NUCLEAR MEDICINE LATEST EXAMS MANUAL QUESTIONS
AND SOLUTIONS GUARANTEE A+
✔✔Acute (suppurative) thyroiditis - ✔✔Bacterial infections caused by Streptococcus,
Staphylococcus, or Pneumococcus. Fever, severe sore throat, and asymmetric
swelling. May result in sepsis from hematogenous spread or extend into mediastinum
via fascial planes.
✔✔Subacute (viral) thyroiditis (de Quervain or granulomatous thyroiditis). - ✔✔Thyroid
pain and hyperthyroidism following upper respiratory infection. Disrupted gland releases
thyroid hormone. Iodine uptake is usually decreased or absent in acute stages.
✔✔Hashimoto thyroiditis - ✔✔Most common cause of goiter and primary
hypothyroidism in adults in developed countries. Autoimmune disorder with circulating
antithyroid antibody.
✔✔Riedel thyroiditis - ✔✔Rare inflammatory fibrosiS that involves thyroid and
commonly extends into neck. Radionuclide uptake is absent (cold) in involved areas.
✔✔Secondary hyperthyroidism may develop in patients with - ✔✔Hydatidiform moles or
choriocarcinoma (secrete HCG). Subunit of HCG is similar to TSH, which may directly
stimulating thyroid.
✔✔Single cold nodules have a _______ incidence of malignancy, whereas malignancy
is exceedingly rare in hot nodules. - ✔✔10% to 15%.
✔✔Thyroid nodule differential - ✔✔Follicular adenoma. Adenomatous hyperplasia.
Thyroid cysts. Hemorrhagic cyst.
✔✔Most common benign neoplasm of the thyroid and represents about 20% of thyroid
nodules. - ✔✔Follicular adenoma.
✔✔Adenomatous nodules, also called ________, are not true neoplasms but are the
result of cycles of hyperplasia and involution of a thyroid lobule. - ✔✔Colloid nodules.
✔✔Signs Suggesting Benign Etiology of Thyroid Nodules - ✔✔Extensive cystic
component. Multiple nodules. Hot on radionuclide scan. Peripheral calcification.
Shrinkage in size following levothyroxine suppression hormone therapy. Sudden onset.
Female gender. Older patient.
✔✔Signs Suggesting Malignancy of Thyroid Nodules - ✔✔Solid nodule. Cold on
radionuclide scan. Irregular contour. Poor margination. Size >4 to 5 cm.
, ✔✔Thyroid malignancies - ✔✔Papillary carcinoma. Follicular carcinoma. Medullary
thyroid carcinoma. Anaplastic carcinoma.
✔✔This thyroid malignancy does not take up I-131? - ✔✔Medullary thyroid carcinoma.
✔✔Most authorities agree with postthyroidectomy ablation in primary thyroid tumors that
are > _____ cm? - ✔✔> 1.5 cm.
✔✔The patient should be hypothyroid with a serum TSH greater than_______ prior to
whole body I-131 imaging or ablation, - ✔✔40 IU/Ml.
✔✔Radioiodine therapy side effects? - ✔✔Sialoadenitis. Xerostomia. Pulmonary
fibrosis. Leukemia.
✔✔Ectopic locations for abnormal parathyroid tissue include: - ✔✔Thymus (10% to
15%). Posterior mediastinum (5%). Retroesophageal (1%). Within carotid sheath (1%).
Parapharyngeal (0.5%).
✔✔Sestamibi and Tetrofosmin Imaging of parathyroid adenoma? - ✔✔Immediate and
delayed images of neck and mediastinum. May be cold on initial imaging. Hot on
delayed (1-2 hours) imaging. Normal thyroid gland washes out.
✔✔Which parathyroid glands are more commonly ectopic? - ✔✔Inferior parathyroid
glands (from third branchial pouch along with thymus). Usually within mediastinum.
✔✔Positive GI bleeding studies demonstrate three cardinal findings: - ✔✔Focal activity
appears out of nowhere. Activity persists and may increase with time. Activity moves
with peristalsis antegrade, retrograde, or in both directions.
✔✔Meckel Scan - ✔✔Tc-99mO4. Activity concentrates within right lower quadrant or
mid abdomen in synchrony with stomach (ectopic gastric mucosa).
✔✔Liver/Spleen Scan - ✔✔Tc-99m-radiolabeled albumin or sulfur colloid. RES cells
phagocytize colloid particles.
✔✔FNH sulfur colloid scan features - ✔✔Isointense or hotter than liver parenchyma.
✔✔Heat-Damaged Red Blood Cell Scan - ✔✔Tc-99m-labeled heat damaged red blood
cells are preferentially extracted from circulation by splenic tissue. Useful for:
Polysplenia. Splenosis. Accessory splenic tissue.
✔✔Normal HIDA scan (Tc-mebrofenin) - ✔✔Activity should be seen in major
extrahepatic ducts, gallbladder, and small bowel within 1 hour.
AND SOLUTIONS GUARANTEE A+
✔✔Acute (suppurative) thyroiditis - ✔✔Bacterial infections caused by Streptococcus,
Staphylococcus, or Pneumococcus. Fever, severe sore throat, and asymmetric
swelling. May result in sepsis from hematogenous spread or extend into mediastinum
via fascial planes.
✔✔Subacute (viral) thyroiditis (de Quervain or granulomatous thyroiditis). - ✔✔Thyroid
pain and hyperthyroidism following upper respiratory infection. Disrupted gland releases
thyroid hormone. Iodine uptake is usually decreased or absent in acute stages.
✔✔Hashimoto thyroiditis - ✔✔Most common cause of goiter and primary
hypothyroidism in adults in developed countries. Autoimmune disorder with circulating
antithyroid antibody.
✔✔Riedel thyroiditis - ✔✔Rare inflammatory fibrosiS that involves thyroid and
commonly extends into neck. Radionuclide uptake is absent (cold) in involved areas.
✔✔Secondary hyperthyroidism may develop in patients with - ✔✔Hydatidiform moles or
choriocarcinoma (secrete HCG). Subunit of HCG is similar to TSH, which may directly
stimulating thyroid.
✔✔Single cold nodules have a _______ incidence of malignancy, whereas malignancy
is exceedingly rare in hot nodules. - ✔✔10% to 15%.
✔✔Thyroid nodule differential - ✔✔Follicular adenoma. Adenomatous hyperplasia.
Thyroid cysts. Hemorrhagic cyst.
✔✔Most common benign neoplasm of the thyroid and represents about 20% of thyroid
nodules. - ✔✔Follicular adenoma.
✔✔Adenomatous nodules, also called ________, are not true neoplasms but are the
result of cycles of hyperplasia and involution of a thyroid lobule. - ✔✔Colloid nodules.
✔✔Signs Suggesting Benign Etiology of Thyroid Nodules - ✔✔Extensive cystic
component. Multiple nodules. Hot on radionuclide scan. Peripheral calcification.
Shrinkage in size following levothyroxine suppression hormone therapy. Sudden onset.
Female gender. Older patient.
✔✔Signs Suggesting Malignancy of Thyroid Nodules - ✔✔Solid nodule. Cold on
radionuclide scan. Irregular contour. Poor margination. Size >4 to 5 cm.
, ✔✔Thyroid malignancies - ✔✔Papillary carcinoma. Follicular carcinoma. Medullary
thyroid carcinoma. Anaplastic carcinoma.
✔✔This thyroid malignancy does not take up I-131? - ✔✔Medullary thyroid carcinoma.
✔✔Most authorities agree with postthyroidectomy ablation in primary thyroid tumors that
are > _____ cm? - ✔✔> 1.5 cm.
✔✔The patient should be hypothyroid with a serum TSH greater than_______ prior to
whole body I-131 imaging or ablation, - ✔✔40 IU/Ml.
✔✔Radioiodine therapy side effects? - ✔✔Sialoadenitis. Xerostomia. Pulmonary
fibrosis. Leukemia.
✔✔Ectopic locations for abnormal parathyroid tissue include: - ✔✔Thymus (10% to
15%). Posterior mediastinum (5%). Retroesophageal (1%). Within carotid sheath (1%).
Parapharyngeal (0.5%).
✔✔Sestamibi and Tetrofosmin Imaging of parathyroid adenoma? - ✔✔Immediate and
delayed images of neck and mediastinum. May be cold on initial imaging. Hot on
delayed (1-2 hours) imaging. Normal thyroid gland washes out.
✔✔Which parathyroid glands are more commonly ectopic? - ✔✔Inferior parathyroid
glands (from third branchial pouch along with thymus). Usually within mediastinum.
✔✔Positive GI bleeding studies demonstrate three cardinal findings: - ✔✔Focal activity
appears out of nowhere. Activity persists and may increase with time. Activity moves
with peristalsis antegrade, retrograde, or in both directions.
✔✔Meckel Scan - ✔✔Tc-99mO4. Activity concentrates within right lower quadrant or
mid abdomen in synchrony with stomach (ectopic gastric mucosa).
✔✔Liver/Spleen Scan - ✔✔Tc-99m-radiolabeled albumin or sulfur colloid. RES cells
phagocytize colloid particles.
✔✔FNH sulfur colloid scan features - ✔✔Isointense or hotter than liver parenchyma.
✔✔Heat-Damaged Red Blood Cell Scan - ✔✔Tc-99m-labeled heat damaged red blood
cells are preferentially extracted from circulation by splenic tissue. Useful for:
Polysplenia. Splenosis. Accessory splenic tissue.
✔✔Normal HIDA scan (Tc-mebrofenin) - ✔✔Activity should be seen in major
extrahepatic ducts, gallbladder, and small bowel within 1 hour.
