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100+ Free AOBNM Nuclear Medicine Practice Questions

Pass your AOBNM Nuclear Medicine Certifying Examination exam on the first try — instant access, no signup required.

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What is the typical activity per radiopharmaceutical for a routine adult Tc-99m bone scan?

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2026 Statistics

Key Facts: AOBNM Nuclear Medicine Exam

~200

MCQs on Written Exam

AOBNM Written Exam

500/800

Scaled Passing Score

AOA scoring policy

1974

AOBNM Established

AOA Bureau of Osteopathic Specialists

25%

Oncology PET (Largest Block)

AOBNM blueprint

10-yr cycle

Recertification (Mandatory since 1995)

AOBNM policy

300-450 hrs

Average Study Time

Nuclear medicine residents

AOBNM Nuclear Medicine is one of the smaller AOA boards - only ~32 active diplomates as of 2011 - reflecting the niche nature of osteopathic nuclear medicine. Eligibility requires an AOA-approved or ACGME-accredited nuclear medicine residency plus active practice and AOA membership. The blueprint emphasizes oncology PET/PET-CT (~25%), cardiovascular nuclear (~20%), and theranostics (Lu-177 DOTATATE, Lu-177 PSMA-617, Ra-223). Recertification on a 10-year cycle has been mandatory since 1995.

Sample AOBNM Nuclear Medicine Practice Questions

Try these sample questions to test your AOBNM Nuclear Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which radiotracer is most commonly used for myocardial perfusion imaging (MPI) in SPECT cardiac stress testing?
A.Tc-99m sestamibi or tetrofosmin
B.I-131
C.F-18 FDG
D.Ga-68 DOTATATE
Explanation: Tc-99m sestamibi (Cardiolite) and tetrofosmin (Myoview) are lipophilic cations that concentrate in mitochondria proportional to myocardial perfusion. They are the workhorse SPECT MPI agents. Rb-82 is the PET equivalent. Sestamibi has higher liver uptake initially.
2What is the threshold for Transient Ischemic Dilation (TID) ratio that indicates extensive multivessel coronary artery disease?
A.>1.05
B.>1.22
C.>2.0
D.>3.0
Explanation: TID >1.22 (post-stress LV cavity to rest LV cavity ratio) suggests severe multivessel or left main coronary artery disease, even when relative perfusion appears 'balanced'. Important marker because relative perfusion may not show the deficit in balanced ischemia.
3Which is a classic SPECT MPI artifact in women due to anatomic structure overlying the heart?
A.Anterior wall attenuation from breast tissue
B.Inferior wall attenuation from diaphragm
C.Lateral wall artifact
D.Apical thinning
Explanation: Breast attenuation creates a FIXED anterior wall defect in women (vs perfusion defect from LAD disease which is REVERSIBLE). Attenuation correction CT and prone imaging help distinguish. Diaphragmatic attenuation affects the inferior wall in men.
4Which PET tracer is used for myocardial perfusion imaging with higher temporal/spatial resolution than SPECT?
A.Rb-82 chloride
B.Tc-99m sestamibi
C.Tl-201
D.F-18 FDG
Explanation: Rb-82 (T1/2 75 sec) is the most commonly used PET MPI tracer in the US, produced by a Sr-82/Rb-82 generator. N-13 ammonia is another PET MPI tracer. PET MPI offers higher diagnostic accuracy and quantification of myocardial blood flow (MBF, reserve).
5Pyrophosphate (Tc-99m PYP) imaging is used to diagnose what?
A.Acute MI
B.Transthyretin (ATTR) cardiac amyloidosis
C.Cardiac sarcoid
D.Myocarditis
Explanation: Tc-99m PYP at 1 hour (and/or 3 hours) imaging diagnoses ATTR cardiac amyloidosis. H:CL ratio >=1.5 + grade 2-3 myocardial uptake (Perugini grade) is diagnostic, with high sensitivity and specificity. Must exclude AL amyloid first (SPEP/IFE/free light chains).
6FDG PET cardiac sarcoidosis imaging requires what patient preparation?
A.Fasting alone for 4 hours
B.High-fat, low-carbohydrate diet for 12-24 hours + fasting + heparin to suppress physiologic myocardial FDG uptake
C.Glucose loading
D.Aspirin pretreatment
Explanation: Cardiac sarcoid FDG PET requires suppression of normal myocardial glucose metabolism. Standard prep: high-fat, low-carbohydrate, no-sugar diet 12-24 hours, fasting >=12 hours, and heparin 50 IU/kg IV 15 min before FDG. Inflammatory cells preferentially uptake FDG.
7MUGA (Multiple-Gated Acquisition) scan is used clinically for what indication?
A.Stress testing
B.Quantitative LV ejection fraction monitoring (e.g., before/during anthracycline chemotherapy)
C.Pulmonary embolism
D.Bone metastasis screening
Explanation: MUGA (also ERNA - Equilibrium Radionuclide Angiography) uses Tc-99m labeled red blood cells to quantify LV ejection fraction with high reproducibility (~5% variability). Used to monitor cardiotoxicity from doxorubicin/trastuzumab. Threshold for treatment hold often LVEF <50% or drop >10% to <50%.
8An FDG PET scan demonstrates a hypermetabolic lung mass with SUVmax 12. What general SUVmax cutoff suggests malignancy?
A.>0.5
B.>2.5
C.>10
D.>20
Explanation: SUVmax >2.5 is the traditional cutoff for malignancy (sensitivity ~80%, specificity ~85% in lung nodules). However, inflammatory processes (granulomatous disease, sarcoidosis, infection) can produce false positives. Some indolent tumors (BAC/AIS, neuroendocrine) may be FDG-cold.
9Patient preparation for FDG PET-CT typically requires fasting for how long?
A.No fasting required
B.At least 4-6 hours
C.12 hours
D.24 hours
Explanation: Standard FDG PET-CT preparation: fast 4-6 hours minimum, glucose <200 mg/dL (ideally <150), avoid strenuous exercise 24 h (muscle uptake), keep warm to suppress brown fat (some institutions use beta-blocker propranolol). No insulin within 6 hours before FDG.
10In Deauville scoring for lymphoma response on FDG PET-CT, what score represents 'no residual disease' for interim assessment?
A.1 (no uptake)
B.3 (uptake > mediastinum but ≤ liver)
C.4 (moderately > liver)
D.5 (markedly > liver or new sites)
Explanation: Deauville score 1-2 (no/minimal uptake) = complete metabolic response. Score 3 (uptake > mediastinum but <= liver) may be considered complete response in interim assessment. Scores 4-5 indicate inadequate response (progression/persistent disease).

About the AOBNM Nuclear Medicine Exam

The AOBNM Nuclear Medicine Certifying Examination is the primary certification pathway for osteopathic physicians (DOs) practicing nuclear medicine. The board was established in 1974 and is one of 18 specialty certifying boards approved by the AOA Bureau of Osteopathic Specialists. Eligibility requires completion of an AOA-approved or ACGME-accredited nuclear medicine residency, active practice, AOA membership, and an unrestricted state license. Recertification on a 10-year cycle has been mandatory since 1995.

Questions

200 scored questions

Time Limit

Approximately 4 hours of testing (oral exam separate)

Passing Score

Scaled score 500/800 on each component

Exam Fee

Approximately $1,200-$1,800 across components (AOBNM 2026) (American Osteopathic Board of Nuclear Medicine (AOBNM))

AOBNM Nuclear Medicine Exam Content Outline

25%

Oncology PET / PET-CT

FDG PET fasting >=4-6 h, glucose <200 mg/dL (<150 ideal), SUV >2.5 suspicious; lymphoma Deauville 1-5 (4-5 positive PMR/PD, mediastinal blood pool and liver as references); melanoma stage III/IV; H&N restaging; Ga-68 DOTATATE for somatostatin-receptor NETs; PSMA PET (Ga-68 PSMA-11, F-18 piflufolastat/pylarify) for prostate biochemical recurrence (PSA >0.2 ng/mL); F-18 fluciclovine (Axumin).

20%

Cardiovascular Nuclear Medicine

Tc-99m MPI (1- or 2-day, attenuation correction, prone/supine, breast/diaphragm artifacts), TID >1.22 = high-risk multivessel CAD, Rb-82 PET MPI (high temporal resolution, MBF reserve <2 abnormal), MUGA gated equilibrium for LVEF (chemo with anthracyclines, trastuzumab), PYP at 1 h and 3 h H:CL >=1.5 grade 2-3 = ATTR cardiac amyloid (rule out monoclonal first), FDG cardiac sarcoid (LV myocardial uptake + perfusion defect mismatch).

10%

Thyroid & Endocrine

I-123 24-h RAIU normal 10-30%; Graves diffuse high uptake; toxic adenoma focal hot + suppressed background; subacute thyroiditis <5%; cold nodule on Tc-99m pertechnetate -> US +/- biopsy; I-131 therapy: Graves 8-15 mCi, thyroid Ca remnant 30 mCi outpatient vs 100-200 mCi for high-risk + nodal disease; parathyroid Tc-99m sestamibi (delayed retention in adenoma).

10%

Bone Scans

Tc-99m MDP (planar + SPECT-CT) for metastatic disease (multifocal asymmetric in axial skeleton), superscan (renal blackout) in extensive prostate/breast mets, flare phenomenon (apparent worsening at 3-6 mo of effective therapy), occult fracture, stress fracture, CRPS (diffuse peri-articular uptake on delayed), 3-phase for osteomyelitis vs cellulitis, prosthesis evaluation (combined WBC + sulfur colloid marrow).

10%

GI / GU / Lung

HIDA (Tc-99m mebrofenin) non-visualization at 1 h then morphine; sphincter contraction at 4 h -> acute cholecystitis if still non-visualized; gastric emptying >10% retained at 4 h normal; Meckel scan (Tc-99m pertechnetate, pre-treat with H2 blocker); GI bleed Tc-99m RBC (sensitivity 0.1-0.5 mL/min); V/Q PIOPED (high probability >=2 large mismatched segmental defects); MAG3 (tubular, function) vs DMSA (cortical scarring).

10%

Infection / Inflammation

Tc-99m HMPAO labeled WBC (4 h imaging, no GI/GU activity) for acute infection; In-111 WBC (24 h imaging) for chronic/spine osteomyelitis; gallium-67 (48-72 h) for sarcoid, FUO, spinal infection, lymphoma; combined WBC + sulfur colloid marrow to differentiate marrow expansion from infection; FDG PET for large-vessel vasculitis (Takayasu, GCA), vascular graft infection, and prosthetic infection.

10%

Radiopharmacy, Physics & Safety

Mo-99/Tc-99m generator (parent T1/2 66 h, daughter 6 h, equilibrium ~24 h), Mo breakthrough <0.15 microCi Mo per mCi Tc and aluminum <10 microgram/mL; radiotracer half-lives (Tc 6 h, F-18 110 min, I-131 8 d, I-123 13 h, Ga-68 68 min, Lu-177 6.7 d, Ra-223 11.4 d); NRC occupational dose limits (whole body 5 rem/yr, fetus 0.5 rem total gestation, extremity 50 rem/yr, eye 15 rem/yr); ALARA; extravasation; pregnancy/breastfeeding restrictions.

5%

Therapy (Theranostics)

I-131 NaI: Graves 8-15 mCi; thyroid Ca 30-200+ mCi (NRC 33 mCi outpatient release threshold). Lu-177 DOTATATE (Lutathera) 200 mCi (7.4 GBq) IV q8wk x 4 for metastatic GEP-NETs (NETTER-1). Lu-177 PSMA-617 (Pluvicto) 7.4 GBq q6wk x 6 for mCRPC post-taxane (VISION). Ra-223 dichloride (Xofigo) 50 kBq/kg q4wk x 6 for symptomatic bone-mets CRPC (ALSYMPCA). Y-90 microspheres (SIRT) for HCC.

How to Pass the AOBNM Nuclear Medicine Exam

What You Need to Know

  • Passing score: Scaled score 500/800 on each component
  • Exam length: 200 questions
  • Time limit: Approximately 4 hours of testing (oral exam separate)
  • Exam fee: Approximately $1,200-$1,800 across components (AOBNM 2026)

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

AOBNM Nuclear Medicine Study Tips from Top Performers

1Master FDG PET preparation and pitfalls: fast 4-6 h, glucose <200 mg/dL (<150 ideal), avoid strenuous exercise 24 h (muscle uptake), avoid recent insulin (skeletal muscle redistribution), warm environment (brown fat suppression with beta-blocker), Deauville 1-5 with mediastinal blood pool and liver reference (>liver = score 4, much greater = score 5).
2Drill cardiac MPI artifacts cold: breast attenuation (anterior wall fixed) vs LAD disease (reversible), diaphragm/inferior attenuation in men (use prone + AC), TID >1.22 = high-risk multivessel CAD, balanced ischemia missed on relative perfusion but seen on Rb-82 PET MBF (<2 reserve). For PYP: 1 h + 3 h H:CL ratio >=1.5 grade 2-3 = ATTR cardiac amyloid - always rule out monoclonal (SPEP/IFE/free light chains) before diagnosing ATTR.
3Internalize radiopharmacy QC: Mo-99/Tc-99m generator, Mo breakthrough <0.15 microCi Mo per mCi Tc (NRC limit), aluminum <10 microgram/mL, daily uniformity + weekly resolution + linearity on gamma camera, dose calibrator quartet (accuracy annual, linearity quarterly, geometry at installation, constancy daily). Memorize half-lives (Tc 6 h, F-18 110 min, I-131 8 d, I-123 13 h, Ga-68 68 min, Lu-177 6.7 d, Ra-223 11.4 d).
4Know NRC 10 CFR Part 35 cold: occupational whole-body 5 rem/yr (50 mSv), fetus 0.5 rem (5 mSv) total gestation with 0.05 rem/month, extremity 50 rem/yr, lens 15 rem/yr; public 0.1 rem/yr; I-131 outpatient release threshold typically 33 mCi or projected dose to public <0.5 rem; pregnancy I-131 is absolute contraindication; breastfeeding pause varies by isotope.
5Drill theranostics dosing and trials: Lu-177 DOTATATE 200 mCi (7.4 GBq) q8wk x 4 for GEP-NETs (NETTER-1 mPFS not reached vs 8.4 mo octreotide); Lu-177 PSMA-617 7.4 GBq q6wk x 6 for mCRPC post-taxane (VISION 4.0 mo OS benefit, rPFS 8.7 vs 3.4 mo); Ra-223 50 kBq/kg q4wk x 6 (ALSYMPCA OS 14.9 vs 11.3 mo); release criteria, pre-treatment counseling, and renal/hematologic monitoring.
6Practice multimodality differentiation: cold thyroid nodule -> US + FNA (NOT just observe); HIDA non-visualization at 1 h then morphine, no GB by 30 min after morphine = acute cholecystitis; V/Q high prob = >=2 mismatched segmental + normal CXR (PIOPED criteria); combined WBC + sulfur colloid marrow scan: discordant uptake (WBC > marrow) = infection, concordant = marrow expansion not infection.

Frequently Asked Questions

Who is eligible for the AOBNM Nuclear Medicine certifying examination?

Candidates must be DO or MD graduates of an accredited medical school, have completed an AOA-approved or ACGME-accredited nuclear medicine residency (or other NRC authorized-user-eligible pathway), be in active nuclear medicine practice, hold AOA membership in good standing, and possess an unrestricted state medical license. A program director attestation of clinical and authorized-user competence is required.

How is the AOBNM Nuclear Medicine exam structured?

The AOBNM Written Exam is computer-based, single-best-answer multiple-choice, with approximately 200 questions delivered over approximately 4 hours of testing. The blueprint emphasizes oncology PET/PET-CT (~25%), cardiovascular nuclear medicine (~20%), thyroid/endocrine (~10%), bone (~10%), GI/GU/lung (~10%), infection/inflammation (~10%), radiopharmacy/physics/safety (~10%), and therapy/theranostics (~5%). An oral exam component is also part of the certification cycle.

What is the fee for the AOBNM Nuclear Medicine exam?

AOBNM does not publish a standalone consumer-facing fee page; AOA specialty boards typically charge $500-$1,000 per component, so candidates should budget approximately $1,200-$1,800 for the written + oral cycle (confirm current fees with AOBNM directly). After certification, an annual OCC fee maintains active status.

What is the passing score on the AOBNM Nuclear Medicine exam?

AOA specialty boards use a 200-800 scaled score system with a passing score of 500 or higher on each component. The standard is criterion-referenced (Angoff-based), so the passing scaled score corresponds to a fixed competency threshold rather than a percentile against the cohort.

How does AOBNM differ from ABNM (American Board of Nuclear Medicine)?

AOBNM is the AOA's osteopathic certifying board for nuclear medicine, established in 1974 and approved by the AOA Bureau of Osteopathic Specialists. ABNM is the allopathic board (member of ABMS) and certifies the majority of nuclear medicine physicians, with a much larger annual cohort. Following the GME single accreditation system (2020), many DOs pursue both ABNM and AOBNM certification; the clinical content overlaps substantially, with AOBNM retaining osteopathic principles as a small component.

How long should I study for the AOBNM Nuclear Medicine exam?

Most nuclear medicine residents report 300-450 hours of dedicated prep during the final year of residency. A high-yield plan allocates ~25% to oncology PET (FDG, PSMA, DOTATATE), ~20% to cardiac (MPI artifacts, PYP for amyloid, FDG for sarcoid), ~20% to physics/radiopharmacy/NRC safety, ~25% to bone/thyroid/GI/GU/infection, and ~10% to theranostics (Lu-177, Ra-223, Y-90, I-131). Daily case-based question practice (40-80/day in the final 8 weeks) is recommended.

What is the recertification requirement for AOBNM diplomates?

Since 1995, AOBNM has required mandatory recertification on a 10-year cycle. Diplomates participate in the AOA Osteopathic Continuous Certification (OCC) program with its four components (licensure, lifelong learning/CME, cognitive assessment, and performance in practice). Diplomates certified before 1995 may pursue voluntary recertification on the same 10-year cycle. Annual fees apply during the cycle.

Does the AOBNM exam cover the newer theranostics (Lu-177 DOTATATE, Lu-177 PSMA, Ra-223)?

Yes - the modern AOBNM blueprint includes radioligand therapy. Expect questions on Lu-177 DOTATATE (Lutathera) 200 mCi (7.4 GBq) q8wk x 4 for GEP-NETs (NETTER-1), Lu-177 PSMA-617 (Pluvicto) 7.4 GBq q6wk x 6 for mCRPC (VISION trial), Ra-223 dichloride (Xofigo) 50 kBq/kg q4wk x 6 for symptomatic bone-mets CRPC (ALSYMPCA), and Y-90 microsphere SIRT for HCC. Authorized-user release criteria, hospitalization thresholds, and patient counseling are also high-yield.