Final Exam Review Based on Test Questions Flashcards
(134 cards)
1
Q
Autopsy provides material for
A
Teaching conferences
Research
Morbidity and mortality review
Residency Training
2
Q
Types of Autopsies
A
Complete Limited Infectious Non-infectious (Gross only is not a type of autopsy)
3
Q
Steps in external examination of the body
A
Photographs
Collection of physical evidence from the body
X-rays
(removal of the liver is not external, but internal)
4
Q
Autopsies provide information about the following to enhance graduate medical education
A
Causes of disease
Causes of accidents
Public health hazards
5
Q
The autopsy is the gold standard for:
A
quality assurance in assessing diagnostic accuracy and cause of death
6
Q
One thing an autopsy can provide to the family of the deceased is:
A
Certainty that everything medically possible was done for their loved one
7
Q
Only next of kin may:
A
request an autopsy
8
Q
All patient identifiers must be verified before:
A
an autopsy can be started
9
Q
Internal examination consists of:
A
inspecting the internal organs of the body
10
Q
Y and T are
A
incisions used during autopsies to examine the internal organs
11
Q
The less potassium in the eye:
A
the shorter the victim has been deceased
12
Q
The cardiovascular system is one of the systems examined in a:
A
complete autopsy
13
Q
A forensic autopsy benefits:
A
the investigation of suspicious deaths
14
Q
An external examination is:
A
An inspection of the physical outer layer of the body
15
Q
A medical autopsy determines
A
Why death occurred in cases where death is poorly understood by the medical team
16
Q
A medical examiner performs
A
autopsies
17
Q
Algor mortis
A
coolness of death
18
Q
Rigor mortis
A
Stiffness of death
19
Q
Vitreous humor
A
levels in the eye tell us how long the victim has been deceased
20
Q
Livor mortis
A
color of death
21
Q
En masse, Virchow, and En bloc are methods of
A
organ removal (during the internal examination)
22
Q
3 of the 5 categories of Forensic Autopsies
A
Homicide
Accident
Unknown
23
Q
EM sections must be
A
Able to withstand electron bombardment
Thin enough to allow passage of electrons while strong enough to hold the tissue together
24
Q
Ultra-thin sections are cut at
A
8-100NM (0.1uM)
25
Secondary fixative for EM to preserve lipids
osmium tetroxide
26
Electron staining has 2 types:
Positive where contrast is on the specimen itself
Negative in which the area around the specimen is electron opaque and the specimen is more translucent
27
Uranyl acetate and lead citrate
are used to stain EM specimens
28
most EM stains are
heavy metal salts
29
What is TEM?
Transmission electron microscopy
30
What is the main use of TEM?
Ultra-microscopic examination of tissue and cellular structures such as mitochondria in muscle biopsies and tubules in renal biopsies attained via bombardment of a specially fixed specimen with an electron beam
31
Compare and contrast EM embedding vs normal surgical specimens with 2 examples
Typical surgical specimens are dehydrated and then infiltrated with and embedded in paraffin where the technician can hold the specimen in place while the mold chills on the cryo-console to achieve proper specimen orientation
For EM specimens the tissue is dehydrated and then infiltrated with and embedded in a resin compound. The mold shapes are similar to bullets, rather than blocks, and hold the specimen in the proper orientation while the embedding media hardens and polymerizes over approximately 8 hours in a special oven
32
3 examples of embedding media
methacrylate
polyesters
epoxy resins
33
What is the superior EM embedding media?
Epoxy resins are considered superior because they polymerize both with themselves and reactive groups in the tissue specimens
34
Three criteria for TEM samples
The specimen must be thin enough to let some electrons pass through, the specimen must be free of water and other volatile compounds, and the specimen must be resistant to high heat and the vacuum necessary for electron bombardment to occur
35
Incomplete preservation of an EM sample can lead to:
Incorrect interpretations
36
In EM we want to observe the specimen as close to it's (blank) state as possible
Natural state
37
Infiltration and polymerization with resin for EM must be complete or:
sectioning will be impossible
38
dehydration is the?
removal of water to allow for infiltration and embedding
39
Osmium tetroxide is what kind of fixative?
Secondary, because it has a slow rate of fixation and does not penetrate very deep
40
Liquid resin replaces the organic solvent:
Infiltration
41
Water is exchanged for organic solvent in the tissue
Dehydration
42
Rapidly arresting cellular processes and cross-linking cellular structures to preserve their "normal" morphology
Fixation
43
Hardening of epoxy resin
Polymerization
44
Used to cut ultra-thin sections for EM
Diamond knife
45
used to cut thick sections for EM
Glass knife
46
Instrument used to cut thin sections of epoxy resin embedded tissue for EM
Ultra-microtome
47
GYN specimens include
Cervix
Endocervix
Vagina
(Not Prostate, which is genital but not gynecological)
48
NONGYNs are specimens:
not from the female genital tract
49
What can a cytotechnologist do, and not do with respect to NONGYNs?
CAN: initial screen on NONGYNs and forward to a pathologist for review
CANNOT: sign out a NONGYN case (must be done by a pathologist)
50
Cytology specimens aren't always sent:
fresh
51
PAP smear is a screen to detect
malignant cells in the endocervical canal
52
Cytology is
the microscopic evaluation of cellular material for disease diagnosis
53
A cell block is
a method of preparing cytology material to view as a histological specimen
54
A pre-fixative is only used for specimens that
are not delivered to the lab immediately (ex courier service from an offsite location)
55
Cytolyt is an additional solution used during NONGYN processing designed to:
Lyse red blood cells (extraneous undesired material)
Dissolve mucous
Preserve cells
56
Squamous cell abnormalities include
Inflammatory changes
HSIL or HGSIL (high grade squamous intraepithelial lesion) squamous cell carcinoma
ASC-US (atypical Squamous Cells of Undetermined significance
57
FNA fine needle aspirants:
A fixative should be used to increase te ability of cells to adhere to slides
58
Common types on NONGYN specimens
Urine
Bronchial washings
Cerebral spinal fluid
(Not stool)
59
Common smear preparations
Direct smears (nickel method)
Pull apart method for FNAs
centrifuge for sparsely cellular samples
60
Heparin is added to avoid clotting
body fluids: pleural, Ascites, peritoneal, pericardial (anything that could be bloody)
61
Prepared by smearing the samples in a circular motion onto a glass slide approximately the size of a nickel
Breast/nipple discharges
62
Do not add fixative to the specimen. Specimens should be refrigerated until they are sent to the lab
Bronchial, esophageal, and gastric washings
63
A pre-fixative holding solution is used if the specimen is not delivered to the lab right away. Alcoholic saline or saccomanno fluid may be used as holding solutions
Cerebral spinal fluid
64
First morning specimens are not recommended because the cells may be exposed to the acidic environment of the bladder during the night. Send fresh as they deteriorate quickly.
Urine
65
May send to the lab in a liquid based solution. May prepare 1-2 smears at the time of collection using the pull apart method. Slides need to be spray fixed immediately to prevent air drying of sample
Bronchial, esophageal, and gastric BRUSHINGS
66
Describe the difference between conventional PAP smear and non-conventional PAP
Conventional PAP uses a brush to collect cells and smear directly onto a slide. Non-conventional PAP uses a brush to collect cells then swirl them in a tube of holding solution or pre-fixative to make a more uniform thin-prep in the lab
67
Name the two types of non-conventional PAP methods and the two main differences between them
Thin-prep: brush with cells is swirled and removed from preservative. Sample is prepped using filtration.
Sure path: brush with cells is swirled and left in the preservative vial. Sample is prepped using sedimentation.
68
Name the 4 main components in PAP staining and what they are used for
Hematoxylin for nuclei
OG-6 for keratinized cells
EA counterstain differentiates types of cytoplasm
PTA (phosphotungstic acid) is a mordant for the counterstain
69
Describe the difference between Sacomanno and Alcoholic Saline
Saccomanno is made of 50% ethyl alcohol and carbowax
| Alcoholic saline is a 1:1 ratio of 50% ethyl alcohol and saline
70
Describe one method of making a cell block
Mix an adhesion substance with the cells such as agar or histogel to help clot the cells together and centrifuge into a button, which can then be submitted in a casette so the cells can be processed like a routine histology specimen
71
What does R.O.S.E. stand for?
Rapid on site evaluation
72
Give 2 examples of why a rose procedure is used
Why does it help the patient?
ROSE is used to assure that a sample contains the cells of interest, and to determine the adequacy of the sample for use in a diagnosis
This helps the patient because it gives quick feedback to the clinician or radiologist
73
What is a healthcare information system?
| Give 2 examples
A healthcare information system is used to store patient data and health records while reducing medical errors and increasing quality of patient care. One example is the EMR, an electronic medical record generated by physicians and other medical staff. A second example is a personal health record where a patient can view their medical history and test results, typically online
74
Give 2 benefits of an electronic procedure manual
An electronic procedure manual can be viewed by multiple technicians at the same time so you aren't restricted to one paper copy that everyone must share. Changes to the procedure are kept on file digitally and must be signed off by all of the appropriate supervisory parties in order to be implemented
75
Common functions of the LIS laboratory information system include:
Ordering and specimen tracking
QA
Billing
(Not notes from a patient office visit, that would go in an EMR)
76
Electric ordering improves:
efficiency
77
Required functionalities of an Anatomic Pathology LIS
Accession cases (unique identifiers)
Document embedding, cutting, and staining
Accept and maintain patient demographic data
Management reports
(Does not document prescription history for patients, this would be done by an EMR or EHR)
78
What does barcode tracking in an LIS allow? Give 2 examples
Barcode tracking creates check points to help decrease errors in the work flow.
This lets the manager know which technician performed each step in the processing of a patient's sample, which can improve troubleshooting at the human error level or help to identify malfunctioning equipment.
79
What does HIPAA stand for?
Health Information Portability and Accountability Act
80
What is HIPAA designed to do?
Meant to protect patents' personal health information (PHI)
81
How do LIS and EMR systems help accomplish HIPAA goals?
LIS and EMR systems can store patient information in an encrypted database and only make certain information available to hospital employees on a need-to-know basis depending on their job description. For example, the EHR would contain the pateint's home address and demographic information, but the home address wouldn't be included in the LIS viewed by histologists because it doesn't impact sample processing.
82
What are 3 functionality requirements unique to autopsy reports?
Whether the autopsy was under the jurisdiction of the coroner before being received by the hospital
How long the body was deceased before the autopsy was conducted
Who authorized the autopsy, such as next of kin
83
What is the difference between an LIS and and EMR
EMR focuses on vitals, test results, demographic data, and diagnoses
LIS is optimized for supply management and tracking of patient samples throughout the lab while tests are being performed in order to render a diagnosis. Ideally the LIS can interface with the EMR when necessary for effective and accurate transmission of patent data from technicians to clinicians and physicians
84
Excisions are used when
lesions are large
85
What type of biopsy is used to diagnose alopecia
Punch biopsy
86
Skin specimens for IF must be
Frozen (no formalin because it will auto-fluoresce)
87
What part of the tissue is examined in MOHS surgery
Only the margins
88
What is the basic principle of MOHS surgery?
MOHs is used to remove an already diagnosed tumor in layers where the tumor is sectioned by a histologist to check for clearance of all margins, and the procedure is typically completed in a single office visit
89
What biopsy is best for management of malignancies
Excision (the big one)
90
Describe 3 differences between handling a MOHS specimen vs a routine surgical dermatology specimen
MOHs are frozen, surgical are formalin fixed and paraffin embedded
MOHs examines only the margins not the center because the tumor has already been diagnosed
Surg path examines all of the tumor to render a diagnosis.
MOHs specimens are thrown away after the procedure, surg specimens are kept and archived
91
Excisions are performed for lesions that require:
complete removal
92
The tips of an excision are embedded
separately from the main body of the lesion
93
MOHs is performed for which cancer types
Melanoma in-situ
Basal cell carcinoma
Squamous cell carcinoma
94
Which types of biopsies should be inked?
all of them for orientation purposes
95
3 advantages of MOHs over traditional biopsy techniques
Highest cure rate
Minimizes removal of normal tissue/better cosmetic results
Procedure is typically completed in a single visit
96
Punch biopsies are always performed with
round disposable blades
97
Not all biopsies require closure with
suture
Typically excisions need it but punches and shaves don't
98
A shave biopsy should not be used on
pigmented lesions
has the potential to be a malignant melanoma
99
What percentage of margins are examined in a MOHs surgery?
100%
100
A punch biopsy must always penetrate the:
fat layer
101
Punch biopsies are bisected
horizontally or vertically
Horizontal is for alopecia
vertical is typically for everything else
102
What is the first thing to do when samples are recieved in lab
accession
103
how to properly handle forceps
wipe in between samples with gauze to prevent cross contamination of samples
104
Accession number on slides must match
accession number on order and casette
105
sub-optimal staining can be prevented by changing
HandE reagents at regular intervals
106
The cutting station and forceps must be:
cleaned in-between each specimen to prevent carryover and cross-contamination
107
The job of the grosser is to
paint an accurate picture of the whole specimen to help the pathologist render a correct diagnosis by combining macroscopic grossing information with microscopic histological information
108
3 things used to contain small biopsies
Why is this done?
Lens paper
Biopsy bags
Biopsy sponges
help to contain small biopsy specimens so they don't fall through holes in the cassettes used for processing. Can also help to keep multiple small pieces together
109
a surgical specimen sent to the lab without a requisition must be:
rejected
110
gross description must include:
What the specimen is and how it was submitted
111
the grosser must designate margins with:
ink, different colors help identify specimen orientation
112
grossing tools include
surgical blades and handles
cutting board
forceps
(not embedding molds, that comes after processing)
113
How many patient identifiers on a specimen?
At least 2
Name, medical record #, DOB
114
6mm skin biopsy requires bisecting to demonstrate
epidermis and dermis in cross section
115
clinical information and special instructions on the requisition
must be read before grossing the specimen
116
"in toto" on a gross description means
submitted in whole
117
skin sampling methods include
ellipse
shave
punch
(curetting is an endometrial scraping)
118
6 examples of information in a gross description
```
Tissue type
Size/dimension
Shape
Color
Texture
Consistency
```
119
6 components of handling a gross specimen
1. Rapid transfer from surgery to surg path or STAT diagnosis via frozens
2. Identification/accessioning of the specimen
3. Description of the specimen, such as orientation and inking
4. Do special studies such as molecular techniques need to be performed before handling the specimen?
5. Does the specimen need to be put in a special fixative?
6. Identify where the sections were taken with respect to the casettes submitted
120
information on the requisition and specimen container must
Match
121
What is a gross only specimen
| 2 examples
A specimen which is considered routine and generally unremarkable which would waste a significant amount of resources if fully processed for histology due to high rate of inicidence in the hospital workflow.
Placentas from uncomplicated births and tonsil removals fall into this category.
122
Indicators that evaluate the procedures for treating a patient specimen (testing procedure)
Analytic indicator
123
Specific indicators selected by the committee to include in the QM plan
Key Indicators
124
Measurable outcomes that affect patient care
Quality indicators
125
The determination of inter-laboratory testing performance by means of inter-laboratory comparisons
Proficiency testing
126
A system-wide program that stresses the interdependence of processes throughout an organization
Quality Management
127
Factors that evaluate the outcomes of patient care
Quality Assurance
128
Factors that are included in procedures to evaluate the uniformity of processes within the laboratory
Quality control
129
An indicator used to assess the proper handling of a specimen prior to testing
Pre-analytic indicator
130
Indicators that assess patient care after the rendered diagnosis
Post-analytic indicator
131
Meets regularly to examine information collected for each indicator (usually monthly or quarterly) depending on the size of the institution Must include a corrective action plan for any discrepancies. Evaluate the QM program annually to identify trends that impact patient care
QA committee
132
Examples of who may be included on a QA committee
Pathologists, residents, and technicians
133
Pre-analytic indicator
instances that occur before a specimen is tested. For example, whether the proper fixative is used in the operating room when collecting the specimen.
134
What should be included in a departmental QM plan for surgical pathology? 3 examples
Documentation of consultations with other departments when rendering a diagnosis. Documentation of any discrepancies between initial diagnosis and later findings such as gross description vs frozen section analysis. Documentation of which specimens require only a gross description rather than microscopic analysis.
