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z Nuc Med z > Cardiac practice test > Flashcards

Cardiac practice test Flashcards

1
Q

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

A. supine with the left arm above the head
B. on their right side with the left arm above the head
C. on their left side with the right arm above the head
D. prone with the right arm above the head

A

supine with left are above the head

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2
Q

What physiologic trigger (initiates the start of an image) on an ECG is used when performing cardiac gating?

a. a new image is started with each shift in the ECG with each respiration
b. a new image is started with each P wave
c. a new image is started with each R wave
d. The ECG doesn’t trigger the camera, instead after an average heartrate is calculated, a new image is started based on the timing of that average rate

A

a new image is started with each R wave

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3
Q

Myocardial perfusion imaging is primarily performed to

A. determine ejection fraction
B. record the rate of delivery of a bolus injection
C. detect the location and extent of ischemia
D. evaluate wall motion of the ventricles

A

detect the location and extent of ischemia

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4
Q

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

A. Must wait for the heart rate to return to normal
B. Because ischemic tissue redistribute faster than normal tissue
C. 4 hours must be waited to allow pulmonary uptake to deminish
D. Because the tracer does not remain fixed in the myocardium, by 4 hours most of the redistribution has taken place showing viable tissue.

A

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

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5
Q

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

A. the beginning of stress
B. 85% of anticipated maximum stress and the exercise continued for 1 to 2 minutes
C. peak stress and exercise terminated immediately
D. 1 to 2 minutes after peak stress and the exercise terminated within 1 minute

A

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

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6
Q

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

A. exercise stress
B. dipyridamole
C. adenosine
D. dobutamine

A

Dobutamine

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7
Q

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

A. none, this comes from the 2d anterior planar view
B. vertical long-axis slices
C. horizontal long-axis slices
D. short-axis slices

A

none, this comes from the 2D anterior planar view ; short axis slices

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8
Q

On the below bull’s-eye image, “A” represents what structure of the heart?

A. the septal wall
B. the anterior region of the heart
C. the lateral wall
D. the apex of the heart

A

Apex of the heart

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9
Q

Which coronary artery primarily supplies region “D” ?

A. Left Anterior Descending (LAD) artery

b. Right Coronary Artery (RCA)
c. Left Circuflex (LCx) artery
d. Obtuse Marginal (OM) artery

A

LCX artery

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10
Q

Which is a possible side effects of adenosine and dipyridamole?

a. bronchio constriction (asthma attack)
b. chest pain
c. slowed conduction of the AV node causing first degree AV block
d. shortness of breath
e. all of the above
f. only b and d

A

E. bronchio constriction (asthma attack), chest pain, slowed conduction of the AV node causing first degree AV block, shortness of breath

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11
Q

Which of the following drugs will reverse the effects of dipyridamole (persantine)?

a. Aminophylline
b. Triptophyline
c. Furosemide
d. Metoclopramide hydrochloride
e. Adenosine

A

Aminophylline

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12
Q

Which of the following drugs will reverse the effects of dobutamine?

a. Atropine
b. Esmolol (Breviblock)
c. Furosemide
d. Reglan
e. Glucagon

A

Esmolol (Breviblock)

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13
Q

What is the standard dose for Regadenosine?

A. 0.4 mg in 5 ml given over 10 seconds
B. 0.84 mg/kg given over 6 minutes
C. 0.57 mg/kg given over 4 minutes
D. 5 to 40 ug/kg/minutes increasing 5 ug every 3 minutes

A

0.4 mg in 5 ml given over 10 seconds

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14
Q

The advantage Regadenosine has over Adenosine and Dipyridamole is

a. It has no side effects
b. It increases the amount of vasodilation in comparison to the other agents
c. It has a decreased risk of respiratory attacks because it only targets A2a receptors
d. It is not effected by methylxanthines

A

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

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15
Q

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

a. recent myocardial infarction (< 4 days)
b. hypertension ( > 160mm systolic)
c. hypotension (< 100mm systolic)
d. allergy to adenosine or aminophylline
e. severe COPD and asthma

A

hypertension ( > 160mm systolic)

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16
Q

201 Tl stress and rest images indicative of ischemia will demonstrate which of the following findings in the area of concern?

a. decreased stress uptake, decreased rest uptake
b. increased stress uptake, decreased rest uptake
c. decreased stress uptake, normal rest uptake
d. increased stress uptake, normal rest uptake

A

Answer: decreased stress uptake, normal rest uptake

17
Q

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

a. NPO prior to the study
b. discourage eating between the rest and stress images
c. encourage consumption of caffeinated substances between the rest and stress images
d. the stress portion must be completed first
e. a, b, & d only
f. all of the above

A

NPO prior to the study

18
Q

In a 201Tl only persantine stress myocardial perfusion exam, which of the following are true concerning patient preparation and procedures (choose the best answer)?

a. NPO prior to the study
b. encourage consumption of caffeinated substances between the stress and rest images
c. discourage nicotine between the stress and rest images
d. stress portion must be completed first
e. a, b, & c only
f. all of the above

A

F. NPO prior to the study, encourage consumption of caffeinated substances between the stress and rest images, discourage nicotine between the stress and rest images, stress portion must be completed first

19
Q

Each of the following is considered an advantage of using 99mTc Sestamibi/Teboroxime over 201Tl-with redistribution for the evaluation of myocardial perfusion EXCEPT:

a. superior imaging gammas
b. increased flexibility in scheduling
c. easily allows for simultaneous evaluation of wall motion (doing a gated study)
d. superior at myocardial viability assessment (stunned and hibernating myocardium)
e. increased patient through put in the laboratory (increases number you can do in a day)

A

superior at myocardial viability assessment (stunned and hibernating myocardium)

20
Q

Where is the highest initial concentration of Tc-sestamibi at rest?

a. lung
b. heart
c. gallbladder and liver
d. spleen

A

gallbladder and liver

21
Q

When does 201Tl redistribution begin?

A. Within approximately 10 minutes after injection

b. in 1-2 hours
c. after 3 hours
d. it remains fixed in the myocardium

A

within approximately 10 mins after injection

22
Q

How soon should you begin imaging after the injection of 99mTc-Sestamibi for the rest portion of the test?

a. Immediately after injection
b. 1-3 minutes after injection
c. 45 - 90 minutes after injection
d. 3 - 4 hours after injection

A

45 - 90 minutes after injection

23
Q

For Dual Isotope studies, which agent is used for the rest images?

A. TI-201
B. Tc-99m Sestamibi or Teboroxime
C. Dobutmane
D. Adenosine

A

Tl-201

24
Q

A Left Bundle Branch Block (LBBB) is a contraindication for performing which of the following?

a. A pharmacologic stress using a vasodilator
b. A pharmacologic stress using an inotropic/chronotropic agent
c. An exercise stress
d. Both a and b
e. Both b and c
f. Both a and c

A

E. a pharmacologic stress using an inotropic/chronotropic agent and an exercise stress

25
Q

The reason why a Left Bundle Branch Block (LBBB) is a contraindication is because

A. It will result in a false positive diagnosis of ischemia in the septal wall
B. Bull’s eye plotting
C. It could be potentially fatal when performing a stress test
D. These patients are unable to achieve their target heart rate
E. None of the above

A

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

26
Q

When performing an exercise stress test, what is the target heart rate for a 67 year old patient (in other words the heart rate that should be achieved so that the injection can be performed)?

a. 153 bpm
b. 130 bpm
c. 220 bpm
d. 182 bpm

A

130 bpm

27
Q

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

a. a 360 degree acquisition around the patient
b. a 180 degree acquisition around the patient starting at the anterior view and ending on the posterior view while moving around the patients left side
c. a 180 degree acquisition around the patient starting at the anterior view and ending on the posterior view while moving around the patients right side
d. 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 patients left side

A

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 patients left side

28
Q

The image below best demonstrates:

a. A normal myocardial perfusion study
b. a narrowed left anterior descending artery
c. a narrowed right coronary artery
d. a 100% occluded / blocked left anterior descending artery

A

a narrowed left anterior descending artery

29
Q

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

a. false negative studies
b. false positive studies
c. improvement in the detection of coronary artery stenosis
d. require a repeat treadmill study

A

false positive studies

30
Q

In myocardial perfusion imaging with a Tc-99m radiopharmaceutical, it is recommended that SPECT imaging begin about 10 minutes after high-level stress exercise to avoid:

a. bradycardia effects
b. attenuation by the stomach
c. cardiac creep
d. cardiac arrythmias

A

cardiac creep

31
Q

When performing equilibrium-gated blood pool studies (a MUGA) to determine cardiac function, the preferred tracer is:

A. thallium-201 chloride
B. technetium-99m - labeled tetrofosmin
C. radiolabeled RBCs
D. technetium-99m - labeled sestamibi

A

radiolabeled RBCs

32
Q

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 11,500 and net (after background is subtracted) end-diastolic counts of 30,800 would be (to the closest 1 %):

13%
27%
37%
63%

A

63%

33
Q

The best general view for a first-pass cardiac study is the

A. anterior
B. LAO (left anterior oblique)
C. RAO (right anterior oblique)
D. LLAT (left lateral)

A

RAO

34
Q

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

A. Regional perfusion of cardiac tissue
B. amount of change in contraction demonstrating hypokinesis
C. The time of contraction demonstrating area of dyskinesis
D. Direct measure of cardiac output

A

The time of contraction demonstrating area of dyskinesis

35
Q

123I-MIBG in cardiac imaging is used to image:

A. cardiac infection
B. myocardial necrosis
C. myocardial ischemia
D. neuron innervasion status of the heart

A

neuron innervasion status of the heart

36
Q

Which PET radiopharmaceutical is primarily used to differentiate viable myocardial tissue that is hibernating or stunned versus infarcted tissue.

A. Ru-82 Rubidium Chloride
B. F-18 Fluoro Depxy Glucose (FDG)
C. N-13 Ammonia
D. O-15 Water

A

F-18 Fluoro Depxy Glucose (FDG)

z Nuc Med z (14 decks)

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