Sichuan University

Final Exam for Nuclear Medicine

For Nepal Medical Students (Spring Term 2004)
Teacher: Li Lin, Zhou Lu-yi

Student’s Name: Score:

Ⅰ. True or false questions (22 scores. Chose true or false answer from the
following statements and circle the letter):
1. The possibility of pregnancy should not be considered for every woman of child-bearing age
referred to the nuclear medicine service for a diagnostic or therapeutic procedure.
A True B False
2. The most commonly used radionuclide generator system in clinical nuclear medicine is
Molybdenum-99/Technetium-99m generator.
A True B False
3. Having carrier of Tc-99 in the generator eluate will not impair labeling efficiency.
A True B False
4. Myocardial perfusion imaging is possible to determine whether a given defect is new or old.
A True B False
5. The primary cause of false negative exercise myocardial perfusion studies in the diagnosis of
CAD is failure to achieve adequate exercise.
A True B False
6. Significantly increased lung uptake during Tl-201 exercise is a secondary sign of heart
disease.
A True B False
7. The right ventricle is typically seen on rest myocardial perfusion studies.
A True B False
8. For myocardial perfusion imaging, attenuation artifacts are more significant problems for Tc-
99m MIBI than Tl-201 because of the lower energy of the photons.
A True B False
9. The skeletal tracer localizes in the tumor tissue rather than in the reactive bone around the
metastatic deposits.
A True B False
10. During bone scintigraphy, radiation dose to the bladder, ovaries, and testes is largely caused
by radioactivity in the bladder. Frequently voiding reduces the radiation dose to these
structures.
A True B False
11. The appearance of the normal skeletal scintigram is the same between infancy, childhood,
adolescence, and mature adulthood.
A True B False
12. Solitary lesion in the anterior rib ends is more probably due to metastasis than lesion in the
in the spine
A True B False
13. For the detection of substernal goiter, Tc-99m is preferred for its ability to perform delayed
imaging at 24 or even 48 hrs.
A True B False
14. The pertechnetate ion is avidly trapped and organified by the thyroid.
A True B False

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15. Thyroid nodules are classified palpably as “cold” (nonfunctioning), “hot” (functioning), or
indeterminate.
A True B False
16. The imaging appearance of thyroid autonomous nodules is that the extranodular thyroid
tissue are always not visualized scintigraphically.
A True B False
17. Thyrotoxicosis is a clinical symptom complex caused by decreased thyroid hormone levels.
A True B False
18. Since it is generally safe to treat hyperthyroidism with I-131, it is not necessary to obtain
informed consent from patient.
A True B False
19. At present, it is possible to prevent late hypothyroidism from happening in the I-131
treatment for hyperthyroidism.
A True B False
20. FDG is a glucose analog and is used as a tracer of oxygen consumption.
A True B False
21. Technetium-99m sulfur colloid scintigraphy is most suitable for the detection of
intermittent G.I bleeding.
A True B False
22. The characteristic scintigraphic finding in liver hemangioma is that images acquired 1 to 2
hours after tracer injection show decreased uptake within the lesion compared with the
normal liver.
A True B False
Ⅱ . Multiple choice questions (48 scores. Chose one correct answer from the
following statements and circle the letter):
1. The positron differs from the electron by having the opposite_________
A. Half-life
B. Mass
C. Charge
D. Atomic number
2. __________________ is the time it takes for the activity to fall by half because of the
combined processes of physical decay and biological clearance.

A. Electron capture
B. Effective half life
C. Dose rate
D. Decay constant
3. In the interaction of γ rays with matter, a γ photon may lose its energy via ____________
A. Gaussian scattering and photoelectric absorption
B. Photoelectric absorption and bremsstrahlung
C. Compton scattering and photoelectric absorption
D. Compton scattering and bremsstrahlung
4. A dose calibrator is basically a (an) ________________________
A. Ionization chamber
A. Inert gas generator
B. Geiger-Müller counter
C. Smiconductor diode

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5. In a gamma camera, ______________ is utilized to project the space distribution of the
radionuclide.
A. Scintillation crystal
B. PMT array
C. Computer
D. Collimator
6. A scintillation detector is composed of _____________________
A. Scintillator and photomultiplier tube
B. Scintillator and photocathode
C. Photocathode and dynodes
D. Photomultiplier tube and preamplifier
7. In nuclear medicine image acquisition, larger matrix can better preserve the image
_____________.
A. Color
B. Counts
C. Storage size
D. Resolution
8. Skeletal imaging belongs to what mechanism of radiopharmaceutical localization:
A Passive diffusion
B Capillary blockade
C Chemical bonding and adsorption
D Compartmental localization
9. In regard of design characteristics of radiopharmaceutical, the ideal gamma emission is:
A 100-200 keV
B 0-80 keV
C 300-400 keV
D Higher than 400 keV
10. Why parent and daughter radionuclides can be separated in generator systems?
A Because they have different photon energies.
B Because they have different physical half-lives.
C Because parent and daughter are different elements, they can be chemically separated.
D Because they have different biological behavior.
11. The appearance of transient ischemia on myocardial perfusion imaging is:
A Cold defects on poststress (exercise) images that fill in or reverse on delayed (rest)
images
B Cold defects on delayed images that fill in or reverse on poststress images
C Cold defects both on poststress and delayed images.
12. The typical imaging appearances of viable myocardium on myocardial perfusion imaging
and F-18 FDG PET imaging is:
A Decreased or no uptake on F-18 FDG PET imaging and increased uptake on
myocardial perfusion imaging.
B Decreased or no uptake on myocardial perfusion imaging and normal or increased
uptake on F-18 FDG PET imaging.
C Decreased or no uptake both on myocardial perfusion imaging and F-18 FDG PET
imaging.
13. The two acquisition techniques of radionuclide ventriculography are:
A Dynamic and static acquisition
B Planar and tomographic acquisition
C First-pass and equilibrium acquisition

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14. The major advantage of skeletal scintigraphy is its:
A High specificity in detecting early disease of many types.
B High sensitivity in detecting early disease of many types.
C High accuracy in detecting primary bone tumors.
15. Dynamic (three-phase) bone imaging is a special technique used in the differential
diagnosis of:
A Primary and metastatic bone lesions.
B Trauma and metabolic bone diseases.
C Cellulitis and osteomyelitis.
16. The classic, “typical” pattern of bone scintigraphy that provides the most diagnostic
certainty of bone metastases is:
A The increased uptake of radioactivity in the long bones.
B The presence of multiple focal lesions distributed randomly throughout the axial
skeleton.
C The generalized increased uptake in the ribs and spine with faint or absent visualization
of kidneys.
17. The common nonosseous tumors that metastasize to bone are:
A Thyroid, brain, liver.
B Kidney, stomach, pancrease.
C Prostate, lung, breast.
18. Systematic approach to the workup of the patients with solitary thyroid nodules is
A Ultrasonography→FNA→thyroid scintigraphy
B Thyroid scintigraphy→ultrasonography→FNA
C FNA→throid scintigraphy→ultrasonography
19. RAIU is specially suited to the differential diagnosis of
A Thyroiditis
B Hyperthyroidism
C Thyroid carcinoma
20. The greatest clinical experience with MIBG is in the evaluation of
A Patients with intraadrenal paraganglioma (pheochromocytoma)
B Renal tumor
C Assessing the functional status of adrenocortical tissue
21. The most commonly used agent for pulmonary ventilation imaging is
A Xe-127
B Xe-133
C Tc-99m DTPA
D Tc-99m MAA
22. The typical diagnostic pattern of V/Q scintigraphy for pulmonary embolism is
A Focal defects on ventilation scintigram, normal perfusion scintigram.
B Wedge-shaped defects on perfusion scintigram, normal ventilation scintigram.
C Wedge-shaped defects both on ventilation and perfusion scintigram.
23. What is the typical characteristic pattern of NPH on radionuclide cisternography?
A Persistent ventricular filling (reflux, penetration) and evidence of a convexity block.
B Increasing accumulation of activity at the site of obsturction.
C No ventricular activity with delayed migration of CSF.
24. The Biologic Basis of Radioiodine Therapy for hyperthyroidism is its:
A Gamma rays
B β-rays
C α-rays

25. The two most important parameters for the calculation of I-131 dose in the treatment of

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 Graves’s hyperthyroidism are:
A T4 and TSH
B Patient height and weight
C Thyroid gland weight and RAIU
26. The most commonly seen complication in the I-131 treatment for hyperthyroidism is:
A Local neck pain and tenderness
B Hypothyroidism
C Increase in thyroid size
27. _____ can be used for the treatment of bone pain from metastases.
A Sr-89
B I-131 MIBG
C Tc-99m DTPA
28. Ga-67 uptake is normally seen in the following organs except:
A Spleen
B Salivary glands
C Heart
D Breast and lacrimal glands
29. Which of the following statements is not true regarding F-18 FDG?
A Uptake is normally high in the brain and heart.
B F-18 FDG is more accurate than CT for staging lung cancer.
C F-18 FDG can be imaged only with a PET camera.
D The mechanism of uptake is identical to that of glucose.
30. Diagnostic criteria of G.I bleeding with Tc-99m RBCs are the following except:
A The activity decreases over time
B Move must be seen through the GI tract.
C The focus must be increasing over time.
D The extravascular activity must be intraluminal.
31. ____ is used for the detection of Meckel’s diverticulum.
A Tc-99m RBCs
B 99mTcO4- (Tc-99m pertechnetate)
C Tc-99m DTPA
D Tc-99m MIBI
32. The normal gallbladder usually fills by ___ minutes for Tc-99m IDA cholescintigraphy.
A 10
B 30
C 90
D 120

Ⅲ. Term Explanation (15 scores)

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1. Radiopharmaceutical
Radioactive materials that have met legal requirements for administration to
patients or subjects.

2. Specific concentration
Radioactivity per unit volume (mCi/ml).

3. Radiochemical purity

The percentage of the total radioactivity in a specimen that is in the specified or

desired radiochemical form.

Ⅳ. Briefly describe the diagnostic patterns of Tc-99m MIBI stress-rest

myocardial perfusion scintigraphy in coronary artery disease (15 scores)
① Normal: no defects noted on either image set.
② Transient ischemia: cold defects on poststress images that fill in or reverse on
delayed images.
③ Infarction: defects that remain “fixed” between the image sets.

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