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EXAM OFFERED BY AMERICAN BOARD OF
NUCLEAR MEDICINE (ABNM) | COMPLETE
EXAM Q&A WITH RATIONALES
1. A 65-year-old male with known coronary artery
disease presents with chest pain. A myocardial
perfusion SPECT study is performed using Tc-99m
sestamibi. Which of the following findings is most
indicative of balanced ischemia (three-vessel
disease)?
A) Diffusely decreased tracer uptake with normal left
ventricular cavity size
B) Increased lung-to-heart ratio on the rest images
C) Transient ischemic dilation of the left ventricle
(TID) on stress images
D) Fixed inferior wall defect
Correct answer: C
Rationale: Transient ischemic dilation (TID) of the left
ventricle on stress images (compared to rest)
suggests severe and extensive coronary artery
disease, often with balanced ischemia.
,2. A 72-year-old male with prostate cancer and bone
pain undergoes a whole-body bone scan with Tc-99m
MDP. Which of the following findings is most
characteristic of diffuse metastatic bone disease
(superscan)?
A) Intense symmetric activity in the axial skeleton
with minimal renal activity
B) Multiple focal "hot spots" in a random distribution
C) Photopenic areas in the liver
D) Increased activity in the soft tissues of the
abdomen
Correct answer: A
Rationale: A superscan (metabolic bone scan) shows
intense, uniform tracer uptake in the axial skeleton
with diminished renal and soft-tissue activity.
3. A 55-year-old female with a history of papillary
thyroid cancer undergoes a whole-body iodine-131
scan after thyroid hormone withdrawal (THW). Which
preparation method yields the highest sensitivity for
detecting metastatic disease?
A) Thyroid hormone withdrawal (THW) for 4 weeks
(TSH >30 mIU/mL)
B) Recombinant human TSH (rhTSH) injection
,C) Low-iodine diet alone
D) Lithium augmentation
Correct answer: A
Rationale: Thyroid hormone withdrawal (THW)
achieves higher TSH levels (>30) than rhTSH, leading
to greater stimulation of sodium-iodide symporters
and higher sensitivity.
4. A 68-year-old female with a history of breast
cancer presents with progressive dyspnea. A V/Q
scan is performed. Which of the following patterns is
most consistent with a high probability of pulmonary
embolism (PE)?
A) Multiple matched V/Q defects involving the right
middle lobe and lingula
B) Two large segmental perfusion defects with
normal ventilation (mismatch)
C) A single subsegmental perfusion defect with
normal ventilation
D) Diffuse bilateral perfusion defects with normal
chest X-ray
Correct answer: B
Rationale: High probability V/Q scan for PE requires
at least two large (>75% of segment) segmental
, perfusion defects with normal ventilation (mismatch)
and a normal chest X-ray.
5. A 45-year-old male with a history of melanoma
undergoes a PET/CT scan with F-18 FDG for staging.
Which of the following physiologic variants may
mimic metastatic disease in the neck?
A) Brown fat uptake in the supraclavicular region
B) Uptake in the submandibular glands
C) Pharyngeal lymphoid tissue
D) Thyroid cartilage calcification
Correct answer: A
Rationale: Brown adipose tissue (BAT) shows intense
FDG uptake in the supraclavicular, paraspinal, and
perirenal regions, especially in cold environments.
6. A 62-year-old male with a history of hypertrophic
cardiomyopathy is evaluated for possible cardiac
sarcoidosis. Which of the following PET tracers is
most specific for inflammatory activity in
sarcoidosis?
A) F-18 FDG
B) Rb-82 (rubidium)
C) N-13 ammonia
EXAM OFFERED BY AMERICAN BOARD OF
NUCLEAR MEDICINE (ABNM) | COMPLETE
EXAM Q&A WITH RATIONALES
1. A 65-year-old male with known coronary artery
disease presents with chest pain. A myocardial
perfusion SPECT study is performed using Tc-99m
sestamibi. Which of the following findings is most
indicative of balanced ischemia (three-vessel
disease)?
A) Diffusely decreased tracer uptake with normal left
ventricular cavity size
B) Increased lung-to-heart ratio on the rest images
C) Transient ischemic dilation of the left ventricle
(TID) on stress images
D) Fixed inferior wall defect
Correct answer: C
Rationale: Transient ischemic dilation (TID) of the left
ventricle on stress images (compared to rest)
suggests severe and extensive coronary artery
disease, often with balanced ischemia.
,2. A 72-year-old male with prostate cancer and bone
pain undergoes a whole-body bone scan with Tc-99m
MDP. Which of the following findings is most
characteristic of diffuse metastatic bone disease
(superscan)?
A) Intense symmetric activity in the axial skeleton
with minimal renal activity
B) Multiple focal "hot spots" in a random distribution
C) Photopenic areas in the liver
D) Increased activity in the soft tissues of the
abdomen
Correct answer: A
Rationale: A superscan (metabolic bone scan) shows
intense, uniform tracer uptake in the axial skeleton
with diminished renal and soft-tissue activity.
3. A 55-year-old female with a history of papillary
thyroid cancer undergoes a whole-body iodine-131
scan after thyroid hormone withdrawal (THW). Which
preparation method yields the highest sensitivity for
detecting metastatic disease?
A) Thyroid hormone withdrawal (THW) for 4 weeks
(TSH >30 mIU/mL)
B) Recombinant human TSH (rhTSH) injection
,C) Low-iodine diet alone
D) Lithium augmentation
Correct answer: A
Rationale: Thyroid hormone withdrawal (THW)
achieves higher TSH levels (>30) than rhTSH, leading
to greater stimulation of sodium-iodide symporters
and higher sensitivity.
4. A 68-year-old female with a history of breast
cancer presents with progressive dyspnea. A V/Q
scan is performed. Which of the following patterns is
most consistent with a high probability of pulmonary
embolism (PE)?
A) Multiple matched V/Q defects involving the right
middle lobe and lingula
B) Two large segmental perfusion defects with
normal ventilation (mismatch)
C) A single subsegmental perfusion defect with
normal ventilation
D) Diffuse bilateral perfusion defects with normal
chest X-ray
Correct answer: B
Rationale: High probability V/Q scan for PE requires
at least two large (>75% of segment) segmental
, perfusion defects with normal ventilation (mismatch)
and a normal chest X-ray.
5. A 45-year-old male with a history of melanoma
undergoes a PET/CT scan with F-18 FDG for staging.
Which of the following physiologic variants may
mimic metastatic disease in the neck?
A) Brown fat uptake in the supraclavicular region
B) Uptake in the submandibular glands
C) Pharyngeal lymphoid tissue
D) Thyroid cartilage calcification
Correct answer: A
Rationale: Brown adipose tissue (BAT) shows intense
FDG uptake in the supraclavicular, paraspinal, and
perirenal regions, especially in cold environments.
6. A 62-year-old male with a history of hypertrophic
cardiomyopathy is evaluated for possible cardiac
sarcoidosis. Which of the following PET tracers is
most specific for inflammatory activity in
sarcoidosis?
A) F-18 FDG
B) Rb-82 (rubidium)
C) N-13 ammonia
