Lympha NM

Question 1

Chylous Ascites

Answer 1

Triglycerides >110 mg/dL
Total protein count 1.4-6.4 g/dL

Question 2

Primary lymphedema

Answer 2

<0.5%
Congenital, during puberty, adult
Praecox/tardal

Question 3

Familial form lymphedema

Answer 3

Milroy disease - early onset, VEGFR3
Meiges sy
Klippel - Trenaunay sy

Question 4

Hereditary lymphedema

Answer 4

Lymphedema-distichiasis (double row of eyelashes)
FOXC2 gene

Question 5

Genetic lymphedema

Answer 5

Turner sy
Noonan sy

Question 6

Particles <100 nm

Answer 6

Enter lymphatic capillaries and transport to LN
Phagocytosis

Question 7

Particles <30 nm

Answer 7

Migrate rapidly
Additional LN

Question 8

Particles >100 nm

Answer 8

Trapped in interstitial compartment

Question 9

Two compartment image

Answer 9

0.2-0.3 ml 11-18 MBq
Inject in epifascial and subfascial space (intramuscular)
Evaluate first deep and then superficial circulation

Question 10

Lymphedema protocol

Answer 10

High resolution parallel hole collimator
12 cm/min

Question 11

Transit time

Answer 11

Time to inguinal LN

Question 12

Tracer appearance time

Answer 12

Time of drainage to locoregional LN
<10 min normal

Question 13

Transport capacity

Answer 13

Clearance rate in first 2h
15% normal

Question 14

Removal rate constant

Answer 14

Local lymph flow
Reduced by 25% if lymphedema

Question 15

Depot clearance rate

Answer 15

Uptake index of left inguinal / right inguinal
Activity ratio at 2h

Question 16

Abnormal pattern

Answer 16

Assymetrical lymphatic channels
Interrupted lymphatic vessel
Assymetrical or absent regional LN
Dermal flow
Dermal back flow

Question 17

Main lymphatic vessel without collateral at 4h

Answer 17

Predictor for favourable response in patients with stage I

Question 18

Lymph capillaries

Answer 18

Many anastomoses

Question 19

Collecting lymphatic

Answer 19

Deep and superficial
Valves, smooth muscle wall

Question 20

Lymphatic trunk

Answer 20

Right - from right upper body
Thoracic duct - rest of body
Drain into right and left subclavian veins

Question 21

Acute phase of infection

Answer 21

Increased flow of lymph drainage
Weak LN visualisation

Question 22

Previous history of cellulite or lymphangitis

Answer 22

Low or no lymphatic flow
Obstruction of lymphatic collectors and thrombosis

Question 23

Radiocolloid uptake depends on

Answer 23

Particle size
Speed of drainage
Increase in venous pressure decrease concentration of leukocytes in lymph
Temperature and pH-dependent
Exercise increase lymph flow

Question 24

Deep injection

Answer 24

2 aliquotes on each side
Leg - first and second inter-metatarsal space 0.1 ml 7 MBq
Hand - second and third intermetacarpal space

Question 25

Superficial injection

Answer 25

15-18 MBq 2 aliquotes subdermally 1-2 cm proximally to interdigital web

Question 26

Colloid

Answer 26

All particles from 1 nm to 4 micrometer

Question 27

Tc-Nanocolloid

Answer 27

5-100 nm 95% <80 nm

Question 28

Sulfur colloid

Answer 28

15-5000 nm Filtered 100-220 nm

Question 29

Tc-Antimony sulfide

Answer 29

3-30 nm Less retained in SLN

Question 30

Breast cancer axillary dissection

Answer 30

80% no MTS

Question 31

Breast cancer axillary staging

Answer 31

Radioguided SLN biopsy

Question 32

Internal mammary chain

Answer 32

3% from deeper portions

Question 33

Tc-Tilmanocept

Answer 33

7.1 nm Lymphoseek

Question 34

SLN breast protocol

Answer 34

5-30 MBq same day Up to 150 MBq prior surgery Peritumoral - gold standard (not for non palpable and multicentric) Co57 point source

Question 35

SLN breast indication

Answer 35

T1 or T2 Older age Obesity Male breast cancer DCIS with mastectomy Before neoadjuvant

Question 36

SLN breast Contra

Answer 36

Inflammatory breast cancer

Question 37

Head and neck region

Answer 37

30% of all LN

Question 38

Oropharyngeal cancer

Answer 38

Injection intramucosally 15-120 MBq 0.1-0.2 mL

Question 39

Oropharyngeal cancer most frequent pitfall

Answer 39

Skin or mucosal contamination

Question 40

Invasion of at least one sample

Answer 40

Complete neck dissection

Question 41

Failure to visualise SLN oropharyngeal

Answer 41

Lower sensitivity for floor of mouth cancer

Question 42

Massive MTS in LN

Answer 42

False negative SLN

Question 43

Indication for oropharyngeal SLN

Answer 43

Early cancer with negative LN status by palpation and imaging Stage T1 or T2 N0 Resectable tumor <4 cm

Question 44

Cervix SLNB

Answer 44

4 Peritumoral or periorificial After conization - pericatricial

Question 45

Uterus SLNB

Answer 45

Periorificial or during hysterectomy around tumor or injection in myometrial or subserosal location during surgery

Question 46

SLNB gyn location

Answer 46

83% Daselers medial inguinal region Minimum to lateral inferior groin

Question 47

SLNB gyn indication

Answer 47

Cervix Ia2, Ib1 and IIa1 Uterus Stage I and II high risk Vulva Ib/II <4 cm N0 Vulvar melanoma

Question 48

SLNB gyn Contra

Answer 48

Suspected extrauterine involvement Pathologic pelvic or paraaortic LN History of surgery or radio of LN General Contra

Question 49

SLNB penile indication

Answer 49

Non palpable LN Only G3 tumor T2-T4

Question 50

SLNB penile

Answer 50

Intradermally around tumor or 2, 6, 10 o'clock 20 MBq for single day 40 MBq for 2-day protocol Image 1 hour post injection, 1 hour before surgery Co57 point source