Final practice test

Question 1

Describe or illustrate two renograms. The first which reflects a normal right kidney and a poorly functioning left kidney. The second which reflects this patient when s/he has not been properly hydrated but is otherwise both kidneys are normal. Label all the parts, note the time of peak activity and when ½ has left the kidney, draw right kidney with dashes and left with solid line.

Answer 1

Diagram

Question 2

Which of the following statements best describe why a kidney with renal artery stenosis appears worse after the administration of captopril? Captopril works to :

a. increases the blood pressure in the afferent (entering) artery and thus shunts the blood away from entering Bowman’s capsule in the poor kidney
b. blocks ACE which produces a decrease in the blood pressure and decreases blood flow entering Bowman’s capsule in the poor kidney
c. promote the conversion of angiotensin I to angiotensin II which ultimately increases the blood entering Bowman capsule in the poor kidney
d. decrease the peripheral blood pressure which in turn increases the glomerular pressure of the poor kidney

Answer 2

B

Question 3

The most common site of renal transplant position is in the:

a. sub diaphragmatic peritoneal space
b. iliac fossa
c. retroperitoneal space
d. diaphragmatic peritoneal space anteriorly

Answer 3

B

Question 4

This radiopharmaceutical is approximately 20% glomerular filtered, and 80% tubular secreted.

a. MAA
b. DTPA
c. MAG3
d. DMSA

Answer 4

C

Question 5

All of the following are indications for renal imaging EXCEPT:

a. detection of renal artery stenosis causing hypertension
b. evaluation of renal artery morphology/anatomy
c. evaluation of the cause of obstructive uropathies
d. estimation of renal function

Answer 5

C

Question 6

The diuretic Lasix is administered after findings of radiopharmaceutical stasis (non-emptying) on the Tc99m-DTPA images. It is used to distinguish benign dilated systems (stasis) from those that have:

a. lacerated ureters
b. ureter reflux
c. mechanical obstruction/blockage
d. poor excretion

Answer 6

C

Question 7

When performing a cystogram on a pediatric patient, the most common method of administering the radiopharmaceutical is to:

a. Infuse it directly into the bladder via a Foley catheter
b. Inject it directly into the bladder via a large needle inserted below the navel
c. Have the patient drink the isotope and wait for it to enter the bladder
d. Inject it intravenously and measure the rate of clearance out of the kidneys

Answer 7

A

Question 8

When performing a cystogram on a pediatric patient, 500 uCi of Tc-Sulfur Colloid has been added to a 500 ml bag of saline. At the end of the procedure, the saline bag contains 150 uCi, and the urine collection bag contains 300 uCi. How many ml of urine is the patient retaining in their bladder?

a. 150 ml
b. 50% of the saline, ml cannot be calculated from this procedure
c. 450 ml
d. 50 ml

Answer 8

50ml

500uCi/500mL=1uCi/mL
15uCi +300uCi= 450uCi
500-450= 50mL retaining inside bladder

Question 9

When performing a cystogram on a pediatric patient, an abnormal (positive for reflux) exam is characterized by

a. Seeing a full bladder after administering the radiopharmaceutical that quickly empties when voiding (urinating)
b. Failing to see a full bladder after administering the radiopharmaceutical
c. Seeing ureters and kidneys after seeing a full bladder
d. Seeing radioactivity spread through the peritoneum

Answer 9

C

Question 10

Of the agents available to evaluate the kidneys, which one clears out of the bloodstream the quickest

a. MAA
b. MAG3
c. DTPA
d. DMSA

Answer 10

B

Question 11

After injecting DMSA, routine imaging should begin

a. immediately after injection
b. at 20-30 minutes after injection
c. at 2-4 hrs after injection
d. at 24 hrs after injection

Answer 11

C

Question 12

After injection, MAG3 activity peaks in the kidneys by what time?

a. ~20 seconds to ~30 seconds
b. ~5 min
c. ~30 min
d. ~1 - 2 hrs

Answer 12

B

Question 13

The major disadvantage of DMSA is its

a. high radiation dose
b. it does not show the collecting system
c. it has short a short useful life and must be injected within 30 minutes of making
d. all of the above
e. none of the above

Answer 13

D

Question 14

For an evaluation of the overall renal function (both GFR and tubular secretion), you would choose

a. MAA
b. DTPA
c. MAG3
d. DMSA

Answer 14

B

Question 15

When using the blood sample method for ERPF calculation, after injection of the MAG3, blood should be drawn

a. immediately
b. at 44.5 min
c. at 60 min
d. at 2 - 4 hrs

Answer 15

B

Question 16

Regions of interest drawn around the bladder during a renal study are used to

a. calculate the residual volume left in the bladder
b. demonstrate that urine is being excreted from the kidneys
c. calculate the ERPF
d. provide split function data between the two kidneys

Answer 16

B

Question 17

The regions of interest (ROIs) required for evaluating a renal scan should include the

a. renal cortex
b. bladder and renal cortex
c. bladder, background and renal cortex
d. bladder, background, renal cortex and aorta

Answer 17

D

Question 18

Giving a diuretic (Lasix) during a renal scan would be used to evaluate

a. hydronephrosis (stasis of collecting system) versus possible obstructive disease (i.e. stones)
b. renal cell carcinoma
c. polycystic disease
d. hypertension from renal arterial stenosis

Answer 18

A

Question 19

A patient who has previously demonstrated a unilaterally (1 side) abnormal MAG3 renal scan is now booked for a Captopril study for evaluation of renal artery stenosis. You should

a. perform the test as requested
b. perform another MAG3 scan, then the Captopril study
c. suggest that an ERPF study would be more appropriate
d. check with the department physician, a Captopril study may not be appropriate in this case

Answer 19

A

Question 20

When doing a Captopril study, you should take the patient’s blood pressure

a. just before the test
b. 30 min following the administration of Captopril
c. before the Captopril is administered, and every 10 minutes for up to 1 hr afterwards
d. taking the patient’s blood pressure is not required for this study

Answer 20

C

Question 21

When evaluating the viability of a kidney after transplantation, imaging should be performed from:

a. the posterior view
b. the anterior view
c. the right or left lateral view depending on kidney location
d. both anterior and posterior views concurrently

Answer 21

B

Question 22

As the size (molecular weight) of molecules in your plasma increases from below 5,200 Daltons to above 30,000 Daltons there is a shift in clearance:

a. from tubular secretion to GFR
b. from hepatic clearance to GFR
c. from hepatic clearance to tubular secretion
d. from GFR to tubular secretion

Answer 22

D

Question 23

You have been asked to evaluate the possible causes of a patient’s severe swelling in their leg (lymphedema). The radiopharmaceutical of choice would be:

a. Tc- Sulfur Colloid
b. Tc-Tilmanocept (Lymphoseek)
c. Tc- MAA
d. In-111 Tagged WBCs

Answer 23

?

a

Question 24

One advantage of filtered Sulfur Colloid over unfiltered when performing lymphoscintigraphy in patients with melanoma is that

a. it migrates through the lymphatic system quicker
b. it stays in the primary (sentinel) lymph nodes longer
c. they have a higher sensitivity for labeling metastatic cancer
d. all of the above

Answer 24

?

a (bigger unfiltered ones get stuck in sentinel)

Question 25

One advantage of Tc-Tilmanocept over Sulfur Colloid when performing lymphoscintigraphy in patients with breast cancer is that

a. it migrates through the lymphatic system quicker
b. it stays in the primary (sentinel) lymph nodes allowing for very delayed images
c. it doesn’t migrate to secondary lymph nodes eliminating the need for unnecessarily removing multiple lymph node
d. all of the above

Answer 25

?

a i think, literally the nm journal says there is no difference but there are “more pathology positive nodes in TM”

Question 26

True or False The highest sensitivity for locating lymph nodes occurs when the patients are injected with both blue dye and the radioactive lymphatic agent.

Answer 26

?

Question 27

When performing a lymphoscintigraphy looking for a sentinel lymph nodes in patients with cancer, a peri-tumoral injection has the advantage over intradermal injections in that:

a. it has a higher sensitivity at finding lymph nodes in the chest cavity
b. it is a much easier injection to perform
c. the radiopharmaceutical migrates much faster
d. it is less painful

Answer 27

?

Question 28

Which of the following are considered to be contraindicated or bad technique when performing a lymphoscintigraphy?

a. injecting using an intra-tumoral injection
b. mixing the radiopharmaceutical with lidocaine to decrease the pain
c. waiting 6-8 hours to do initial image if using filtered sulfur colloid
d. all of the above

Answer 28

?

Question 29

What is the transmission scan when performing a lymphoscintigraphy?

a. the image acquired without placing lead on the injection site
b. the dynamic image acquired during the first 10 minutes of imaging
c. the static image acquired with a Cobalt sheet source illuminating the patients outline
d. a CT done in conjunction with the lymphoscintigram

Answer 29

?

Question 30

One disadvantage of using sulfur colloid for assessing a GI bleed is

a. its lack of sensitivity
b. the persistent high body background
c. that it is only good if the patient is actively bleeding
d. that it takes a relatively long time to perform

Answer 30

C

Question 31

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

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

Answer 31

B

Question 32

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

a. recent myocardial infarction (< 3 weeks)
b. hypertension ( > 160mm systolic)
c. hypotension (< 100mm systolic)
d. allergy to adenosine or aminophylline
e. severe COPD and asthma

Answer 32

A

Question 33

At what point should you administer the imaging agent when doing an exercise stress test?

a. when the patient reaches the desired peak exercise level of treadmill stress
b. 2 minutes after peak exercise has been achieved
c. 2 minutes after the exercise starts
d. 2 minutes after the treadmill stops

Answer 33

A

Question 34

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

Answer 34

C

Question 35

A quantitative lung study is used to

a. determine total lung capacity
b. corroborate spirometry results
c. predict the likelihood of transplant rejection
d. predict post-pneumonectomy lung function

Answer 35

D

Question 36

On the illustration of a myocardial perfusion polar plot, region “B” represents:

a. septum
b. apex
c. anterior wall
d. inferior wall

Answer 36

Diagram

Question 37

Region “A” is supplied by which vessel?

a. LAD
b. LCx
c. RCA
d. RPD

Answer 37

Diagram

Question 38

What appearance is most common with the presence of metastasis on a liver/spleen sulfur colloid scan?

a. multiple cold spots
b. increased flow to the affected area
c. hepatomegaly
d. multiple hot spots

Answer 38

A

Question 39

What is the typical appearance of a positive Meckel’s diverticulum?

a. activity in the stomach
b. activity by 20 minutes in the bowel that fades with time
c. a small focus of activity in right lower quadrant that appears at the same time as the stomach
d. activity in the upper right quadrant that moves with time

Answer 39

C

Question 40

What is the advantage of a nuclear medicine GI bleed study over other modalities?

a. is a very sensitive test
b. is able to locate bleeds precisely
c. takes very little time
d. rarely produces false positive or negative results

Answer 40

A

Question 41

99mTc MAA is usually injected into a supine patient as this position:

a. prevents the particles from entering systemic circulation
b. is less likely to form microembolisms
c. allows more even distribution of particles from the lung apex to the base
d. matches the ventilation and perfusion patterns of lungs more evenly
e. removes the particles from circulation more quickly

Answer 41

C

Question 42

Which of the following is considered an advantage for the use of 133Xe over 99mTc-DTPA aerosol for ventilatory evaluation?

a. Better overall resolution
b. Ventilation may be performed after the perfusion
c. Beneficial for evaluation of patient’s COPD
d. provides for multiple views of the lungs

Answer 42

C

Question 43

What is the purpose of the stannous (Sn, aka tin) ions when labeling red blood cells with 99mTc?

a. lowers the oxidation state of the 99mTc trapping it in the RBCs
b. allows the 99mTc to enter the red blood cells
c. stabilizes the red blood cells
d. stannous ions are not typically required to label red blood cells

Answer 43

A

Question 44

What is the major advantage of performing a SPECT liver/spleen study?

a. decrease the dose of radiopharmaceutical
b. improved spatial resolution
c. decrease in imaging time
d. improved sensitivity.

Answer 44

D

Question 45

What is the advantage of performing gastric emptying with a solid over that of a liquid?

a. solids are emptied faster
b. imaging with solids is more sensitive for abnormalities
c. the labeling procedure is easier (faster)
d. the patient need not be fasting

Answer 45

B

Question 46

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

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

Answer 46

A

Question 47

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. 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 (number you can do in a day)

Answer 47

D