Clinical Medicine Flashcards

1
Q

Describe the components of the SPIKES framework for breaking bad news

A
  • Setting
  • Perception
    • How much does the patinet know?
  • Invitation
    • How much does the patient want to know?
  • Knowledge
    • Share the news
  • Empathy
  • Summary and next steps
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2
Q

What diagnostic method is used to evaulate a tumor’s immunophenotype?

A

Flow cytometry

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3
Q

Describe the NURSES pneumonic for responding to patient emotions

A
  • Naming the emotion
    • I can see that you are upset/angry/shocked
  • Understanding/validating
    • But avoid saying that you understand how the patient is feeling unless you really do understand (have experienced the same situation
  • Respect
    • You have done an amazing job coping with such a horrible illness
  • Support
  • Explore the emotion
    • Can you say more about what makes you so angry?
  • Silence

These don’t have to be in order (vs. SPIKES, where it’s probably good to pick a setting before you share the knowledge)

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4
Q

What findings would you expect on digital rectal exam for a patient with BPH?

A

Enlarged, smooth contoured prostate

Hard nodule is concerning for prostate cancer

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5
Q

Where would an inguinal vs. femoral hernia present?

A
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6
Q

Which marker indicates that a B-cell is from the germinal center

(aka immature)?

A

CD10+

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7
Q

What findings would you expect on digital rectal exam for a patient with prostate cancer?

A

Hard nodule - may alter the contour of the gland

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8
Q

What findings would you expect on digital rectal exam for a patient with acute prostatitis?

A

Warm, boggy, tender

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9
Q

List 3 translocations that may be associated wtih Burkitt lymphoma

A

t(8;14)

t(2;8)

t(8;22)

Think Burk-eight lymphoma

Basically, any time an active promoter is moved in frot of the MYC gene on chromosome 8 we get constituitive expression of MYC -> burkitt lymphoma

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10
Q

Which method of cytogenetic analysis does not require dividing cells?

A

FISH

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11
Q

Which hematopoietic malignancy usually has many genetic abnormalities?

A

B-lymphoblastic leukemia

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12
Q

What is the best diagnostic method to use if you suspect a chromosome abnormality in a tumor but you don’t know exactly where to look?

A

Karyotype (chromosome analysis)

  • Need specific probes for FISH and PCR*
  • Disadvantages; requires dividing cells, limited resolution*
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13
Q

Which test is sensitve for post-treatment follow-up in a patient with CML?

  1. FISH
  2. Flow cytometry
  3. RT-PCR
A

c. RT-PCR

PCR is the most sensitive assay for determining minimal residual disease

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14
Q

What are the characteristics of acute promyelocytic leukemia on flow cytometry?

A
  • Heavy granulation
  • Many auer rods
  • Bi-lobed nucleus

Clinical picture: relatively young pt (median = 44 years) who is bleeding (often intracranially)

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