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Nuclear Medicine in Bone and Joint Disorders

  • Majid Assadi
  • Hojjat Ahmadzadehfar
  • Hans-Jürgen Biersack
Chapter

Abstract

  1. 1.
    Which of the following radiopharmaceuticals has been proposed as an agent that reduces the required interval between injection and scan?
    1. (a)

      99m Tc-dicarboxypropane-diphosphonate (DPD)

       
    2. (b)

      99mTc-dimethyl-amino-diphosphonate (DMAD)

       
    3. (c)

      99mTc-aminomethylenediphosphonic acid (AMDP)

       
    4. (d)

      99mTc-EC-AMDP

       
     
  2. 2.
    Which radiopharmaceutical can detect equivocal lesions observed on the 99mTc-MDP scan in a symptomatic patient?
    1. (a)

      99m Tc-dicarboxypropane-diphosphonate (DPD)

       
    2. (b)

      99mTc-dimethyl-amino-diphosphonate (DMAD)

       
    3. (c)

      99mTc-aminomethylenediphosphonic acid (AMDP)

       
    4. (d)

      99mTc-hydroxymethylene-diphosphonate (HMDP)

       
     
  3. 3.
    How long is the shelf life of 99mTc-medronate?
    1. (a)

      12 h

       
    2. (b)

      10 h

       
    3. (c)

      8 h

       
    4. (d)

      5 h

       
     
  4. 4.
    In the SPECT imaging of the knee, the most important information can be obtained from:
    1. (a)

      Sagittal images

       
    2. (b)

      Transaxial images

       
    3. (c)

      Coronal images

       
    4. (d)

      All views produce the same information

       
     
  5. 5.
    In the bone scan of a patient with Blount’s disease:
    1. (a)

      The medial half of the femoral physis has greater activity than the lateral half.

       
    2. (b)

      The lateral half of the femoral physis has greater activity than the medial half.

       
    3. (c)

      The lateral half of the tibial physis has greater activity than the medial half.

       
    4. (d)

      The medial half of the tibial physis has greater activity than the lateral half.

       
     
  6. 6.
    On bone scan:
    1. (a)

      An improperly set photopeak produces a false-negative bone scan.

       
    2. (b)

      Uptake by the thyroid alone has been reported in metastatic visceral calcification.

       
    3. (c)

      The clearance of retained urine following frusemide administration is not helpful in identifying patients with obstruction.

       
    4. (d)

      Gastric air bubble is especially observed in the elderly.

       
     
  7. 7.
    Regarding the alteration of the biodistribution of bone tracer following radiotherapy:
    1. (a)

      It does not have any effect on the nonirradiated bone.

       
    2. (b)

      The most important effect is the decrease in areas of increased uptake.

       
    3. (c)

      No lesion occurs 2 months following radiotherapy.

       
    4. (d)

      All lesions resolve in 1 year.

       
     
  8. 8.
    Hot kidneys on bone scan are NOT seen in:
    1. (a)

      Hyperparathyroidism

       
    2. (b)

      Amphotericin B therapy

       
    3. (c)

      Myoglobinuria

       
    4. (d)

      Nephrocalcinosis

       
     
  9. 9.
    Focal myocardial accumulation on bone scan is seen in:
    1. (a)

      Kawasaki disease

       
    2. (b)

      Amyloidosis

       
    3. (c)

      Acute myocardial necrosis

       
    4. (d)

      Hypercalcemia

       
     
  10. 10.
    Regarding the uptake in soft tissue tumors on bone scan:
    1. (a)

      All malignant and 50% of benign soft tissue tumors accumulate the bone agents.

       
    2. (b)

      Approximately 70% malignant and benign soft tissue tumors accumulate the bone agents.

       
    3. (c)

      Approximately 50% of malignant and benign soft tissue tumors accumulate the bone agents.

       
    4. (d)

      Nearly all malignant and benign soft tissue tumors accumulate the bone agents.

       
     
  11. 11.
    In which of the following conditions is pelvic diastasis observed on bone scan?
    1. (a)

      Pregnant women

       
    2. (b)

      Gait disorder

       
    3. (c)

      Obese subjects

       
    4. (d)

      Advanced osteoporosis

       
     
  12. 12.
    A symmetric circular lesion with distinct edges is observed in the mid-lower sternum on the bone scan of a 35-year-old patient suspected to have femoral osteomyelitis. What is the most probable diagnosis?
    1. (a)

      Simple bone cyst

       
    2. (b)

      Establishment of infection in the sternum (multifocal osteomyelitis)

       
    3. (c)

      Sternal foramen (natural variation)

       
    4. (d)

      Destructive metastasis

       
     
  13. 13.
    Bone scan in a patient with pulmonary cancer reveals a generalized increase in cortical uptake in both tibias as well as an enhanced focal uptake in the periarticular regions of the knee. What is the most possible diagnosis?
    1. (a)

      Reflex sympathetic dystrophy (RSD)

       
    2. (b)

      Shin splint

       
    3. (c)

      Bone metastasis

       
    4. (d)

      Hypertrophic pulmonary osteoarthropathy (HPO)

       
     
  14. 14.
    Which of the following changes in the bone scan of elderly patients is unusual and must be taken seriously?
    1. (a)

      Observation of femoral arteries

       
    2. (b)

      Nonhomogenous increase in uptake in large joints

       
    3. (c)

      Focal increase in activity in the ribs

       
    4. (d)

      Observation of thyroid cartilage

       
     
  15. 15.
    What is the most common cause of diffusely increased uptake in visceral organs on bone scan?
    1. (a)

      Infectious/inflammatory process

       
    2. (b)

      Metabolic bone disease

       
    3. (c)

      Traumatic lesions

       
    4. (d)

      Metastatic visceral calcification

       
     
  16. 16.
    Which of the following items has the greatest “bone marrow expansion”?
    1. (a)

      Sickle thalassemia (Hb S-Thal)

       
    2. (b)

      Aplastic anemia

       
    3. (c)

      Alpha trait thalassemia

       
    4. (d)

      Sickle cell anemia (Hb S/S)

       
     
  17. 17.
    Which of the following statements regarding hypertrophic osteoarthropathy and bone scan findings is correct?
    1. (a)

      Hypertrophic osteoarthropathy results from renal failure.

       
    2. (b)

      The activity of long bones increases from epiphysis.

       
    3. (c)

      An increased focal uptake is found in the long bones, fingers, scapula, and clavicle.

       
    4. (d)

      Radiography is superior to bone scan in identifying lesions.

       
     
  18. 18.
    Which item has NO effect on the radiopharmaceutical uptake in radiotherapy of bone?
    1. (a)

      Type of bone tissue

       
    2. (b)

      Dose and intensity of the radiotracer

       
    3. (c)

      Extent of the surrounding soft tissue

       
    4. (d)

      Interval between radiation and scan

       
     
  19. 19.
    Which modality is the most sensitive for the detection of rhabdomyolysis?
    1. (a)

      Simple radiography

       
    2. (b)

      CT scan

       
    3. (c)

      MRI

       
    4. (d)

      Bone scan

       
     
  20. 20.
    Which of the following findings on bone scan demonstrates the concurrent administration of the hematopoietic growth factor along with radiotherapy?
    1. (a)

      Generalized increase in skeletal uptake

       
    2. (b)

      Increase in cranial uptake

       
    3. (c)

      Generalized decrease in vertebral uptake

       
    4. (d)

      Decrease in organ uptake

       
     
  21. 21.
    In which of the following conditions is bone scan recommended?
    1. (a)

      Screening for histiocytosis X

       
    2. (b)

      Evaluation of the progression of bone lesions in multiple myeloma

       
    3. (c)

      Negative radiographic findings in a multiple myeloma patient with bone pain

       
    4. (d)

      Evaluation of the whole skeleton in a patient with a unicameral bone cyst in the calcaneus

       
     
  22. 22.
    Which of the following findings is considered a normal variant on bone scan?
    1. (a)

      Noticeable cranial sutures in adults

       
    2. (b)

      Increased uptake in the spinous process in the C2 vertebra

       
    3. (c)

      Absence of growth plates in an 11-year-old girl

       
    4. (d)

      Increased uptake in the patella

       
     
  23. 23.
    Flare phenomenon:
    1. (a)

      The appearance of new lesions excludes the flare phenomenon.

       
    2. (b)

      It indicates the improvement of metastasis after radiotherapy.

       
    3. (c)

      It is commonly observed in bone metastasis of prostate cancer.

       
    4. (d)

      It appears as an increased SUV in FDG-PET.

       
     
  24. 24.
    Which organ exhibits the highest uptake of 99mTc-MDP on bone scan?
    1. (a)

      Bone

       
    2. (b)

      Bone marrow

       
    3. (c)

      Kidney

       
    4. (d)

      Bladder

       
     
  25. 25.
    Bone scan is performed on a 28-year-old patient. An aligned increase in uptake is observed in the bilateral ribs in the posterior view. What is the most probable diagnosis?
    1. (a)

      Metastasis

       
    2. (b)

      Shine-through of the costochondral junction

       
    3. (c)

      Previous traumatism

       
    4. (d)

      Calcification of muscle attachment sites

       
     
  26. 26.
    An increased uptake is observed at the base of the cranium on the bone scan of a 4-month-old baby. What is the most probable diagnosis?
    1. (a)

      Osteomyelitis

       
    2. (b)

      Pituitary tumor

       
    3. (c)

      Normal finding

       
    4. (d)

      Fracture of the cranial base

       
     
  27. 27.
    Which region is NOT involved in hypertrophic osteoarthropathy?
    1. (a)

      Long bones

       
    2. (b)

      Hip

       
    3. (c)

      Vertebrae

       
    4. (d)

      Scapula

       
     
  28. 28.
    The bone scan of a patient with low back pain reveals an increased focal activity on both sides of the L4–L5. What is the most probable diagnosis?
    1. (a)

      Primary tumor

       
    2. (b)

      Spondylolisthesis

       
    3. (c)

      Metastasis

       
    4. (d)

      Osteomyelitis

       
     
  29. 29.
    In which of the following conditions is the watershed effect reported on bone scan?
    1. (a)

      Osteomyelitis

       
    2. (b)

      Infection of soft tissue

       
    3. (c)

      Bone metastasis

       
    4. (d)

      Bone fracture

       
     
  30. 30.
    Which of the following findings is reported in a patient with chronic reflex sympathetic dystrophy?
    1. (a)

      Increased activity in all three phases

       
    2. (b)

      Increased activity in angiography and blood pool, normal pattern in the static phase

       
    3. (c)

      Increased activity in angiography and blood pool, decreased activity in the static phase

       
    4. (d)

      Decreased activity in all three phases

       
     
  31. 31.
    Which statement about hypertrophic osteoarthropathy and bone scan is NOT correct?
    1. (a)

      Increased cortical uptake in the distal regions of long bones.

       
    2. (b)

      Small bones of the foot and hand are usually involved.

       
    3. (c)

      Nonhomogenous and irregular increase in activity is indicative of the ruling out of the disease.

       
    4. (d)

      Abnormal scan findings are reversible after treatment of the underlying disease.

       
     
  32. 32.
    What changes are expected on the bone scan after treatment with primary therapeutic doses of bisphosphonates?
    1. (a)

      Decreased bone uptake, increased soft tissue uptake

       
    2. (b)

      Increased bone uptake, decreased soft tissue uptake

       
    3. (c)

      Increased bone and soft tissue uptake

       
    4. (d)

      No change in bone uptake, increased soft tissue uptake

       
     
  33. 33.
    Which statement about hypertrophic osteoarthropathy is NOT correct?
    1. (a)

      A tramline sign can be found in long bones.

       
    2. (b)

      Normal bone scan is obtained at least 6 months after a successful treatment.

       
    3. (c)

      It is NOT observed in the vertebra.

       
    4. (d)

      It is commonly observed in pulmonary cancer.

       
     
  34. 34.
    The thinning of which cranial bone as a region of reduced uptake on bone scan is demonstrated?
    1. (a)

      Temporal

       
    2. (b)

      Parietal

       
    3. (c)

      Occipital

       
    4. (d)

      Frontal

       
     
  35. 35.
    The increased uptake of labeled MDP in which cranial region is observed in renal osteodystrophy?
    1. (a)

      Frontal

       
    2. (b)

      Parietal

       
    3. (c)

      Temporal

       
    4. (d)

      Suture

       
     
  36. 36.
    A decreased uptake of radiopharmaceutical in bones and an increased activity in soft tissue are reported on bone scan. What is the most probable diagnosis?
    1. (a)

      Active acromegaly

       
    2. (b)

      Severe thyrotoxicosis

       
    3. (c)

      Aluminum-induced osteomalacia

       
    4. (d)

      Hypervitaminosis D

       
     
  37. 37.
    What is the most common site of the symmetrical increase in MDP uptake in hypertrophic pulmonary osteoarthropathy (HPO)?
    1. (a)

      Tibia

       
    2. (b)

      Scapula

       
    3. (c)

      Clavicle

       
    4. (d)

      Rib

       
     
  38. 38.
    What is the most appropriate position for the spot scintigraphy of the lumbar vertebrae in the posterior view?
    1. (a)

      Sitting with bended back

       
    2. (b)

      Prone

       
    3. (c)

      Upright

       
    4. (d)

      Supine

       
     
  39. 39.
    Symphysis pubis evaluation in the anterior view of bone scan is not possible because of a full bladder. What is the alternative view?
    1. (a)

      Cephalad

       
    2. (b)

      Posterior

       
    3. (c)

      Lateral

       
    4. (d)

      Caudal

       
     
  40. 40.
    Which bone is the most common site of a single malignant lesion with an increased uptake of MDP in a patient with a history of breast cancer?
    1. (a)

      Tibia

       
    2. (b)

      Radius

       
    3. (c)

      Sternum

       
    4. (d)

      Rib

       
     
  41. 41.
    Bone scan shows an increased focal uptake near the fourth and fifth proximal metacarpal bones of the wrist. In which bone is the mentioned focus located?
    1. (a)

      Trapezoid

       
    2. (b)

      Hamate

       
    3. (c)

      Lunate

       
    4. (d)

      Scaphoid

       
     
  42. 42.
    An increased uptake is observed in one of the lumbar vertebrae on the bone scan of a 67-year-old woman with breast cancer. SPECT investigation shows an increased uptake in the anterior margin of L3. What is the most probable cause of this finding?
    1. (a)

      Infection

       
    2. (b)

      Degeneration

       
    3. (c)

      Metastasis

       
    4. (d)

      Fracture

       
     
  43. 43.
    Bone scan is requested to evaluate the metastasis of breast cancer in a patient who received intravenous bisphosphonate yesterday. How long should the bone scan be postponed?
    1. (a)

      1 week

       
    2. (b)

      2 weeks

       
    3. (c)

      3 weeks

       
    4. (d)

      4 weeks

       
     
  44. 44.
    A 56-year-old man recently diagnosed with small-cell carcinoma of the right lung underwent chemotherapy 3 years ago. Bone scan is performed to identify the cause of acute joint pains in the lower extremities. A dissymmetric increase in uptake is observed in the hip, knee, and ankle joints, whereas the other parts of the skeleton show a normal uptake. No noticeable finding is found in the radiography of the mentioned regions. What is the most probable diagnosis?
    1. (a)

      Paraneoplastic polyarthritis

       
    2. (b)

      Metastatic arthropathy

       
    3. (c)

      Pulmonary hypertrophic osteoarthropathy

       
    4. (d)

      Reaction to bone marrow suppression secondary to chemotherapy

       
     
  45. 45.
    In which of the following conditions does bone scan have the highest paraclinical value for the diagnosis of a suspected lesion?
    1. (a)

      A 67-year-old woman with hip pain after a fall 3 years ago; normal radiography.

       
    2. (b)

      A 32-year-old man with back pain; radiography shows bone lesion in the neural arch of L4.

       
    3. (c)

      A 27-year-old football player with chronic pain of the knee; for the evaluation of the cause of pain.

       
    4. (d)

      A 49-year-old woman with rheumatoid arthritis; for therapeutic monitoring.

       
     
  46. 46.
    Bone scan is performed on a young patient with pain in the vertebral column without a history of any disease. Only a minor diffuse and a homogenous uptake are observed in the liver and spleen. No abnormal uptake in bones or other parts can be seen. What is the most probable diagnosis?
    1. (a)

      Diffuse metastasis of the liver due to a malignancy

       
    2. (b)

      Higher free technetium in the administered radiopharmaceutical

       
    3. (c)

      Colloid formation during the preparation of the radiopharmaceutical

       
    4. (d)

      Acute hepatitis with diffuse necrosis

       
     
  47. 47.
    A diffuse uptake in the liver is observed on the bone scan of a 49-year-old patient with back pain. Which diagnosis is NOT possible?
    1. (a)

      Amyloidosis

       
    2. (b)

      Hepatic necrosis

       
    3. (c)

      Colorectal metastasis

       
    4. (d)

      Aluminum increase

       
     
  48. 48.
    A reduced activity is observed around a brown tumor on the bone scan of a patient with hyperparathyroidism. A repeat of the bone scan 2 months later shows an increased activity in this region. What is the reason for the change in activity over time?
    1. (a)

      Parathyroidectomy

       
    2. (b)

      Normal pattern of the disease

       
    3. (c)

      Drug treatment

       
    4. (d)

      Contamination

       
     
  49. 49.
    A 74-year-old woman with a history of mastectomy is referred for bone scan. An increased activity is observed in the T12 aside from the sternum and ribs. Furthermore, SPECT shows an increased activity in the vertebral body and pedicle of this vertebra. What is the most probable cause of this increased activity?
    1. (a)

      Metastasis

       
    2. (b)

      Degenerative lesions

       
    3. (c)

      Trauma

       
    4. (d)

      Infection

       
     
  50. 50.
    Bone scan of the knee is performed because of edema after trauma. An increased activity in all three phases of angiography, blood pool, and delayed is observed only in the femoral parts near the knee. Which of the following conditions is indicated?
    1. (a)

      Septic arthritis

       
    2. (b)

      Arthritis

       
    3. (c)

      Osteomyelitis

       
    4. (d)

      Adjacent soft tissue infection

       
     
  51. 51.
    In which cranial region is an increased uptake of the labeled MDP radiotracer observed in renal osteodystrophy?
    1. (a)

      Frontal

       
    2. (b)

      Parietal

       
    3. (c)

      Temporal

       
    4. (d)

      Suture

       
     
  52. 52.
    Which of the following disorders is characterized by a decrease in radiotracer uptake in bones and an increase in soft tissue activity on bone scan?
    1. (a)

      Active acromegaly

       
    2. (b)

      Severe thyrotoxicosis

       
    3. (c)

      Aluminum-induced osteomalacia

       
    4. (d)

      Hypervitaminosis D

       
     
  53. 53.
    A 56-year-old patient with pain in the lower extremities that began last year is referred for bone scan. Atrophic changes are observed in the physical examination. Furthermore, decreased perfusion and blood pool and a periarticular increased uptake in the left leg are observed on bone scan. What is the most probable diagnosis?
    1. (a)

      Degenerative changes

       
    2. (b)

      Inflammation and infection

       
    3. (c)

      Trauma

       
    4. (d)

      Reflex sympathetic dystrophy

       
     
  54. 54.
    Focal uptake in the L5 interarticularis region is found on the bone scan and SPECT of a 12-year-old girl, who is referred because of back pain. What is the most probable diagnosis?
    1. (a)

      Spondylolysis

       
    2. (b)

      Spondylolisthesis

       
    3. (c)

      Facet joint arthropathy

       
    4. (d)

      Traverse sacral articulation

       
     
  55. 55.
    What is the cause of a tramline on a bone allograft scan?
    1. (a)

      Ossification

       
    2. (b)

      Fracture

       
    3. (c)

      Tumor relapse

       
    4. (d)

      Osteomyelitis

       
     
  56. 56.
    Which statement is correct?
    1. (a)

      Bone scan with 99mTc-MDP has better quality in infants than in adults.

       
    2. (b)

      Bone scan with 99mTc-HDP has better quality in infants than in adults.

       
    3. (c)

      Bone scan with 99mTc-MDP has better quality in adults than in infants.

       
    4. (d)

      Bone scan with 99mTc-HDP has better quality in adults than in infants.

       
     
  57. 57.
    Which method is NOT indicated for the diagnosis of Osgood–Schlatter?
    1. (a)

      Bone scan

       
    2. (b)

      Radiography

       
    3. (c)

      Clinical examination

       
    4. (d)

      CT scan

       
     
  58. 58.
    An 8-year-old child with flank pain is referred for bone scan. Bone scan only shows an increase in uptake in L2, and the rest is normal. No lesion is observed in radiography. What is the next appropriate step?
    1. (a)

      Lumbar MRI

       
    2. (b)

      Lumbar CT scan

       
    3. (c)

      99mTc-WBC scan

       
    4. (d)

      Repeat of bone scan after 3 months

       
     
  59. 59.
    Effects of radiotherapy on bone scan:
    1. (a)

      Bone uptake decreases until 5 years after radiotherapy.

       
    2. (b)

      This effect has NO defined threshold.

       
    3. (c)

      An increased bone uptake can be observed immediately after radiotherapy.

       
    4. (d)

      The induction of bone necrosis is the mechanism of this effect.

       
     
  60. 60.
    Which of the following items is the least responsible for the diffuse hepatic uptake in bone scintigraphy with 99mTc-MDP?
    1. (a)

      Presence of free technetium in the radiopharmaceutical

       
    2. (b)

      Increase in aluminum in the eluted technetium generator

       
    3. (c)

      Formation of colloidal molecules in the prepared radiopharmaceutical

       
    4. (d)

      Presence of diffuse hepatic calcification

       
     
  61. 61.
    The spleen is NOT observed in hepatosplenic scintigraphy, but a diffuse uptake in the spleen is seen on bone scan. What is the most probable diagnosis?
    1. (a)

      Budd–Chiari syndrome

       
    2. (b)

      Cirrhosis

       
    3. (c)

      Malignant melanoma

       
    4. (d)

      Sickle cell anemia

       
     
  62. 62.
    Hot skull:
    1. (a)

      It is indicative of metastasis in patients suffering from cancer.

       
    2. (b)

      It is observed in patients suffering from lung and breast cancer but is NOT indicative of metastasis.

       
    3. (c)

      It is observed in renal osteoarthropathy.

       
    4. (d)

      b and c.

       
     
  63. 63.
    A child who was healthy until yesterday is referred for bone scan because of bone pain. A multifocal increase in uptake is observed on the scan. What is the most probable diagnosis?
    1. (a)

      Multiple bone metastases

       
    2. (b)

      Hematogenous osteomyelitis

       
    3. (c)

      Battered child

       
    4. (d)

      Multiple bone infarcts due to sickle cell anemia

       
     
  64. 64.
    Radiotracer uptake is observed in the stomach, lungs, and kidneys in addition to bones in the whole-body bone scan with 99mTc-MDP. What is the most probable diagnosis?
    1. (a)

      Histiocytosis

       
    2. (b)

      Myelofibrosis

       
    3. (c)

      Hyperparathyroidism

       
    4. (d)

      Hyperthyroidism

       
     
  65. 65.
    What is the flare phenomenon?
    1. (a)

      Improvement of scan pattern with a completely normal pattern of bone scan

       
    2. (b)

      Improvement of bone scan pattern with reduced number or intensity of regions with an increased uptake

       
    3. (c)

      Deterioration of bone scan pattern with the diffused involvement of the skeleton, with more concentration in the extremities, and the absence of kidneys

       
    4. (d)

      Deterioration of bone scan pattern with increased number or intensity of regions with an increased uptake

       
     
  66. 66.
    Which of the following conditions is NOT associated with the increase in bone turnover?
    1. (a)

      Hyperparathyroidism

       
    2. (b)

      Increase in growth hormone

       
    3. (c)

      Hypothyroidism

       
    4. (d)

      Increase in cortisol

       
     
  67. 67.
    In hypertrophic pulmonary osteoarthropathy (HPOA):
    1. (a)

      The symptoms disappear after treatment of the underlying disease.

       
    2. (b)

      The symptoms are always accompanied by the underlying disease.

       
    3. (c)

      Involvement of the bone marrow is the main pathologic finding.

       
    4. (d)

      A diffuse increase in uptake in the long bones is reported on the bone scan.

       
     
  68. 68.
    In the quantitative evaluation of the sacroiliac joint on bone scan:
    1. (a)

      The specificity of this test is high.

       
    2. (b)

      The accuracy of the test decreases if there is a concurrent involvement of the sacrum and sacroiliac joints.

       
    3. (c)

      The sensitivity of the test increases with the progression of the inflammatory lesions of the sacroiliac joints.

       
    4. (d)

      The relative activity of the sacroiliac joints to the sacrum joints normally increases with age.

       
     
  69. 69.
    Which item about the flare phenomenon is NOT correct?
    1. (a)

      It happens in the early months after the treatment of bone metastasis.

       
    2. (b)

      It usually occurs in hematological tumors.

       
    3. (c)

      Repeat of scan after 4–6 months shows improvement of lesions.

       
    4. (d)

      Clinical improvement is observed at this time.

       
     
  70. 70.
    Which of the following bone scan findings is associated with Tietze syndrome?
    1. (a)

      Increase in costochondral uptake

       
    2. (b)

      Decease in anterolateral costal uptake

       
    3. (c)

      Increase in costovertebral uptake

       
    4. (d)

      Decrease in costovertebral uptake

       
     
  71. 71.
    Hypertrophic osteoarthropathy (HOA):
    1. (a)

      Sarcoidosis and tuberculosis can be accompanied by HOA.

       
    2. (b)

      Involvement of the axial bones is reported.

       
    3. (c)

      It is observed only in abdominal and pulmonary malignant lesions.

       
    4. (d)

      The primary and idiopathic forms are more common in those aged >50 years.

       
     
  72. 72.
    Which of the following bone regions has the maximum radiotracer retention in those aged <15 months?
    1. (a)

      Physeal–metaphyseal region

       
    2. (b)

      Diaphyseal region

       
    3. (c)

      Metaphyseal region

       
    4. (d)

      Epiphyseal region

       
     
  73. 73.
    Bone SPECT scan:
    1. (a)

      It is valuable for the evaluation of cranial lesions and growth plate in children.

       
    2. (b)

      A full bladder can cause a false-positive increase in uptake in the hip and femoral head bones.

       
    3. (c)

      A significant uptake in the C1 cranial vertebrae is a normal variation.

       
    4. (d)

      The thoracic vertebrae have a lower uptake than the lumbar vertebrae.

       
     
  74. 74.
    In which of the following diseases is a four-phase bone scan indicated?
    1. (a)

      Malignant bone tumor

       
    2. (b)

      Sudeck’s atrophy

       
    3. (c)

      Bone fracture

       
    4. (d)

      Diabetic foot

       
     
  75. 75.
    What is the most common cause of appearance of cranial sutures on the bone scan of an adult subject?
    1. (a)

      Renal osteodystrophy

       
    2. (b)

      Paget’s disease

       
    3. (c)

      Fibrous dysplasia

       
    4. (d)

      Hyperparathyroidism

       
     
  76. 76.
    What are the bone scan and bone marrow scan patterns on the day after bone marrow infarction, respectively?
    1. (a)

      Decreased uptake, increased uptake

       
    2. (b)

      Increased uptake, decreased uptake

       
    3. (c)

      Decreased uptake, decreased uptake

       
    4. (d)

      Increased uptake, increased uptake

       
     
  77. 77.
    Which component of hydroxyapatite is replaced by 18F in the PET imaging of bones?
    1. (a)

      Calcium

       
    2. (b)

      Phosphate

       
    3. (c)

      Oxygen

       
    4. (d)

      Hydroxyl

       
     
  78. 78.
    A remarkable decrease in bone uptake is found on the bone scan. Which of the following diseases is NOT possible?
    1. (a)

      Aluminum toxicity in chronic renal failure

       
    2. (b)

      Osteoporosis

       
    3. (c)

      Treatment with etidronate disodium (EHTP)

       
    4. (d)

      Cirrhosis

       
     
  79. 79.
    Which of the following regions demonstrates an uptake on the bone scan due to recent chemotherapy?
    1. (a)

      Periarticular zone

       
    2. (b)

      Kidneys

       
    3. (c)

      Lungs

       
    4. (d)

      Liver

       
     
  80. 80.
    Which of the following regions demonstrates an uptake on the bone scan due to heterotopic calcification?
    1. (a)

      Liver

       
    2. (b)

      Periarticular zone

       
    3. (c)

      Lungs

       
    4. (d)

      Kidneys

       
     
  81. 81.
    Which of the following regions demonstrates an uptake on the bone scan due to vitamin D toxicity?
    1. (a)

      Periarticular zone

       
    2. (b)

      Kidneys

       
    3. (c)

      Lungs

       
    4. (d)

      Liver

       
     
  82. 82.
    Which of the following diseases is associated with the Mickey Mouse sign?
    1. (a)

      Renal osteodystrophy

       
    2. (b)

      Paget’s disease

       
    3. (c)

      Pulmonary hypertrophic osteoarthropathy

       
    4. (d)

      Humeral traumatic periostitis

       
     
  83. 83.
    Which of the following diseases is associated with Ringman’s lesion?
    1. (a)

      Renal osteodystrophy

       
    2. (b)

      Paget’s disease

       
    3. (c)

      Pulmonary hypertrophic osteoarthropathy

       
    4. (d)

      Humeral traumatic periostitis

       
     
  84. 84.
    Which of the following diseases is associated with the Lone Ranger sign?
    1. (a)

      Renal osteodystrophy

       
    2. (b)

      Paget’s disease

       
    3. (c)

      Pulmonary hypertrophic osteoarthropathy

       
    4. (d)

      Humeral traumatic periostitis

       
     
  85. 85.
    Which of the following diseases is associated with the tramline sign?
    1. (a)

      Renal osteodystrophy

       
    2. (b)

      Paget’s disease

       
    3. (c)

      Pulmonary hypertrophic osteoarthropathy

       
    4. (d)

      Humeral traumatic periostitis

       
     
  86. 86.
    All the following items regarding 18F-FDG-PET of bones are correct except:
    1. (a)

      Normal bones show a low uptake of 18F-FDG.

       
    2. (b)

      18F-FDG uptake in the vertebral body and the proximal femoral shaft is greater than that of other bones.

       
    3. (c)

      The uptake of 18f-FDG is directly related to MDP uptake.

       
    4. (d)

      Bone shaft and bone marrow uptake are equal.

       
     
  87. 87.
    In which of the following conditions is the diffuse increase in uptake in the calvarium NOT evident on bone scan?
    1. (a)

      Chemotherapy

       
    2. (b)

      Metabolic disorders

       
    3. (c)

      Elderly patients

       
    4. (d)

      Treatment with bisphosphonates

       
     
  88. 88.
    About vertebral tumors:
    1. (a)

      If the goal is to detect malignancy, the positive predictive value of an increased vertebral body uptake on bone SPECT scan is 43–50%.

       
    2. (b)

      An increased uptake in the posterolateral and anterolateral regions of the vertebral body is associated with the resolution of the vertebral body on the SPECT bone scan due to malignancy.

       
    3. (c)

      MRI is NOT a useful method for the detection of metastasis and epidural tumors with paravertebral involvement.

       
    4. (d)

      Vertebral hemangioma with a diameter of 3 cm can be observed as a decrease or an increase in uptake in SPECT.

       
     
  89. 89.
    In which of the following situations is a faint kidney sign observed on the 99mTc-MDP bone scan?
    1. (a)

      Renal obstructive disease

       
    2. (b)

      Diffuse bone metastasis

       
    3. (c)

      Diffuse osteoporosis

       
    4. (d)

      Pulmonary osteoarthropathy

       
     
  90. 90.
    What is the role of leptin in bone growth?
    1. (a)

      Stimulation of sympathetic activity and inhibition of osteoblastic activity with a central mechanism

       
    2. (b)

      Inhibition of ossification with a peripheral effect on growth cartilage

       
    3. (c)

      Decrease in bone growth with a decrease in thickness of the growth plate

       
    4. (d)

      Stimulation of the pre-osteoclastic activity and bone resorption

       
     
  91. 91.
    What is the main weakness of a bone scan?
    1. (a)

      High-radiation exposure when the patient is dehydrated

       
    2. (b)

      Hepatosplenic uptake if the MDP kit is exposed to oxygen

       
    3. (c)

      Low sensitivity

       
    4. (d)

      Non-specific

       
     
  92. 92.
    A bone scan is requested for a 49-year-old woman with a history of sarcoidosis to rule out the possible involvement of bone. Which bony regions are more likely to be involved?
    1. (a)

      Humerus

       
    2. (b)

      Phalanx bones of the feet and hands

       
    3. (c)

      Femurs

       
    4. (d)

      Ribs

       
     
  93. 93.
    What is the most common cause of skull sclerosis?
    1. (a)

      Paget’s disease

       
    2. (b)

      Hyperostosis frontalis interna (HFI)

       
    3. (c)

      Histiocytosis x

       
    4. (d)

      Craniopharyngioma

       
     
  94. 94.
    Which of the following conditions is associated with the pseudo-Charcot joint?
    1. (a)

      Hemochromatosis

       
    2. (b)

      Tabes dorsalis

       
    3. (c)

      Hemophilia

       
    4. (d)

      Calcium pyrophosphate deposition disease (CPPD)

       
     
  95. 95.
    A patient with a history of cirrhosis is presented with pain in the upper limb. Bone scintigraphy shows increased activity in the distal third of the radius and ulna bones. The patient’s radiograph also reveals a linear periosteal reaction in the same region. What is the most likely diagnosis?
    1. (a)

      Hypertrophic osteoarthropathy

       
    2. (b)

      Melorheostosis

       
    3. (c)

      Avascular necrosis

       
    4. (d)

      Venous stasis

       
     
  96. 96.
    Which of the following diseases is associated with osteoblastic changes?
    1. (a)

      Systemic mastocytosis

       
    2. (b)

      Whipple disease

       
    3. (c)

      Amyloidosis

       
    4. (d)

      Eosinophilic gastroenteropathy

       
     
  97. 97.
    A skeletal survey by scintigraphy is better than X-ray in all of the following diseases except:
    1. (a)

      Metastasis

       
    2. (b)

      Multiple myeloma

       
    3. (c)

      Stress fractures

       
    4. (d)

      Non-Hodgkin’s lymphomas (NHLs)

       
     
  98. 98.
    A focal cardiac uptake of the radiotracer on the bone scan is reported in all of the following situations except:
    1. (a)

      Hypercalcemia

       
    2. (b)

      Unstable angina

       
    3. (c)

      Pericarditis

       
    4. (d)

      Kawasaki disease

       
     
  99. 99.
    All of the following statements regarding the whole-body bone scan (WBBS) in amyloidosis are correct except:
    1. (a)

      WBBS is valuable in primary amyloidosis in plasma cell disorders.

       
    2. (b)

      99mTc-pyrophosphate is preferred over Tc-MDP.

       
    3. (c)

      Kidneys are observed in the WBBS of patients with amyloidosis.

       
    4. (d)

      Tc-MDP uptake may be observed in cardiac amyloidosis.

       
     
  100. 100.
    Which of the following complexes is capable of detecting lesions that do NOT appear on the MDP scan and demonstrates a very low uptake in normal bone and a highly intense uptake in lesions?
    1. (a)

      Dimethyl-amino-diphosphonate (DMAD)

       
    2. (b)

      Aminomethylenediphosphonic acid (AMDP)

       
    3. (c)

      Hydroxyethylidene diphosphonate (HEDP)

       
    4. (d)

      Hydroxymethylene diphosphonate (HMDP)

       
     
  101. 101.
    What is the most reliable method for the evaluation of bone tumors (especially size and therapeutic monitoring)?
    1. (a)

      Bone scan

       
    2. (b)

      Gallium scan

       
    3. (c)

      Thallium scan

       
    4. (d)

      MIBI scan

       
     
  102. 102.
    Which of the following items are advantages of hybrid PET/MRI in musculoskeletal malignancies?
    1. (a)

      High soft tissue contrast.

       
    2. (b)

      May reduce the overall imaging time (“one-stop shop”).

       
    3. (c)

      Advanced MRI sequences are suitable for multiparametric lesion characterization.

       
    4. (d)

      All of the above.

       
     
  103. 103.
    Which of the following statements about bone scan imaging is NOT correct?
    1. (a)

      Bone uptake generally reaches its peak in 2 h.

       
    2. (b)

      Upright position or sitting with bended spine is the best position for acquiring data on the lumbar spine.

       
    3. (c)

      The quantitative evaluation of activity has gained clinical acceptance for the evaluation of hip avascular necrosis or arthritis (ratio of the involved region to diaphysis).

       
    4. (d)

      The key point of the accumulation of the radiotracer in bone extracellular fluid is definitely the occlusion of the opening of microvascular pathways.

       
     
  104. 104.
    In which of the following regions is the pinhole collimator recommended for bone scan?
    1. (a)

      Frog-leg hip

       
    2. (b)

      Maximal internal rotation hip

       
    3. (c)

      Tarsal bones

       
    4. (d)

      All of the above

       
     
  105. 105.
    In which of the following items are the mechanisms of intraosseous and extraosseous uptake of the radiotracer similar?
    1. (a)

      Binding to tissue receptors

       
    2. (b)

      Precipitation of the calcium salts of the radiotracer in amorphous calcium phosphate (ACP)

       
    3. (c)

      Precipitation of the calcium salts of the radiotracer in myofibrils

       
    4. (d)

      Binding to collagen

       
     
  106. 106.
    Which part of the growth plate uptakes the bone radiotracer?
    1. (a)

      Resting

       
    2. (b)

      Proliferative

       
    3. (c)

      Hypertrophic

       
    4. (d)

      All of the above

       
     
  107. 107.
    In which of the following situations is the asymmetric uptake in growth plate or even the delayed appearance of the radiotracer in ossific centers reported?
    1. (a)

      Chronic renal failure

       
    2. (b)

      Long-term corton therapy

       
    3. (c)

      Radiotherapy

       
    4. (d)

      All of the above

       
     
  108. 108.
    Regarding the interpretation of a bone scan:
    1. (a)

      Medial femoral physis shows higher activity than lateral physis, and vice versa, for proximal tibial physis.

       
    2. (b)

      The bone scan pattern in a type V Salter–Harris fractures is an increased activity.

       
    3. (c)

      The intense accumulation of activity in sternoclavicular and acromioclavicular joints in adults is pathologic.

       
    4. (d)

      The prominence of the C1 vertebrae is a normal variant.

       
     
  109. 109.
    The differential diagnosis of a diffuse uptake along the entire calvarium includes:
    1. (a)

      Aging

       
    2. (b)

      Extensive chemotherapy

       
    3. (c)

      Metabolic disorders

       
    4. (d)

      All of the above

       
     
  110. 110.
    The differential diagnosis of thyroid uptake includes all of the following conditions except:
    1. (a)

      Poor labeling

       
    2. (b)

      Papillary thyroid cancer

       
    3. (c)

      Hyperthyroid state

       
    4. (d)

      Visceral metastatic calcification

       
     
  111. 111.
    What is the most identified and specific pattern of visceral metastatic calcification?
    1. (a)

      Gastric uptake

       
    2. (b)

      Lung uptake

       
    3. (c)

      Thyroid uptake

       
    4. (d)

      Colon uptake

       
     
  112. 112.
    The differential diagnosis of a hot kidney in a bone scan includes all of the following conditions except:
    1. (a)

      Administration of amphotericin B

       
    2. (b)

      Hyperkalemia

       
    3. (c)

      Myoglobinuria

       
    4. (d)

      Cirrhosis

       
     
  113. 113.
    What is the bone scan pattern in patients being treated with etidronate disodium (EHDP)?
    1. (a)

      Appearance of spleen on the bone scan

       
    2. (b)

      Hot kidney on the bone scan

       
    3. (c)

      Marked decrease of bone uptake

       
    4. (d)

      Marked increase of uptake of cranial sutures

       
     
  114. 114.
    Which of the following statements about radiotherapy and bone scan is NOT correct?
    1. (a)

      Regions of decreased uptake due to radiotherapy are the most common iatrogenic changes on bone scan.

       
    2. (b)

      Bone scan rarely shows decreased activity in regions receiving less than 30 Gy of radiation.

       
    3. (c)

      Decreased activity on bone scan appears 4–6 months after radiotherapy.

       
    4. (d)

      Decreased activity on bone scan may remain for 1.5 years.

       
     
  115. 115.
    Which of the following statements about radiotracer retention in the pyelocaliceal system on bone scan is NOT correct?
    1. (a)

      Pyelocaliceal retention is observed in more than 20% of cases of bone scans.

       
    2. (b)

      Pyelocaliceal retention in the supine position is NOT important.

       
    3. (c)

      In one study, only 2.1% of cases with pyelocaliceal retention have shown obstructive uropathy.

       
    4. (d)

      Furosemide administration can help in the diagnosis.

       
     
  116. 116.
    All of the following situations are included in the differential diagnosis of the focal renal uptake (often linear) on bone scan except:
    1. (a)

      Urinary retention

       
    2. (b)

      Administration of iron dextran V

       
    3. (c)

      Adrenal uptake of the radiotracer

       
    4. (d)

      Costal uptake of the radiotracer

       
     
  117. 117.
    All of the following findings are reported in limb paralysis except:
    1. (a)

      Marked increase in the axial skeleton uptake on bone scan

       
    2. (b)

      Increased uptake in the paralyzed zone on bone scan

       
    3. (c)

      Increased osteogenesis and bone resorption

       
    4. (d)

      Decreased osteogenesis and bone absorption

       
     
  118. 118.
    All of the following statements regarding the presentation of blood disorders on bone scan are correct except:
    1. (a)

      Femoral vein thrombosis can cause an extensive femoral uptake on bone scan.

       
    2. (b)

      Chronic vein insufficiency commonly causes a marked uptake on bone scan.

       
    3. (c)

      The appearance of the spleen on the bone scan of all patients suffering from sickle cell anemia is indicative of functional asplenia.

       
    4. (d)

      Only half of the patients suffering from sickle cell anemia in whom the spleen does NOT appear on bone scan demonstrate functional asplenia.

       
     
  119. 119.
    All of the following statements regarding the presentation of visceral metastatic calcification on bone scan are correct except:
    1. (a)

      A diffuse increase in uptake in different organs is commonly due to visceral metastatic calcification, which is usually associated with hypercalcemia.

       
    2. (b)

      Hypercalcemia may be due to hyperparathyroidism, and the severity of disorders in the primary form of the disease is greater than that in the secondary forms.

       
    3. (c)

      Different carcinomas, such as lymphoma and multiple myeloma, can become the primary pathologies.

       
    4. (d)

      It may be observed in the lungs, myocardium, kidneys, thyroid, liver, and spleen.

       
     
  120. 120.
    All of the following statements regarding breast uptake on bone scan are correct except:
    1. (a)

      90% of benign breast lesions are associated with the bilateral uptake of the bone radiotracer.

       
    2. (b)

      25% of malignant breast lesions are associated with the bilateral uptake of the bone radiotracer.

       
    3. (c)

      Further workup is required only for the unilateral breast uptake.

       
    4. (d)

      Further workup is required for both the unilateral and the bilateral breast uptake.

       
     
  121. 121.
    Which of the following types of metastasis is best demonstrated in FDG-PET?
    1. (a)

      Osteolytic lesion.

       
    2. (b)

      Osteoblastic lesion.

       
    3. (c)

      Both items are equally demonstrated.

       
    4. (d)

      Mostly osteoblastic lesion.

       
     

Suggested Readings

  1. 1.
    Ahmadzadehfar H, Biersack HJ, Freeman LM, Zuckier L. Clinical nuclear medicine. 2nd ed. Berlin: Springer; 2018.Google Scholar
  2. 2.
    Ell PJ, Gambhir SS. Nuclear medicine in clinical diagnosis and treatment. 3rd ed. Edinburgh, NY: Churchill Livingstone; 2004.Google Scholar
  3. 3.
    Sandler MP, Coleman RE, Patton JA, Wackers FJT, Gottschalk A. Diagnostic nuclear medicine. 4th ed. Philadelphia: Lippincott & Williams Wilkins; 2003.Google Scholar
  4. 4.
    Henkin RE. Nuclear medicine. 2nd ed. Philadelphia: Mosby Elsevier; 2006.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Majid Assadi
    • 1
  • Hojjat Ahmadzadehfar
    • 2
  • Hans-Jürgen Biersack
    • 3
  1. 1.Department of Nuclear MedicineBushehr University of Medical SciencesBushehrIran
  2. 2.Department of Nuclear MedicineUniversity Hospital BonnBonnGermany
  3. 3.Department of Nuclear MedicineUniverity Hospital BonnBonnGermany

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