MCQS in Clinical Nuclear Medicine

Rosie Allan, Gary J. R. Cook, Deborah Cunningham, David Scullion

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781000150872
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Written specifically for those candidates about to sit for the FRCR part II examination, the format will also be of use to other trainee radiologists who are not specialists in this field. It contains a number of multiple choice questions covering all aspects of nuclear medicine with particular emphasis on the more common techniques, ie bone, renal and lung scanning. Extensive use is made of review articles, and important articles in the major nuclear medicine journals and references are provided.

Chapter 1
Bone scintigraphy

Malignancy

Q. 1.

a.	In multiple myeloma the MDP bone scan is usually abnormal.
b.	Increased ^99mTc MDP uptake into metastatic deposits two months after chemotherapy indicates failure of response and progression of disease.
c.	A solitary rib hot spot in a cancer patient usually represents benign disease.
d.	A rib hot spot which is present over a year is likely to represent a simple healing fracture.
e.	A solitary area of abnormal uptake in a patient with a known primary cancer with normal plain film appearances is likely to be benign.

A. 1.

a.	T	Bone scintigraphy is less sensitive than plain film radiography in detecting myeloma deposits as myeloma tends not to excite an osteoblastic response. It is still possible to see some areas of increased activity however and with modern cameras, resolution has improved to an extent where it is possible to discern cold lesions where bone has been replaced.
b.	F	The flare response, with increasing activity in the areas of metastases following chemotherapy, may persist for three months or more and indicates healing with successful treatment. Scans carried out before this time will therefore not be able to differentiate progressive disease from successful chemotherapy.
c.	F	About 40% of solitary rib lesions turn out to be metastatic (Nucl Med Commun, 1995; 16:834–837). Solitary rib lesions may also be due to minor trauma which may not even be recalled by the patient. In the context of breast carcinoma, lesions in the upper anterior ribs are often secondary to radiation necrosis.
d.	F	A simple traumatic fracture would be expected to show some resolution by this time. Metastases or pathological fractures from radiation necrosis would be expected to persist for longer. Metastatic rib lesions are often scattered and tend to grow along the bones with time rather than remaining focal.
e.	T	Bone scintigraphy is much more sensitive than plain film radiology in detecting metastases, often showing pathology many months before plain film changes. Surprisingly however less than 20% of bone scan lesions with negative plain radiology turn out to be malignant. (Radiology, ...