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NMED 251 - Clinical Procedures > CV Review > Flashcards

CV Review Flashcards

1
Q

what is the best view on a MUGA for calculating LVEF?

A

45 LAO

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2
Q

What portion of the heart wall does the ANT planar image best assess in a MUGA study?

A

right atrial and ventricle size and wall motion

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3
Q

which will not reverse the effects of dipy (persantine)?

A

atropine

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4
Q

which of the following is NOT a contraindication for an exercise study?
beta blockers, calcium channel blockers, LBBB, caffeine

A

caffeine

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5
Q

if counts from the left atrium are included in the LV ROI, how will this affect the EF?

A

falsely lowers EF

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6
Q

pharmacological stress in an asthma patient would be done with this agent.
dipy, adenosine, persantine, dobutamine

A

dobutamine

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7
Q

which is most likely to cause artifactual ant or lat wall defects on MPI?
COR error, resp motion, LBBB, breast attenuation

A

breast attenuation

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8
Q

why must there be 2 separate injections of mibi for an MPI?

A

no redistribution in heart

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9
Q

which of the following situations could lead to a false negative MPI?
incorrect placement of ECG leads, LBBB, diaphragmatic attenuation, inadequate stress

A

inadequate stress

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9
Q

Which of following is correct regarding thallium localization? (select all)

A) localization by passive diffusion

B) localization by active transport

C) proportional to myocardial blood flow

D) according to myocardial viability

A

b, c, d

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10
Q

Check all that apply.

Which of the following are preparation for a 1 day dipyridamole MPI.

A) NPO for at least 4 hours

B) Place an IV

C) Discontinue caffeine for 24 hours

D) Discontinue xanthine meds for 48 hours

A

a, b, c, d

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11
Q

Which RP can be used to assess myocardial perfusion with the use of a single injection?
A) 201Tl chloride

B) 99mTc-RBC

C) 99mTc-tetrofosmin

D) 99mTc-sestamibi

A

A

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12
Q

What does the bulls eye display created after myocardial perfusion imaging represent?

A) Short axis images

B) An entire set of stress and rest SPECT images

C) All parts of the myocardial wall except apex

D) None of the above

A

A

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13
Q

Check all the apply.

Which of the following are differences between myocardial perfusion imaging with Tl versus mibi?

A) High resolution collimator can be used with thallium

B) Less soft tissue attenuation with Tl

C) Higher photon flux with mibi

D) Less respiratory motion with Tl stress images

A

a, c

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14
Q

Why do we wait 45-90 min between stress injection of Myoview and imaging?

A) To allow for respiratory motion to decrease

B) To allow for liver and lung activity to decrease

C) To allow time for uptake in the myocardium

D) To allow time to monitor the patient

A

B

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15
Q

What is an approximate effective dose for MPI imaging using 201Tl (with reinjection)?

5 mSv

13 mSv

22 mSv

40 mSv

A

40 mSv

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16
Q

Which of the following is an appropriate indication for MPI imaging?

Assessment of wall motion

Monitoring of LVEF and cardiotoxicity

Risk assessment in patient with episode of chest pain

Determine degree of mitral valve dysfunction

A

Risk assessment in patient with episode of chest pain

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17
Q

When stressing a patient with Dobutamine, when is the 99mTc-Mibi administered?

When HR reaches 220-age

When HR reaches (220-age) x 0.85

At 3 min into infusion

At 7 min into infusion

A

When HR reaches (220-age) x 0.85

18
Q

Which of the following would NOT cause you to alert the stressing physician about stopping exercise?

ST segment elevation or depression on ECG

Increase in BP with mild chest pain

Patient complains of dizziness and fatigue

Blood pressure drops from baseline reading

A

Increase in BP with mild chest pain

19
Q

Which of the following is correct regarding Dobutamine stressing?

Max dosage is 40ug/kg/min

RP injected 2min after infusion ends

Works as a vasodilator in the heart

Caffeine counteracts effects

A

Max dosage is 40ug/kg/min

20
Q

How would aminophylline be used during an MPI protocol?

100mg IV for symptom relief after dipy stress

100mg IV for arrhythmias that may occur during exercise stress

500mg po for sypmtom relief after dipy stress

500 mg po for arrhythmias that may occur during exercise stress

A

100mg IV for symptom relief after dipy stress

21
Q

After performing a 201Tl rest/redistribution protocol, the radiologist asks you to give a 37MBq dose of Tl and reimage in 15 min. What is the most likely reason for this request?

There was a reversible defect on the rest/redistirubtion portion

There was a fixed defect on the rest/redistribution portion

There were inadequate counts acquired in the rest/redistribution portion

There was motion in the rest/redistribution portion

A

There was a fixed defect on the rest/redistribution portion

22
Q

What are appropriate dose and protocol parameters for a 2 day MPI study with 99mTc-MIBI?

925MBq 64 projections/25 sec each

925MBq, 128 projections/20 sec each

370MBq, 64 projections/25 sec each

370MBq, 128 projections/20 sec each

A

925MBq 64 projections/25 sec each

23
Q

Which parameters are appropriate for acquiring a a low dose attenuation correction CT scan as part of a MPI study?

Current 50 mA, slice thickness, 0.5-1 mm, breath hold

Current 50 mA, slice thickness 2-5 mm, tidal breathing

Current 5mA, slice thickness, 0.5-1 mm, breath hold

Current 5mA, slice thickness 2-5 mm, tidal breathing

A

Current 5mA, slice thickness 2-5 mm, tidal breathing

24
Q

What would you expect on the MPI perfusion images if exercise stress was performed on a patient with LBBB?

defect on lateral wall on stress images, normal on rest

defect on septal wall on stress images, normal on rest

defect on lateral wall on rest images, normal on stress

defect on septal wall on rest images, normal on stress

A

defect on septal wall on stress images, normal on rest

25
Q

Choose the best artifact to match the description.
____ hurricane sign on processed images
____ defect on septal wall on stress images
____ ant wall defect, usually fixed
____ inferior wall defect usually fixed
____ may mask or cause inferior wall defects
____most common with Tl stress study, reversible inferior wall defect

  1. LBBB
  2. Breast attenuation
  3. Diaphragmatic attenuation
  4. Hot Bowel
  5. Cardiac creep
  6. Motion
A

motion - hurricane sign on processed images
LBBB - defect on septal wall on stress images

breast attenuation - ant wall defect, usually fixed

diaphragmatic attenuation - inferior wall defect usually fixed

hot bowel - may mask or cause inferior wall defects

cardiac creep - most common with Tl stress study, reversible inferior wall defect

26
Q

Which is correct regarding the LHR performed with 201Tl imaging?

ROI drawn on Ant image, normal is less than 0.35

ROI drawn on LAO image, normal is less than 0.35

ROI drawn on Ant image, normal is less than 0.5

ROI drawn on LAO image, normal is less than 0.35

A

ROI drawn on Ant image, normal is less than 0.5

27
Q

What is the method of localization for tagged RBC’s to image the blood pool?

a) Compartmental

b) Active Transport

c) Passive Diffusion

d) Cell sequestration

A

A

28
Q

What is an advantage of using Ultratag compared to other RBC labeling methods?

a) less centrifugation is required

b) Decreased radiation dose to the patient

c) Higher % tag

d) Less expensive

A

C

29
Q

What is the expected % tag for in-vivo labelled RBCs?

a) > 95%

b) 90-95%

c) 70-80%

d) 50-60%

A

C

30
Q

placement of 3 lead ecg when performing MUGA?

A
  • one over the apex of each lung + one on upper left abdomen
31
Q

What is the advantage of acquiring 32 over 16 frames/cardiac cycle?

a) Increased accuracy on volume curve

b)Increased statistics per frame

c) Less chance of visualizing artifacts like flicker artifact

d)There is no advantage of acquiring 32 frames

A

A

32
Q

Which planar MUGA view best demonstrates wall motion of the inferior wall of the heart?

a) ANT

b) LAO

c) LLAT

d) RPO

A

C

33
Q

What would be the result of excluding a portion of the LV in your ROI for ejection fraction?

a) Overestimation of ejection fraction

b) Underestimation of ejection fraction

c) There would be no effect on ejection fraction

A

B

34
Q

Which of the following is a normal gated equilibrium result?

a) LVEF 52%

b) EDV 50ml

c) LVEF 45%

d) EDV 210mL

A

A

35
Q

If a patient’s heart rate increases during a gated equilibrium study, what is most likely to occur?

EDV falsely decreased

EDV falsely increased

ESV falsely increased

ESV falsely decreased

A

EDV falsely decreased

36
Q

How is the analysis of left ventricular end systole on a MUGA study best described?

Place an ROI around the left ventricle on the frame with the highest number of counts

Place an ROI around the left ventricle on the frame with the lowest number of counts

Place an ROI around both ventricles on the frame with the lowest counts

End systole is not used when analyzing a MUGA study

A

Place an ROI around the left ventricle on the frame with the LOWEST number of counts

37
Q

Dose for MUGA

A

740-1850 MBq

38
Q

Dose for rest MPI (1 day protocol)

A

296-370 MBq

39
Q

Dose for stress MPI (1 day protocol)

A

925-1110 MBq

40
Q

Dose for MPI stress (2 day protocol)

A

740-1110 MBq

41
Q

Dose of 201Tl-Cl for MPI

A

74-148 MBq

42
Q

Dose of 99mTc-PYP for amyloidosis scan

A

370-740 MBq

NMED 251 - Clinical Procedures (11 decks)

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