Nuclear Medicine Practice Set

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Practice Set of Nuclear Medicine

1. Choose false statement regarding side effects of bone pain palliation therapy with different radionuclide.
(1) Flare phenomenon is commonly observed within 72 hours of treatment in 10% patients.
(2) Myelosuppression is seen earlier with Sm-153EDTMP compared to Sr-89 Chloride and P-32.
(3) Myelosuppression Is usually temporary and recovers within 3 months.
(4) Flushing sensation is common with Sm-153 EDTMP.

2. Most common gene mutation associated with Hobnail variant of papillary carcinoma thyroid is
(1) BRAF V600E
(2) RET
(3) RAS
(4) APC

3. Thyroid carcinoma commonly associated with a germline mutation in the Adenomatous Polyposis Coll (APC) gene is
(1) Hobnail variant of papillary carcinoma thyroid
(2) Invasive Follicular carcinoma thyroid
(3) Cribriform-morular variant of papillary carcinoma thyroid
(4) None of these

4. The encapsulated follicular variant of papillary carcinoma thyroid frequently have
(1) RAS mutations
(2) BRAFY600E
(3) PAX8/PPARc
(4) RET

5. Papillary carcinoma thyroid in children more commonly associated with following mutation :
(1) RET/PTC
(2) RAS
(3) BRAFYS00E
(4) Both (1) and (2)

6. Burch and Wartofsky diagnostic criteria is used for diagnosis of
(1) Myxedeme coma
(2) Thyroid storm
(3) Graves’ opthalmopathy
(4) Carcinoid syndrome

7. Which of the following is not used for assessment of Graves’ opthalmopathy ?
(1) EUGOGO
(2) NOSPECS
(3) VISA
(4) Burch and Wartofsky

8. Which is not included in Clinical activity scoring criteria for Graves’ Opthalmopathy ?
(1) Decrease of acuity equivalent to Snellen line
(2) Inflammation of caruncle
(3) Spontaneous orbital pain
(4) Epiphora

9. Which of the following alpha emitters is also nano generator ?
(1) Actinium 225
(2) Radium 223
(3) Astatine 211
(4) Thorium 227
10. ALSYMPCA trial with Ra223 in castrate resistance prostate cancer showed
(1) Prolong survival and skeletal related events
(2) Prolong time to increase in PSA levels only
(3) Prolong time to skeletal related events only
(4) No impact on survival.

11. 53 years male patient presented with a swelling in anterior neck. USG showed 4 cm nodule in right lobe of thyroid. FNAC showed papillary carcinoma of thyroid. He underwent tight lobectomy followed by completion thyroidectomy, central compartment clearance and right neck dissection. Final histopathology showed PCT with metastasis to level VI and VII group of lympth nodes. 1-131 whole body scan showed mild uptake only in thyroid remnant with no distance metastasis. What would be the disease stage ?
(1) Stage I
(2) Stage II
(3) Stage III
(4) Stage IV

12. All are true about Neuroendocrine Tumors (NET), EXCEPT :
(1) There is overexpression of SSTR receptor 2, 3, 5 by neuroendocrine tumor.
(2) Low grade tumor shows more Ga-68-DOTANOC avidity than high grade tumors.
(3) F-18-FDG PET-CT can be helpful is evaluation of grade I tumor.
(4) Leutitium-177 labelled Peptide Receptor Radionuclide Therapy (PRRT) is a promising treatment option in neuroendocrine tumors.

13. Grade II Neuroendocrine tumors show increase radiotracer uptake on
(1) Ga-68-DOTA NOC PET-CT
(2) F-18-FDG PET-CI
(3) F-18-FDG PET CI is not useful grade II NET.
(4) Both (1) and (2)

14. Choose false statements regarding Thyroglobulin in monitoring patients with carcinoma thyroid.
(1) Serum Throglobulin levels after 3-4 weeks of throidectomy helps in identifying high risk patients.
(2) Serum Thyroglobulin levels serves as marker for assessing response to Radioiodine therapy.
(3) Stimulated Serum Thyroglobulin levels along with 1-131 whole body radioiodine scan at 6 months post radioiodine therapy can be used as predictor or recurrence free survival.
(4) Low Serum Throglobulin levels obviates the need of I-131 whole body radioiodine scan.

15. Patient performance scale used for cancer patient status assessment
(1) ECOG has grades from 0 to 5.
(2) Kamofsky performance status index is between 0-10.
(3) In ECOG performance scale Lower grade suggests good performance.
(4) Karofsky index 100 indicates poor patient status.

16. According to latest WHO classification. high grade Neuroendocrine tumors ins defined as
(1) Ki 67 index > 20%
(2) Mitotic rate 2-20
(3) Ki 67 index 3-20 %
(4) Both (2) & (3)

17. All of the following agents are used for intra-arterial radionuclide therapy for LICC, except :
(1) I-131 Lipiodol
(2) Rhenium-188 Lipiodol
(3) Scandium-47
(4) Holmium-166 microspheres

18. True about Yttrium-90 radioembolization therapy is all, except :
(1) It is a form of intravascular brachytherapy, delivering implantable radioactive microspheres into the arteries that feed liver tumors.
(2) Hepatopulmonary shunt that would deliver 30Gy to lungs with a single infusion is absolute contraindication to vttrium-90 radiombolization therapy.
(3) Compromised pulmonary function and an inadequate liver reserve is relative contraindication for radioembolization therapy with Yttrium-90.
(4) Patients with history of prior irradiation to liver is relative containdication for radiocembolization therapy with Yttrium-90.

19. False statement about Iodine-124 is
(1) It is a positron emitting radionuclide.
(2) It’s a reactor produced radionuclide.
(3) It has very high positron energies.
(4) It has very high X-ray energies.

20. Ga-68 Exendine is a radiopharmaceutical for imagine patient with
(1) Carcinoma prostate
(2) Neuroblastoma
(3) Glucagonoma
(4) Insulinoma

21. F-18 Florbetapir in imaging agent for
(1) Intracellular deposition of Tau protein
(2) Aβ amyloid
(3) Post synaptic dopamine receptor
(4) Both for Tau protein and Aβ amyloid

22. Which is incorrect about Ga-68 DOTA-FAPI PET-CT ?
(1) It is fibroblast activation protein inhibitor.
(2) There is overexpression of FAP in cancer associated fibroblast.
(3) There is less radiotracer uptake in liver, brain and oral mucosa compared to FDG.
(4) Effective dose is more compared to F18-FDG PET-CT.

23. Choose the incorrect statement regarding F-18 FLT.
(1) It monitors DNA synthesis as a reflection of cell proliferation.
(2) Actively transported through cell like thymidine and phosphorylated by TKI.
(3) Further metabolized into difluorothymidine, trifluorothymidine and then get incorporate into DNA.
(4) It shows intense uptake in bone marrow, moderate uptake in liver and no uptake in brain.

24. ISCIIEMIA trial concludes :
(1) There was no difference in cardiovascular events and death between revascularization and optimum medical treatment.
(2) Cardiovascular events and death rates were lower in patients treated with coronary revascularization than in patients treated with optimum medical treatment.
(3) Study included patients with chronic stable angina and acute coronary syndrome.
(4) Optimum medical treatment shows less cardiovascular events and death.

25. All are TRUE about functional imaging in patients with dementia, EXCEPT :
(1) Glucose hypometabolism is a characteristic features of neurodegeneration and hence F-18 – FDG PET CT can be useful in this condition.
(2) F-18 – Florbetapir is used for Imaging intracellular protein deposition inside neurofibrillary tangles.
(3) Amyloid-beta deposition is a relatively early event on the path to Alzheimer’s disease and can be imaged by C-11-PIB compounds.
(4) F-18-THK 5117 is the imaging agent used for intracellular Tau deposition.

26. PET-CT “PROMISE” criteria is for
(1) Prostate cancer
(2) Pancreatic Neuroendocrine tumor
(3) Differentiated Thyroid cancer
(4) Neuroendocrine tumor

27. False about PSMA RAD PET-CT reporting system is
(1) Category 2 : “likely benign” with equivocal uptake at sites atypical; for prostate cancer involvement.
(2) Category 3 : “equivocal” with lesion suggestive of malignancy on anatomic imaging but no uptake at sites typical for prostate cancer involvement.
(3) Category 4 : “prostate cancer was highly likely” with intense uptake at typical sites of prostate cancer involvement but lacking definitive findings on conventional imaging and biopsy is mandatory.
(4) Category 5 : “prostate cancer almost certainly present” with intense uptake at typical sites of prostate cancer involvement and with/without corresponding findings on conventional imaging. Unlikely that biopsy confirmation will be needed.

28. Both Copper-67 and Scandium-47 are comparable in all aspects, except :
(1) Half life
(2) Beta energy
(3) Imageable photon energy
(4) Specific activity & Radiochemistry

29. When a neutron deficient nucleus emits a positron ?
(1) Atomic mass number decreased by 1.
(2) Atomic mass number increased by 1.
(3) Atomic number increases by 1.
(4) Atomic mass number is unchanged.

30. Bragg’s peak occurs in
(1) Interaction of alpha particles
(2) Interaction of neutron
(3) Interaction of gamma rays
(4) Both (1) & (2)

31. What is not true about photoelectric effects ?
(1) It is the interaction of gamma rays with tightly bound inner shell electrons.
(2) Gamma ray is completely absorbed and electron is ejected.
(3) It is more probable with high density material.
(4) It is directly proportional to the gamma ray energy.

32. Which of the following scintillator has the maximum light output ?
(1) LSO
(2) Nal (TI)
(3) BGO
(4) GSO

33. Gamma rays were discovered by
(1) Joliot Curie
(2) Lawrence
(3) Villard
(4) Roentgen

34. Which of the following statement is false ?
(1) Crystal hydration in a camera can be checked by shifting the photopeak.
(2) Electrons can’t be accelerated in cyclotron because it achieves relativistic mass very shortly.
(3) The medical exposure to Indian population is 0.14 mSv/year.
(4) The efficiency of a parallel hole collimator decreases with the increase in distance.

35. Incorrect statement about Semiconductor detectors is
(1) It can be used for energy selective radiation counting.
(2) Si(Li) and Ge(Li) need liquid nitrogen to reduced thermal induced background current.
(3) Lithium impurity can cause electron trap and reduces amount of electrical signals.
(4) CZT can be operated at room temperature.

36. Most effective absorbing material fore neutron beam is
(1) Lead
(2) Tungsten
(3) Mercury
(4) Polyethylene

37. Interaction of low energy photon and atom as whole is known as
(1) Compton scatter
(2) Cerenkov effect
(3) Pair production
(4) Rayleigh scattering

38. Which of the following detectors that have been used in PET imaging is intrinsically radioactive ?
(1) LSO (Lutetium oxyorthosilicate)
(2) Bal, (Barium flouride)
(3) BGO (Bismuth germinate)
(4) GSO (Gadolinium orthosilicate)

39. Which radiation detector can perform energy sensitive counting ?
(1) Ionization chamber
(2) Proportional counter
(3) Geiger Muller counter
(4) All gas field detectors

40. All are correct for the differences between electron emitted in internal conversion and β-decay, except :
(1) In beta decay electron originates from nucleus.
(2) In Internal conversion decay electron originates from nucleus.
(3) Internal conversion emits electron with discrete energy.
(4) β-particle has spectrum of energy.

41. Choose incorrect statement regarding Bremsstrahlung photon.
(1) It is interaction of sufficiently high energy charged particle and nucleus.
(2) Energy of Bremsstrahlung photon can be from zero upto the energy of incident particle.
(3) It increases with increasing the atomic number of absorbing material.
(4) Percentage radiation losses in given by formula : ZEβmax/2000 x 100

42. What is the most common interaction of gamma rays with water ?
(1) Bremsstrahlung
(2) Photoelectric effect
(3) Compton effect
(4) Pair production