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z Nuc Med z > Cardiac practice test > Flashcards

Cardiac practice test Flashcards

1
Q 
What portion of an EKG wave represents the
depolarization of the ventricles?
a. QRS complex
b. P-wave
c. ST segment
d. T-wave
A

a

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2
Q

A patient is only able to tolerate 3 images during a 201Tl
chloride myocardial perfusion study. From those views
listed, which would be the best choice of images to
obtain?
a. RAO 10, LAO 45, and left lateral
b. anterior, LAO 25 and LAO 60
c. anterior, LAO 45 and LAO 70
d. anterior, LAO 70 and left lateral

A

c

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3
Q

Within what time frame must imaging be initiated
following injection of 201Tl chloride in an exercise
perfusion study?
a. within 5 minutes
b. within 10–15 minutes
c. within 20–30 minutes
d. within a 4 hours

A

b

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4
Q 
Of the choices offered, which is the best imaging view
for calculating right ejection fraction?
a. RAO 60%
b. RAO 30%
c. anterior
d. LAO 10%
A

b

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5
Q 
Of the choices offered, which is the best imaging view
for calculating left ejection fraction?
a. anterior
b. LAO 5%
c. LAO 45%
d. left lateral
A

c

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6
Q 
Given the data below, calculate the left ventricular
ejection fraction.
net ED = 58, 219
net ES = 35,317
a. 16%
b. 39%
c. 43%
d. 60%
A

b

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7
Q

The left ventricular ejection fraction determined
in question 6 is within the normal range.
a. true
b. false

A

b

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8
Q

Figure 8.1 (p. 66) shows computer generated time activity
curves over a cardiac cycle for two patients. Which curve
represents the patient with the higher ejection fraction?
a. upper curve
b. lower curve

A

b

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9
Q 
Which of the following cannot be evaluated by a MUGA
scan?
a. wall motion
b. wall thickness
c. aneurysmal flow
d. vessel patency
A

b

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10
Q

During a gated study, 24 images per cardiac cycle are
obtained. If the patient’s heart rate is 65 bpm, the length
of time per image is:
a. 3.8 msec
b. 38 msec
c. 4.1 msec
d. 41 msec

A

b

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11
Q

A right anterior oblique is useful for:
a. facilitating calculation of LVEF and RVEF on first
pass
b. separation of ventricles from stomach on first pass
c. visualizing the lateral wall of the left ventricle
d. increasing patient comfort and potentially improving
image quality

A

a

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12
Q

What will reverse the effects of dipyridamole?

a. dobutamine
b. cholecystokinin
c. aminophylline
d. adenosine
e. thallium

A

c

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13
Q 
Which of the following will most negatively affect
radionuclide ventriculography?
a. sinus tachycardia
b. sinus bradycardia
c. long QT interval
d. occasional PVC
e. sinus arrhythmia
A

3

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14
Q 
The vertical long axis view of the heart is most
comparable to a:
a. coronal image
b. sagittal image
c. transverse image
A

b

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15
Q

As an alternative to exercise studies, pharmacologic
stress can be achieved through the use of any of the
following except:
a. dipyridamole
b. aminophylline
c. dobutamine
d. adenosine

A

b

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16
Q

In multigated analysis of the left ventricular, end systole
is best described as:
a. the frame with the highest number of counts in the
ROI around the left ventricle
b. the frame with the lowest number of counts in the
ROI around the right ventricle
c. the frame with the lowest number of counts in the
ROI around the left ventricle, plus the counts from the
background ROI
d. all of the above
e. none of the above

A

e

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17
Q

All of the following will negatively affect a myocardial
study with 201Tl chloride except:
a. wrong collimator
b. arrhythmia
c. incorrect COR
d. increased patient to detector distance
e. none of the above

A

b

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18
Q

Dipyridamole is supplied to a nuclear medicine
department in 10 ml vials, each containing 50 mg. If a
patient weighs 155 pounds, how many milliliters must
be injected for him to receive 0.56 mg/kg?
a. 7.9 ml
b. 8.7 ml
c. 17.4 ml
d. 39.5 ml

A

a

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19
Q

Which of the following does not describe correct
preparation for an exercise myocardial study?
a. NPO at least 4 hours prior to radiopharmaceutical
administration
b. catheter placement for injection of radiopharmaceutical during exercise
c. halt all medication 24 hours before study
d. none of the above

A

c

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20
Q

During an exercise gated study, the ECG pattern
suddenly becomes dramatically different, although the
patient is responsive, has an unchanged pulse rate,
continues to exercise, and has no pain. The technologist
should first:
a. start CPR
b. call a code
c. check for a disconnected lead
d. call the referring physician
e. do nothing

A

c

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21
Q 
Which of the following radiopharmaceuticals is not
used to study the heart?
a. 99mTc sestamibi
b. 99mTc HSA
c. 99mTc PYP
d. 99mTc WBCs
e. both b and d
A

d

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22
Q

Which of the following is not a critical factor in
obtaining a gated first pass study?
a. tracer bolus of small volume
b. regular heartbeat
c. use of a multi-crystal gamma camera
d. positioning heart in the center of the field of view
e. injection of at least 10 mCi of radiotracer

A

c

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23
Q

The best collimator for use during a first pass study is:

a. LEAP
b. high sensitivity
c. high resolution
d. medium energy

A

b

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24
Q

A neonatal first pass study is performed and the time
activity curve for the ROI around the left ventricle
shows a peak of activity occurring before the activity
peak on the lung ROI. This most likely indicates:
a. improperly drawn regions of interest
b. interventricular shunt
c. prolapsed mitral valve
d. radiotracer contained in too high a volume

A

b

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25
Q

A nuclear medicine physician prefers that static
myocardial perfusion images be obtained according
to the best septal visualization. If the septum is well
visualized on LAO 45°, what other views should be
obtained?
a. anterior, LAO 70°
b. RAO 20°, LAO 60°
c. anterior, LAO 60°
d. RAO 5°, LAO 65°

A

d

26
Q

Cardiac contraction is initiated in the:

a. SI node
b. AV node
c. bundle of His
d. P wave

A

a

27
Q

Treadmill exercise tests increase heart rate by:

a. increasing the resistance of the treadmill
b. increasing treadmill speed
c. simulating infarct
d. all of the above

A

b

28
Q

A high resolution collimator would be most appropriate
for:
a. myocardial perfusion study with 201Tl chloride
b. myocardial perfusion with 99mTc sestamibi
c. first pass study with 99mTc DTPA
d. myocardial imaging with 99mTc pyrophosphate

A

b

29
Q

On Monday morning, a technologist receives a telephone
request to perform a myocardial study with 99mTc PYP
for detection of a myocardial infarct suspected to have
taken place that morning at about 8:00 a.m. What
should be done?
a. the patient should be injected, but not scanned until
at least 8:00 a.m. on Tuesday
b. the study should be delayed until 8:00 a.m.
on Tuesday
c. the study should be delayed until 8:00 a.m.
on Thursday
d. the patient should be injected and scanned as soon
as possible

A

b

30
Q

Infarct-avid myocardial imaging with 99mTc PYP is
usually interpreted by comparing cardiac activity in:
a. rib
b. sternum
c. kidneys
d. all of the above
e. a and b only

A

e

31
Q

If a SPECT myocardial study with 99mTc PYP is
performed using 64 views of 20 seconds each over 360°,
how long will the study take assuming continuous
rotation?
a. 18 minutes
b. 21 minutes
c. 92 minutes
d. 112 minutes

A

b

32
Q 
Gated equilibrium cardiac blood pool images can be
used to reliably determine:
a. hibernating myocardium
b. LVEF
c. interventricular shunt
d. ischemia
e. all of the above
A

b

33
Q

Akinesis refers to:

a. a lack of wall motion
b. diminished wall motion
c. paradoxical wall motion
d. septal motion

A

a

34
Q 
The R-R interval represents:
a. only repolarization
b. arrhythmia filtering
c. the length of a cardiac cycle
d. length of time data is held in a buffer before being
accepted or rejected
A

c

35
Q

When labeling RBCs with 99mTc for radionuclide
ventriculography, the highest labeling efficiency will be
obtained by:
a. the invivo method
b. the invitro method
c. the modified invivo/invitro method
d. all result in the same labeling efficiency

A

b

36
Q

In which of the following cases must imaging be
initiated as soon as possible after radiopharmaceutical
injection?
a. radionuclide ventriculography with 99mTc labeled
RBCs
b. radionuclide ventriculography with 99mTc HSA
c. myocardial perfusion imaging with 99mTc sestamibi
d. resting myocardial perfusion with 201Tl chloride

A

b

37
Q

A patient has an enlarged left atrium. When drawing
an ROI for calculation of LVEF following radionuclide
ventriculography, the technologist includes some activity
from the left atrium. The resulting ejection fraction
will be:
a. unchanged
b. falsely elevated
c. falsely lowered
d. cannot be determined from the information given

A

c

38
Q

Gated blood pool ventriculography is often used to:
a. diagnose arrhythmia
b. obtain a baseline measurement of cardiac function
in potential radiation therapy patients
c. detect hematologic spread of metastases
d. determine effect of chemotherapy on cardiac function

A

d

39
Q

Set up for a SPECT imaging of myocardial perfusion
with 99mTc sestamibi includes all of the following except:
a. ensuring that the detector head will not snag IV lines
or oxygen tubing
b. setting a 10° caudal tilt to differentiate left atrium
from left ventricle
c. moving patients arms over his or her head
d. ensuring that COR correction for high sensitivity
collimator is selected

A

b

40
Q

A patient who cannot exercise and who has asthma can
undergo a stress myocardial perfusion study through
the use of:
a. the Bruce protocol
b. dipyridamole
c. dobutamine
d. adenosine

A

c

41
Q

A patient will be asked to fast, or to eat lightly between
stress and redistribution studies with 201Tl chloride
because:
a. peristalsis will degrade images
b. stomach activity may obscure myocardium
c. gall bladder contraction will be stimulated
d. the patient will experience nausea following the
stress test

A

b

42
Q

Which radiopharmaceutical can be used to assess
myocardial perfusion, right ventricle ejection fraction
and left ventricle ejection fraction with a single
injection?
a. 201Tl chloride
b. 99mTc PYP
c. 99mTc labeled RBCs
d. 99mTc sestamibi

A

d

43
Q

Choose the correct order in which the structures appear
during a first pass study.
a. right ventricle, pulmonary artery, lungs, pulmonary
veins, left ventricle
b. right ventricle, pulmonary veins, lungs, pulmonary
artery, left atrium
c. left ventricle, pulmonary artery, lungs, pulmonary
veins, right ventricle
d. left ventricle, pulmonary veins, lungs, pulmonary
artery, right ventricle
e. right ventricle, pulmonary artery, lungs, pulmonary
veins, left atrium

A

e

44
Q

Which of the following is the most likely cause of false
anterior or lateral wall defects on myocardial perfusion
imaging with 201Tl chloride?
a. center of rotation error
b. respiratory motion
c. too few projections
d. attenuation by breast tissue or implant

A

d

45
Q

During a one day myocardial perfusion study with 99mTc
sestamibi including both stress and rest:
a. rest images must be obtained before stress images
b. the second dose of sestamibi should be higher than
the first
c. the higher dose of sestamibi is always injected for
the stress portion
d. the sestamibi doses should be identical for best
comparison of stress and rest

A

b

46
Q

Why is it necessary to inject two doses of 99mTc sestamibi
for a myocardial perfusion study including both stress
and rest conditions?
a. because the physical half life of 99mTc is too short
to obtain both image sets from one injection
b. because there is no redistribution of 99mTc sestamibi
within the myocardium
c. because the effective half life is too short
d. because sestamibi is not retained by the myocardium
for a sufficient time

A

b

47
Q

Soft tissue attenuation is less problematic in:
a. SPECT myocardial imaging with 99mTc sestamibi
than with planar imaging with 99mTc sestamibi
b. SPECT myocardial imaging with 201Tl chloride
than with planar imaging with 201Tl chloride
c. myocardial imaging with 201Tl chloride than
with 99mTc sestamibi
d. myocardial imaging with 99mTc sestamibi than
with 201Tl chloride

A

d

48
Q

The bulls eye display created after myocardial perfusion
imaging represents:
a. only short axis images
b. an entire set of stress or rest SPECT images
c. all part of the myocardial wall except the apex
d. none of the above
e. b and c

A

b

49
Q

Differences between myocardial perfusion imaging with 201Tl chloride and 99mTc sestamibi include:
a. high resolution collimator can be used with 201Tl
b. less soft tissue attenuation with 201Tl
c. higher photon flux with 99mTc
d. less respiratory motion with 201Tl due to delay after
exercise before imaging

A

c

50
Q

When performing a radionuclide venogram to visualize
deep venous thrombosis, what should be injected,
and where?
a. 99mTc MAA in bilateral pedal veins
b. 99mTc MAA subcutaneously in either foot
c. 99mTc pertechnetate in the femoral artery
d. 99mTc PYP in the left foot

A

a

51
Q

Following injection of 99mTc sestamibi, during a resting
myocardial perfusion study, imaging is delayed for one
hour because:
a. respiratory motion will decrease
b. liver and lung activity is too high to allow high
quality images of the myocardium
c. until one hour after injection, sestamibi has not had
sufficient time to be taken up by the myocardium
d. the patient should be monitored for adverse reactions
during the first hour

A

b

52
Q

When performing a dual isotope myocardial perfusion
rest/stress study, which isotope should be injected first?
a. 201Tl
b. 99mTc
c. it doesn’t matter which is injected first, as long as 99mTc is used for the stress study
d. either can be injected first without any consequence

A

a

53
Q

Which of the following technical considerations are
applicable for radionuclide venography?
a. tourniquets applied about the ankles and just below
the knee
b. radioactive markers taped atop each patella
c. knees elevated with a pillow
d. all of the above

A

a

54
Q

False negative stress myocardial perfusion studies are
usually caused by:
a. failure of the myocardium to extract 201Tl chloride
from the bloodstream
b. electrocardiogram leads
c. failure of the patient to reach maximal stress
d. thallium contained in too large a volume

A

c

55
Q

Which of the following should be prepared ahead
of a dipyridamole stress myocardial perfusion study?
a. dose of dipyridamole
b. dose of radiopharmaceutical
c. dose of aminophylline
d. all of the above
e. a and b only

A

d

56
Q

During a MUGA study, data collection is stopped when:
a. a preset number of counts has been acquired
b. a preset number of cardiac cycles has been reached
c. a present time has been reached
d. when either a preset number of counts or a preset
number of cardiac cycles has been reached
e. when either a preset number of cardiac cycles
or a preset time has been reached

A

d

57
Q

A technologist injects a patient with 1 mg of unlabeled
stannous phosphate. After 20 minutes, 20 mCi of 99mTc
pertechnetate is administered. This is:
a. an invitro labeling procedure
b. an invivo labeling procedure
c. a modified invivo labeling procedure
d. none of the above

A

b

58
Q 
A disadvantage of using 99mTc HSA for radionuclide
ventriculography includes:
a. high radiation dose
b. lung uptake
c. liver uptake
d. relatively low photon flux
e. difficult labeling procedure
A

c

59
Q

Which of the following may have an effect on the time
it takes to acquire a cardiac gated blood pool study?
a. amount of radiopharmaceutical injected
b. heart rate
c. use of arrhythmia filtering
d. all of the above
e. a and b only

A

d

60
Q

Relative to one another, 82Rb and 82Sr are:

a. isobars
b. isotopes
c. isotones
d. none of the above

A

a

61
Q

A patient has undergone myocardial PET scans using 13N
ammonia and 18FDG. There is little inferoapical activity
on the 13N scan, but there is homogeneous uptake in the
same area on the 18FDG images. This suggests that:
a. an incorrect dose of 13N has been administered.
b. the inferoapical area may revascularize.
c. there is little viable tissue in the inferoapical wall.
d. the system requires a quality control check.

A

b

62
Q

Patient A and Patient B are injected with the same dose
of 13N ammonia for a myocardial PET scan. The patients
are the same height but Patient A weighs 120 lbs. and
Patient B weighs 180 lbs. From which patient would
more true coincidence be detected?
a. Patient A
b. Patient B

A

a

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