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Part
5. Radiopharmacy 1. Mark
the following statements True or False: ____ a)
Tc-99m Sestamibi has a short biological half-life in the heart ____ b)
Tc-99m Teboroxime has a short biological half-life in the heart ____ c)
Tc-99m HMPAO has a long biological half-life in the brain ____ d)
The tbiol of Tc-99m HSA in the blood pool is >Tc-99m RBC's ____ e)
The tbiol of Tl-201 chloride in the body is less than 5 days 2. Match the renal agents listed below with their
routes/percentages of excretion ______ Tc-99m
DTPA
(A) tubular
secretion/glomerular filtration 50/50 ______ Tc-99m
MAG3
(B ) tubular secretion/glomerular
filtration 80/20 ______ I-131
Hippuran
(C) glomerular
filtration/tubular secretion 80/20 ______ Tc-99m Glucoheptonate
(D) predominantly
tubular binding ______ Tc-99m DMSA
(E) tubular
binding/glomerular filtration/tubular secretion 20/40/40 (F) Tubular
secretion 100% (G) Glomerular
filtration 100% 3. Which of the following statements is incorrect? a) Tc-99m
pertechnetate is distributed only in the blood pool b) Lesions
detected on a cerebral radionuclide angiogram usually show increased uptake. c) Lesions
detected on a delayed brain scan usually show decreased uptake. d) All
of the above e) None
of the above 4. Which
statement(s) is/are correct? a) Bone scanning is more sensitive than x-rays b) Bone
scans detect metastatic disease prior to x-ray changes. c) Bone
scans are less specific than x-rays d) a
and b e) All
of the above 5. The mechanism of radiopharmaceutical localization
in lung scanning is: a) phagocytosis b) capillary
blockade c) active
transport d) adsorption
to hydroxyapatite crystals 6. Match
the following: a) Ventilation
lung scan
_____ 1. Tc-99m macroaggregated albumin b) Perfusion
lung scan
_____ 2. Xenon-133 c) Myocardial
perfusion scan
_____ 3. Thallium-201 d) Myocardial
infarct scan
_____ 4. Tc-99m pyrophosphate 7. The mechanism of uptake of radiopharmaceutical in
liver-spleen scanning is a) Particulate
blockade b) Phagocytosis
by the RE system c) Hydrolysis
of the colloid particles by the hepatocytes d) b
and c e) None
of the above 8.
The percent of Tc-99m sulfur colloid cleared from the circulation and the
half-time of clearance are, respectively, a) 50%,
8 min b) >90%,
2.5 min c) <10%,
3 min d) >90%,
8 min e) 50%,
3 min 9. Clinical indications for spleen scanning with Tc-99m
SC include a) suspected lung abscess b) suspected
splenic trauma and infarction c) evaluating
the half-life of RBCs in splenic sequestration d) all
of the above e) and
c 10. Which of the following is/are suitable for
thyroid imaging? a) Tc-99m
sodium pertechnetate b) I-123
sodium iodide c) I-125
sodium iodide d) I-131
sodium iodide 11. Pertechnetate
and iodide uptake by the thyroid may be invalidated by which of the following? a) Angiographic
contrast agents b) Propranolol
c) Thyroid
hormone ingestion d) a
and c e) all
of the above 12. Normal thyroid uptake of I-131 at 24 hours may be
from a) 3-10%
b) 7-30%
c) >40%
d) <2% 13. Which of the following radiopharmaceuticals
is/are suitable for blood pool scanning? a)
Tc-99m sulfur colloid b) Tc-99m
MAA c) Tc-99m
tagged red blood cells d) Tc-99m
tagged DTPA e) None
of the above 14. Tl-201 is a useful cardiac imaging agent because
of the following properties: a) It
is a potassium analog b) It
localizes in acutely infarcted myocardium c) It
is distributed proportional to relative blood flow. d) a
and c only e) All
of the above 15. The optimal time for detection of acute
myocardial infarction by infarct avid agents is: a)
6 hours after onset of symptoms b) one
week after onset of symptoms c) during
chest pain d) 24
to 72 hours after onset of symptoms e) during
maximum exercise 16. Match the following ____1) Active transport
a) Tc-99m MAA localizes
in the lungs ____2) Capillary blockage
b) Fluorine-18 localizes
in bone ____3) Phagocytosis
c) In-111 Octreoscan ____4) Compartmental localization
d) Iodine-131 localizes in thyroid ____5) Exchange diffusion
e) Tc-99m HSA localizes
in blood pool ____6) Sequestration
f) Tc-99m Sulfur
Colloid localizes in RES cells ____7) Metabolic Trapping
g) In-111 Oncoscint ____8) Antigen/antibody reaction
h) Denatured Tc-99m RBC localizes in spleen 17. The
ideal diagnostic radiopharmaceutical has an effective half-life a) of
1 day b) 1
to 1½ times the biological half‑life c) of
6 hours d) 1
to 1½ times the length of time necessary to complete the test 18. Which
of the following is/are suitable for reducing pertechnetate prior to tagging to
a chelating agent?
b) stannic
ion (Sn4+) c) thallous
ion (Tl1+) d) mercuric
ion (Hg2+) e) none
of the above 19. When can the effective half-life of a
radioisotope equal the biological half‑life? a) when
the physical half-life is very short b) when
the physical half-life is infinitely long c) when
the biological half-life is very short d) when
the biological half-life is infinitely long e) when
the biological and physical half-lives are equal 20. We
analyze all of our Tc-99m
radiopharmaceuticals for impurities. These include
b) free
Tc, Mo99, Hydrolyzed Reduced Tc c) Al3+
, Mo99, Hydrolyzed Reduced Tc d) free
Tc, Hydrolyzed Reduced Tc e) perchlorate,
molybdate 21. Images of blood pool studies may be taken at what
time post injection? a) minutes
b) hours
c) weeks
d) a
and b e) b
and c 22. Which
of the following radiopharmaceuticals represents an example of compartmental
localization? a) Tc
- RBC b) Tc
- HSA c) Tc
- MAA d) a
and b only e) all
of the above 23. Match
radiation absorbed dose in right hand column with the item in the left hand
column. ____ LD50 in humans (total body dose)
a) O.l5R ____ LD100 in humans (total body dose)
b) O.OlOR ____ Dose to thyroid gland of hyperthyroid patient
c) 11,000R following administration of 10 mCi of I‑131 NaI
d) 500-550R ____ Whole body background if you live at sea level
e) 1 x 106
R ____ Whole body background if you live in Denver
f) 350R ____ Whole body dose from anterior chest film
g) 0.3 R 24. Match particle size range with
radiopharmaceutical ______ Tc-sulfur colloid
a) 10-90 mm ______ Tc-MAA
b) 5-10 mm ______ Tc-MDP
c) 0.1-2 mm ______ Tc-MIAA
d) no particles
present 25. Match
number of particles of Tc-MAA to inject with patient population ______ Adult patient w/o pulmonary HTN
a) 50,000 ______ Adult patient w/ pulmonary HTN
b) 350,000 ______ 3 year old child
c) 100,000 ______ Neonate
d) 150,000 26. Three
patients underwent dual Schillings Tests in which Co-57 labeled vitamin B12
bound to intrinsic factor and Co-58 vitamin B12 were administered.
Match the results of the test with the proper diagnosis. % excretion in 24 hrs.
Co-57 / Co-58
Diagnosis: ____ 21/18
a. Malabsorption syndrome ____ 4/3.6
b. Normal ____ 9/3
c. Pernicious anemia 27
A patient underwent the first stage of a Schilling Test and the percent
of administered Co-57 activity found in the urine at 24 hr post administration
of the dose was 11.1%. The appropriate course of action is to a. Release
the patient- test is complete b. Administer
second stage of test c. Prescribe
round of antibiotics, then repeat stage one d. Request
an additional 24 hours of urine collection and pool specimens 28. Match
the procedure listed in column 1 with the typical adult dose in column 2 Column 1 (Procedure)
Column 2 (Adult dose)
_____ bone scan
a) 200 mCi _____ perfusion lung scan
b) 1 mCi _____ thyroid uptake test
c) 3 mCi _____ liver scan
d) 5‑10
mCi _____ thyroid therapy (Ca)
e) 10‑15
mCi _____ perfusion brain scan
f) 15‑25
mCi _____ tumor/abscess scan with Ga-67
g) 100‑150
mCi _____ MUGA
h) 50 mCi 29. Answer True/False to the following statements regarding hepatobiliary
agents a) Typical
injected dose is 1 mCi b) In an emergency, one could substitute Tc‑99m Sulfur
Colloid for Tc-DISIDA for use in hepatobiliary imaging c) If gallbladder accumulation of the DISIDA first appears
on scan at 90 minutes post injection, this is a normal study. d) Gallbladder emptying is sometimes effected following
administration of a glass of milk. e) The
-IDA ending on DISIDA stands for -imidodiacetic acid. f) Administration of IV morphine effectively empties
the gall bladder g) typical administered dose of 3-8 mCi is based on body
surface area 30. Match isotopes in left hand column with principal imaging energy (KeV)
in right hand column
Isotope
Energy (KeV) ________ Tc-99m
a. 71 ________ Co-57
b. 511 ________ F-18
c. 122 ________ I-131
d. 159 ________ Tl-201
e. 140 ________ I-123
f. 365
31. Match a
radiopharmaceutical in the right hand column with the scan type in the left
hand column. ______
Lung Perfusion
A. In-lll
leukocytes ______
Meckels diverticulum
B. Tc-99m
pertechnetate ______
Bone Marrow
C. I-123 mIBG ______
Parotid
D. I-131
iodocholesterol ______
Abscess
E. In-lll DTPA ______
Hepatobiliary
F. Tc-Disofenin ______
Glomerular Filtration
G. Tc-MAA ______
Tubular secretion
H. Tc-Glucoheptonate ______
Adrenal cortical tumor
I. Tc-DTPA ______
Thyroid uptake test
J. Tc-99m
MAG3 ______
Neuroblastoma
K. Ga-67 citrate ______
Insulinoma/glucagonoma
L. Tc-99m
RBC’s ______
Recurrent ovarian Ca
M. I-123 Sodium
iodide ______ Hepatic hemangioma
N. Tc-99m sulfur
colloid O.
In-111 Octreoscan P.
In-111 Oncoscint 32. What test animals were used for the original USP
pyrogen test? a. dogs b. Limulus polyphemus c. mice d. rats e. rabbits 33.
What advantage(s) does the Limulus Amebocyte Lysate test have over the
“in vivo” pyrogen test? a. very rapid b. relatively inexpensive c. very sensitive d. all of the above 34.
Cold, non-radioactive vitamin B12 is given as part of the
Schilling Test to: a.
Initiate therapy in the patient b.
Block B12 binding sites in the liver c.
Reduce facial flushing d.
Help differentiate between pernicious anemia and simple malabsorption 35.
The most common long-term adverse effect observed following the
administration of an I-131 NaI therapy dose for treatment of Graves Disease is a.
Adenocarcinoma of the thyroid b.
Hypothyroidism c.
Leukemia d.
Pancytopenia 36.
The fraction of the pulmonary vasculature occluded by a typical dose of
human albumin microspheres may be expected to be: a.
0.1 or less b.
0.01 or less c.
0.001 or less 37.
The ideal particle size to use in man for lung scanning is: a. 5-15 mm b. 20-40 mm c. 100-150 mm d. 200-400 mm 38.
The chances of picking up functioning metastases from thyroid carcinoma
by scan are increased by which of the following: a. thyroidectomy b. use of iodine‑123 c. use of pertechnetate d. scanning at 72-96 hours e. a and d 39.
The ideal radiopharmaceutical for clinical imaging studies has 1.
an effective half‑life equal to 1½ times duration of test. 2. an
absence of particulate radiation 3. a
gamma energy of 100 to 250 keV 4. a
decay by isomeric transition Answer: a. if
only 1, 2 and 3 are correct b. if
only 1 and 3 are correct c. if
only 2 and 4 are correct d. if
only 4 is correct e.
if all are correct 40. The effective half-life of Tc-99m is a. 6.02 hr b. 12.04 hr c. 6.02 hr x (½)10 d. Not enough information to answer question 41. Within what % of the prescribed dose must the calibrated dose be? a. 5% b. 10% c. 25% d. 50% 42. The prescribed dose of Tl-201 chloride is 2.0 mCi. A technologist
administers a 3.0 mCi dose since he has a very obese patient to inject. Whole
body dose is estimated to be 3 R and no single organ receives more than 5 R.
Which of the following describes the situation? a. Misadministration reportable only to the Nuclear
Regulatory Commission |