfusion after a stroke. Which agent is most suitable?

a. Tc-99m ECD (Neurolite)

b. Tc-99m sulfur colloid

c. Tc-99m MAA

d. Tc-99m sestamibi

83. A neonate is suspected of having biliary atresia. Which agent should be used for imaging?

a. Tc-99m pertechnetate

b. Tc-99m HIDA

c. Tc-99m sestamibi

d. Tc-99m MAA

84. Why is hydration recommended before administering F-18 Sodium Fluoride for bone imaging?

a. To reduce radiation dose to the bladder

b. To enhance skeletal uptake

c. To prevent radiopharmaceutical degradation

d. To delay imaging for better results

85. A patient is scheduled for an In-111 WBC scan for infection detection but has a low white blood cell count. What is the most appropriate action?

a. Proceed with the scan

b. Use Tc-99m HMPAO-labeled leukocytes instead

c. Delay the scan until WBC levels normalize

d. Use Ga-67 Citrate instead

86. Why is I-131 not used for diagnostic thyroid imaging as frequently as I-123?

a. I-131 emits only beta radiation

b. I-131 has a longer half-life and higher radiation dose

c. I-123 has better resolution for imaging

d. Both b and c

87. A physician needs to evaluate myocardial viability. Which radiopharmaceutical would be most appropriate?

a. Tc-99m MDP

b. F-18 FDG

c. In-111 WBC

d. Tc-99m DMSA

88. A patient suspected of Parkinson's disease requires functional brain imaging. Which radiopharmaceutical is most suitable?

a. Tc-99m Sestamibi

b. I-123 Ioflupane (DaTscan)

c. Tc-99m MDP

d. In-111 WBC

89. What is the advantage of using PET/CT over conventional nuclear medicine scans for oncology imaging?

a. Higher sensitivity and specificity

b. Ability to measure metabolic activity

c. Improved anatomical localization

d. All of the above

90. A PET scan using F-18 FDG shows increased uptake in the brain and heart. What does this indicate?

a. Normal physiological uptake

b. Metastatic disease

c. Hypometabolism

d. Poor radiotracer preparation

91. Point out the physical half-life of I-131.

a. 13.2 hours

b. 8 days

c. 6 hours

d. 2.8 days

92. Point out the principal mode of decay for Tl-201:

a. Isomeric transition

b. Beta minus

c. Electron capture

d. Positron emission

93. Which of the following are the two principal radiochemical impurities in technetium-labeled radiopharmaceuticals?

a. Free Tc-99m-pertechnetate and bound Tc-99m

b. Free Tc-99m-pertechnetate and hydrolyzed Tc-99m

c. Hydrolyzed Tc-99m and oxidized Tc-99m

d. Bound Tc-99m and reduced Tc-99m

94. If a patient undergoing a bone scan with Tc-99m MDP has abnormally high uptake in the kidneys, what could be a potential cause?

a. Bone metastases

b. Renal failure

c. Hyperparathyroidism

d. Poor hydration

95. If a technologist suspects that a Tc-99m preparation has a high amount of hydrolyzed Tc-99m, which quality control procedure could confirm the presence and quantity of this impurity?

NUCMED P2

a. Gamma spectrometry

b. Thin-layer chromatography

c. Dynamic renal imaging

d. Pulse oximetry

96. How might the presence of radiochemical impurities, such as free Tc-99m-pertechnetate and hydrolyzed Tc-99m, affect the diagnostic quality of a Technetium-labeled radiopharmaceutical?

a. It will enhance imaging contrast.

b. It may reduce imaging specificity and biodistribution accuracy.

c. It will have no impact on diagnostic quality.

d. It will increase the half-life of the radiopharmaceutical.

97. Which of the following refers to the principal photon energy of Ga-67?

a. 140 keV

b. 159 keV

c. 93 keV

d. 245 keV

98. Point out the primary purpose of colorimetric qualitative spot testing in radiopharmaceutical preparation?

a. To measure the physical half-life of Tc-99m

b. To identify radiochemical impurities in the preparation

c. To determine if unacceptable levels of contaminants, such as aluminum, are present

d. To ensure the chemical bonding of Tc-99m to its carrier molecule

99. Point out a potential clinical impact of excessive aluminum in radiopharmaceuticals?

a. Decreased gamma-ray emission

b. Altered photon energy during imaging

c. Increased lung activity with Tc-99m sulfur colloid and liver uptake with Tc-99m MDP

d. Prolonged biological clearance of radiopharmaceuticals

100. Point out the mechanism of localization which involves cellular metabolic processes that expend energy to concentrate the radiopharmaceutical into a tissue against a concentration gradient and above plasma levels.

a. Passive diffusion

b. Physiochemical adsorption

c. Receptor binding

d. Active transport