1. ortthis test
    is cool
  2. the importance of neuroglia
    responsible for structural and functional support for neurons.
  3. The Reflex Arc
    Monosynaptic: direct commuinicaiton between sensory and motor neurons.

    polysynaptic: interneuron facilitates sensory-motor communication.
  4. The importance of the choroid plexues
    creates cerebral spinal fluid
  5. Circle of willis
    • Ring of arteries that supply the brain.
    • common source of strokes.
  6. importance of Tight junctions
    at the interface between the blood and the brain, endothelial cells and astrocytes are stiched together into structures called Tight Junctions that restrict passage of all but certain materials
  7. causes of dementia
    • Alzheimers' disease
    • multi infarct disease
    • parkinson's disease
    • alcohol/drugs
    • misc, endocrine disorders, b-12deficiency
  8. importance of Substiantia Nigra
    Area of brain that contains dopamine sectreting neurons affected by Parkinsons disease
  9. Lewy Bodies
    Present in neurons affected by Parkinsons
  10. Petit and Grand Mal Seizure
    • Affects all or most of brain
    • General symtoms that involve most of the body
  11. Importance of Uniform determination of Death act?
    Brain Death (irreversible loss of all brain function) constitutes death in the same way as stopping of the heart.
  12. What are the divisions of the sensory neurons?
    • Sensory goes from periphery to CNS
    • Somatic Sensory
    • Visceral Sensory
  13. what are the divisions of the motor neurons?
    • CNS to the periphery
    • Somatic Motor (voluntary)
    • Automatic Motor (involuntary)
  14. lumber puncture is done where?
    between L3 and L4
  15. CSF flows from
    • choroid plexus
    • ventricles
    • cisterns
    • thecal space
  16. describe role of blood brain barrior
    restrict flow of microscopic objects between bloodstream and neural tissue, while allowing passage of substances essentional to metabolic function.
  17. part of brain that controls memory?
  18. part of brain that contols thinking and learning?
  19. part of brain that controls muscle control?
  20. part of brain that controls hearing?
  21. Part of brain that controls speech?
  22. part of brain the controls vision?
  23. Part of brain the controls movement?
  24. Part of brain the controls involuntary vital functions?
  25. Area of brain most affected by Alzheimers?
    • Frontal
    • parietal
    • temporal
    • hippocampus
  26. Area of brain most affected by Parkinsons?
    Substantia Nigra
  27. Area of brain most affected by Depression?
    • Cerebral cortex
    • Amygdala
    • Frontal
  28. Area of brain most affected by Huntingtons?
    Cerebral cortex
  29. area of brain most affected by Epilepsy?
  30. Common reason for a stroke?
    • Thrombosis
    • embolisim
    • hemmorage
  31. what is a stroke?
    Rapid loss of brain function due to disturbance in blood supply to brain.
  32. difference between stroke and trans ischemic attack(TIA)?
    in TIA blood flow to a part of the brain is temporarily blocked or reduced, same symptoms as a stroke but after a few minutes they go away
  33. First stage of Alzheimers? and affected brain parts?
    • Mild.
    • mild congitive impairment
    • Hippocampus
    • memory affected
  34. Second stage of Alzheimers? parts of brain affected?

    • cortical areas
    • logic and reasoning affected
  35. third stage of Alzheimers? parts of brain affected?
    • Severe.
    • additional brain regions damaged,
    • physiological functions affected.
    • shrinkage of cortical, and hippocampus
    • enlargement of ventricles
  36. Distingushing molecular features of Alzheimers?
    • Amyloid protiens are not folded correctly
    • Amyloid plaques cause extrenal damage to neurons
    • Neurofibral Tau tangles internal neural damage
    • Microgliosis inflammatory damage
  37. Clinical features of parkinsons disease?
    • Loss of dopamine secreting neurons in substantia nigra
    • Reduced dopamine levels
    • Brain structures appears normal
  38. The Classic Triad of Parkinson's disease.
    • Tremor
    • Rigidity
    • Bradykinesia
  39. The two major molecular mechanisims of parkinsons?
    • Alpha-Synuclein is altered and results in less dopa secretions.
    • (alpha-synuclein is needed to properly form the synaptic vessels that store dopamine.)
    • Normally soluable Alpha-Synuclein becomes insoluable and toxic, resulting in oxidative damage to neural mitocondria..ultimitly resulting in neural cell death,
  40. 3 cardinal findings for brain death.
    • Coma
    • Apnea
    • absence brainstem reflex.
  41. what is luxury perfusion?
    instead of decreased perfusion, an increased perfusion is seen in the subacute phase of the stroke
  42. what is cerebellar diaschisis?
    Contralateral hypoperfusion
  43. what are Ictal and Inter-ictal phases of epilepsy?
    Ictal imaging: done while patent is seizing increased uptake in seizure focus

    Inter-ictal: decreased activity in area of seizure focus
  44. what is Cisternography?
    imaging of the basal cistern.

    evaluation of CSF leaks

  45. what is a pledget?
    placed in nose or ear of patient before injection, if pledgets are hot it can id a leak.
  46. distingushing feature of Alzheimers causing external damage to neurons?
    Amyloid plaque
  47. in this imaging patients will have decreased activity in area of seizure focus.
    Inter-ictal imaging
  48. what is a Trident sign?
    in normal cisternogram when activity is seen in basal cisterns.
  49. Lab test that determines if patient has normal number of blood cells.
  50. What is Leukocyte bone marrow imaging?
    assess osteomyleitis and Marrow distribution at suspected osteomyleitis sites.
  51. Radiopharmecutical used to determine blood plasma volume
    radioactive iodine human serum albumin.
  52. what is a splenic sequesteration study?
    determines if RBCs are removed from circulation at accelerated rate
  53. Rx that is mainly excreted through kidneys in first 24hrs and then through the GI tract. sticks in liver and bone marrow. not seen in spleen.
    Ga-67 citrate
  54. a life threatining situation when injecting non-human antibodies.
    HAMA reaction
  55. radionuclide used in Zevalin therapy
  56. non-hodgkins lymphoma therapy radiopharm that needs thyroprotection
  57. Radiopharm for non-hodgkins therapy that does not need isolation instructions.
    Y-90 ibritumomab tiuxetan
  58. Scintimammography, where the patient is seated
  59. What is the sentinal lymph node?
    First lymph node draining from the tumor site.
  60. Tumor that can be imaged with I-131 MIBG??
    • Pheochromocytoma
    • Neuroblastoma
    • Neuroendocrine tumor
  61. Treatment that concentrate bone seeking Beta emitters for temporary relief of symptoms from bony mets
    Bone pain palliation
  62. radionuclide that can be used for palliative therapy and imaging?
  63. Balloon in brain to combat glioma
    I-125 iotrex gliaSite
  64. Blue baby syndrome is from
    a right to left shunt.
  65. What is a LeVeen shunt?
    Artifical passage for fluid from the peritoneal cavity to be diverted to the general circulation.
  66. Brain imaging radiopharm that is also used for WBC labeling.
    Tc-99m HMPAO
  67. what is I-123 Loflupane Da tscan?
    To catch parkinsons.
  68. HMPAO
    • hexamethyl
    • propylene
    • amine
    • oxime
  69. Agent used to measure cerebral blood flow.
    Tc-99m exametazine (ceretec)
  70. Total blood volume =
    Plasma volume / decimal plasmacrit
  71. Plasmacrit =
    1- decimal hematocrit
  72. Red Cell Volume=
    TBV-Plasma vol
  73. what is the cross fire effect?
    when malignant cells near the target cells are killed by radiation from the target cells.
  74. antibody radiolabels that can only be used for imaging?
    • Tc-99m
    • In-111
    • I-123
  75. antibody radiolabeled that can only be used for therapy?
  76. Antibody radiolabeled that can be used for both therapy and imaging?
  77. difference between Fc and Fab
    • Fc = heavy chain, constant portion (HAMA)
    • Fab= light chain, variable regions
  78. whole vs antibody fragment?
    Fragments; diffuse better into tumor, no Fc region, rapid clearance allows for same day imaging, can use tc-99m

    Whole; longer bioavailability, need delayed imaging, label with In-111, I-131, decreased kidney and bladder uptake, HAMA.
  79. Generic name for In-111/ Y-90 Ibritumomab Tiuxetan?
  80. generic name for I-131 tositumomab?
  81. Generic name for In-111 Satumomab
  82. Generic name for In-111 Capromab
  83. Generic name for Tc-99m Arcitumomab?
  84. Generic name for Tc-99m Nofetumomad ?
  85. Generic name for Tc-99m Fanolesomab?
  86. Generic name for In-111 Imciromab pentetate
  87. Rx used to target CD-20
    Zevalin and Bexxar
  88. Rx used to target CD-15?
  89. Rx used to target PMSA?
  90. Rx used to target Carcinoembryonic antigen?
  91. Rx used to target TAG-72 Glycoprotein?
  92. Fragment, whole or Chimeric?
    NeutroSpec, CEA-Scan, ProstaScint, Zevalin, Bexxar
    • NeutroSpec = Frag
    • CEA-Scan = Frag
    • ProstaScint = whole
    • Zevalin/bexxar = whole chimerci
  93. Indications for using Tc-99m Fanolesomab(NeutroSpec)
    • Targets CD-15
    • WBC infection imaging
    • off market.
  94. indications for using -Tc-99m Arcitumomab (CEA-Scan)
    Targets Carcinoembryonic antigen of GI carcinoma
  95. Indicaiton for using In-111 Capromab (Prostascint)
    • Reacts with PMSA (prostate specific membrane antigen)
    • good for imaging extrapelvic disease
  96. Indications for using In-111/y-90 Ibritumoab Tiuextan (Zevalin)
    Imaging cancer of lymphatic system\

    binds to CD20 antigen

    • In-111 can assess biodistribution
    • Y-90 can ablate tumor.
  97. Indicaitons for I-131 Tositumomab (bexxar)
    Treatment for non hodgkins lymphoma (relapsed or refactory) not for intial treatment.

    binds to CD-20
  98. Difference between hodgkins and non hodgkins?
    In hodgkins there is the presence of reed sternberg cells.
  99. syringe sheilding used for y-90 and in-111
    • for Y-90 use acrylic b/c its a beta emitter
    • lead for In-111 its a gamma emmitter
  100. purpose of Rituximab during zevalin therapy?
    • block CD20 sites on
    • B-cells in blood & spleen
  101. How is Y-90 dose calculated for zevalin therapy?
    based of weight and platelet count
  102. Requirments for injecting Ibritumoab Tiuxetan?
    inject over 10 min

    0.22u filter

    slow saline flush
  103. Rx dose limit for ibritumoab tiuxetan
  104. what organs get a high dose during Ibritumoab tiuxetan therapy?
    Spleen, liver , lungs
  105. importance of pre-dose in I-131 Tositumomab therapy.
    • enhances tumor penetration
    • occupy accessable non tumor sites, b-cells. in spleen
  106. why image before prior to I-131 Tositumomab therapy?
    counts for Paitent specific dose calc

    assesment of biodistrubutioin
  107. Rx used for scintimammography?
    Tc-99m sestamibi ( Miraluma)
  108. How is HAMA reaction recognized in immunoscintigraphy?
    blood pool is not seen.
  109. injection site for scintimammography?
    contralateral arm, or pedal vein/
  110. contridicitons for scintimammography?
    Less the 2 wks post needle aspiration.

    Less than 4 weeks post biopsy
  111. How is the patient positioned for scintimammogrphy
    • Prone imaging –
    • Breast freely dependent; arms extended; head turned away; contralateral breast compressed
  112. What is the tumor size that can be detected with
  113. What are the benefits of breast specific gamma
    imaging technology?
    High res, breast compression, correlat to all mammographic views
  114. Why & how is gamma ray guided localization
    system used in breast scintigraphy?
    • determines lesion local and depth.
    • perform biopsies
  115. What are the consequences of injection
    infiltration in scintimammography?
    false positve.
  116. What is the organ imaged and what are the
    clinical indications for MIBG imaging?
    • images adrenal medulla and sympathetic nervous tissue
    • indications: pheochromocytoma and neuroblastoma
  117. Classify Pheochromocytoma & Neuroblastoma
    according to tumor type
    neuroendocrine tumors
  118. What is the basis of MIBG uptake in tumor
    its simular to norepinepherine
  119. Patients of which melanoma stage are ideal candidates
    for lymphoscintigraphy? Why?
    stage 0 , no mets.
  120. How does modified radical mastectomy &
    lumpectomy differ & how can scintigraphy help?
    • modified radical mastectomy removes affected breast.
    • lumpectomy removese cancerous only lump
    • scintigraphy removal of sentinal node, to stop spread of Ca
  121. What is sentinel lymph node and why is it
    important in lymphoscintigraphy?
    • The first lymph node reached by cancer cells from a primary tumor.
    • lymphoscintigraphy seeks to ID the sentinel node for removal.
  122. What is the radiopharmaceutical used in breast
    lymphoscintigrphy and how much?
    Filtered Sulfur Colloid

    2-6 injections totaling up to 1 mCi
  123. Identify common types of injections done in breast lymphoscintigraphy
    & how they are done
    • Perilseional injections(most common), on side of lesion
    • Dermal, above lesion
    • Areolar, 3-5 dermal inj around areola
  124. Identify position of the transmission sheet
    source w.r.t patient/camera in lymphoscintigraphy
    patient is placed between transmission sheet source and camera, to get body conture
  125. how do you knw the sentinal node?
    its the closest to the injection site
  126. What are the uses of intraoperative gamma probe
    in lymphoscintigraphy?
    Localize incision site.

    confirm removal of SNL
  127. What is the basis of 111In-Pentetreotide
    imaging? What is the target?
    images somatostatin receptor positive tumors

    target somatostatin peptide
  128. What are some of the reasons of altered
    biodistribution in 111In-Pentetreotide imaging
    • urine contamination
    • focal collection of stools
    • octreotide therapy
  129. Chemically, octreotide, depreotide &
    apcitide are what type of radiopharmaceuticals?
    •Synthetic peptide radiopharmaceutical
  130. What is 99mTc-Depreotide & 99mTc-Apcitide
    indicated for?
    • Deoreotide (NeoTect) is for evaluating malignant lung nodules
    • Apcitide (AcuTect) Acute Venous thrombosis imaging.
  131. What is the gold standard for detecting breast
    A mammogram
  132. I-131 sodium iodide. clinical uses?
    • Hyperthyroidism
    • Thyroid carcinoma
  133. Malignant gliomas, therapy agent ?
    I-125 Lotrex
  134. P-32 Sodium Phosphate,
    Clinical Uses?
    • Polycythemia vera
    • Certain leukemias
    • Skeletal metastases
  135. P-32 Chromic Phosphate ,
    clinical uses
    • Peritoneal cancer
    • pleural effusions
    • radiation synovectomy
  136. Sm-153 lexidronam
    Sr-89 strontium chloride
    clinical uses?
    Relief (palliation) of pain from bony metastases
  137. Non-Hodgkin’s lymphoma (NHL) agents used to treat..
    • Y-90 Ibritumomab tiuxetan (Zevalin)
    • I-131 Tositumomab (Bexxar)
  138. 90Y Microspheres, clinical uses?
    Inoperable liver cancer.
  139. what is an Osteoclast?
    removed bone tissue
  140. what is an Osteoblast?
    builds bone tissue
  141. Identify 3 types of cancers that has high
    prevalence for bone metastasis
    • Prostate
    • Breast
    • Multiple myeloma
  142. What are the 4 common reasons for metastatic
    bone pain?
    • mets streching the periosteum
    • mets pressing on nerve roots
    • chemicals secreted by mets
    • mets causing reflex muscle spasm and pain.
  143. Metastron, generic
    • Sr-89
    • samarium 153 lexidronam
  144. Which of the bone pain palliative therapy Rps
    Lowest myelosuppression
    Highest myelosuppression
    • low- sm-153
    • high- p-32
  145. Which of the bone pain palliative therapy Rps
    Fastest on-set of pain relief
    sm-153 lexidronam
  146. Which of the bone pain palliative therapy Rps
    Longest duration of pain suppression
    Sr-89 metastron
  147. Which of the bone pain palliative therapy Rps
    Gamma energy that can be imaged with gamma camera
    Sm-153 quadramet
  148. Which of the bone pain palliative therapy Rps
    Longest half-life
    Sr-89 metastron
  149. how is leveen shunt imaging done?
    intraperitoneal injection of Tc-99m -MAA
  150. Striatal Dopamine Transporter visualization using SPECT
  151. How does I123- ioflupane (DaTscan) work?
    DaT takes dopamine back into presynaptic neuron.
  152. difference between a leukocyte and lymphocyte
    • a leukocyte is a WBC
    • a lymphocyte is a type of WBC that is for specific immune responses (b cells , T cells)
  153. difference between macrophage and Mast cell
    • Macrophage engulfs invaders
    • Mast cells trigger inflammatory responses.
  154. explain chemotaxis,
    leukocytes accumulate at site of infection by process called chemotaxis, which is used to transport radiotracer to infected area
  155. Chemokines
    induce chemotaxis
  156. the sequence of the 3 immune response phases
    • phase 1: non induced innate response, nonspecific (skin)
    • phase 2: Induced innate response, broadly specific
    • complement activiation, phagocytosis, target cell lysis, inflammation.
    • phase 3: induced adapative response, uniquely specific.
    • b-cells(antibodies), T-helper cells(cytokines), T-cytotoxic cells(cytolysis)
  157. What are the effects of recent blood transfusion/
    gadolinium MRI on Ga67 biokinetics
    Localization goes down
  158. Identify the two major body structures visible
    in a normal 48hr Ga-67 scintigram
    liver and bone
  159. What is the preferred radiopharmaceutical for
    diagnosing fever of unknown origin?
  160. In WBC imaging, which type of leukocytes will be
    getting labeled the most?
  161. What is the one property of HMPAO that lets it
    slip through cell membranes & BBB?
  162. Identify three major structures in a normal 24hr
    111In-WBC image?
    liver, spleen bone marrow
  163. what structures are seen in normal 24hr
    Tc-WBC image?
    liver, spleen, GI tract, bone marrow
  164. Identify the effect of the following on
    hematocrit (1) dehydration (2) increased
    plasma volume (2) decreased plasma volume
    • 1. hematocrit falsley elevated
    • 2. falsley decreased hematocrit
    • 3. falsley elevated
  165. Name one indication for red cell survival study
    hemolytic anemia
  166. abnormal shunt imaging?
    obstruction will show as non dranage of traces.
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