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
b. Misadministration reportable only to the State Department
of Nuclear Safety
c. Misadministration reportable to both the Nuclear
Regulatory Commission and the State Department of Nuclear Safety
d. Not a misadministration
43. The approximate distribution of Tc-99m sulfur colloid in the RES is
a. 40% liver, 40% spleen, 20% marrow
b. 50% liver, 25% spleen, 25% marrow
c. 60% liver, 30% spleen, 10% marrow
d. 85% liver, 10% spleen, 5% marrow
44. What is the following correctly characterizes hydrolyzed reduced Tc?
a. Soluble, ionic compound
b. Insoluble, large particles
c. Insoluble, colloidal particles
d. Volatile gas
45. A bone scan reveals a bone:soft tissue ratio of 5:1 and a lesion:bone
ratio of 5:1. What is the ratio of lesion:soft tissue?
a. 1:1
b. 5:1
c. 10:1
d. 25:1
46. What % of the injected dose of Tc-99m bone agents localizes in bone
and what % is excreted through the kidneys? Assume normal renal function.
a. 30%/70%
b. 50%/50%
c. 70%/30%
d. 90%/10%
47. In which of the following
patients scheduled for a MUGA would you choose Tc-HSA over Tc-RBC’s?
a. Patient undergoing chemotherapy with methotrexate
b. Patient on high-dose antibiotic therapy
c. Patient who has received an injection of Sr-89 chloride
d. Patient who has been heparinized
48. A patient scheduled for an RAIU
is taking 100 mg
of synthroid daily. How long must the patient be off synthroid to obtain a valid
RAIU
a. 1 day
b. 1 week
c. 2 weeks
d. 4 weeks
e. synthroid is not contraindicated for an RAIU
49. A patient scheduled for a
Schilling Test is taking therapeutic vitamin B12 on a daily basis.
How long must the patient be off vitamin B12 to obtain a valid test?
a. 1 day
b. 3-5 days
c. 10-14 days
d. 4 weeks