NUCLEAR MEDICINE LATEST 2026 CORE TEST QUESTIONS
AND SOLUTIONS GUARANTEE A+
✔✔Lung uptake - ✔✔osteosarcoma
✔✔Single bone lesion - ✔✔80% of the time is benign
classic exception is a single sternal lesion in a patient with breast cancer
✔✔Sacral insufficiency fracture - ✔✔honda sign
most common cause is osteoporosis
alternative cause radiation
✔✔Diffusely decreased skeletal uptake - ✔✔free Tc
bisphosphate therapy
✔✔Fractures in the elderly - ✔✔bone scan may be negative for several days
bone scan obtained at 1 week will exclude a fracture
✔✔Vertebral body fracture (benign vs malignant) - ✔✔benign from osteoporosis-
horizontal, linear
malignant- tracer extends from the vertebral body into the posterior elements and
involves the pedicles
✔✔Rhabdomyolysis - ✔✔uptake quads, calves, shoulders marathon runner
✔✔Flair phenomenon - ✔✔seen 2 weeks to 3 months after treatment
good response to therapy mimics a bad response
how can you tell?
-plan film lesions should get more sclerotic
-after 3 months, they should improve
✔✔Prostate cancer mets are uncommon int a PSA less than - ✔✔10mg/ml
✔✔Breast cancer bone mets are most common to the - ✔✔spine
but the solitary sternal lesion is more specific
, ✔✔Neuroblastoma frequently mets to - ✔✔the bones (metaphysis of long bones)
✔✔* and * are superior for detection of neuroblastoma bone mets - ✔✔I-123 and 131
MIBG
✔✔Cold lesions - ✔✔radiation therapy
early osteonecrosis
early or late infarction
anaplastic tumor (renal, thyroid, neuroblastoma, myeloma)
artifact from prosthesis, pacemaker, spine
hemangioma
✔✔Bone island vs prostate met - ✔✔bone island cold
prostate hot
✔✔osteopokilosis should be cold - ✔✔
✔✔bone scan is more sensitive than skeletal survey for dealing with blastic mets
skeletal survey is preferred for lytic mets like multiple myeloma - ✔✔
✔✔Heterotopic ossification - ✔✔you can follow it with imaging until it's mature (cold)
then take it out
if it is still hot, it means it's active and has a high recurrence rate
✔✔Hypertrophic osteoarthopathy - ✔✔tramline along the periosteum of long bones
associated with chronic hypoxia (CF, cyanotic heart disease, mesothelioma,
pneumoconiosis)
*lung cancer
next step? CT chest
✔✔Pagets - ✔✔older patients
shown 5 ways:
1. hot enlarged femur
AND SOLUTIONS GUARANTEE A+
✔✔Lung uptake - ✔✔osteosarcoma
✔✔Single bone lesion - ✔✔80% of the time is benign
classic exception is a single sternal lesion in a patient with breast cancer
✔✔Sacral insufficiency fracture - ✔✔honda sign
most common cause is osteoporosis
alternative cause radiation
✔✔Diffusely decreased skeletal uptake - ✔✔free Tc
bisphosphate therapy
✔✔Fractures in the elderly - ✔✔bone scan may be negative for several days
bone scan obtained at 1 week will exclude a fracture
✔✔Vertebral body fracture (benign vs malignant) - ✔✔benign from osteoporosis-
horizontal, linear
malignant- tracer extends from the vertebral body into the posterior elements and
involves the pedicles
✔✔Rhabdomyolysis - ✔✔uptake quads, calves, shoulders marathon runner
✔✔Flair phenomenon - ✔✔seen 2 weeks to 3 months after treatment
good response to therapy mimics a bad response
how can you tell?
-plan film lesions should get more sclerotic
-after 3 months, they should improve
✔✔Prostate cancer mets are uncommon int a PSA less than - ✔✔10mg/ml
✔✔Breast cancer bone mets are most common to the - ✔✔spine
but the solitary sternal lesion is more specific
, ✔✔Neuroblastoma frequently mets to - ✔✔the bones (metaphysis of long bones)
✔✔* and * are superior for detection of neuroblastoma bone mets - ✔✔I-123 and 131
MIBG
✔✔Cold lesions - ✔✔radiation therapy
early osteonecrosis
early or late infarction
anaplastic tumor (renal, thyroid, neuroblastoma, myeloma)
artifact from prosthesis, pacemaker, spine
hemangioma
✔✔Bone island vs prostate met - ✔✔bone island cold
prostate hot
✔✔osteopokilosis should be cold - ✔✔
✔✔bone scan is more sensitive than skeletal survey for dealing with blastic mets
skeletal survey is preferred for lytic mets like multiple myeloma - ✔✔
✔✔Heterotopic ossification - ✔✔you can follow it with imaging until it's mature (cold)
then take it out
if it is still hot, it means it's active and has a high recurrence rate
✔✔Hypertrophic osteoarthopathy - ✔✔tramline along the periosteum of long bones
associated with chronic hypoxia (CF, cyanotic heart disease, mesothelioma,
pneumoconiosis)
*lung cancer
next step? CT chest
✔✔Pagets - ✔✔older patients
shown 5 ways:
1. hot enlarged femur
