NMTCB NMAA Nuclear Medicine Advanced Associate

An NMAA is performing a pre-procedure assessment on a patient scheduled for a PET/CT scan. Which of the following findings would be MOST important to address before administering F-18 FDG?

• APatient has a known allergy to iodinated contrast media
• BPatient's fasting blood glucose is 245 mg/dL
• CPatient reports mild claustrophobia
• DPatient took aspirin earlier that morning

During a pharmacologic cardiac stress test using regadenoson (Lexiscan), a patient develops severe bronchospasm. What is the MOST appropriate immediate intervention?

• AAdminister intravenous diphenhydramine 50 mg
• BAdminister aminophylline 100-200 mg IV slowly
• CAdminister sublingual nitroglycerin 0.4 mg
• DAdminister intravenous metoprolol 5 mg

Which of the following BEST describes the scope of practice for a Nuclear Medicine Advanced Associate (NMAA)?

• AIndependent practitioner who may prescribe radiopharmaceuticals without physician oversig…
• BPhysician extender who performs clinical duties under the supervision of an authorized us…
• CTechnologist with expanded authority to operate imaging equipment
• DRadiologist assistant authorized to interpret nuclear medicine studies independently

A patient presents for a thyroid uptake and scan after discontinuing methimazole. The 24-hour I-123 uptake is 58%. Which condition is MOST consistent with this finding?

• ASubacute thyroiditis
• BGraves' disease
• CFactitious thyrotoxicosis
• DStruma ovarii

An NMAA is reviewing a Tc-99m MDP bone scan and notes diffusely increased skeletal uptake with faint renal visualization. This pattern is MOST consistent with which finding?

• ARenal failure causing delayed clearance
• BMetabolic superscan from widespread osseous metastases
• CImproper radiopharmaceutical preparation with free pertechnetate
• DPatient dehydration requiring repeat imaging

According to NRC regulations (10 CFR 35.75), what is the dose-rate criterion for releasing a patient treated with I-131 sodium iodide for thyroid cancer?

• ALess than 2 mR/hr at 1 meter
• BLess than 7 mR/hr at 1 meter
• CLess than 5 mR/hr at 1 meter
• DLess than 33 mR/hr at 1 meter or total effective dose equivalent to any individual is unl…

A patient is referred for Lu-177 PSMA-617 (Pluvicto) therapy for metastatic castration-resistant prostate cancer. Which prerequisite study is required before initiating therapy?

• AF-18 FDG PET/CT to confirm metabolically active disease
• BGa-68 PSMA-11 or F-18 PSMA PET/CT demonstrating PSMA-positive disease
• CTc-99m MDP bone scan showing at least 3 osseous metastases
• DCT chest/abdomen/pelvis with IV contrast within the past 90 days

Which of the following radiation effects is classified as a stochastic effect?

• ARadiation-induced cataract formation
• BAcute radiation syndrome
• CRadiation-induced thyroid cancer
• DErythema following high-dose fluoroscopy

An NMAA is evaluating a patient with suspected pulmonary embolism. The ventilation-perfusion (V/Q) scan shows multiple segmental perfusion defects with normal ventilation in the corresponding areas. This pattern is classified as:

• ALow probability for pulmonary embolism
• BIntermediate probability for pulmonary embolism
• CHigh probability for pulmonary embolism
• DNormal study excluding pulmonary embolism

What is the primary mechanism of action of F-18 FDG in oncologic PET imaging?

• AIt binds to tumor-specific surface receptors and is internalized
• BIt is trapped intracellularly after phosphorylation by hexokinase because FDG-6-phosphate…
• CIt undergoes oxidative phosphorylation in mitochondria of metabolically active cells
• DIt passively accumulates in areas of increased blood flow surrounding tumors

A patient receiving I-131 therapy for thyroid cancer asks about radiation safety precautions at home. Which instruction is MOST appropriate?

• AAvoid all contact with household members for 30 days after treatment
• BSleep in a separate bed, maintain distance from others, and use separate utensils for sev…
• CThere are no precautions needed once the patient is released from the hospital
• DOnly avoid contact with children but normal interaction with adults is acceptable

Which cell type is MOST radiosensitive according to the Law of Bergonie and Tribondeau?

• AMature neurons
• BLymphocytes
• CSkeletal muscle cells
• DHepatocytes

An NMAA obtains informed consent for a Ga-68 DOTATATE PET/CT. Which element is NOT a required component of valid informed consent?

• ADescription of the procedure and its purpose
• BRisks, benefits, and alternatives to the procedure
• CGuarantee of a specific diagnostic outcome
• DThe patient's right to refuse or withdraw consent

During a treadmill exercise stress test, which of the following is an absolute indication to immediately terminate the test?

• APatient reaches 85% of maximum predicted heart rate
• BST-segment depression of 1 mm in leads V5-V6
• CSustained ventricular tachycardia
• DPatient reports mild leg fatigue

What is the primary advantage of Tc-99m as a radionuclide for diagnostic imaging?

• AIts long half-life of 24 hours allows delayed imaging
• BIts 140 keV gamma energy is optimal for gamma camera detection and its 6-hour half-life b…
• CIt emits positrons suitable for PET imaging
• DIt has no radiation dose to the patient due to its short half-life

In radiation protection, the inverse square law states that if the distance from a point source is tripled, the radiation intensity becomes:

• AOne-third of the original intensity
• BOne-sixth of the original intensity
• COne-ninth of the original intensity
• DOne-twenty-seventh of the original intensity

A patient with known renal artery stenosis is scheduled for a Tc-99m MAG3 renal scan with captopril challenge. What is the expected finding in the affected kidney after captopril administration?

• AImproved perfusion and accelerated tracer excretion
• BNo change in renal function compared to baseline
• CProlonged cortical retention with delayed excretion (worsened renogram curve)
• DAbsent renal perfusion with no tracer uptake

What is the primary mechanism of action of Lu-177 DOTATATE (Lutathera) in the treatment of neuroendocrine tumors (NETs)?

• ABlockade of somatostatin receptors, preventing tumor growth signaling
• BBinding to somatostatin receptor type 2 (SSTR2) and delivering cytotoxic beta radiation t…
• CInhibition of angiogenesis by targeting VEGF receptors on tumor vasculature
• DDirect DNA intercalation causing apoptosis independent of receptor binding

An NMAA is auscultating heart sounds during a pre-procedure assessment. A holosystolic murmur heard best at the apex with radiation to the axilla is MOST consistent with:

• AAortic stenosis
• BMitral regurgitation
• CMitral stenosis
• DAortic regurgitation

Which of the following Tc-99m radiopharmaceuticals is used for myocardial perfusion imaging and demonstrates redistribution similar to Tl-201?

• ATc-99m sestamibi (Cardiolite)
• BTc-99m tetrofosmin (Myoview)
• CTc-99m teboroxime
• DTc-99m pyrophosphate (PYP)

A patient undergoing I-131 therapy for differentiated thyroid cancer has a measured retained activity of 85 mCi at the time of potential discharge. Using the default NRC release criteria (without patient-specific calculations), can this patient be released?

• AYes, because the patient feels well enough to go home
• BNo, because retained activity exceeds the default 33 mCi threshold for I-131
• CYes, because there is no activity-based release criterion
• DNo, because all I-131 therapy patients must be hospitalized for 72 hours

On a myocardial perfusion SPECT study, a fixed defect in the inferior wall that does not change between stress and rest images MOST likely represents:

• AStress-induced ischemia requiring urgent intervention
• BMyocardial scar or infarction
• CSoft tissue attenuation artifact from the diaphragm
• DEither myocardial scar or attenuation artifact; gated SPECT wall motion analysis helps di…

Ra-223 dichloride (Xofigo) is indicated for the treatment of which condition?

• AHepatocellular carcinoma with portal vein thrombosis
• BCastration-resistant prostate cancer with symptomatic bone metastases and no known viscer…
• CDifferentiated thyroid cancer with distant metastases
• DNeuroendocrine tumors with somatostatin receptor-positive liver metastases

An NMAA is reviewing a patient's ECG before a cardiac stress test. Which finding would require physician consultation before proceeding?

• ANormal sinus rhythm at 72 bpm
• BLeft bundle branch block (LBBB)
• CSinus arrhythmia with respiratory variation
• DOccasional premature atrial contractions

Under HIPAA regulations, which of the following actions by an NMAA constitutes a violation?

• ADiscussing a patient's scan results with the supervising physician in a private office
• BSharing a patient's nuclear medicine images with the referring physician for clinical man…
• CDiscussing a patient's diagnosis and treatment plan with a colleague in a crowded hospita…
• DDocumenting the radiopharmaceutical administered and dose in the patient's medical record

A patient develops urticaria, facial flushing, and mild hypotension 5 minutes after receiving IV iodinated contrast for the CT portion of a PET/CT. What is the MOST appropriate initial treatment?

• AIntramuscular epinephrine 0.3 mg and call for emergency assistance
• BOral diphenhydramine 25 mg and continue monitoring
• CIntravenous normal saline bolus and diphenhydramine 25-50 mg IV
• DAdminister corticosteroids and discharge the patient after 30 minutes

What is the annual occupational whole-body effective dose limit for radiation workers as established by NRC regulations?

• A1 mSv (100 mrem)
• B5 mSv (500 mrem)
• C50 mSv (5,000 mrem)
• D500 mSv (50,000 mrem)

An NMAA is interpreting an ECG during a stress test and observes ST-segment elevation >2 mm in leads II, III, and aVF that was not present at baseline. This finding MOST likely indicates:

• ANormal exercise-induced changes
• BLeft ventricular hypertrophy
• CAcute inferior wall ischemia or evolving myocardial infarction
• DEarly repolarization variant

Which of the following correctly describes the physical decay characteristics of Lu-177?

• AAlpha emitter with a half-life of 11.4 days
• BBeta emitter with a half-life of 6.6 days and imageable gamma emissions at 113 and 208 keV
• CPure beta emitter with a half-life of 8.0 days and no gamma emissions
• DPositron emitter with a half-life of 6.6 days suitable for PET imaging

During sedation monitoring, an NMAA observes that a pediatric patient's oxygen saturation drops to 88% and respirations decrease to 6 breaths per minute. What is the MOST appropriate initial action?

• AContinue monitoring and recheck in 5 minutes
• BStimulate the patient, open the airway with jaw thrust/chin lift, and administer suppleme…
• CImmediately intubate the patient
• DAdminister flumazenil regardless of what sedative was used

The Standardized Uptake Value (SUV) on a PET scan is calculated using which formula?

• ASUV = (Tissue radioactivity concentration) × (Patient weight) / (Injected dose)
• BSUV = (Injected dose) / (Tissue radioactivity concentration × Patient weight)
• CSUV = (Tissue radioactivity concentration) / (Injected dose × Patient weight)
• DSUV = (Injected dose × Patient weight) / (Tissue radioactivity concentration)

Which radiation dose-response relationship model assumes no threshold dose and that even the smallest dose carries some risk of cancer?

• AThreshold model
• BLinear no-threshold (LNT) model
• CHormesis model
• DSupralinear model

A pregnant radiation worker in a nuclear medicine department is declared pregnant. According to NRC regulations, what is the fetal dose limit for the remainder of the pregnancy?

• A1 mSv (100 mrem) total for the gestational period
• B5 mSv (500 mrem) total for the gestational period
• C50 mSv (5,000 mrem) total for the gestational period
• D0.5 mSv (50 mrem) per month

An NMAA is performing a physical examination on a patient presenting for a hepatobiliary iminodiacetic acid (HIDA) scan. Which finding would be MOST consistent with acute cholecystitis?

• ARebound tenderness in the left lower quadrant
• BPositive Murphy's sign with right upper quadrant tenderness on deep palpation
• CDiffuse abdominal rigidity with absent bowel sounds
• DPeriumbilical tenderness with radiation to the back

Which adverse event is MOST commonly associated with Lu-177 DOTATATE (Lutathera) therapy for neuroendocrine tumors?

• ASevere hepatotoxicity requiring liver transplant
• BLymphopenia and thrombocytopenia (myelosuppression)
• CAcute renal failure requiring dialysis
• DSevere mucositis and alopecia

During cross-sectional image review, an NMAA identifies a structure located posterior to the stomach and anterior to the aorta at the level of L1-L2. This structure is MOST likely the:

• ALeft kidney
• BSpleen
• CPancreatic body
• DDuodenum

What is the critical organ (organ receiving the highest radiation dose) for Tc-99m MAG3 in a patient with normal renal function?

• ALiver
• BThyroid
• CBladder wall
• DKidneys

Ac-225, an emerging alpha-emitting radionuclide for targeted alpha therapy, produces how many alpha particles in its complete decay chain?

• AOne alpha particle
• BTwo alpha particles
• CFour alpha particles
• DSix alpha particles

An NMAA is managing a diabetic patient scheduled for an F-18 FDG PET/CT. The patient's blood glucose is 185 mg/dL. Which approach is MOST appropriate?

• AProceed with the scan since the glucose is below 200 mg/dL
• BAdminister regular insulin to lower glucose below 150-200 mg/dL, then wait at least 1-2 h…
• CCancel the scan entirely and reschedule
• DAdminister FDG immediately and double the standard dose to compensate

Which of the following is the correct half-value layer (HVL) shielding material for Tc-99m (140 keV)?

• A0.03 mm of lead
• B0.3 mm of lead
• C3 mm of lead
• D30 mm of lead

A nuclear medicine department discovers that a Tc-99m radiopharmaceutical was administered to the wrong patient. According to NRC regulations, this event must be reported if the effective dose equivalent exceeds:

• A0.5 mSv (50 mrem)
• B5 mSv (500 mrem) effective dose or 50 mSv (5 rem) to an organ
• C50 mSv (5,000 mrem)
• DThere is no reporting requirement for medical events

In gated myocardial perfusion SPECT, the left ventricular ejection fraction (LVEF) is calculated from which data?

• AThe ratio of stress-to-rest perfusion counts in the left ventricle
• BEnd-diastolic and end-systolic volume measurements derived from gated images
• CThe time-activity curve of tracer washout from the myocardium
• DBlood pool activity measured in the left atrium compared to the left ventricle

A patient presents for Ga-68 DOTATATE PET/CT to evaluate a suspected neuroendocrine tumor. Which organ demonstrates physiologically intense uptake that should NOT be mistaken for pathology?

• ALungs
• BSpleen
• CBrain
• DSkeletal muscle

When administering Lu-177 PSMA-617 (Pluvicto) therapy, co-administration of which agent is NOT routinely required?

• AAntiemetics (ondansetron or equivalent)
• BAmino acid infusion (lysine and arginine) for nephroprotection
• CAdequate hydration to promote renal clearance
• DCold amino acid infusion is routinely required

A patient receiving I-131 therapy develops nausea and vomiting within 2 hours of administration. What is the PRIMARY concern?

• APatient discomfort and dehydration
• BRadiation contamination of the environment from radioactive vomitus
• CAllergic reaction to the I-131 preparation
• DIneffective therapy due to incomplete gastric absorption

What is the primary advantage of F-18 PSMA-1007 over Ga-68 PSMA-11 for prostate cancer imaging?

• AF-18 PSMA-1007 has no urinary excretion, reducing bladder artifacts near the prostate
• BF-18 PSMA-1007 has higher PSMA receptor affinity
• CF-18 PSMA-1007 is available from a generator, eliminating the need for a cyclotron
• DF-18 PSMA-1007 provides superior spatial resolution due to lower positron energy

During a regadenoson pharmacologic stress test, the NMAA administers the radiopharmaceutical injection at what time point relative to regadenoson administration?

• ASimultaneously with the regadenoson bolus
• BApproximately 10-20 seconds after the regadenoson bolus, following the saline flush
• C5 minutes after regadenoson administration
• DAfter aminophylline reversal