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Radiology Core Exam > Comprehensive > Flashcards

Comprehensive Flashcards

1
Q

Type of radionuclide: spleen > liver

A

WBC (very low counts)

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2
Q

Type of radionuclide: liver = spleen

A

Sulfur colloid

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3
Q

Type of radionuclide: spleen

A

Gallium (Also shows bowel)

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4
Q

Type of radionuclide: Heart and kidneys seen

A

MIBI

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5
Q

Type of radionuclide: liver without kidneys or bones

A

MIBG

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6
Q

Type of radionuclide: very hot spleen and kidneys

A

octreotide (has very high counts)

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7
Q

Tag for WBCs

A

In-111

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8
Q

Type of radionuclide: bones and lacrimal glands visible

A

gallium or free Tc

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9
Q

Type of radionuclide: lacrimal glands visible without bones

A

Sulfur colloid, WBCs

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10
Q

When to image Tc-WBCs

A

4 hours (too much lung) vs. 24 hours (too much bowel)

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11
Q

Tc-WBCs vs. In-WBCs

A

Indium shows no renal or GI

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12
Q

MDP dose

A

20 mCi +/- 5

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13
Q

Timing for delayed images in MDP

A

2-4 hours

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14
Q

MDP mechanism

A

Chemisorption (phosphate binding)

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15
Q

HDP is AKA

A

Tc-MDP

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16
Q

F-18 vs. FDG with increased bone uptake

A

FDG shows brain activity

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17
Q

Skull sutures very bright on MDP

A

renal osteodystrophy

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18
Q

Unilateral breast activity on MDP

A

mastitis or cancer

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19
Q

Bilateral breast activity on MDP

A

Lactating

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20
Q

Very bright renal activity on MDP

A

chemotherapy

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21
Q

Liver seen on MDP (3 things)

A
  1. Aluminum contamination
  2. Malignancy
  3. Amyloidosis
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22
Q

Spleen on MDP

A

Sickle cell disease

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23
Q

Probability that single bright bone lesion on MDP is cancer:

A

15-20%

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24
Q

Decreased skeletal uptake on MDP

A

Dose issue or bisphosphonates

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25
Q

Flair phenomenon for bony mets (timing)

A

Starts at 2 weeks, ends at 3 months.

X-rays show increasing sclerosis.

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26
Q

PSA threshold for bone scan

A

PSA

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27
Q

Radionuclide of choice for bone mets in neuroblastoma

A

MIBG

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28
Q

Alternative to MDP for lytic mets

A

skeletal survey

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29
Q

Double density on bone scan

A

Osteoid osteoma

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30
Q

Hot mandible on MDP

A

Fibrous dysplasia

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31
Q

Mature heterotopic ossification on MDP

A

cold lesion

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32
Q

Hot AVN on MDP

A

repairing (middle phase)

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33
Q

Metabolic vs. metastatic superscan

A

Metabolic = hotter skull and extremities

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34
Q

Nuc Med for spine

A

Gallium

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35
Q

Nuc med for bowel

A

WBC

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36
Q

Positive WBC/Sulfur Colloid study

A

Hot on WBC, cold on colloid

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37
Q

Prosthetic loosening (Rule in)

A

Sulfur Colloid/WBC

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38
Q

Prosthetic loosening (rule out)

A

3 phase bone scan

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39
Q

When to do 4th phase bone scan

A

PAD or diabetes (slower blood pool clearance)

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40
Q

Tc-HMPAO WBC over In-WBC

A

Children

Small body parts (hands/feet)

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41
Q

Xe-133 physical Halflife

A

5.3 days

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42
Q

Xe-133 biological halflife

A

30 seconds (not absorbed)

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43
Q

Xe-133 energy

A

80 keV

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44
Q

In V/Q, which performed first?

A

Ventilation

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45
Q

Size of MAA in VQ

A

10-100 micrometers (capillary = 10 micrometers)

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46
Q

When to halve MAA dose (5 things)

A
  1. Children
  2. Pneumonectomy
  3. Right to left shunt
  4. Pulmonary hypertension
  5. Pregnancy
47
Q

Clumped activity on Q portion of VQ

A

MAA clumped from tech drawing blood into syringe

48
Q

Hepatic activity on Xe-133

A

Fatty liver (xe is fat soluble)

49
Q

Free Tc on VQ

A

gastric + thyroid

50
Q

Right to left shunt on VQ

A

brain +/- gastric or thyroid

51
Q

Unilateral perfusion defect on VQ (3 things)

A

Mass
Fibrosing mediastinitis
Central PE

52
Q

Gallium mechanism

A

Iron analogue, bound to lactoferrin (inflammation or rapid cell turnover)

53
Q

Radionuclide of choice for chronic infection

A

Gallium binds dead neutrophils; more sensitive than WBC

54
Q

Gallium production

A

cyclotron (Zn68)

55
Q

Ga halflife

A

78 hours

56
Q

Gallium photopeak

A

93, 184, 300, 393

57
Q

Gallium imaging

A

24 hours

58
Q

Gallium critical organ

A

colon

59
Q

Panda sign (radionuclide and 3 Dx)

A

Gallium

  1. Sarcoid (classic)
  2. Sjogren’s
  3. Treated lymphoma
60
Q

Kaposi Sarcoma (Nuc med results)

A 
Gallium = negative
Thallium = Positive
61
Q

Which thyroid radionuclide is not organified

A

Tc (I-123 and I-131 are)

62
Q

Fetal thyroid formation (trimester)

A

Late first (8-12 weeks)

63
Q

I-131 Half life

A

8 days

64
Q

I 131 photopeak

A

364 keV

65
Q

I-123 half life

A

13 hours

66
Q

I-123 photopeak

A

159 keV

67
Q

I-131 decay type

A

beta emission

68
Q

I-123 decay type

A

electron capture

69
Q

Breast feeding (thyroid imaging; 3 radionuclides)

A

Rule of thumb - 4 half-lives:

  1. I-131 = stop entirely
  2. I-123 = 2-3 days
  3. Tc = 12-24 hours
70
Q

Normal thyroid uptake (4 hours and 24 hours)

A

6-18% (4 hours)

10-30% (24 hours)

71
Q

Increased thyroid uptake

A

Graves, hashimotos, medication rebound, I deficiency

72
Q

Decreased thyroid uptake

A

Renal failure (increased free I pool), medications (anti thyroidals, nitrates, IV contrast, amiodarone), toxicosis

73
Q

Plummer disease

A

Toxic multinodular goiter

74
Q

Non-toxic multinodular goiter

A

Background uptake not entirely suppressed

75
Q

Graves antibody

A

Anti-thyroTROPIN

76
Q

Hashimotos antibodies (2)

A

Anti-TPO and antithyroGLOBULIN

77
Q

Hashimotos co-morbidity

A

Primary thyroid lymphoma

78
Q

Hashimotos appearance on thyroid scan

A

Acute (hyperthyroid) = identical to Graves

Later = heterogeneous with cold spots

79
Q

Graves vs. De Quervains thyroiditis

A

DeQuervains = granulomatous thyroiditis

= Decreased uptake (Graves is increased)

80
Q

Discordant nodule on thyroid scan

A

Hot on Tc, cold on I123

81
Q

Most common thyroid cancer

A

papillary

82
Q

Thyroid cancer that does not organify

A

Medullary (don’t give I-131)

83
Q

Medullary thyroid cancer syndromes

A

MEN 2A and 2B

84
Q

Retreatment dose for I-131 in cancer

A

150% original dose

85
Q

Medicine associated with I-131 resistant cancer

A

methimazole

86
Q

Ideal post-surgical thyroid uptake for I-131 treatment

A

5% will be painful, treat with steroids/NSAIDs)

87
Q

I-131 pre-treatment (2)

A
  1. Stop thyroid hormone

2. Give thyrogen (AKA TSH)

88
Q

Initial I-131 cancer dose (3 different doses)

A
  1. Thyroid only = 100
  2. Nodal disease = 150
  3. Distal disease = 200

Alternative = volumetric

89
Q

I-131 hospital admission rules

A

NRC: > 7mR/h at 1 meter from chest

33 mCi residual activity

90
Q

At increased risk for non-target injury in I-131

A

Sjogrens (salivary)

91
Q

Home I-131 precaution duration (33 mCi dose)

A

3 days

92
Q

Abstinence from pregnancy post I131

A

6-12 months

93
Q

How to identify post-treatment Iodine scan

A

Activity in the liver

94
Q

Absolute contraindications to I-131 treatment (2)

A
  1. Pregnancy

2. Acute or severe thyrotoxicosis

95
Q

I-131 treatment on dialysis (2 considerations)

A
  1. Tubing goes into storage (liquids can get dumped)

2. Decrease dose

96
Q

I-131 dose for graves vs. multinodular goiter

A 
Graves = 15 mCi
Goiter = 30 mCi
97
Q

Thyroid eye disease and I-131

A

I-131 may worsen

98
Q

Wolff-Chaikoff

A

Large iodine ingestion followed by decreased hormone production (10 days)

99
Q

False positives on parathyroid sestamibi (4)

A

Cancer
Lymphadenopathy
Thyroid nodules
Brown fat

100
Q

Hot nodule on sestamibi and Tc

A

Thyroid nodule

101
Q

Hot nodule on sestamibi, but cold on Tc

A

Parathyroid adenoma

102
Q

Tc DTPA vs. HMPAO for brain imaging (2)

A
  1. Perfusion imaging only

2. Can be repeated (no parenchymal localization) in epilepsy cases

103
Q

Thallium 201 Mechanism

A 
Potassium analogue (Na/K)
--Needs living cells to work (viability detector)
104
Q

Thallium half life

A

73 hours

105
Q

Thallium photopeaks

A

69 and 81 keV

106
Q

Thallium decay

A

electron capture

107
Q

Thallium brain (infection vs cancer)

A

Lymphoma positive

Toxo negative

108
Q

Kaposi on nuclear medicine (2 tests)

A 
Thallium positive
Gallium negative (opposite of PJP)
109
Q

Thallium brain (recurrent cancer vs. radiation necrosis)

A 
Cancer = thallium positive
Necrosis = negative
110
Q

Vasovagal pt, poorly responsive to IV fluids (med and dose).

A

Atropine 0.6-1.0 mg (max dose ~3 mg)

111
Q

Epi dose for severe urticaria (and route).

A

0.1 - 0.3 ml 1:1000 (IM)

112
Q

Bronchospasm/facial and laryngeal edema/Hypotension treatment algorithm (3 steps)

A
  1. Albuterol
    2a. Epi 1:1000 (IM) 0.1-0.3 ml (0.1 - 0.3 mg), up to 1 mg
    or
    2b. Epi 1:10k (IV) 1-3 ml (0.1 - 0.3 mg), up to 1 mg

If hypotension, add IV fluids

113
Q

Seizure treatment

A

Diazepam 5 mg vs. midazolam 0.5-1 mg

Radiology Core Exam (1 decks)

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