Radiopharm Final Exam 2023 Update with complete solution

Radiopharm Final Exam 2023 Update with complete solution How does 201Tl decay? (a) By positron emission (b) By electron capture (c) By beta emission (d) None of the above Correct answer- B. By electron capture What is the role of the stannous ion in the preparation of pharmaceuticals labeled with 99mTc? (a) To increase the valence state from +4 to +7 (b) To reduce the amount of Al3+ present (c) To reduce the valence state of 99mTc (d) To reduce the radiation dose Correct answer- C. To reduce the valence state of 99mTc If the biological half-life of an isotope is 6 h and the physical half-life is 12 h, what is the effective half-life? (a) 6 h (b) 12 h (c) 2 h (d) 4 h Correct answer- D. 4 h Which of the following is used to abbreviate physical half-life? (a) Tp (b) T/2 (c) T2 (d) P 1⁄2 Correct answer- A. Tp The physical half-life of a radionuclide is the time it takes: (a) For half of the substance to leave the body (b) For the nuclide to decay to one-half of the original activity (c) For the kit to become half expired (d) For half of the substance to be metabolized Correct answer- B. For the nuclide to decay to one-half of the original activity Which of the following is boiled during preparation? (a) MAA (b) Sulfur colloid (c) Albumin colloid (d) Diphosphonates Correct answer- B. Sulfur colloid The presence of 12 μg Al+3 in 1 ml of 99mTc eluate is: (a) An example of radionuclidic impurity (b) An example of chemical impurity (c) An example of radiochemical impurity (d) Acceptable since it is less than 15 μg/ml Correct answer- B. An example of chemical impurity Which body decides on the acceptable levels of radionuclidic impurity? (a) USP (b) NRC (c) FDA (d) Both (a) and (b) Correct answer- D. Both (a) and (b) NRC, FDA Which of the following is an example of radionuclidic impurity? (a) Presence of free 99mTc in a preparation of 99mTc sulfur colloid (b) Presence of 99Mo in 99mTc eluate (c) Presence of aluminum ions in 99mTc eluate (d) Presence of pyrogens in eluate Correct answer- B. Presence of 99Mo in 99mTc eluate What is the maximum amount of aluminum ions (Al+3) allowed in 1 ml of 99mTc eluate according to the USP? (a) None is allowed (b) 5μg (c) 10μg (d) 15μg Correct answer- C. 10μg What is indicated by the front of an instant thin layer chromatography (ITLC) strip? (a) Radionuclidic impurity. (b) Particles of incorrect size. (c) Pyrogens. (d) This depends on the solvent and strip used. Correct answer- D. This depends on the solvent and strip used. What is the most likely size of an MAA particle if correctly prepared? (a) 0-100 mm (b) 10-30μm (c) 10-30 mm (d) 0-250μm Correct answer- B. 10-30μm 99mTc MAA has a biologic half-life of 2-4 h; what will the effective half-life be? (a) 1.5-3.0 h (b) 2.0-4.0 h (c) 0.5-1.0 h (d) 1.5-2.4 h Correct answer- D. 1.5-2.4 h Which radiopharmaceutical is made with 99mTc without a reducing agent? (a) MAG3 (b) MAA (c) Sulfur colloid (d) Sestamibi Correct answer- C. Sulfur colloid Which of the following is an example of radiochemical impurity? (a) Presence of free 99mTc in a preparation of 99mTc sulfur colloid (b) Presence of 99Mo in 99mTc eluate (c) Presence of aluminum ions in 99mTc eluate (d) Presence of pyrogens in eluate Correct answer- A. Presence of free 99mTc in a preparation of 99mTc sulfur colloid Which of the following can be said regarding effective half-life? (a) It is always longer than the physical half-life. (b) It always shorter than both the physical and the biologic half-life. (c) It is always shorter than physical half-life, but longer than the biologic half-life. (d) It is always longer than the biologic half-life, but shorter than the physical half-life. Correct answer- B. It always shorter than both the physical and the biologic half-life. The purpose of adding EDTA to sulfur colloid when labeling with 99mTc is: (a) To prevent aggregation of sulfur colloid (b) To bind excess Al3+ (c) To prevent loss of the radiolabel (d) a and b only (e) b and c only Correct answer- D. a and b only To prevent aggregation of sulfur colloid, To bind excess Al3+ A diphosphonate kit should generally be used within how many hours after preparation? (a) 2 h (b) 12 h (c) 4-6 h (d) 24 h Correct answer- C. 4-6 hours What is the usual particle size of sulfur colloid? (a) 0.3-1.0μm (b) .03-0.1μm (c) 2.0-10μm (d) 4.0-15μm Correct answer- A. 0.3-1.0μm Which radiopharmaceutical, when correctly prepared, will have the smallest particle size? (a) 99mTc sulfur colloid (b) 99mTc albumin colloid (c) 99mTc human serum albumin (d) 99mTc macroaggregated albumin Correct answer- C. 99mTc human serum albumin Following injection of 99mTc MAA for a perfusion lung scan, activity is seen in the kidneys and brain. This is indicative of: (a) Right to left cardiac shunt (b) Renal failure (c) Congestive heart failure (d) Incorrect particle size Correct answer- A. Right to left cardiac shunt While performing a GI bleeding study with labeled red blood cells, a technologist notices gastric activity that he suspects is the result of free pertechnetate. What could be done to support this suspicion? (a) Reimage the patient in the erect position. (b) Narrow the window around the photopeak. (c) Image the thyroid. (d) Have the patient drink two glasses of water and empty his or her bladder. Correct answer- C. Image the thyroid. If excessive aluminum is present in 99mTc eluate, which of the following would be expected on a bone scan? (a) Lung uptake (b) Liver uptake (c) Thyroid uptake (d) Gastric uptake Correct answer- B. Liver uptake Radiochemical impurities often result from: (a) Introduction of water into the kit (b) Introduction of oxygen into the kit (c) Introduction of nitrogen into the kit (d) a and b only (e) All of the above Correct answer- D. a and b only, Introduction of water into the kit, Introduction of oxygen into the kit Following reconstitution of a kit with 99mTc pertechnetate, a technologist should ensure that all of the following are present on the vial except: (a) Date and time of preparation (b) Lot number (c) Concentration and volume (d) Patient name or identification number Correct answer- D. Patient name or identification number In most reconstituted radiopharmaceutical kits, in what form is 99mTc present? (a) Free pertechnetate (b) Bound technetium (c) Reduced, hydrolyzed technetium (d) All of the above Correct answer- D. All of the above. A 99Mo/99mTc generator exists in _____ equilibrium and the parent isotope has a _____physical half-life than the daughter isotope. (a) Transient, longer (b) Transient, shorter (c) Static, longer (d) Static, shorter Correct answer- A. Transient, longer All of the following are examples of common biologic compartments, EXCEPT: a. lung airways. b. lymphatic channels. c. peritoneal cavity. d. Meckel's diverticulum. Correct answer- D. Meckel's diverticulum. Which of the following mechanisms is the basis for visualization of a site of GI bleeding? a. cell sequestration b. cellular migration c. facilitated diffusion d. leakage from compartment Correct answer- D. leakage from compartment Movement (flow) within a compartment is the mechanism of localization for each of the following procedures, EXCEPT: a. gastric emptying. b. lacrimal drainage. c. ureteral reflux. d. myocardial perfusion. Correct answer- D. myocardial perfusion. Regarding passive diffusion, which of the following is true? a. In some biological systems, net movement can be from an area of low concentration to an area of higher concentration. b. Its rate is a function of the concentration gradient. c. Input of external energy is needed for diffusion across biological membranes d. It may be competitively inhibited by similar molecules. Correct answer- C. Input of external energy is needed for diffusion across biological membranes Localization of Tc-99m tetrofosmin in the myocardial muscle is dependent on all of the following, EXCEPT: a. glucose blood levels. b. coronary blood flow (delivery to the tissue). c. passive diffusion in the cells. d. retention in the cells. Correct answer- A. glucose blood levels. Regarding glomerular filtration, which of the following situations would NOT be a problem? a. cardiovascular shock (abnormally low blood pressure) b. highly and tightly protein-bound c. high concentration of similar molecules in the blood d. MW > 5000 Correct answer- C. high concentration of similar molecules in the blood Characteristics of facilitated diffusion include all of the following, EXCEPT: a. It can be saturated. b. It requires a concentration gradient. c. Its rate is solely a function of the concentration gradient. d. It uses a carrier (membrane transporter). Correct answer- C. Its rate is solely a function of the concentration gradient. Characteristics of active transport include all of the following, EXCEPT: a. It can be competitively inhibited by similar molecules. b. It can transport molecules against a concentration gradient. c. It requires the input of external energy. d. Saturation is theoretically possible but unlikely in biological systems. Correct answer- D. Saturation is theoretically possible but unlikely in biological systems. Examples of active transport systems include all of the following, EXCEPT: a. GLUT. b. Na+/I- symporter. c. Na+/K+ pump. d. norepinephrine transporter. Correct answer- D. norepinephrine transporter. Localization of Tc-99m pertechnetate in a Meckel's diverticulum is by the mechanism of: a. ion exchange. b. secretion. c. passive diffusion. d. receptor binding. Correct answer- B. secretion. "Colloid shift" refers to a shift in the biodistribution of Tc-99m sulfur colloid in patients with diffuse liver disease, resulting in decreased uptake in liver with increased uptake in: a. spleen and bone marrow. b. kidneys/urine. c. lungs. d. lymphatic system/lymph nodes. Correct answer- A. spleen and bone marrow. Which of the following is an example of cell sequestration? a. localization of In-111 leukocytes in a site of infection b. localization of Tc-99m RBCs in cardiac blood pool c. localization of Tc-99m RBCs in a site of GI bleeding d. localization of heat-damaged Tc-99m RBCs in the spleen Correct answer- D. localization of heat-damaged Tc-99m RBCs in the spleen An appropriate particle size for capillary blockade is _____ microns. a. 10-50 b. 0.1-0.5 c. 1-5 d. 100-500 Correct answer- A. 10-50 Treatment of liver tumors with Y-90 microspheres relies on which of the following mechanisms of localization? a. compartmentalization b. passive diffusion c. phagocytosis d. capillary blockade Correct answer- C. phagocytosis Localization of Sr-89 strontium chloride in skeletal hydroxyapatite is by the mechanism of: a. active transport. b. ion exchange. c. chemisorption. d. receptor binding. Correct answer- B. ion exchange. Which of the following is localized by cellular migration? a. leukocytes b. metastatic tumor cells c. platelets d. red blood cells Correct answer- A. leukocytes Which of the following radiopharmaceuticals binds to somatostatin receptors? a. C-11 PiB b. I-123 iobenguane c. I-123 ioflupane d. In-111 pentetreotide Correct answer- D. In-111 pentetreotide If faulty preparation of a Tc-99m labeled radiopharmaceutical results in a large fraction of free pertechnetate impurity, localization would be expected in all of the following organs, EXCEPT: a. salivary glands. b. stomach. c. liver. d. thyroid. Correct answer- C. liver. Regarding parathyroid/thyroid scintigraphy, which of the following statements is true? a. Tc-99m pertechnetate and Tc-99m sestamibi are localized by the same mechanism. b. Thyroid uptake of Tc-99m sestamibi is NOT affected by TSH. c. Tc-99m sestamibi is localized in parathyroid adenomas by passive diffusion whereas it is localized in thyroid by active transport. d. Tc-99m sestamibi washes out of parathyroid adenomas whereas it tends to be retained in normal thyroid tissue. Correct answer- B. Thyroid uptake of Tc-99m sestamibi is NOT affected by TSH. 3. The upper limit of the acceptable size range for technetium 99mTc MAA particles is: a. 1 μm b. 10 μm c. 90 μm d. 150 μm Correct answer- C. 90μm 4. Radiochemical purity of a technetium 99m diphosphonate radiopharmaceutical is established by: a. Chromatography b. Colorimetric analysis c. 99Mo breakthrough testing d. pH determination Correct answer- A. Chromatography 5. Which of the following is a method to determine radionuclidic purity? a. Chromatography b. Colorimetric analysis c. 99Mo breakthrough testing d. pH determination Correct answer- C. 99Mo breakthrough testing 6. Technetium 99mTc pertechnetate present in 99mTc MAA is a: a. Chemical impurity b. Physical impurity c. Radiochemical impurity d. Radionuclidic impurity Correct answer- C. Radiochemical impurity 10. What type of contamination is technetium 99mTc pertechnetate found in a technetium 99mTcDTPA preparation? a. Chemical b. Physical c. Radiochemical d. Radionuclidic Correct answer- 11. Which of the following is an example of a radionuclidic impurity? a. Aluminum ion in technetium 99mTc pertechnetate b. Hydrolyzed reduced technetium 99mTc in 99mTc mebrofenin c. Molybdenum 99Mo in 99mTc tetrofosmin d. Technetium 99mTc pertechnetate in 99mTc bicisate Correct answer- 13. Radionuclidic testing is routinely performed in a nuclear pharmacy using: a. A dose calibrator b. A multi-channel analyzer c. Colorimetric analysis d. HPLC Correct answer- 15. Al+++ is an example of a: a. Chemical impurity b. Physical impurity c. Radiochemical impurity d. Radionuclidic impurity Correct answer- 19. Which instrument is NOT acceptable for measuring radioactive counts in chromatography samples? a. Dose calibrator b. G-M survey meter c. Multi-channel analyzer d. Single channel analyzer Correct answer- 1. The chemical state of technetium as it is obtained from the 99mTc generator is: A. TcO3+ B. TcO4- C. TcO2 D. TcO2+ Correct answer- B. TcO4- 2. The oxidation state of technetium as it is obtained from the 99mTc generator is: A. Tc(I) B. Tc(III) C. Tc(V) D. Tc(VII) Correct answer- D. Tc(VII) 3. The number of electrons technetium pertechnetate must gain if it is reduced to the ground state of technetium metal is: A. 7 B. 5 C. 2 D. 1 Correct answer- A. 7 5. Which one of the following technetium compounds does not require reducing conditions in its preparation? A. 99mTc-exametazime B. 99mTc-medronate C. 99mTc-sulfur colloid D. 99mTc-mebrofenin Correct answer- 9. Which one of the following reducing agents is typically used when labeling technetium compounds in alkaline pH? A. Iron-ascorbate. B. Stannous chloride. C. Stannous fluoride. D. Sodium borohydride. Correct answer- 12. Typically oxygen is excluded from technetium kits to minimize the generation of radiochemical impurities. However, one kit that requires the presence of air during radiolabeling to minimize the formation of technetium radiochemical impurities is the: A. exametazime kit. B. medronate kit. C. sulfur colloid kit. D. mertiatide kit. Correct answer- 13. One cause of radiochemical impurity formation in technetium kits is autoradiolysis. All of the following adjuvants are used in radiopharmaceutical kits to retard radiolytic degradation except: A. citric acid. B. ascorbic acid. C. para-amino benzoic acid. D. gentisic acid. Correct answer- 3. Maximum activity of 99mTc is available from the Moly generator in: A. 4 half-lives of 99mTc B. 5-7 half-lives of 99mTc c. 66 hr D. 6 hr Correct answer- 4. The maximum permissible concentration of 99M0 in the 99mTc-eluate is: A. 5 pCi per mCi of 99mTc at the time of injection B. 0.15 pCi/mCi of 99mTc at the time of injwtion c. as much as maximum permissible concentrations in water allowed b NRc a D. 1 ~Ci/mCi of 99mTc Correct answer- 9.The important chemical reaction in the 99m'Tc-labeling of MAG3, sestamibi and HMPAO kits involves: A. only chelation B. ligand exchange c. heat release D. vaporization Correct answer- 11. The shelf-life of most 99mTc radiopharmaceuticals is: A. 6 hr B. 12 hr C. 6 months D. 1 yr Correct answer- 24. The column of the Moly generator is made of? A. Sn02 B. A120g c. NaCl D. DTPA Correct answer- If a 99Mo/99mTc generator is eluted on Monday at 0600, the maximum 99mTc activity could next be eluted at what time? a. 1200 Monday b. 1800 Monday c. 0600 Tuesday d. 0600 Wednesday Correct answer- C. 0600 Tuesday