Clinical Nuclear Medicine
Textbook Exam Questions
Course Introduction
Clinical Nuclear Medicine is a specialized field that focuses on the use of radioactive substances for the diagnosis, treatment, and monitoring of various diseases. This course covers the principles and techniques of nuclear imaging modalities such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and gamma camera imaging. Emphasis is placed on the clinical applications in cardiology, oncology, neurology, and endocrinology. Students will learn about radiopharmaceuticals, patient safety, image interpretation, and the integration of nuclear medicine with other diagnostic techniques. The course also addresses regulatory considerations, radiation safety, and recent advancements in the field.
Recommended Textbook
Nuclear Medicine and PETCT Technology and Techniques 8th Edition by Kristen M. Waterstram
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Chapter 1: Mathematics and Statistics
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Sample Questions
Q1) The dose equivalent for occupational whole-body exposure is commonly limited to 50 mSv.How many rem is this?
A)5000 rem
B)500 rem
C)50 rem
D)5 rem
Answer: D
Q2) A nuclear medicine test produces a positive test result in only 80 of the 100 patients known to be ill.Similarly, the test produces a negative test result in only 190 of the 200 patients known to be not ill.Which is correct?
A)Sensitivity = 80%, specificity = 95%, accuracy = 90%, prevalence = 33%
B)Sensitivity = 90%, specificity = 95%, accuracy = 90%, prevalence = 33%
C)Sensitivity = 90%, specificity = 80%, accuracy = 90%, prevalence = 33%
D)Sensitivity = 90%, specificity = 80%, accuracy = 70%, prevalence = 33%
Answer: A
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3
Chapter 2: Cell and Molecular Biology
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Sample Questions
Q1) Which are the three main cell cycle checkpoints?
A)G<sub>1, </sub>restriction, and metaphase/anaphase
B)G<sub>1</sub>, G<sub>2</sub>/M, and mitotic spindle
C)G<sub>1</sub>, G<sub>2</sub>/M, and anaphase/telophase
D)Restriction, DMA damage, and anaphase/telophase
Answer: B
Q2) CDK2 is the partner for both cyclins:
A)A and E.
B)D and E.
C)A and B.
D)D and B.
Answer: A
Q3) An organelle composed of a network of interconnected, closed, membrane-bounded vesicles that extend from the nucleus to the cell membrane is the A)Golgi body.
B)endoplasmic reticulum.
C)centrosome.
D)lysosome.
Answer: B
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Chapter 3: Chemistry/biochemistry
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Sample Questions
Q1) Atoms that differ only in the number of neutrons present in the nucleus are called A)isomers.
B)isotones.
C)isotopes.
D)isomorphs.
Answer: C
Q2) A characterization of a weak acid is that it
A)completely dissociates in water.
B)does not completely dissociate in water.
C)needs a buffer water.
D)neutralizes water.
Answer: B
Q3) A compound, regardless of its origin or method of preparation, always contains the same elements in the same proportions by weight; this is called A)the law of constant composition.
B)the law of multiple proportions.
C)a complex ion.
D)a ligand.
Answer: A
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Page 5
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Sample Questions
Q1) A patient is having a reaction to adenosine.The technologist should ensure the availability of a dose of A)nitroglycerin.
B)aminophylline.
C)morphine.
D)nothing; it has rapid reversal.
Q2) The consequence of a neutron-rich nucleus is A)an Auger electron.
B)electron capture.
C)production of positron emission.
D)production of negative beta particle.
Q3) Dipyridamole is administered to a patient as part of a pharmacological stress test.The patient has an onset of angina pectoris.To reverse this adverse reaction of the dipyridamole, the patient is given A)morphine.
B)aminophylline.
C)atropine.
D)nitroglycerin.
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Chapter 5: Radiation Safety in Nuclear Medicine
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Q1) A technologist is in the room when a patient receives a therapeutic administration of <sup>131</sup>I sodium iodide for thyroid ablation.The technologist should
A)have a bioassay before and after participating in the administration.
B)have a bioassay between 6 and 72 hours after participating in the administration.
C)only have a bioassay if the airborne concentration of the <sup>131</sup>I is less than 10% of the annual dose.
D)only have a bioassay if the room background levels exceed 2 mrem/hr.
Q2) The exposure rate from a point source radioactive source is 250 mrem/hr at 2 m.What would be the exposure in mrem/hr at 3 m?
A)13.8
B)42
C)111
D)562
Q3) According to NRC regulations, radioactive waste from P-32
A)should be shipped for land burial.
B)should be returned to the manufacturer.
C)can be held for decay-in-storage.
D)should be flushed into the sanitary sewer.
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Chapter 6: Patient Care
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Q1) A technologist determines a patient's pulse rate to be 120 beats per minute (bpm).The technologist recognizes this to be A)eucardia.
B)bradycardia.
C)tachycardia.
D)hypocardia.
Q2) The vein usually used for the administration of radiopharmaceuticals is the A)carotid.
B)antecubital.
C)vastus lateralis.
D)most superficial vein.
Q3) The most direct way to intervene in the cycle of infection is to
A)provide a susceptible host for the pathogen outside of the human body. B)limit contact with patients.
C)prevent transmission of the pathogen from the reservoir to a susceptible host.
D)isolate vector-borne pathogens.
Q4) MR contrast media is administered in high doses compared to CT contrast media.
A)True B)False
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Chapter 7: Department Administration
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Sample Questions
Q1) Licensure and certification are forms of
A)accreditation.
B)problem-solving techniques.
C)evaluation.
D)credentialing.
Q2) What are the three components of reimbursement?
A)Coverage, payment, and refund
B)Policy, procedure, and payment
C)Policy, coverage, and refund
D)Coding, coverage, and payment
Q3) The leadership behavior that refuses to accept the status quo as the only alternative for the future is
A)model the way.
B)encourage the heart.
C)challenge the process.
D)inspire a shared vision.
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Chapter 8: Clinical Research
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Sample Questions
Q1) A record of clinical study observations and other information that a study protocol designates that must be completed for each subject is the
A)clinical report form.
B)case report form.
C)source document.
D)monitor report.
Q2) In the U.S., clinical trials must be approved by an independent ethics committee, which is called the
A)Contract Research Organization (CRO).
B)Good Clinical Practice (GPC).
C)Institutional Review Board (IRB).
D)Common Rule.
Q3) The Food and Drug Administration governs clinical research performed by
A)the Department of Agriculture.
B)manufacturers of drugs, devices, and biologicals.
C)the Nuclear Regulatory Agency.
D)all investigators.
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10
Chapter 9: Health Informatics in Imaging
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Sample Questions
Q1) In an 8-bit color image, the range of displayed color intensities would be
A)0 to 64.
B)0 to 100.
C)0 to 128.
D)0 to 255.
Q2) The quality of the cardiac data during a MUGA can be compromised by A)breathing.
B)bradycardia.
C)tachycardia.
D)PVCs.
Q3) Digital Imaging and Communications in Medicine (DICOM) is the standard for A)analog to digital conversion.
B)filtering software.
C)the system in each hospital for archiving EHRs.
D)data set-up to allow for image transfer among systems.
Q4) When using nine-point image smoothing, all of the following is true EXCEPT
A)there is a slight increase in image resolution.
B)there is a slight decrease in image resolution.
C)there is a blending of pixel values.
D)it creates a more aesthetic image.
Page 11
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Chapter 10: Physics of Nuclear Medicine
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Q1) When using the standard notation in the physical sciences for representing elements with a one- or two-letter chemical name symbol, the letter Z represents the A)atomic mass.
B)atomic number.
C)number of neutrons.
D)number of electrons.
Q2) An unstable configuration of protons and neutrons is referred to as nuclides.
A)True
B)False
Q3) Positron decay comes from the nucleus that is A)proton-rich.
B)neutron-rich.
C)electron-rich.
D)neutrino-rich.
Q4) In Compton scattering, the energy of the emitted electron
A)is equal to the energy of the incoming photon.
B)is less than the energy of the incoming photon.
C)is greater than the energy of the incoming photon.
D)is equal to the binding energy of the electron.
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Chapter 11: Instrumentation
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Sample Questions
Q1) In the reconstruction of SPECT images, segmenting refers to A)volume rendering.
B)determining the number of counts per pixel.
C)separating the organ from the background or nearby structures.
D)dividing an organ into different components.
Q2) Quenching gas is used in a(n)
A)dose calibrator.
B)Geiger-Mueller (GM) detector.
C)ionization chamber.
D)pocket dosimeter.
Q3) The center-of-rotation measurement
A)determines the number of projections.
B)corresponds to the pixel size at the center of the orbit.
C)corresponds to the radius.
D)determines the offset between the camera center and projections.
Q4) When referring to image quality, resolution
A)refers to how well objects can be separated in space.
B)determines whether two objects have different activity concentrations.
C)refers to the ability to see the edge of a structure.
D)occurs because of the random nature of counting statistics.
Page 13
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Chapter 12: CT Physics and Instrumentation
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Q1) Which of the following may be used to reduce streaking artifacts when scanning anatomy with high-density objects?
A)Bow-tie filter
B)Adaptive detector array
C)Thinner collimation
D)Decreased kVp
Q2) In an x-ray tube, a low kVp results in
A)high-energy Bremsstrahlung x-rays.
B)low-energy Bremsstrahlung x-rays.
C)fewer Bremsstrahlung x-rays.
D)an increase in tungsten characteristic x-rays.
Q3) In a CT scanner, the oil bath that may surround the rotating anode tubes serves to
A)make the tubes rotate more quickly.
B)make the tubes rotate more smoothly.
C)cool the tubes.
D)provide efficient conduction of the current.
Q4) Thin collimation has an advantage because it results in faster scanning time.
A)True
B)False
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Chapter 13: Pet Instrumentation
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Q1) The standard uptake value is useful in
A)performing attenuation correction.
B)calculating scatter correction.
C)differentiating between malignant and benign tissue.
D)determining the time span between injection and scan.
Q2) With PET radionuclides, the higher the energy particle,
A)the greater the mean range for the travel of the positron.
B)the shorter the mean range for the travel of the positron.
C)won't have an effect on the mean range for the travel of the positron.
D)it reduces the mean range for the travel of the positron.
Q3) Regarding septa on a PET system, all of the following are true EXCEPT
A)they limit the field of view of events to those within the same detector ring, or events with contiguous planes.
B)they reduce the number of scatter and random events from outside the plane.
C)they allow for the system to operate in 2D mode.
D)they allow for the system to operate in 3D mode.
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Chapter 14: Principles of Magnetic Resonance Imaging
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Sample Questions
Q1) If energy is delivered to the hydrogen nuclei at a different frequency than that of the Larmor frequency of the nucleus, then
A)resonance will occur.
B)resonance will not occur.
C)it will stop any resonance.
D)precession is increased.
Q2) The magnetic moment describes the magnetic field characteristics of the A)neutron.
B)nucleus.
C)cell.
D)proton.
Q3) All of the following are true regarding the gyromagnetic ratio EXCEPT
A)it is a constant.
B)it relates angular momentum and magnetic moment.
C)it is characteristic of each nuclei.
D)it relates the number of spin-up and spin-down nuclei.
Q4) T1 refers to the recovery of longitudinal magnetization.
A)True
B)False
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Chapter 15: Clinical Petct in Oncology
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Sample Questions
Q1) At the time of a PET scan, ideally the blood glucose level should not be above
A)60 mg/dL.
B)100 mg/dL.
C)120 mg/dL.
D)180 mg/dL.
Q2) Which type of testicular tumor avidly takes up FDG?
A)Seminoma
B)Mature teratoma
C)Non-seminoma
D)Adenoma
Q3) When imaging lymphomas, PET
A)can distinguish between scar tissue and residual tumor after therapy.
B)is comparable to CT in distinguishing scar tissue and residual tumor after therapy.
C)is comparable to MRI in distinguishing scar tissue and residual tumor after therapy.
D)is not involved in staging but is involved in therapy evaluation.
Q4) PET has proved to be effective as a screening tool for colorectal cancers.
A)True
B)False
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Chapter 16: Central Nervous System
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Q1) Which form of dementia demonstrates on SPECT with hypoperfusion and PET with reduced glucose metabolism in the frontal and temporal lobes with sparing of the remaining cerebral cortex?
A)Alzheimer's disease
B)Parkinson's disease
C)Frontotemporal dementias
D)Lewy body dementia
Q2) Acetylcholine is
A)excitatory in the brain and inhibitory in the heart.
B)inhibitory in the brain and excitatory in the heart.
C)excitatory in the brain and excitatory in the heart.
D)inhibitory in the brain and inhibitory in the heart.
Q3) A patient is scheduled for a SPECT brain procedure.Before the radiopharmaceutical is administered, the patient should
A)be well hydrated.
B)be placed in a quiet, dimly lit room.
C)have received Lugol's solution.
D)have undergone a CT scan of the brain.
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18
Chapter 17: Endocrine System
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Sample Questions
Q1) Thyroid hormone synthesis depends on the
A)trapping and secretion of iodine.
B)regulation and secretion of iodine.
C)organification and regulation of iodine.
D)trapping and organification of iodine.
Q2) On a scan, within the thyroid, thyroid carcinoma is often seen as
A)a hyperactive ("hot") area.
B)a hypoactive ("cold") area.
C)diffuse areas of increased activity.
D)total suppression of gland activity.
Q3) When using a <sup>99m</sup>Tc-MIBI double-phase study for imaging the parathyroid gland, after the early phase, the technologist should repeat images
A)20 to 30 minutes after injection.
B)40 to 60 minutes after injection.
C)90 to 120 minutes after injection.
D)24 hours after injection.
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Chapter 18: Respiratory System
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Q1) Which ventilation agent has the longest half-life?
A)(<sup>99m</sup>)Tc-DTPA Aerosol
B)(<sup>133</sup>)Xe
C)(<sup>99m</sup>)Tc MAA
D)All have equal half-lives
Q2) In the supine position, ventilation of the upper parts of the lung
A)has the same distribution as in the upright position.
B)increases from about 1 1/2 to 2 times from upper third to lower third.
C)decreases from about 1 1/2 to 2 times from upper third to lower third.
D)has a gradient from anterior to posterior.
Q3) The fate of MAA particles is that they are broken up
A)by and removed by an anticoagulant.
B)and eliminated via the urinary system.
C)and removed by the liver and spleen.
D)and removed via the bowel.
Q4) All of the following are indications for lung scintigraphy, EXCEPT
A)evaluate lung transplants.
B)evaluate congenital heart or lung disease.
C)determine the likelihood for pulmonary embolism.
D)differentiate lung neoplasms.
Page 20
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Chapter 19: Cardiovascular System
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Q1) When performing a myocardial perfusion exercise stress test, ideally the radiopharmaceutical should be injected at A)the beginning of stress.
B)peak stress and the exercise continued for 1 to 2 minutes.
C)peak stress and the exercise terminated immediately.
D)1 to 2 minutes after peak stress and the exercise terminated within 1 minute.
Q2) In cardiac SPECT imaging, the transverse slices are reoriented along the A)long axis of the left ventricle.
B)short axis of the left ventricle.
C)horizontal axis of the left ventricle.
D)vertical long axis.
Q3) When performing equilibrium-gated blood pool studies, the computer is programmed to have the first frame of data recorded at the A)R wave.
B)Q wave.
C)QRS complex.
D)T wave.
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21
Chapter 20: Gastrointestinal System
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Q1) Using the condensed image method to display results of an esophageal transit study allows for the display of
A)a gated dynamic sequence.
B)the complete dynamic sequence in a single image.
C)the count rate to be calculated using a region of interest (ROI) over the entire esophagus.
D)four parameters from a single curve.
Q2) In preparation for an esophageal transit study, the technologist prepares
A)300 mCi of <sup>111</sup>In in tap water.
B)a meal for the patient using 300 µCi of <sup>111</sup>In.
C)a meal for the patient using 300 µCi of <sup>99m</sup>Tc-sulfur colloid.
D)300 µCi of <sup>99m</sup>Tc-sulfur colloid in tap water.
Q3) Data from a hepatobiliary study are given below.What is the ejection fraction of the gallbladder? Net maximum gallbladder counts = 235,000
Net minimum gallbladder counts = 75,000
A)3%
B)21%
C)32%
D)68%
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Chapter 21: Genitourinary System
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Q1) If normal effective renal plasma flow (ERPF) is about 600 mL/min, normal glomerular filtration rate (GFR) is
A)1.2 L/min.
B)5 L/min.
C)120 mL/min.
D)600 mL/min.
Q2) If normal resting cardiac output is 5 L/min; the total renal blood flow would be approximately
A)0.5 L/min.
B)1.2 L/min.
C)2.5 L/min.
D)3.7 L/min.
Q3) The two most common agents used for morphologic renal imaging are
A)(<sup>99m</sup>)Tc-DMSA and <sup>99m</sup>Tc-glucoheptonate.
B)(<sup>99m</sup>)Tc-MAG3 and <sup>99m</sup>Tc-DTPA.
C)(<sup>99m</sup>)Tc-DMSA and <sup>99m</sup>Tc-DTPA.
D)(<sup>99m</sup>)Tc-MAG3 and <sup>99m</sup>Tc-glucoheptonate.
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Chapter 22: Skeletal System
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Q1) In the evaluation of primary bone neoplasms, bone scans
A)are the first step in diagnosis.
B)are used to detect disease elsewhere.
C)are used instead of radiographs for diagnosis.
D)demonstrate the primary bone neoplasm as a photopenic area.
Q2) Strontium is an analog of A)calcium.
B)phosphorous.
C)hydroxyl.
D)technetium.
Q3) What are the two types of bone tissue?
A)Compact and spongy
B)Spongy and trabecular
C)Cortical and compact
D)Trabecular and cortical
Q4) Metastatic lesions that have no osteoblastic activity
A)can be confused with a renal abnormality.
B)are usually detected as a photon-rich area.
C)are usually detected as a photon-deficient area.
D)often result in breast uptake.
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Chapter 23: Inflammatory Tumoroncology Imaging and Therapy
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Q1) For optimal targeting and minimal blood pool activity,<sup> 111</sup>In-capromab pendetide imaging should begin at
A)6 to 24 hours after injection.
B)36 to 48 hours after injection.
C)60 to 90 hours after injection.
D)96 to 120 hours after injection.
Q2) The radionuclide used to visualize primary neuroendocrine tumors is
A)(<sup>99m</sup>)Tc-sestamibi.
B)(<sup>99m</sup>)Tc-arcitumomab.
C)(<sup>111</sup>)In-capromab pendetide.
D)(<sup>111</sup>)In-pentetreotide.
Q3) In imaging with <sup>67</sup>Ga-citrate, target-to-background ratio increases over time because of gallium concentration in tissue
A)remaining the same while blood clearance progresses.
B)decreasing while blood clearance progresses.
C)remaining the same while blood clearance decreases.
D)decreasing while blood clearance decreases.
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Chapter 24: Hematopoietic System
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Q1) The hematocrit (Hct) represents the A)percentage of RBCs in whole blood.
B)percentage of RBCs in the packed cells.
C)ratio of RBCs to platelets.
D)ratio of RBCs to WBCs.
Q2) Anemia refers to a condition of A)a reduced number of WBCs.
B)a reduced number of RBCs.
C)splenomegaly.
D)malabsorption.
Q3) Platelet kinetics are best studied using platelets labeled with A)(<sup>111</sup>)In oxine.
B)(<sup>125</sup>)I-HAS.
C)(<sup>32 </sup>)P-chromic phosphate.
D)(<sup>51</sup>)Cr-ascorbic acid.
Q4) The average volume of blood plasma for a normal adult is A)25 liters.
B)50 liters.
C)3000 mL.
D)2000 mL.
Page 26
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