Clinical Medicine Flashcards
Describe the components of the SPIKES framework for breaking bad news
- 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
What diagnostic method is used to evaulate a tumor’s immunophenotype?
Flow cytometry
Describe the NURSES pneumonic for responding to patient emotions
- 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)
What findings would you expect on digital rectal exam for a patient with BPH?
Enlarged, smooth contoured prostate
Hard nodule is concerning for prostate cancer
Where would an inguinal vs. femoral hernia present?
Which marker indicates that a B-cell is from the germinal center
(aka immature)?
CD10+
What findings would you expect on digital rectal exam for a patient with prostate cancer?
Hard nodule - may alter the contour of the gland
What findings would you expect on digital rectal exam for a patient with acute prostatitis?
Warm, boggy, tender
List 3 translocations that may be associated wtih Burkitt lymphoma
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
Which method of cytogenetic analysis does not require dividing cells?
FISH
Which hematopoietic malignancy usually has many genetic abnormalities?
B-lymphoblastic leukemia
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?
Karyotype (chromosome analysis)
- Need specific probes for FISH and PCR*
- Disadvantages; requires dividing cells, limited resolution*
Which test is sensitve for post-treatment follow-up in a patient with CML?
- FISH
- Flow cytometry
- RT-PCR
c. RT-PCR
PCR is the most sensitive assay for determining minimal residual disease
What are the characteristics of acute promyelocytic leukemia on flow cytometry?
- Heavy granulation
- Many auer rods
- Bi-lobed nucleus
Clinical picture: relatively young pt (median = 44 years) who is bleeding (often intracranially)