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HomeStretch/Numbers > HomeStretch CRACK vol 1. NUCS > Flashcards

HomeStretch CRACK vol 1. NUCS Flashcards

1
Q

Bone scan - relatively hotter kidney = ?

A

hemochromatosis or chemotherapy

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2
Q

Bone scan marked skull suture activity = ?

A

renal osteodystrophy

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3
Q

liver uptake on bonescan = ?

A

too much Al+3 chemical contamination in the Tc

Hepatoma or mets

Amyloidosis

Liver necrosis

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4
Q

Bone scan with muscle uptake?

A

Rhabdo

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5
Q

Particle size for MAA

A

MAA = 10-100 micrometers

Sulfur colloid (unfiltered) = 1 micrometer

Ultrafiltered sulfur colloid and DTPA (inhaled portion) = 0.1 micrometers

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6
Q

Particle size for DTPA (inhaled)

A

MAA = 10-100 micrometers

Sulfur colloid (unfiltered) = 1 micrometer

Ultrafiltered sulfur colloid and DTPA (inhaled portion) = 0.1 micrometers

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7
Q

Particle size for sulfur colloid (filtered)

A

MAA = 10-100 micrometers

Sulfur colloid (unfiltered) = 1 micrometer

Ultrafiltered sulfur colloid and DTPA (inhaled portion) = 0.1 micrometers

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8
Q

Particle size for sulfor colloid (unfiltered)

A

MAA = 10-100 micrometers

Sulfur colloid (unfiltered) = 1 micrometer

Ultrafiltered sulfur colloid and DTPA (inhaled portion) = 0.1 micrometers

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9
Q

When do you reduce the particle amount in a V/Q scan?

What is the normal amount of particles? what do you reduce it down to?

How about in a neonate?

Will this reduce the dose?

A
  • Pregant people
  • Right to left shunts
  • Pulmonary HTN
  • Children
  • People with one lung
    • Normal particle count = 500,000
    • decrease it to 100,000
    • down to 10,000-50,000 in a neonate
      • Dose will not decrease. . .
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10
Q

Indium, Thallium, Gallium

Half-lives and energies

A
  • Indium
    • 67 hours
    • 175 and 250
  • Thallium = 73 hours
    • major emissions are via characteristics xrays of its daughter product, Mercury 201
      • 69 and 81 KeV
  • Gallium = 78 hours
    • 100, 200, 300, 400
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11
Q

Tc-99m in the thyroid - trapped or organified?

A

trapped and not organified

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12
Q

Breastfeeding versus Tc-99m, I-123 and I-131

A

Tc-99m = 12-24 hours

I-123 = 2-3 days

I-131 = contraindicated - pump and dump!

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13
Q

Does renal failure increase or decrease Iodine update

A

decrease it (since there is more circulating normal iodine)

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14
Q

Iodine uptake test

What dose do you give with I-131? How about I-123?

What is normal uptake at 6 hours? How about 24 hours?

A

I-131 = 5 micro curie

I-123 = 10-20 microcurie

normal uptake is 5-15 (say 10%) at 5 hours and 25 at 24 hours

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15
Q

Plummer disease

A

Multi-nodular toxic goiter

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16
Q

I-131 dosing for cancer therapy and for hyperthyroidism

A
  • hyperthyroidism
    • 15 mCi for graves
    • 30 mCi for multinodular goiter
  • Cancer: depends on stage
    • 100 for thyroid only
    • 150 for thyroid +nodes
    • 200 for distal
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17
Q

When do I-131 treated patient’s need to be admitted to hospital?

A

NRC limit is 7mR/h at 1 meter from patient’s chest

33mCi of residual activity

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18
Q

What are the three renal tracers?

A

DTPA, MAG3, DMSA, (GH too)

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19
Q

Most common cause of hyperPTH?

A

hyperfunctioning adenoma

second is multiple gland hyperplasia

third is cancer

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20
Q

What are the three agents used in CNS nukes? Which two are similar?

A

HMPOA and ECD are similar (are extracted and can be used for parenchymal imaging; HMPOA washes out faster while ECD has better blood clearance [better brain to background ratio]).

DTPA: not extracted and can’t be used for parenchymal imaging. This has the advantage of being repeated without delay. main utility is for shunt studies, NPH and Brain death

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21
Q

DTPA

A

Filtered (GFR)

Good in people with normal renal function

critical organ = bladder

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22
Q

GI Bleed Sensitivity for RBC scan, CTA and Angiogram

A

RBC scan = 0.1 mL/min

CTA = 0.4 mL/min

Angiogram = 1.0 mL/min

23
Q

What are you looking for in a GI bleed RBC scan?

A
  1. Tracer outside vascular distribution
  2. Tracer that moves like bowel
  3. Tracer that increases in intensity overtime
24
Q

Dose of CCK?

Dose of Morpine?

Dose of phenobarb?

A

Dose of CCK = 0.02 microgram/KG over 60 minutes.

Dose of Morpine = 0.02 mg/kg over 60 minutes.

Dose of phenobarb = 5 mg/kg x 5 days

25
Q

In a HIDA scan, what medications can cause prompt uptake with delayed biliary excretion?

A

Erythromycin, Estrogen (contraceptives), Anabolic steroids, chlorpromazine, sometimes statins

26
Q

HIDA SCAN BLITZ!

No bowel activity + persistent blood pool = ?

No bowel activity + blood pool goes away normally = ?

No gallballder activity x 4 hours (or 1 hour + morphine) = ?

Abnormal GB emptying (EF < 20%) = ?

A

Hepatic dysfunction (hepatitis)

CBD obstruction

Acute chole

Chronic chole

27
Q

Diffuse pulmonary activity on a sulfur colloid scan = ?

A

excess aluminium in the colloid

28
Q

renal activity on sulfur colloid = ?

A

CHF

Alternatively in renal transplant can indicate rejectoins

other rare causes = coxsackie b virus, DIC and TTP

29
Q

MAG 3

A

secreted (threecreated) (ERPF)

concentrated better in poor kidney function

critical organ is bladder

30
Q

DMSA

A

binds to renal cortex

critical organ = kidney

31
Q

How does a kidney with renal artery stenosis look when using MAG3? How about DTPA?

A

MAG 3 = the sick kidney holds on the the tracer

DTPA = the sick kidney has decreased uptake and flow.

32
Q

Renal transplant nucs renogram - ATN versus rejection

A

both will have delayed excretion, but ATN has preserved flow and rejection has decreased flow

33
Q

Meningiomas can be hot on what scans?

A

Hot on Octreotide and MDP

34
Q

What medications interfere with the workings of MIBG?

A

Kids with neuroblastoma don’t need TLC or cocaine!

TCA’s, labetalol, Ca channel blockers and cocaine

35
Q

MIBG versus Octreotide

A

MIBG is superior for neuroBlastoma and non-malignant (adrenal) pheos

oCtreotide = superior for Carcinoid and malignant (extra-adrenal) pheos

36
Q

Critical organs for:

Indium prostascint (PMSA)

Indium WBC

Indium octreotide

A
  • Indium prostascint (PMSA) = Liver
  • Indium WBC = Spleen
  • Indium octreotide = Spleen!
37
Q

What is the best view for a MUGA scan?

A

left anterior oblique

38
Q
A
39
Q

What gives a false low EF on MUGA?

A

Screwed up view with overlap of LV by the RV or great vessels

40
Q

What gives a false high EF on MUGA?

A

Wrong (high) background ROI (over the spleen)

41
Q

What is the only pet agent made with a generator? half life?

A

Rb-82; super short half life

42
Q

Cardiac scan artifacts

Breast tissue

left hemidiaphragm

LBBB

A

Breast tissue = anterior wall

left hemidiaphragm = inferior wall

LBBB = septal defect sparing apex

43
Q
A
44
Q

Dipyridamole

A

vasodilator - inhibits breakdown of adenosine, lower side effect profile

no caffeine

45
Q

adenosine

A

vasodilator, no caffeine, worse side-effects relative to dipyridamole

46
Q

Ragedenoson

A

vasodilator (selective A2a)

fewer side effects

no caffeine

47
Q

Dobutamine

A

Beta 1 agonist

better in patients with COPD or Asthma

avoid with LBBB

48
Q

aminophyline

A

antidote for adenosine

half-life shorter than dipryidaomele

49
Q

What are the three agents used for treatment of boner pain?

A

Strotium 89

Samarium 153

Radium 223 Xofigo

50
Q

Sr89

A

Pure beta emitter

Most boner marrow toxicity (longest recovery)

renal excretion

51
Q

Sm153

A

Beta emmitter with some immageable gamma rays

less boner marrow toxicity

renal excretion

52
Q

Ra223

A

alpha emmitter

least bone marrow toxicity

GI excretion

improved survival for prostate mets

Long half life of 11.4 days

53
Q

Yttrium-90

A

pure betta emmiter, maximum tissue penetration = 1 cm

particle size = 20-40 microns

dose typically is 100-1000 Gy

can image it’s 175 and 185 keV emissions

half-life = 64 hours

54
Q

What is radioimmune therapy?

A
  • first line or refractory treatment for NH-lymphoma
  • basically bind Y-90 to a mab
  • dont give with plt under 100K

HomeStretch/Numbers (24 decks)

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