key: cord-0036254-ldkh2jua
authors: Assadi, Majid; Ahmadzadehfar, Hojjat; Biersack, Hans-Jürgen
title: Nuclear Medicine in Acute Care
date: 2018-10-14
journal: Principles of Nuclear Medicine
DOI: 10.1007/978-3-319-91701-6_5
sha: cd0ed83a05c33319cb2b418260a5da7508d6f355
doc_id: 36254
cord_uid: ldkh2jua

1. What is the gold standard diagnostic test for cardiac transplant rejection? a. PET; b. (123)I-IPPA. c. MRI. d. Endomyocardial biopsy. 2. All of the following radionuclide imaging methods are examined for the diagnosis of cardiac transplant rejection EXCEPT: a. (99m)Tc-annexin V. b. Radiolabeled somatostatin analog; c. (111)In-antimyosin; d. (11)C-MQNB;

Pulmonary Embolism . New defects are found in the repeat of a pulmonary perfusion scan 1 week after the first scan of a patient with pulmonary emboli. Which of the following statements is NOT correct? (a) They can be due to the resolution of large defects and obstruction of other capillaries. (b) Changes in the regional pulmonary blood pressure can convert partial obstruction to complete obstruction. (c) They can be due to increased pleural effusion or pulmonary edema. 13. In the scintigraphic detection of GI bleeding: (a) In vivo labeling of RBC increases the labeling efficiency in comparison with the in vitro method. (b) The required time for detecting the minimum volume of bleeding is longer for 99m Tc-RBC than for sulfur colloid. (c) The sensitivity of the RBC scan for the diagnosis of intermittent bleeding is lesser than that of sulfur colloid scan. (d) Scintigraphy is more important than endoscopy if the goal is to detect upper GI bleeding. 14. In GI bleeding:

(a) Scintigraphy after the once or twice passing of a substantial amount of blood with stool is NOT effective in the localization of bleeding. scintigraphy. (d) For infants younger than 2 months with biliary atresia, the liver-heart ratio 5 min after injection is similar to that of patients with neonatal hepatitis syndrome. 6. Which of the following findings is the most indicative of biliary atresia on hepatobiliary scintigraphy? (a) Decreased hepatic uptake, decreased serum clearance of the radiotracer, increased activity in the heart (b) Absence of the gallbladder and the common bile duct (c) Lack of activity in intestines up to 24 h after the administration of the radiotracer (d) Decreased hepatic uptake and increased renal clearance of the radiotracer 7. What is the first imaging step for a neonate with an increased level of serum bilirubin? (a) Hepatobiliary scintigraphy (b) Liver sonography (c) Abdominal CT scan (d) Hepatic scintigraphy with sulfur colloid 8. HIDA scan is indicated for neonates with suspected biliary atresia. Which statement is correct? (a) Intra-and extrahepatic bile ducts must be observed on a normal scan. (a) Gallium scan (b) BBB imaging (c) CT scan (d) rCBF scan 18. In which of the following phases of cerebral infraction does the temporary loss of visibility of an infarct occur on the CT scan (fogging phenomenon)? (a) Acute (after hours) (b) Early subacute (after 1 week) (c) Late subacute (after 2 weeks) (d) Chronic (after 1 month) 19. Lesions causing acute stroke that are overlooked on a brain perfusion scan are commonly reported in: (a) Brain stem (b) Cerebellum (c) Cortex (d) Subcortical 20. A 48-year-old man is suspected to have brain death based on clinical symptoms and apnea test. Which of the following modalities has the highest diagnostic sensitivity and specificity? (a) 99m Tc-HMPAO brain SPECT (b) 99m Tc-pertechnetate cerebral perfusion (c) Electroencephalogram (d) 99m Tc-DTPA cerebral perfusion

21. The 111 In-WBC scan is performed on a patient with suspected abdominal abscess. The appearance of which organ on the scan is considered normal? (a) Lung (b) Kidney (c) Small intestine (d) Colon 22. A 67-year-old woman with discopathy underwent surgical therapy 6 weeks ago. She is currently complaining about back pain. Blood test is normal, destructive changes are found on the radiography of the vertebral column, and an increased activity is detected in the delayed phase of the three-phase bone scan. Therefore, osteomyelitis is suspected. Which of the following diagnostic methods has the highest sensitivity and specificity? 45. Which of the following characteristics is considered an advantage of 67 Ga over 52. Which of the following imaging methods earlier shows the positive findings of acute infection (e.g., osteomyelitis)? (a) 99m Tc-MDP scan (b) 111 In-WBC scan (c) 68 Gallium scan (d) CT scan 53. The 111 In-labeled leukocyte scan is conducted prior to the 99m Tc-labeled leukocyte scan in all of the following situations except: (a) Chronic infections (e.g., fever of unknown origin) (b) Suspected infection of the urinary tract (c) Quantification of the GI inflammatory process (d) Exact localization of the GI process 54. A 4-year-old boy is referred to the emergency ward with fever, lymphadenopathy, erythema, and edema of the cervical lymph nodes that began 5-6 days ago. Oral cephalexin was prescribed 3 days ago, but fever and edema have NOT yet diminished. The child is hospitalized and subjected to intravenous antibiotic therapy, but fever and edema continue for more than 48 h. Which of the following studies is recommended? (a) Gallium scan (b) Neck sonography (c) Thoracic 

Clinical nuclear medicine

Nuclear medicine in clinical diagnosis and treatment

Diagnostic nuclear medicine

Nuclear medicine

 99m Tc-HMPAO (c) 99m Tc-glucoheptonate (d) 99m Tc-IMP 5. Which of the following findings does NOT appear on the brain scan of a patient with cerebrovascular accident? (a) Increased uptake in the same cerebellar hemisphere (b) Increased perfusion around the infarcted zone (c) Delayed parenchymal uptake and clearance of the involved hemisphere in the angiography phase (d) Shift of blood flow to the external carotid system 6. Evaluation of rCBF with SPECT is performed a few hours after stroke. In which of the following conditions is thrombolytic therapy indicated? (a) Acute complete absence of rCBF (b) No change in rCBF (c) Acute decrease in rCBF (d) Increase in rCBF 7. Brain MRI shows a focal lesion for an AIDS patient. Radiotracer accumulation in the same region is also reported on the 201 Tl SPECT scan. What is the most probable diagnosis? (a) Toxoplasmosis (b) Lymphoma (c) Tuberculosis (d) Fungal granuloma 21. A patient with suspected herpes encephalitis is subjected to the 99m Tc-HMPAO scan. What are the scan findings 1 day and 40 days after onset of the disease, respectively? (a) Mild increase in uptake, normal uptake (b) Severe increase in uptake, decrease in uptake (c) Severe increase in uptake on both scans (d) Decrease in uptake, increase in uptake 22. Which statement is NOT correct regarding the diagnosis of herpes simplex encephalitis with the 99m Tc-HMPAO brain perfusion scan? (a) Increased uptake in the involved brain regions in the acute phase of the disease. (b) Increased uptake mainly in the temporal lobe. (c) The 99m Tc-HMPAO scan is effective when the MRI is unremarkable. (d) Uptake in the involved brain regions increases over time. 23. What is the pattern of brain death in SPECT?(a) Diffuse cerebral distribution of Tc-HMPAO (b) Diffuse cerebral distribution of Tc-ECD (c) Empty skull (d) Observation of the sagittal sinus 24. In brain death:(a) Brain scintigraphy has NO role in the identification of brain death. (b) Hot nose sign is indicative of brain death. (c) Delayed cerebral activity after Tc-HMPAO injection is suggestive of brain death. (d) Barbiturates do NOT affect the scan pattern in brain death. 25. What is the preferred radiopharmaceutical for the confirmation of brain death in a patient in deep coma? (a) 99m Tc-DTAP (b) 99m Tc-ECD (c) 99m TcO4− (d) 133 Xe 26. In acute viral encephalitis, the findings of which scan is NOT an increased uptake? (a) 99m Tc-DTPA (b) 99m Tc-HMPAO (c) 99m Tc-IMP (d) 99m Tc-ECD 27. About the evaluation of brain death in nuclear medicine:(a) An important sign in brain death is the lack of tracer activity in the superior sagittal sinus during the venous phase of the flow study. (b) In brain death, blood flow superior to the circle of Willis circulation may exist. (c) SPECT is necessary in all cases with suspected brain death. (d) Reduced flow in the scalp is also observed in brain death aside from reduced flow of ACA and MCA. (a) Binding to lactoferrin, extravasal leakage, and binding to bacterial receptors and WBC at the infection site (b) Binding to leucocytes in blood circulation and accumulation at the infection site (c) Binding to transferrin, extravasal leakage, and binding to lactoferrin and siderophore at the infection site (d) Antigen-antibody bound between gallium and lactoferrin and binding to WBC receptors at the infection site 11. The In-WBC scan shows an increased uptake around the right shoulder joint, but the sulfur colloid scan is normal. What is the most probable diagnosis? (a) Loose prosthesis (b) Decreased bone marrow activity (c) Infection around the prosthesis (d) Tumoral infiltrations 12. Which organ is highly exposed to radiation after 111 In-WBC administration? (a) Spleen (b) Bone marrow (c) Gonads (d) Lungs 13. Which item is NOT the mechanism of 67 Ga uptake at the infection site?(a) Lymphocyte cell surface binding (b) Increase in vascular permeability (c) Bacterial siderophore binding (d) Macrophage uptake through iron binding 14. In which of the following conditions is gallium scan is preferred over 111 In-WBC? (a) Tissue encapsulation (b) Abdominal abscess (c) Inflammatory bowel disease (IBD) (d) Orthopedic infections 15. Which of the following complexes is used for WBC labeling in plasma and increases its viability and function? (a) 111 In complex with transferrin (b) 111 In complex with mercaptopyridine N-oxide and tropolone (c) 111 In-tropolone (d) 111 In-acetylacetone and tropolone 16. Which of the following patterns on the gallium scan is indicative of peritonitis in a child? (a) Haziness of the abdomen and pelvis, reduced uptake in the liver (b) Sporadic focal increase in activity in the abdomen and pelvis, increased activity in the liver (c) Accumulation of activity on the lateral and diaphragmatic sides of the liver, diffuse activity in the pelvis and abdomen, decreased liver uptake (d) Observation of a region without activity in the abdomen and pelvis, increased uptake in the liver 17. Gallium scan is performed on a patient. Diffuse abdominal uptake particularly in the liver and progression of liver uptake from the lateral border to the right subdiaphragmatic space are reported. What is the most probable diagnosis? underwent heart transplantation. After surgery, he experiences fever, and multiple pulmonary nodules are found on radiography. What is the most probable diagnosis? (a) Nocardiosis (b) Pneumocystis carinii (c) Pneumococcus pneumonia (d) Aspergillus 18. What is the main finding of the pulmonary gallium scan for pneumocystis carinii pneumonia in a patient suffering from AIDS? (a) Negative gallium scan + abnormal radiography (b) Abnormal diffuse pulmonary uptake + normal radiography (c) Multifocal gallium uptake (d) Focal or regional gallium uptake 19. What is the main finding of the pulmonary gallium scan for actinomycosis in a patient suffering from AIDS? (a) Negative gallium scan + abnormal radiography (b) Abnormal diffuse pulmonary uptake + normal radiography (c) Multifocal gallium uptake (d) Focal or regional gallium uptake 20. What is the main finding of the pulmonary gallium scan for Kaposi's sarcoma in a patient suffering from AIDS? (a) Negative gallium scan + abnormal radiography (b) Abnormal diffuse pulmonary uptake + normal radiography (c) Multifocal gallium uptake (d) Focal or regional gallium uptake