CV Review Flashcards by Cecilia Nguyen

what is the best view on a MUGA for calculating LVEF?

45 LAO

How well did you know this?

Not at all

Perfectly

What portion of the heart wall does the ANT planar image best assess in a MUGA study?

right atrial and ventricle size and wall motion

How well did you know this?

Not at all

Perfectly

which will not reverse the effects of dipy (persantine)?

atropine

How well did you know this?

Not at all

Perfectly

which of the following is NOT a contraindication for an exercise study?
beta blockers, calcium channel blockers, LBBB, caffeine

caffeine

How well did you know this?

Not at all

Perfectly

if counts from the left atrium are included in the LV ROI, how will this affect the EF?

falsely lowers EF

How well did you know this?

Not at all

Perfectly

pharmacological stress in an asthma patient would be done with this agent.
dipy, adenosine, persantine, dobutamine

dobutamine

How well did you know this?

Not at all

Perfectly

which is most likely to cause artifactual ant or lat wall defects on MPI?
COR error, resp motion, LBBB, breast attenuation

breast attenuation

How well did you know this?

Not at all

Perfectly

why must there be 2 separate injections of mibi for an MPI?

no redistribution in heart

How well did you know this?

Not at all

Perfectly

which of the following situations could lead to a false negative MPI?
incorrect placement of ECG leads, LBBB, diaphragmatic attenuation, inadequate stress

inadequate stress

How well did you know this?

Not at all

Perfectly

Which of following is correct regarding thallium localization? (select all)

A) localization by passive diffusion

B) localization by active transport

C) proportional to myocardial blood flow

D) according to myocardial viability

b, c, d

How well did you know this?

Not at all

Perfectly

Check all that apply.

Which of the following are preparation for a 1 day dipyridamole MPI.

A) NPO for at least 4 hours

B) Place an IV

C) Discontinue caffeine for 24 hours

D) Discontinue xanthine meds for 48 hours

a, b, c, d

How well did you know this?

Not at all

Perfectly

Which RP can be used to assess myocardial perfusion with the use of a single injection?
A) 201Tl chloride

B) 99mTc-RBC

C) 99mTc-tetrofosmin

D) 99mTc-sestamibi

How well did you know this?

Not at all

Perfectly

What does the bulls eye display created after myocardial perfusion imaging represent?

A) Short axis images

B) An entire set of stress and rest SPECT images

C) All parts of the myocardial wall except apex

D) None of the above

How well did you know this?

Not at all

Perfectly

Check all the apply.

Which of the following are differences between myocardial perfusion imaging with Tl versus mibi?

A) High resolution collimator can be used with thallium

B) Less soft tissue attenuation with Tl

C) Higher photon flux with mibi

D) Less respiratory motion with Tl stress images

a, c

How well did you know this?

Not at all

Perfectly

Why do we wait 45-90 min between stress injection of Myoview and imaging?

A) To allow for respiratory motion to decrease

B) To allow for liver and lung activity to decrease

C) To allow time for uptake in the myocardium

D) To allow time to monitor the patient

How well did you know this?

Not at all

Perfectly

What is an approximate effective dose for MPI imaging using 201Tl (with reinjection)?

5 mSv

13 mSv

22 mSv

40 mSv

How well did you know this?

Not at all

Perfectly

Which of the following is an appropriate indication for MPI imaging?

Assessment of wall motion

Monitoring of LVEF and cardiotoxicity

Risk assessment in patient with episode of chest pain

Determine degree of mitral valve dysfunction

Risk assessment in patient with episode of chest pain

How well did you know this?

Not at all

Perfectly

When stressing a patient with Dobutamine, when is the 99mTc-Mibi administered?

When HR reaches 220-age

When HR reaches (220-age) x 0.85

At 3 min into infusion

At 7 min into infusion

When HR reaches (220-age) x 0.85

Which of the following would NOT cause you to alert the stressing physician about stopping exercise?

ST segment elevation or depression on ECG

Increase in BP with mild chest pain

Patient complains of dizziness and fatigue

Blood pressure drops from baseline reading

Increase in BP with mild chest pain

Which of the following is correct regarding Dobutamine stressing?

Max dosage is 40ug/kg/min

RP injected 2min after infusion ends

Works as a vasodilator in the heart

Caffeine counteracts effects

Max dosage is 40ug/kg/min

How would aminophylline be used during an MPI protocol?

100mg IV for symptom relief after dipy stress

100mg IV for arrhythmias that may occur during exercise stress

500mg po for sypmtom relief after dipy stress

500 mg po for arrhythmias that may occur during exercise stress

100mg IV for symptom relief after dipy stress

After performing a 201Tl rest/redistribution protocol, the radiologist asks you to give a 37MBq dose of Tl and reimage in 15 min. What is the most likely reason for this request?

There was a reversible defect on the rest/redistirubtion portion

There was a fixed defect on the rest/redistribution portion

There were inadequate counts acquired in the rest/redistribution portion

There was motion in the rest/redistribution portion

There was a fixed defect on the rest/redistribution portion

What are appropriate dose and protocol parameters for a 2 day MPI study with 99mTc-MIBI?

925MBq 64 projections/25 sec each

925MBq, 128 projections/20 sec each

370MBq, 64 projections/25 sec each

370MBq, 128 projections/20 sec each

925MBq 64 projections/25 sec each

Which parameters are appropriate for acquiring a a low dose attenuation correction CT scan as part of a MPI study?

Current 50 mA, slice thickness, 0.5-1 mm, breath hold

Current 50 mA, slice thickness 2-5 mm, tidal breathing

Current 5mA, slice thickness, 0.5-1 mm, breath hold

Current 5mA, slice thickness 2-5 mm, tidal breathing

What would you expect on the MPI perfusion images if exercise stress was performed on a patient with LBBB? defect on lateral wall on stress images, normal on rest defect on septal wall on stress images, normal on rest defect on lateral wall on rest images, normal on stress defect on septal wall on rest images, normal on stress

defect on septal wall on stress images, normal on rest

Choose the best artifact to match the description. ____ hurricane sign on processed images ____ defect on septal wall on stress images ____ ant wall defect, usually fixed ____ inferior wall defect usually fixed ____ may mask or cause inferior wall defects ____most common with Tl stress study, reversible inferior wall defect 1. LBBB 2. Breast attenuation 3. Diaphragmatic attenuation 4. Hot Bowel 5. Cardiac creep 6. Motion

motion - hurricane sign on processed images LBBB - defect on septal wall on stress images breast attenuation - ant wall defect, usually fixed diaphragmatic attenuation - inferior wall defect usually fixed hot bowel - may mask or cause inferior wall defects cardiac creep - most common with Tl stress study, reversible inferior wall defect

Which is correct regarding the LHR performed with 201Tl imaging? ROI drawn on Ant image, normal is less than 0.35 ROI drawn on LAO image, normal is less than 0.35 ROI drawn on Ant image, normal is less than 0.5 ROI drawn on LAO image, normal is less than 0.35

ROI drawn on Ant image, normal is less than 0.5

What is the method of localization for tagged RBC's to image the blood pool? a) Compartmental b) Active Transport c) Passive Diffusion d) Cell sequestration

What is an advantage of using Ultratag compared to other RBC labeling methods? a) less centrifugation is required b) Decreased radiation dose to the patient c) Higher % tag d) Less expensive

What is the expected % tag for in-vivo labelled RBCs? a) > 95% b) 90-95% c) 70-80% d) 50-60%

placement of 3 lead ecg when performing MUGA?

- one over the apex of each lung + one on upper left abdomen

What is the advantage of acquiring 32 over 16 frames/cardiac cycle? a) Increased accuracy on volume curve b)Increased statistics per frame c) Less chance of visualizing artifacts like flicker artifact d)There is no advantage of acquiring 32 frames

Which planar MUGA view best demonstrates wall motion of the inferior wall of the heart? a) ANT b) LAO c) LLAT d) RPO

What would be the result of excluding a portion of the LV in your ROI for ejection fraction? a) Overestimation of ejection fraction b) Underestimation of ejection fraction c) There would be no effect on ejection fraction

Which of the following is a normal gated equilibrium result? a) LVEF 52% b) EDV 50ml c) LVEF 45% d) EDV 210mL

If a patient's heart rate increases during a gated equilibrium study, what is most likely to occur? EDV falsely decreased EDV falsely increased ESV falsely increased ESV falsely decreased

EDV falsely decreased

How is the analysis of left ventricular end systole on a MUGA study best described? Place an ROI around the left ventricle on the frame with the highest number of counts Place an ROI around the left ventricle on the frame with the lowest number of counts Place an ROI around both ventricles on the frame with the lowest counts End systole is not used when analyzing a MUGA study

Place an ROI around the left ventricle on the frame with the LOWEST number of counts

Dose for MUGA

740-1850 MBq

Dose for rest MPI (1 day protocol)

296-370 MBq

Dose for stress MPI (1 day protocol)

925-1110 MBq

Dose for MPI stress (2 day protocol)

740-1110 MBq

Dose of 201Tl-Cl for MPI

74-148 MBq

Dose of 99mTc-PYP for amyloidosis scan

370-740 MBq