HomeStretch CRACK vol 1. NUCS Flashcards

(54 cards)

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
In a HIDA scan, what medications can cause prompt uptake with delayed biliary excretion?
Erythromycin, Estrogen (contraceptives), Anabolic steroids, chlorpromazine, sometimes statins
26
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%) = ?
Hepatic dysfunction (hepatitis) CBD obstruction Acute chole Chronic chole
27
Diffuse pulmonary activity on a sulfur colloid scan = ?
excess aluminium in the colloid
28
renal activity on sulfur colloid = ?
CHF Alternatively in renal transplant can indicate rejectoins other rare causes = coxsackie b virus, DIC and TTP
29
MAG 3
secreted (threecreated) (ERPF) concentrated better in poor kidney function critical organ is bladder
30
DMSA
binds to renal cortex critical organ = kidney
31
How does a kidney with renal artery stenosis look when using MAG3? How about DTPA?
MAG 3 = the sick kidney holds on the the tracer DTPA = the sick kidney has decreased uptake and flow.
32
Renal transplant nucs renogram - ATN versus rejection
both will have delayed excretion, but ATN has preserved flow and rejection has decreased flow
33
Meningiomas can be hot on what scans?
Hot on Octreotide and MDP
34
What medications interfere with the workings of MIBG?
Kids with neuroblastoma don't need TLC or cocaine! TCA's, labetalol, Ca channel blockers and cocaine
35
MIBG versus Octreotide
MI**B**G is superior for neuroBlastoma and non-malignant (adrenal) pheos o**C**treotide = superior for Carcinoid and malignant (extra-adrenal) pheos
36
Critical organs for: Indium prostascint (PMSA) Indium WBC Indium octreotide
* Indium prostascint (PMSA) = Liver * Indium WBC = Spleen * Indium octreotide = Spleen!
37
What is the best view for a MUGA scan?
left anterior oblique
38
39
What gives a false low EF on MUGA?
Screwed up view with overlap of LV by the RV or great vessels
40
What gives a false high EF on MUGA?
Wrong (high) background ROI (over the spleen)
41
What is the only pet agent made with a generator? half life?
Rb-82; super short half life
42
Cardiac scan artifacts Breast tissue left hemidiaphragm LBBB
Breast tissue = anterior wall left hemidiaphragm = inferior wall LBBB = septal defect sparing apex
43
44
Dipyridamole
vasodilator - inhibits breakdown of adenosine, lower side effect profile no caffeine
45
adenosine
vasodilator, no caffeine, worse side-effects relative to dipyridamole
46
Ragedenoson
vasodilator (selective A2a) fewer side effects no caffeine
47
Dobutamine
Beta 1 agonist better in patients with COPD or Asthma avoid with LBBB
48
aminophyline
antidote for adenosine half-life shorter than dipryidaomele
49
What are the three agents used for treatment of boner pain?
Strotium 89 Samarium 153 Radium 223 Xofigo
50
Sr89
Pure beta emitter Most boner marrow toxicity (longest recovery) renal excretion
51
Sm153
Beta emmitter with some immageable gamma rays less boner marrow toxicity renal excretion
52
Ra223
alpha emmitter least bone marrow toxicity GI excretion improved survival for prostate mets Long half life of 11.4 days
53
Yttrium-90
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
What is radioimmune therapy?
- first line or refractory treatment for NH-lymphoma - basically bind Y-90 to a mab - dont give with plt under 100K