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

What findings would you expect on digital rectal exam for a patient with BPH?

Answer 4

Enlarged, smooth contoured prostate

Hard nodule is concerning for prostate cancer

Question 5

Where would an inguinal vs. femoral hernia present?

Answer 5

Question 6

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

(aka immature)?

Answer 6

CD10+

Question 7

What findings would you expect on digital rectal exam for a patient with prostate cancer?

Answer 7

Hard nodule - may alter the contour of the gland

Question 8

What findings would you expect on digital rectal exam for a patient with acute prostatitis?

Answer 8

Warm, boggy, tender

Question 9

List 3 translocations that may be associated wtih Burkitt lymphoma

Answer 9

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 10

Which method of cytogenetic analysis does not require dividing cells?

Answer 10

FISH

Question 11

Which hematopoietic malignancy usually has many genetic abnormalities?

Answer 11

B-lymphoblastic leukemia

Question 12

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 12

Karyotype (chromosome analysis)

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

Question 13

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

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

Answer 13

c. RT-PCR

PCR is the most sensitive assay for determining minimal residual disease

Question 14

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

Answer 14

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

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