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DEP Paper 1 > General Procedures > Flashcards

General Procedures Flashcards

1
Q

What does MDT stand for?

A

Multi Disciplinary Team

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2
Q

Who attends MDT meetings?

A

Surgeons and advanced practitioners
Radiologists and radiographers
Pathologists
Oncologists
Cancer care nurses
Research nurses
MDT coordinators

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3
Q

What is the aim of MDT meetings?

A

To discuss the diagnosis and treatment for a patient. This will include the patient follow-up

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4
Q

What determines the block selection at dissection?

A

Clinical history
Specimen type
Orientation of specimen
Hollow/solid organ

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5
Q

How can clinical history influence block selection?

A

Incisional biopsies for alopecia
WLE for MM
Hard descended gall bladder for gall stones

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6
Q

How can Orientation alter block selections?

A

Punch biopsies for alopecia. In correct orientation can affect the dioagnosis
If trimming is required some information may be lost

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7
Q

How would you dissect a hollow organ?

A

Longitudinal margins en face x2
Tumour and relationship to organ
Radial margins if present
Background/normal tissue

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8
Q

How would you dissect a solid organ?

A

Tumour x2
Tumour in relation to the margins
Lymphatic/vascular/perinural invasion

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9
Q

What is the aim of Datasets and tissue pathways?

A

Standardise practices
Allows for statistical analysis of treatments
Ensure minimum standards
Ensure collection of relevant information for diagnosis
Are not rigid in obscure cases

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10
Q

What is the purpose of SOPs?

A

Ensures uniformity
Ensures correct procedures are performed
Standardised training

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11
Q

It is important to always keep SOPs…?

A

Up to date
Inline with datasets
For every type of procedure

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12
Q

What is important for competency documents?

A

UKAS requirement
Ensures everyone’s practice is current
Highlights areas for training

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13
Q

Why are photographs helpful in dissection?

A

Can be printed and annotated at dissection
Help during MDTs
Teaching purposes
For part of medicolegal cases
Allow Pathologists to see specimens if not at dissection
Record of appearance before the specimen is damaged and no longer fully visual

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14
Q

How can specimens be orientated for embedding?

A

Double agar embedding
Bags
Foam inserts in cassette
Metal inserts in cassette
Inking margins
Orange dots up

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15
Q

How does orientation at dissection help embedding?

A

Specimen shrinks during processing may be difficult to orientate
Specimen can twist/bend during processing so may be difficult
Speeds up the process making orientation easier

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16
Q

How can we prevent tissue loss during processing?

A

Sponges in cassette
Wrap the tissue
Tissue bags
Embed in agar first

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17
Q

How do you approach dissection of a random specimen?

A

Check pots and form for identifiers
Check pots and form for specimen type
Check pots and forms for orientation
Describe specimen type
Meansure/weigh
Orientate
Describe outer surface/appearance
Photograph
Ink margins
Slice perpendicular to surface
Describe cut surface/walls/inner surface/lumen
Measure lesions and margins
Select blocks
Trim if necessary
Wrap if necessary
Ink for orientation
Place in cassette and lid

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18
Q

How many identifiers should match on specimen form checks?

A

3

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19
Q

Give examples of patient identifiers?

A

Name
Date of birth
MRN (medical record number)
NHS number

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20
Q

Name 3 specimen types that require weighing?

A

Breast lumps
Parathyroids
TURPS

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21
Q

What can you use as descriptors in Macroscopic descriptions?

A

Colour
Shape
Contour
Size
Regular/irregular
Homogenous/heterogeneous
Effect (structures etc)

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22
Q

How do you measure a specimen?

A

Use SI units
Measure length, width and depth

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23
Q

Give examples of ways to Ink margins?

A

India ink
Alcian blue and water
Commercial marking dyes

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24
Q

Why do we mark margins?

A

Help with measuring
Help with orientation
Useful once specimen is cut smaller
Helps consultants
Helps if you need to return to a disected specimen
Helps embedders
Aid in evaluating the distance of a lesion from the margin/invasion
Distinguishes between margins and cut aurfaces

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25
Q

What is a margin?

A

A boundary of a specimen made by the surgeon cutting through something

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26
Q

What does an en face block demonstrate?

A

Show the entire margin of a specimen
Full face of specimen

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27
Q

What does a cruciate demonstrate?

A

Part of the margin.

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28
Q

What are the benefits and limitations of en face blocks?

A

Benefit
Shows all margins and the lesion in that plane and their relationship to each other
Allows for accurate measurements to be taken

Limitations
Only one plane
Mayneed to be a mega block with those limitations

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29
Q

What are the benefits and limitations of cruciate blocks?

A

Benefit
Can show the same margin at several points without trimming/cutting out
Small blocks benefit ancillary testing

Limitations
Only accurate for that point
Can lead to lots of blocks

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30
Q

What equipment is needed for dissection?

A

PPE
Extraction
Sharpes
Forcepts
Rulers/scales
Computer
Dictation devises
Inks
Disposable rolls
Cutting board
Ink/fixatives/brushes
Camera
Processor racks
Formalin
Tissue wraps
Cassettes/lids

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31
Q

What are the key points to describe in a Macroscopic description?

A

Location (Central/apex)
Appearance (nodule/ulceration)
Boarders (regular/irregular)
Surrounding tissue appearance
Photos/drawing
Medical terminology (lateral/superior)

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32
Q

What is the purpose of block IDs?

A

Record where the tissue comes from
Records the number of blocks for the dataset
Form part of the final report
Record if tissue is remaining

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33
Q

Why is it important to know if any tissue is remaining?

A

Helps if more information is needed from the specimen
Generates the specimen disposal lists
Important in PM cases as the coroner must record what is taken (Full paper trail for HTA)

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34
Q

How would you describe a hollow organ?

A

Length
Circumference
Wall thickness
Description of background serosa/mucosa
Length, width and thickness of tumour
Depth of invasion through wall
Distance from longitudinal margins
Distance from radial margins

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35
Q

How would you describe a bag like hollow organ?

A

3 perpendicular diameters
Wall thickness
Length and diameters of input tubes
Thickness of encasing soft tissue
Description of background serosa/mucosa
Length, width and thickness of tumour
Depth of invasion through the wall
Distance from longitudinal margins
Distance from radial margins

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36
Q

How would you describe a solid organ?

A

3 dimensions of organ +/- surrounding fat
Ink margins different colours
3 dimensions of tumour
Relationship to margins and anatomical structures
Sequencial slices
Sample tumour, +/- margins if close
Sample background

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37
Q

How can you prevent carry over?

A

Only deal with one sample at a time
Clean bench
Clean equipment
Clean between specimen and deep clean at end of the day

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38
Q

What are the implications of specimen carryover?

A

Can lead to upstaging of a diagnosis
Patients may receive treatments they do not need
Patient anxiety/stress
False positive results
Legal case

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39
Q

What should you be aware of if a fresh specimen is received?

A

Some sent for appraisal before fixation
May be for frozen section/electron microscopy/research

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40
Q

If a specimen is sent for electron microscopy how is it treated?

A

Specimen requires fixing in gluteraldehyde.
May need dissection first

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41
Q

What is a radial margin?

A

A margin that exists around the Circumference of an organ

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42
Q

What is a pedicle?

A

Connective tissue also containing vessels, lympatics and nerves that holds an organ in place within the body

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43
Q

Give 3 examples of where a pedicle can be found?

A

Spine
Brain
Attaching a skin tag to the body

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44
Q

What does TNM grades stand for?

A

Tumour
Nodes
Metastases

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45
Q

How is TNM staging determined?

A

By how far the tumour has spread through the organ/surrounding organs/Lymphatic spread/distal organs

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46
Q

What are the general sections of a hollow organ?

A

Mucosa
Submucosa
Muscularis propia
Serosa
Attached peritoneum/organs/connective tissue/ fat

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47
Q

How are the six sides of a solid organ referenced during dissection?

A

Superior
Inferior
Medial
Lateral
Anterior
Posterior

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48
Q

Are solid organs actually solid?

A

No they often have a network of spaces that relates to their function

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49
Q

Give 4 examples of a solid organ?

A

Kidney
Liver
Breast
Thyroid

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50
Q

Give 4 examples of a hollow organ?

A

Gall bladder
Bowel
Oesophagus
Fallopian tube

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51
Q

Give 13 examples of hazards in the lab?

A

Biological
Chemical
Radiation
Toxic
Flammable
Allergic
Carcinogenic
Electrical
Sharps
Mechanical (stainers/cover slipper)
Trip
Corosive
Manual lifting
Infection

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52
Q

Name 11 things that can help prevent hazards?

A

Good lighting
Good ventilation
Safety equipment
PPE
Disinfectants
Spillage kits
Training
Tracking/barcodes
No absorbant surfaces
Wipe clean surfaces
Only 1 specimen at a time

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53
Q

Name 20 things a dissection room should have?

A

Good lighting
Good ventilation
Non-absorbant wipe clean surfaces
PPE
Camera
Disposal bins
Different size knives
Forcepts
Rumlers
Scales
Quiet
Processor racks
Cassettes
Cassette lids
10% neutral buffered formalin
Sinks
Ink
brushes
Fixing spray
Absorbant cloths
Dictation device
Access to LIMS

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54
Q

What is a proforma?

A

A guide to Dictation that includes all the relevant details for a specific specimen
Aide memoir

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55
Q

What are the benegits/limitations to prformas?

A

Benefit
Promote standardisation
Ensure key information is included
Aide memoir

Limitation
Prevent free thicking
Help loose skill set

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56
Q

What types of genomic studies are there?

A

Cytogenetic
Biochemical
Molecular

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57
Q

What doez a cytogenetic study consider?

A

Entire chromosomes

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58
Q

What does a Biochemical study consider?

A

Proteins produces by the genes

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59
Q

What does a molecular study consider?

A

Mutations in DNA

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60
Q

What does a diagnostic study aim to do?

A

Diagnose disease

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61
Q

What does a predictive study aim to do?

A

Predict if the patient will suffer from a disease, a concern in hereditary conditions

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62
Q

What does a carrier testing study aim to do?

A

Access if the patient will pass on a disease

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63
Q

What does a pharmogenetic study aim to do?

A

Determine helpful medications or dosage

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64
Q

What does a prenatal study aim to do?

A

See if the fetus is likely to develop symptoms after birth

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65
Q

Give 2 examples of a diagnostic study?

A

Cystic fibrosis
Huntington’s disease

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66
Q

Give 2 examples of a predictive study?

A

BRAC 1 and 2

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67
Q

Give 2 examples of a carrier testing study?

A

Cystic fibrosis
Sickle cell anemia

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68
Q

Give 2 examples of a prenatal study?

A

Down syndrome
Trisomy 18 syndrome

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69
Q

What sample types can be involved in genetic testing?

A

Blood
Swabs
Amniocentesis
Chronic villus sampling
Curls from FFPE block

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70
Q

Give 2 examples iof a newborn screening study?

A

Sickle cell anemia
Hypothyroidism

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71
Q

What is the aim of newborn screening tests?

A

To test the baby’s DNA

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72
Q

What is the aim of preimplantation testing?

A

Test the embryo before in vitro fertilisation

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73
Q

What is bio-banking?

A

Storage of tissues/biological material or data in connection with the above

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74
Q

What must be in place before bio-banking can take place?

A

HTA licence
Patient consent (pending or given)

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75
Q

What are the benefits of bio-banking?

A

Increase research pools
Can be fixed or frozen, prolonging the life
Large pool can help understand genetic links to disease

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76
Q

What are the limitations of bio-banking?

A

Maintaining privacy is difficult
High cost (setting up and maintaining)
Difficult to encourage donations especially if the patient doesn’t see the benefits themselves

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77
Q

Name 6 intervention Al clinical trials

A

Pilot
Feasibility study
Prevention
Screening
Treatment
Multi arm multi stage

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78
Q

What is a pilot study?

A

Small version of the main study

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79
Q

What is a feasibility study?

A

To see if it will be possible to carry out the main study

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80
Q

What is a prevention study?

A

To see if the treatment can prevent the disease

81
Q

What is a screening study?

A

To test for early signs of the disease

82
Q

What is a treatment study?

A

Set in stages
Early stages look at side effects and safety
Late phases look at is treatment better than current practice

83
Q

What is a multi arm multi stage study?

A

Will have a control group and a treatment group

84
Q

Name 3 types of observational study?

A

Cohort
Case control
Cross sectional

85
Q

What are the 2 types of clinical trial?

A

Interventional
Observational

86
Q

How does a cohort clinical trail work?

A

Follows a group, usually disease free, overtime to identify risk factors

87
Q

What are the limitations of a cohort clinical trail?

A

Expensive
Time consuming

88
Q

How does a case control trial work?

A

Considers a group with a disease and a group without and considers risks and exposure

89
Q

What are the benefits and limitations of a case control clinical trial?

A

Benefit
Cheap

Limitations
Can be unreliable (relies on memory)

90
Q

What are the benefits and limitations of a criss sectional clinical trial?

A

Benefit
Only take a short period of time
Can identify causes and links

Limitations
Can be unreliable (often used to find initial cause/link and used to form the basis of the main study)

91
Q

What considerations are needed when dealing with high risk specimens?

A

Lots of viruses survived formalin
All specimens are potentially high risk
Specimens from IV drug users are high risk
Be aware, normal procedures are enough to protect
Leave for 24hrs
Do not process/dissect cat 4 specimens (ebola/haemorrhagic fever) send to specialist centres

92
Q

Give examples of communication within the lab?

A

Pathologist
Dissection assistant
Secretaries
Clinician/nurses

93
Q

How do you approach dissection?

A

Check bench is safe
Check branch is clean
Check required equipment is too hand
Check request form, specimen pot data
Record patient name, case number and specimen type
Check specimen is fixed
Check orientation
Describe and measure specimen
Photograph or draw
Ink
Follow procedures for specific specimen type or clinical information

94
Q

Name 3 techniques that can mark the tissue when dissecting

A

Ink margin in a single colour
Multiple ink colours to represent the orientation of the margins
Using seperate cassettes for different margins and note in the block ID
Orange dot to denote which side should be embedded downwards

95
Q

5 main purposes of tissue pathways

A

Standardised practices
Ensure diagnostic and prognostic information is recorded
Allows for consistent handling of specimens
Allows for clinical audits to be preformed
Promotes quality and evidences the practice

96
Q

What should a clinical history included?

A

Tissue type
Number of pots
Method of sampling
Clinical impressions
Orientation sutures
If specimen is high risk
If specimen is part of cancer pathway
Specific requests

97
Q

5 measures that can be used to audit dissection practice

A

Datasets/pathways
Comparison to department templates
SOPs
Comparisons of why EBs are taken
Questionnaires to colleagues/consultants/Secretaries

98
Q

4 criteria to accept a specimen at reception

A

At least 2 matching identifiers between pot and form
Appropriate pot
Appropriate fixative
Correct specimen type on pot and form

99
Q

What steps are taken when a specimen fails the acceptance criteria?

A

Phone the requestor/requestor explain error
Ask for them to attend the lab, identify the specimen and rectify the issue
Document all changes and staff details on request card and LIMS

100
Q

What must be documented as well as the Macroscopic description when dissecting a case?

A

Procedure type
Orientation
Specimen type
Inking guide
Block ID

101
Q

What should be included in the Macroscopic description?

A

Patient name
Unique identifier
Specimen type
Specimen location (left/right)
Orientation
Size
Weight
Outer surface description
Cut surface description
Description of lesion
Size of lesion
Margins from lesion
Invasion
Inking key
Block ID

102
Q

Why is fixation important?

A

Stops purification
Preserves tissue
Produces known artefacts that can be accounted for
Benefits ancillary testing

103
Q

How can clinical history influence block selection?

A

Suspicions - guides actions to aid in diagnosis eg MM levels at dissection
History - eg Fast growing extensive sampling
Type of specimen - eg inc bx would be handled differently from exc bx
High risk - leave in formalin for an additional 24hrs eg HIV
Cancer pathway - prioritise case eg endoscopic biopsies
Orientation - ink margins with different colours

104
Q

What are the principles behind gross examination?

A

Formal documentation of specimen
Measurement of the lesion
Opinion of the lesion
Can influence further surgery
Block selection
Record of atypical features
Allows audit of a surgeons practice

105
Q

What actions would you take if a specimen was partially dissected by a surgeon?

A

Describe findings
If possible sample arround altered tissue
If unable to exclude, sample and note as part of the block ID

106
Q

What are the advantages of a template for dissection?

A

Ensures inclusion of essential information
Standardises practices
Allows for additional information to be included
Training prompt

107
Q

What are the disadvantages of a template for dissection?

A

Reduction in lateral thinking
Encourages lazy descriptions
De-skilling
Free thinking decreases
Require surveillance and updating

108
Q

What does PMB stand for? And it’s clinical implications

A

Post menopausal bleeding
Common symptom in malignancy and not normal, requires investigation

109
Q

What does SLNB stand for? and it’s clinical implications?

A

Sentinel lymph node biopsy
First lymph node that drains the tumour site. Indicates metastatic spread

110
Q

What does RIF pain stand for? and it’s clinical implications?

A

Right iliac fossa pain
Can indicate appendicitis

111
Q

What does BBT stand for? and it’s clinical implications?

A

Basal body temp
If raised may indicate fever/infection

112
Q

What does MF stand for?

A

Myofibrosis

113
Q

What does CRSWP stand for?

A

Chronic rhinosinusitis with nasal polyps

114
Q

What does TAH BSO stand for? and it’s clinical implications?

A

Total abdominal hysterectomy and bilateral sphingoophectomy
Removal of cervix, uterus, both tubes and both ovaries

115
Q

Give examples of when residual tissue should not be kept at dissection.

A

Biopsies
Lymph nodes
Both all put through at dissection as important to sample it all.

Appendix when it looks healthy important to demonstrate entire specimen for hidden pathology

116
Q

How do you prevent carry over at dissection?

A

Clean bench, equipment, blades and cutting board
One specimen at a time
Wrap small/friable specimens

117
Q

What is the important of weighing some specimens?

A

Allows for assessment against normal ranges. Indicates how dense a specimen is. Enlarged by cyst is less dense than enlarged by cells
Part of dataset
Breast lumpectomy, needs to be 20g or below or biopsy is required first

118
Q

What do you do if tissue is missing at embedding?

A

Check embedding centre and surrounding areas incase specimen has flipped out.
Check all around cassette, processor racks and wax bath
Check processor and dissection bench
Note on LIMS and request form
Incident
If found embed seperately.
Explain to consultant and they can assess, same tissue type/ same pathology.
Clinician informed

119
Q

What does BXO stand for and what it’s the definition?

A

Blantis Xerotica Obliterans - chronic inflammatory condition that affects the male genitalia

120
Q

What does EMR stand for and what it’s the definition?

A

Endoscopic Mucossal Resection - removal of GI cancer and precancerous tissue using an endoscope

121
Q

What does BCC stand for and what it’s the definition?

A

Basal Cell Carcinoma - epithelial cancer that originates in the basal cells that lie in the deepest level of the epithelium

122
Q

What does UC stand for and what it’s the definition?

A

Ulcerative Colitis - inflammatory condition of the large bowel and rectum

123
Q

What does IBD stand for and what it’s the definition?

A

Inflammatory Bowel Disease - inflammation of the bowel that is longstanding and chronic

124
Q

What does MM stand for and what it’s the definition?

A

Malignant Melanoma - malignant tumour that originates in the melanocytes of the epidermis

125
Q

Give 3 examples of marking techniques used at dissection

A

Using one colour to mark the resection margin
Using multiple colours to identify different margins
Orange dot up to aid embedding
Different cassettes to distinguish the different parts

126
Q

If writing a dissection SOP, what needs to be included in order to comply with the recent ISO:15189 changes?

A
127
Q

If writing a dissection SOP, what needs to be included in order to comply with the recent ISO:15189 changes?

A

Purpose
Principle
Equipment required
Reagents
COSHH
Risk assessments especially to the patient
Staff responsibilities
References
Document control
Author
Authorisation
Location of copies

128
Q

What would you include in a dissection template?

A

Patient name
Case identifier
Nature of specimen as on pot
Specimen number
Orientation of specimen
Site of sample
Size of specimen +/- weight
Description outer surface
Description of inner/cut surface
Description of lesion
Size of lesion
Distance of lesion to margins

129
Q

What factors determine block selection?

A

Clinical history
Where a specimen is from
Orientation of a specimen
Specimen type (Inc, exc, punch)
Visual apperance

130
Q

What block selection would you use for hollow organs?

A

Resection margins en face
Lesion/tumour and the relationship to the organ
Any other pathology
Radial margins
Background tissue

131
Q

What block selection would you UAE for solid organs?

A

2 blocks of lesions/tumour
Tumour and their relationship to the margin (cruciate)
Lymphatic /vascukar/perinural invasion

132
Q

What is the aim of clinical history?

A

Gives clinical impressions
Guide best way to dissect inorder to best demonstrate
Examples : incisional biopsies for alopecia
Re-excisuon following melanoma

133
Q

What are the reasoning behind staff competency documents?

A

UKAS requirement
Ensure current practices are up to date
Reminds staff of key points that may not be encountered often

134
Q

What are the benefits of Macroscopic photographs?

A

Can be printed and annotated at dissection
A record that cab aid reporting or MDTs
Teaching aide
Form part of medicolegal cases
Helpful for Pathologists as they may never see the intact specimen

135
Q

What can be done to help orientate a specimen at embedding?

A

Double agar embedding
Tissue bags
Foam/metal inserts in the caasette
Inking margins
Orange dot up
Note for embedding sheet

136
Q

What is the point of orientation for embedding?

A

Allows embedded to embed the specimen so that they show the correct area of the specimen on the slide for consultants
Incorrect orientation could lead to loss of vital information that can mot be retrieved once trimmed. Eg alopecia

137
Q

What equipment is needed for dissection?

A

PPE (lab coat, apron, gloves, safety glasses/visor, spillage equipment)
Sharpes (knives various sizes, scissors)
Forceps
Ruler/scales
Computer/Dictation device
Ink/fixative/brushes
Blunt ended probe
Camera/pencil
Cutting board
Ventilation

138
Q

How are margin distances measured?

A

In SI units
Length, width, depth/height

139
Q

What counts as a margin?

A

Can be natural or acquired.
A boundary made by a surgeon cutting through the tissue
Surface that is preexisting as an outer part of the specimen

140
Q

Why do we ink margins?

A

Aids in the measurement microscopically
Aids in orientation
Aids in evaluating the relationship between the lesion, is further surgery required
Not always clear on the slide which is a cut at surgery or a cut at dissection.

141
Q

How can resection margins be demonstrated at dissection and what are their advantages or disadvantages?

A

En face
Shows the entire margin
Eg - ureter in kidney resection
Considerable limitations
Still not true due to trimming
Only a snap shot
One side if same lesion or seeding/skip lesion

longitudinally
Only shows part of the margin longitudinally, not all of it

cruciate
Only shows part of the margin longitudinally, but more than just longitudinal margin
Leads to more blocks, workload

142
Q

What must be included in a description?

A

Required information for datasets and tissue pathways
Tissue type
Tissue size
Orientation
Appearance

143
Q

How should lesions be described?

A

Location (Central, apex, marginal)
Appearance (nodule, ulcerated)
Boarders (regular, irregular, well circumscribed)
Surrounding tissue appearance
Photos, drawings if necessary
Medical terminology

144
Q

What is the purpose of a block ID?

A

Record of where the r tissue in a block is from
Record of the number of pieces taken
Part of the final report
May record the orientation
Record of tissue remaining

145
Q

Why is it important to know if there is retained tissue after dissection?

A

Part of the block ID
If more information is required let’s the consultant know if it’s available
Generates specimen disposal lists
Important in CP cases as a record is a legal requirement, HTA - audit trail

146
Q

How would you approach the dissection of a hollow organ?

A

Length
Circumference/diameter
Thickness of wall
Description of serosa, mucosa
Length, width and depth of tumour, pathology
Depth of invasion through the wall, accessory tissues
Distance from margins
Sequential slicing
Sample - margins, tumour, background

147
Q

What is the general anatomy of hollow organs?

A

Serosa
Muscularis propria
Submucosa
Mucosa

148
Q

How would describe bag hollow organs?

A

3 perpendicular lengths
Thickness of wall
Length and diameter of input tubes
Thickness of encassing soft tissue
Description of background serosa, mucosa
Thength, width and depth/height of lesion
Depth of invasion of wall, encassing soft tissue
Distance from margins

149
Q

How would you describe solid organs?

A

3 dimensions of organ
3 dimensions of surrounding soft tissue
Ink margins
3 dimensions and relationships to margins or architecture of any kesions
Sequential slices
Sample tumour, background and margins
The six sides can be referred to by the anatomical directions if orientated
If ducts, vessels and nerves are present they are all a margin for invasion
Lymph nodes also need processing

150
Q

What is a solid organ and examples?

A

Has no lumen other than any inlet/outlet tubes
May have a network of spaces

Kidney
Liver
Breast
Thyroid

151
Q

Give examples when a specimen would not be retained after dissection.

A

Biopsies - entire specimen processed
Lymph nodes - entire node sampled
Appendix when unremarkable - tissue pathway
Fallopian tubes, ovaries - prophylactic, risk reducing

152
Q

How can you reduce the risk of carry over?

A

Only deal with one specimen at a time
Clean bench, equipment are cleaned between specimens
End of the day thoroughly clean bench and equipment

153
Q

What are the implications of carry over between specimens?

A

Can lead to upstaging of diagnosis
Excessive or unnecessary treatment
Increased anxiety for patients and their families
Medicolegal cases

154
Q

Give examples of fresh specimens and how they are dealt with in the lab?

A

Rentals - in PBS. Small amount into glutaldehyde for up to 72hrs for electron microscopy

Placenta - initial assessment before fixation and routine processing

Frozen sections - frozen with the lab and rapid H&E. Allows for initial assessment and confirmation of tissue type whilst patient is still within surgery

Skins for immunoflourscence - frozen within the lab then stained for antibodies

155
Q

What does TNM stand for?

A

Tumour decided by size of tumour, relationship to adjacent organs. Decided by a combination of histology, radiology and clinical assessment

Nodes lymph node involvement

Metastases spread from initial organ to surrounding organs or regions

156
Q

What are the advantages and disadvantages of proforma?

A

Advantages
Promote standardisation
Ensure all key information is included

Disadvantages
Prevent free thinking
Allow loss of skill set
Do not fit all cases

157
Q

Name 10 hazards in the cut up room?

A

Biological
Chemical
Radiation
Toxic
Flammable
Allergic
Carcinogenic
Electrical
Sharps
Mechanical (equipment)
Trip
Corosive
Manual handling

158
Q

How can you prevent or reduce the risk of hazards?

A

Goods lighting
Ventilation
Safety equipment
Disinfectant
Spillage kits
Training
Tracking/barcodes
PPE
Non-absorbant surfaces
Wipe clean surfaces
Only one pot at a time

159
Q

What can genetic studies consider?

A

Cytogenetic - entire chromosome
Biochemical - proteins the genes produce
Molecular - mutations within the DNA

160
Q

What tissue can be used to test in genetic studies?

A

Blood
Cheek swabs
Aminioncentesis
Chronoinic villus sampling

161
Q

What types of genetic studies are there?

A

Preimplantation testing
Newborn testing
Diagnostic
Predictive
Carrier testing
Pharmogenetic
Prenatal

162
Q

What is the aim of preimplantation testing, give examples of these type of tests.

A

Testing the embryo before in vitro fertilisation

Huntington’s disease
Sickle cell anemia

163
Q

What is the aim of newborn screening, give examples of these type of tests.

A

Testing the fetus’ DNA

Sickle cell anemia
Congenital hypothyroidism

164
Q

What is the aim of genetic diagnostic testing, give examples of these type of tests.

A

To diagnose diseases

Cystic fibrosis
Huntington’s disease

165
Q

What is the aim of genetic predictive testing, give examples of these type of tests.

A

Used in cases where a family history is a concern

BRAC 1 and BRCA 2

166
Q

What is the aim of carrier testing, give examples of these type of tests.

A

Can a patient pass on a autosomal recessive disease

Sickle cell anemia
Cystic fibrosis

167
Q

What is the aim of pharmogenetic testing, give examples of these type of tests.

A

Determine medication dosages

Tamoxifen (breast cancer)
Abacavir (HIV)

168
Q

What is the aim of prenatal screening, give examples of these type of tests.

A

Testing during pregnancy

Down syndrome
Trisomy 18 syndrome (Edward’s syndrome)

169
Q

What is biobanking and what is required in order to do this?

A

Storage of tissues/biological material/data for future use

A HTA 2004 licence
Patient consent, can be stored without it as long as it is pending. If not given it must be disposed of

170
Q

What is the purpose of biobanking?

A

Research
Used to understand the genetic links to disease

171
Q

How are tissues transported for biobanking?

A

Fixed
I dry ice

Depends on research protocol

172
Q

What are the advantages and disadvantages of biobanking?

A

Advantages
Pools resources from different sites
Increased sample size
Can bring in geographical/ethnicity differences to form patterns
Increases statistical significance

Disadvantages
Maintaining privacy is difficult
High costs - set up and maintaining
Difficult to encourage donations - patients unlikely to see the result

173
Q

What forms of clinical trials are there?

A

Interventional
Observational

174
Q

What types of observational clinical trials are there?

A

Cohort
Case control
Cross sectional

175
Q

What do cohort clinical trials consider? Are there any advantages or disadvantages?

A

Follow a group, usually disease free, over time and attempt to establish risk factors

Expensive
Time consuming

176
Q

What do case control clinical trials consider? Are there any advantages or disadvantages?

A

A group with a disease and a disease free group. Look back at experiences and risks that connect to the disease

Quick
Cheap
Memory can be unreliable

177
Q

What do cross-sectional clinical trials consider? Are there any advantages or disadvantages?

A

Look at a short period of time to establish causes and links. Often used to find out initial data that can guide further studies

Cheap
Quick
Can be unreliable

178
Q

What type of interventional genetic studies are there?

A

Pilot
Prevention
Feasibility
Screening
Treatment
Multiarm

179
Q

What do pilot clinical trials consider? Are there any advantages or disadvantages?

A

Small versions of the main study. Pinpoints areas of interest

Not statistically relevant

180
Q

What do prevention clinical trials consider? Are there any advantages or disadvantages?

A

Can be treatment to prevent the disease

181
Q

What do Feasibility clinical trials consider? Are there any advantages or disadvantages?

A

Considers if the main study is possible. Same as a pilot study.

Can save money if not feasible
Small groups

182
Q

What do screening clinical trials consider? Are there any advantages or disadvantages?

A

Testing for early signs of the disease

Cheap
Can help prevent progression
Cheap
Aim to treat the patient when it’s likely to be more successful

183
Q

What do treatment clinical trials consider? Are there any advantages or disadvantages?

A

Carried out in phases. Early phase - considers safety and side affects. Late phase - if any improvement on current practice

184
Q

What do Multiarm clinical trials consider? Are there any advantages or disadvantages?

A

Multi stage trials with one control group. Other treatment groups change throughout the study

185
Q

How do you deal with high risk specimens?

A

All specimens are potentially high risk
Lots of viruses survive formalin
Specimens from IV drug users should be considered high risk
Normal processes are enough
Leave for an additional 24hrs
Never process/dissect/deal with category 4 specimens (Ebols Haemorrhagic fever, CJD) send to specialist centres

186
Q

During dissection, who do you communicate with?

A

Pathologista
Secretaries
Clinicials
Nurses
Dissection assistant

187
Q

How do you approach dissection?

A

Check bench is safe and clean
Check equipment is at hand, safe and clean
Check patient request form and specimen pot
Check specimen types and orientation are as expected
Check cassette and case/specimen number matches
Check clinical history
Record dictation verbally or written
Check fixation
Describe and measure specimen from the outside inwards
Follow specific procedure for specimen type and clinical information
Ink margins
Photograph, draw
Describe block ID
Record specimen pieces per cassette and if specimen is remaining

188
Q

Dissection rooms need…?

A

Good lighting
Clean/well organised
Quiet/few distractions
Downdraft ventilation
Running water/sinks
Processor racks
Cassettes and lids
Non-absorbant wipe surfaces
PPE
10% buffered formalin
Dictation device
Access to LIMS (history/results)
Sharps bins
First aid kit
Dissection bench
Spillage kit
Blunt ended probe
Camera
Ink and fixative
Brushes
Forceps
Cutting board
Scissors and knives of various sizes
Rulers/scales
Bins
Specimen storage
Absorbant cloths

189
Q

What key checks are required before beginning dissection?

A

Patient details on the pot and request form
Specimen type against the request form
At least 3 patient identifiers
Accurately enter case details onto LIMS and dictation

190
Q

What should you consider before dissecting a case?

A

Review the case to be dissected
? Urgent
? Scope of practice
Does it require opening
Analyse clin info, history
Is the specimen fixed adequately
Is the work area clean
Is the equipment clean and safe
Is the PPE maintained, right size
Do the patient, case details match

191
Q

What dissection equipment is needed?

A

Cutting board
Ruler/scales
Disposable knives, various sizes
Forceps
Blunt ended scissors
Blunt ended probe
Brushes
Ink
Fixative
Specimen wraps/bags

192
Q

What should you consider when opening a specimen?

A

It should be done in a manner that does not compromise block selection
Photographs/diagrams may be beneficial at dissection or reporting
Breast and thyroid need measurements taking and brief description before, as opening distorts the shape
Cysts may need a brief description making immediately upon opening as contents are lost if fluid.

193
Q

Important considerations of dictation?

A

Clear and concise
Ben eficial as stored and accessed later
An accurate record of description given
System must be robust
Information can be lost if devise breaks, also write vital information

194
Q

Who attend MDT meetings?

A

Surgeons
Advanced nurse practitioners
Radiologists
Radiographers
Pathologists
Oncologists
Nurses involved in patient care
Research nurses
MDT co-ordinators

195
Q

What is a MDT?

A

Multi departmental team meeting

All staff involved in a patients care meet together to discuss the results and possible patient pathway

196
Q

What types of cases are discussed at MDT?

A

Cancer disgnoses
Cases where results obtained in various departments vary. A conscious is required whether on a diagnosis or future tests
Difficult cases
Cases where the patient cannot underho the usual management and a new route is required, allows for assessment of the involved risks

197
Q

What do tissue marking dyes need to achieve and examples?

A

Permanent
Used for orientation or margins
Varied colours
Aid reporting and embedding
Distinguish between cuts made in surgery and those made at dissection
Ensure specimen is dry for optimal adhesion
Minimal tracking/penetration through the tissue

Indian ink
Alcian blue
TMD tissue marking dyes
Surface coating with starch

198
Q

What is the aim of histology?

A

Identify the tumour type based on tissue of origin or differentiation
Degree of differentiation grading
Extent of spread staging
Prognostic factors (eg - ER, PR status)

199
Q

What is the aim of histology?

A

Identify the tumour type based on tissue of origin or differentiation
Degree of differentiation grading
Extent of spread staging
Prognostic factors (eg - ER, PR status)

DEP Paper 1 (5 decks)

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