Clinical Medicine

Question 1

Describe the components of the SPIKES framework for breaking bad news

Answer 1

• 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

Question 2

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

Answer 2

Flow cytometry

Question 3

Describe the NURSES pneumonic for responding to patient emotions

Answer 3

• 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)

Question 4

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

(aka immature)?

Answer 4

CD10+

Question 5

List 3 translocations that may be associated wtih Burkitt lymphoma

Answer 5

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

Question 6

Which method of cytogenetic analysis does not require dividing cells?

Answer 6

FISH

Question 7

Which hematopoietic malignancy usually has many genetic abnormalities?

Answer 7

B-lymphoblastic leukemia

Question 8

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?

Answer 8

Karyotype (chromosome analysis)

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

Question 9

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

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

Answer 9

c. RT-PCR

PCR is the most sensitive assay for determining minimal residual disease

Question 10

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

Answer 10

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

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