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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

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

40
Q

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

A

Specimen requires fixing in gluteraldehyde.
May need dissection first

41
Q

What is a radial margin?

A

A margin that exists around the Circumference of an organ

42
Q

What is a pedicle?

A

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

43
Q

Give 3 examples of where a pedicle can be found?

A

Spine
Brain
Attaching a skin tag to the body

44
Q

What does TNM grades stand for?

A

Tumour
Nodes
Metastases

45
Q

How is TNM staging determined?

A

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

46
Q

What are the general sections of a hollow organ?

A

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

47
Q

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

A

Superior
Inferior
Medial
Lateral
Anterior
Posterior

48
Q

Are solid organs actually solid?

A

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

49
Q

Give 4 examples of a solid organ?

A

Kidney
Liver
Breast
Thyroid

50
Q

Give 4 examples of a hollow organ?

A

Gall bladder
Bowel
Oesophagus
Fallopian tube

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

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

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

54
Q

What is a proforma?

A

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

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

56
Q

What types of genomic studies are there?

A

Cytogenetic
Biochemical
Molecular

57
Q

What doez a cytogenetic study consider?

A

Entire chromosomes

58
Q

What does a Biochemical study consider?

A

Proteins produces by the genes

59
Q

What does a molecular study consider?

A

Mutations in DNA

60
Q

What does a diagnostic study aim to do?

A

Diagnose disease

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

62
Q

What does a carrier testing study aim to do?

A

Access if the patient will pass on a disease

63
Q

What does a pharmogenetic study aim to do?

A

Determine helpful medications or dosage

64
Q

What does a prenatal study aim to do?

A

See if the fetus is likely to develop symptoms after birth

65
Q

Give 2 examples of a diagnostic study?

A

Cystic fibrosis
Huntington’s disease

66
Q

Give 2 examples of a predictive study?

A

BRAC 1 and 2

67
Q

Give 2 examples of a carrier testing study?

A

Cystic fibrosis
Sickle cell anemia

68
Q

Give 2 examples of a prenatal study?

A

Down syndrome
Trisomy 18 syndrome

69
Q

What sample types can be involved in genetic testing?

A

Blood
Swabs
Amniocentesis
Chronic villus sampling
Curls from FFPE block

70
Q

Give 2 examples iof a newborn screening study?

A

Sickle cell anemia
Hypothyroidism

71
Q

What is the aim of newborn screening tests?

A

To test the baby’s DNA

72
Q

What is the aim of preimplantation testing?

A

Test the embryo before in vitro fertilisation

73
Q

What is bio-banking?

A

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

74
Q

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

A

HTA licence
Patient consent (pending or given)

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

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

77
Q

Name 6 intervention Al clinical trials

A

Pilot
Feasibility study
Prevention
Screening
Treatment
Multi arm multi stage

78
Q

What is a pilot study?

A

Small version of the main study

79
Q

What is a feasibility study?

A

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

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

DEP Paper 1 (5 decks)

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