Clinical examination of patient with pathology

Question 1

Types of palpation?

Answer 1

Digital- use of a single finger
bidigital- finger and thumb of same hand
bimanual- fingers and thumb each hand simultaneous
Bilateral- both hands same time on corresponding structure on opposite side of body.

Question 2

Guidelines for lymph node palpation characteristics:

1. soft, tender, movable is?
2. hard or fixed, non-tender, movable or fixed

Answer 2

1. acute inflammation or infection

2. maliganancy or chonric infection

Question 3

Describe:
Flat lesions: 1. Macule size?
2. Patch?
Elevated lesion: 3. Papule size?
4. Plaque?
5. Nodule?
6. Tumour
Fluid filled: 7. vesicle?
8. Bulla?

Answer 3

1. <10mm/1cm
2. > 10mm/1cm
3. <5mm height
4. diameter>thickness
5. > 5mm height
6. any swelling >2cm
7. <5mm
8. > 5mm

Question 4

5 Types of biopsies? Important!

Answer 4

1. Smear biopsy (candida albicans)
2. core biopsy (thicker kind of needle they get a core of tissue cylinder)
3. Fine need aspiration (aspirate fluid from cells)
4. Incisional biopsy (cut into the lesion)
5. Excisional biopsy (excise the entire lesion)

Question 5

Special stains:

1. TB?
2. syphilus?

Answer 5

1. Ziehl Neelson

2. Wartin starry syphilus

Question 6

Give the armamentarium of a smear biopsy:

Answer 6

PPE, pencil, clean microscope sclides, paper towel, cell harvesting instrument (wood or metal spatula), histological/cytological request form.

Question 7

Process of taking a smear biopsy!

Answer 7

• label clean microscope slides with pencil
• place slides on paper towel
• prep the tissue: no wiping/drying, wet gauze to gently clean excessive debris/slough
• harvesting cells: scrape wet spatula over lesion/mucosa in 1 direction and pick scrapings up.
• preparing the smear: spread evenly and thinly over empty slide and allow to air dry.
• Complete request form and submit specimen

Question 8

Name 2 aids to help determine biopsy site

Answer 8

Toludine blue

velscope

Question 9

Give the method of using toluidine blue.

Answer 9

Rinse 20s with 1% acetic acid to clean area
20s with plain water
60s with 1% toluidine blue solution
20s 1% acetic acid
20s water

Question 10

Give the method of using velscope.

Answer 10

Tissues are illuminated with light, normal tissue appears apple green fluorescence and diseased tissue shows loss of fluoresense.