NMAA 2026 Exam Prep: Nuclear Medicine Advanced
Associate —Practice Questions with Answer
Rationales Advanced Imaging | Therapy |
Radiopharmaceuticals | Patient Care | Clinical
Decision Making Review
SECTION 1: PATIENT CARE, ASSESSMENT & CLINICAL DECISION
MAKING (Questions 1–30)
Question 1. Which laboratory value is most critical to review before administering
an iodine-based contrast agent for a PET/CT study?
A) Serum calcium
B) BUN/creatinine ratio
C) Serum potassium
D) Hemoglobin
Rationale: Elevated BUN/creatinine indicates impaired renal function, increasing
the risk of contrast-induced nephropathy. Renal function must be assessed before
contrast administration.
Question 2. A patient scheduled for a myocardial perfusion study reports a history
of severe asthma. Which pharmacologic stress agent is contraindicated?
A) Adenosine
B) Regadenoson
C) Dipyridamole
D) Dobutamine
Rationale: Adenosine can precipitate bronchospasm and is contraindicated in
patients with reactive airway disease. Dobutamine is the preferred agent in
asthmatic patients.
,Question 3. During a gated SPECT acquisition, the left ventricular ejection
fraction (LVEF) is calculated as 35%. Which of the following best describes the
clinical implication?
A) Normal systolic function
B) Mildly reduced systolic function
C) Moderately reduced systolic function
D) Severely reduced systolic function
Rationale: An LVEF of 35% falls within the range for moderate systolic
dysfunction (30–40%).
Question 4. A patient with a history of severe asthma requires a pharmacologic
stress test. Which agent is least likely to precipitate bronchospasm?
A) Adenosine
B) Regadenoson
C) Dipyridamole
D) Dobutamine
Rationale: Dobutamine is a beta-agonist that increases heart rate and contractility
without causing bronchoconstriction, making it safer in asthmatic patients.
Question 5. Which of the following is the primary purpose of attenuation
correction in PET/CT imaging?
A) Reduce patient radiation dose
B) Improve quantification accuracy by correcting for photon attenuation
C) Increase scanner sensitivity
D) Eliminate the need for CT contrast
Rationale: Attenuation correction compensates for photon absorption in body
tissues, improving quantitative accuracy of PET images.
Question 6. A 68-year-old patient with known coronary artery disease is scheduled
for a pharmacological stress test. The patient has a history of second-degree AV
block. Which stress agent should be avoided?
,A) Dobutamine
B) Adenosine
C) Exercise
D) Regadenoson
Rationale: Adenosine and other adenosine receptor agonists can worsen AV
block. Dobutamine is a safer alternative as it does not directly affect the AV node.
Question 7. Which of the following laboratory values should be evaluated before
administering a radiopharmaceutical primarily eliminated by the kidneys?
A) Serum creatinine and GFR
B) Serum calcium
C) Serum potassium
D) Serum albumin
Rationale: Renal function (creatinine, GFR) determines clearance of renally
excreted radiopharmaceuticals. Impaired renal function may require dose
adjustment or alternative agents.
Question 8. A patient scheduled for 131I therapy has a serum thyroglobulin level
that is markedly elevated but a negative neck ultrasound. Which next step is most
appropriate?
A) Proceed with therapy; imaging is unnecessary
B) Obtain a whole-body 131I diagnostic scan to locate occult disease
C) Cancel therapy and refer for surgery
D) Perform a PET/CT with 18F-FDG to assess for dedifferentiated disease
Rationale: A diagnostic whole-body 131I scan can identify metastatic or residual
thyroid tissue not seen on ultrasound, guiding therapeutic dosing.
Question 9. A patient undergoing a 99mTc-HDP bone scan is found to have a
serum calcium of 12.5 mg/dL. Which precaution should be taken?
A) No change; calcium does not affect bone scan imaging
B) Administer a calcium-lowering agent before the scan
, C) Delay the scan until calcium is normalized, as hypercalcemia can cause
soft-tissue uptake and false-positive lesions
D) Increase the administered activity to compensate
Rationale: Hypercalcemia can cause soft-tissue uptake and false-positive lesions
on bone scan; the scan should be delayed until calcium is normalized.
Question 10. A patient with a known shellfish allergy is scheduled for a contrast-
enhanced PET/CT. What is the most appropriate action?
A) Cancel the study
B) Administer a corticosteroid premedication
C) Proceed with standard screening; shellfish allergy does not cross-react with
iodinated contrast
D) Use a gadolinium-based contrast agent instead
Rationale: The myth of shellfish-iodine cross-reactivity has been disproven.
Allergy risk is independent, and standard screening determines the need for pre-
medication.
Question 11. Which of the following is a key difference between deterministic and
stochastic radiation effects?
A) Deterministic effects have a dose threshold; stochastic effects do not
B) Stochastic effects are always reversible
C) Deterministic effects only affect the skin
D) Stochastic effects are limited to children only
Rationale: Deterministic effects (e.g., skin erythema) manifest above a threshold
dose, while stochastic effects (e.g., cancer) can occur at any dose with probability
increasing with dose.
Question 12. A patient undergoing a PET/CT for evaluation of lymphoma shows
intense FDG uptake in the tonsils but no corresponding CT abnormality. What is
the most likely explanation?
Associate —Practice Questions with Answer
Rationales Advanced Imaging | Therapy |
Radiopharmaceuticals | Patient Care | Clinical
Decision Making Review
SECTION 1: PATIENT CARE, ASSESSMENT & CLINICAL DECISION
MAKING (Questions 1–30)
Question 1. Which laboratory value is most critical to review before administering
an iodine-based contrast agent for a PET/CT study?
A) Serum calcium
B) BUN/creatinine ratio
C) Serum potassium
D) Hemoglobin
Rationale: Elevated BUN/creatinine indicates impaired renal function, increasing
the risk of contrast-induced nephropathy. Renal function must be assessed before
contrast administration.
Question 2. A patient scheduled for a myocardial perfusion study reports a history
of severe asthma. Which pharmacologic stress agent is contraindicated?
A) Adenosine
B) Regadenoson
C) Dipyridamole
D) Dobutamine
Rationale: Adenosine can precipitate bronchospasm and is contraindicated in
patients with reactive airway disease. Dobutamine is the preferred agent in
asthmatic patients.
,Question 3. During a gated SPECT acquisition, the left ventricular ejection
fraction (LVEF) is calculated as 35%. Which of the following best describes the
clinical implication?
A) Normal systolic function
B) Mildly reduced systolic function
C) Moderately reduced systolic function
D) Severely reduced systolic function
Rationale: An LVEF of 35% falls within the range for moderate systolic
dysfunction (30–40%).
Question 4. A patient with a history of severe asthma requires a pharmacologic
stress test. Which agent is least likely to precipitate bronchospasm?
A) Adenosine
B) Regadenoson
C) Dipyridamole
D) Dobutamine
Rationale: Dobutamine is a beta-agonist that increases heart rate and contractility
without causing bronchoconstriction, making it safer in asthmatic patients.
Question 5. Which of the following is the primary purpose of attenuation
correction in PET/CT imaging?
A) Reduce patient radiation dose
B) Improve quantification accuracy by correcting for photon attenuation
C) Increase scanner sensitivity
D) Eliminate the need for CT contrast
Rationale: Attenuation correction compensates for photon absorption in body
tissues, improving quantitative accuracy of PET images.
Question 6. A 68-year-old patient with known coronary artery disease is scheduled
for a pharmacological stress test. The patient has a history of second-degree AV
block. Which stress agent should be avoided?
,A) Dobutamine
B) Adenosine
C) Exercise
D) Regadenoson
Rationale: Adenosine and other adenosine receptor agonists can worsen AV
block. Dobutamine is a safer alternative as it does not directly affect the AV node.
Question 7. Which of the following laboratory values should be evaluated before
administering a radiopharmaceutical primarily eliminated by the kidneys?
A) Serum creatinine and GFR
B) Serum calcium
C) Serum potassium
D) Serum albumin
Rationale: Renal function (creatinine, GFR) determines clearance of renally
excreted radiopharmaceuticals. Impaired renal function may require dose
adjustment or alternative agents.
Question 8. A patient scheduled for 131I therapy has a serum thyroglobulin level
that is markedly elevated but a negative neck ultrasound. Which next step is most
appropriate?
A) Proceed with therapy; imaging is unnecessary
B) Obtain a whole-body 131I diagnostic scan to locate occult disease
C) Cancel therapy and refer for surgery
D) Perform a PET/CT with 18F-FDG to assess for dedifferentiated disease
Rationale: A diagnostic whole-body 131I scan can identify metastatic or residual
thyroid tissue not seen on ultrasound, guiding therapeutic dosing.
Question 9. A patient undergoing a 99mTc-HDP bone scan is found to have a
serum calcium of 12.5 mg/dL. Which precaution should be taken?
A) No change; calcium does not affect bone scan imaging
B) Administer a calcium-lowering agent before the scan
, C) Delay the scan until calcium is normalized, as hypercalcemia can cause
soft-tissue uptake and false-positive lesions
D) Increase the administered activity to compensate
Rationale: Hypercalcemia can cause soft-tissue uptake and false-positive lesions
on bone scan; the scan should be delayed until calcium is normalized.
Question 10. A patient with a known shellfish allergy is scheduled for a contrast-
enhanced PET/CT. What is the most appropriate action?
A) Cancel the study
B) Administer a corticosteroid premedication
C) Proceed with standard screening; shellfish allergy does not cross-react with
iodinated contrast
D) Use a gadolinium-based contrast agent instead
Rationale: The myth of shellfish-iodine cross-reactivity has been disproven.
Allergy risk is independent, and standard screening determines the need for pre-
medication.
Question 11. Which of the following is a key difference between deterministic and
stochastic radiation effects?
A) Deterministic effects have a dose threshold; stochastic effects do not
B) Stochastic effects are always reversible
C) Deterministic effects only affect the skin
D) Stochastic effects are limited to children only
Rationale: Deterministic effects (e.g., skin erythema) manifest above a threshold
dose, while stochastic effects (e.g., cancer) can occur at any dose with probability
increasing with dose.
Question 12. A patient undergoing a PET/CT for evaluation of lymphoma shows
intense FDG uptake in the tonsils but no corresponding CT abnormality. What is
the most likely explanation?
