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AT 1
| Question | Answer |
|---|---|
| study of the cellular morphology of tissue | histology |
| what does post mortem dissection of a body determine? | cause of death and create record of anatomic findings |
| if a patient has a clinical history of mycosis fungoides/sezary syndrome, what test needs to be performed? | lymphoma protocol |
| how should tissue be received for lymphoma protocol? | fresh |
| what 5 things need to be checked when you receive a specimen? | requisition, container, block/cassette, lid of container, and clinical history |
| what type of organs must be weighed? | solid |
| how to determine the surgical margin? | where the surgeon cut |
| to observe genetic alterations in cells, done for inherited disease, infectious disease, and cancer | molecular genetics |
| how is molecular genetics submitted? | fresh tissue, frozen in a -70 degree freezer |
| to determine what microbe may be causing infection, done for skin infection, bone infection, and/or rule out infection | microbiology |
| how must a specimen be submitted for micro? | sterile swab, Seale collection tube, and submit to micro lab with proper orders/requisition |
| detects, identifies, and counts specific cells or components within cells based on physical characteristics and/or antigens on cell surface, done for disease such as lymphoma | flow cytometry |
| how to submit flow cytometry? | tissue in RPMI |
| what is RPMI considered? | culture medium or transport medium |
| Branch of genetics that studies the structure of DNA within the cell nucleus done for genetic disease and/or cancer | cytogenetics |
| how to submit cytogenetics? | fresh tissue, then submit in RPMI |
| localizes antigen-antibody complexes in tissue, done for a number of inflammatory autoimmune disease | immunofloresence |
| How to submit immunofloresence? | michels |
| what is michels considered? | transport media |
| done to visualize tissue ultrastructure and kidney disease | electron microscopy |
| how is electron microscopy submitted? | glutaraladehyde |
| what does CA-125 test for? | ovarian and colon cancer |
| what is the proper fixation volume ratio? | 1:15-20 |
| What is ammonia used for in stain lines? | bluing for hematoxylin |
| slides are milky or hazy when placed in xylene during staining. what is the problem, and how can it be fixed? | dip in xylene |
| what are some limitation of frozen section procedure? | freeze spray, crystals, bone, time, sample error, pathologist, lack consult, lack special studies |
| what is the 1st node invaded by cancer called? | sentinel node |
| what is the main protein of connective tissue? | collagen |
| what does mesothelium make up? | pleura, pericardium, peritoneum |
| what is it called if cancer has not crossed the basement membrane | carcinoma in situ |
| mesichymal cancer considered as? | sarcoma |
| ganglion cells absent from submucosal and myenteric plexus | Hirschsprung disease |
| how does Barrett esophagus form? | length of esophagus, # of years GERD present, and presence of bile in gastric juice |
| what type of stain is performed on liver cores? | iron, Prussian blue |
| what 7 things make up the lymphoma protocol? | touch prep, squash prep, flow cytometry, zinc formalin, formalin for light microscopy, snap freeze for DNA/rna extraction, cytogenetics |
| for lymphoma protocols, what will the lymphoma do and the epithelial cells do? | disassociate into single cells and clump up |
| what does not work for Hodgkins lymphoma? | IHC, light microscopy |
| not for DNA extraction, can impair immunostains, and a hazardous material that requires special handling | cytology |
| what is an AUB? | abnormal uterine bleed |
| sample of biopsy dictation | this is joshlyn dictating case ... for patient (last, fist, DOB) received in formalin labeled .. the tissue is approximatly (measurement) and (color). specimen submitted in block.. |
| one specimen in cassette, how do you submit. measurement? | highest number first ex. 10cmx8cmx6cm |
| if more than 1 piece of tissue submitted in 1 cassette, how do you dictate measurement? | small to largest specimen with largest number first to smallest number |
| Gross exam and surg path only cpt code? | 88300 |
| Appendix, fallopian tube, finger, toe, foreskin, hernia, nerve, skin, testis, vas defrens CPT code? | 88302 |
| Abortion, abscess, aneurysm, bone, cyst, cornea, gallbladder, hematoma, hemorrhoids, vertebral disc, joint, lipoma, vein, T&A, polyp, sinus cpt code? | 88304 |
| right lung weight male | 475g |
| right lung weight female | 455g |
| left lung weight male | 375g |
| left lung weight female | 402g |
| liver weight | 1650g |
| pancreas weight male | 143g |
| pancreas weight female | 122g |
| combined kidney weight male | 313g |
| combined kidney weight female | 288g |
| 1 male adrenal gland weight | 9.7g |
| 1 female adrenal gland weight | 8.3g |
| parathyroid combined weight | .12-.18g |
| pituitary weight 10-20 years of life | .56g |
| pituitary weight 21 years-life | .61g |
| pituitary weight in pregnancy | .95g |
| thyroid weight in males | 25g |
| thyroid weight in females | 18g |
| how much does 1 testes weigh? | 25g |
| prostate weight 20-30 years of life | 15g |
| prostate weight 31-50 years of life | 20g |
| prostate weight 51-80 years of life | 40g |
| nullipara of uterus weight | 35g |
| 1 ovary weight | 5-8g |
| nullipara of uterus weight after pregnancy | 110g |
| thymus weight 6-25 years of life | 25g |
| thymus weight 26-35 years of life | 20g |
| thymus weight 36-65 years of life | 16g |
| thymus weight 66 years to life | 6g |
| spleen 16-20 years of life weight | 170g |
| spleen weight 21-65 years of life | 155g |
| spleen weight 80 years to life | 100g |
| male brain weight | 1400g |
| female brain weight | 1275g |
| pineal gland weight | .2g |
| spinal chord weight | 27g |
| ring shaped | annular |
| covered with small rounded eminences | bosselated |
| containing calcium | calcific |
| containing hollow spaces within a structure | cavity |
| occupying the entire outer edge or border of a lumen | circumferentially |
| limited to space | circumscribed |
| having spherically depressed surface | concave |
| running together | confluent |
| two structures touching along a boundary or point | contiguous |
| column like tube like | cylindrical |
| extremely soft or mushy | diffluent |
| raised | elevated |
| a symmetrical oval | elliptical |
| lengthened from the usual form | elongated |
| wearing away | eroding |
| hollowed out, forming a depression | excavating or excavated |
| abrasive surface | excoriated |
| outgrowth from a surface | excrescence |
| oozing of fluids | exudative |
| having openings | fenestrated |
| having a disagreeable odor | fetid |
| containing acellular refractile fibrin | fibrinoid, fibrinous |
| covered with long thread like structures | filamentous |
| not yielding easily under pressure | firm |
| occurring in a particular area | focal |
| growing along a surface | fungating |
| necrosis followed by putrefaction | gangrenous |
| coagulum of fluid mass, semi solid | gelatinous |
| smooth, shiny | glassy |
| sparkling, shining, and gleaming | glistening |
| spherical | globular |
| on a surface, sand like, finely roughened | granular |
| lumpy, clotted | grumose |
| uniform in structure or composition | homogenous |
| hardened when it is normally soft | indurated |
| the ability to break through barriers | invasive |
| lip like | labial |
| irregular tears | lacerated |
| space within a tubular structure | lumen |
| thin, transparent, pliable, lining or covering | membranous |
| discolored areas | mottled |
| of, relating to, resembling, or contain mucin | mucinous |
| any of a group of mucoproteins that are found in various human and animal secretions and tissues and that are white or yellowish powders when dry and viscid when moist | mucin |
| a viscid slippery secretion that is usually rich in mucin and is produced by mucous membranes which it moistens and protects | mucus |
| many, several | multiple |
| mucoid, mucus like | myxoid |
| dead tissue | necrotic |
| large bumps or masses | nodular |
| cloudy or non transparent | opaque |
| bone like | ossified |
| having to do with the eye lid | palpebral |
| finger like projections | papillary |
| on a stalk | pedunculated |
| having a visible color | pigmented |
| prominence beyond a surface | protuberant |
| patches of purple discoloration from extravasation of blood into the skin and mucous membranes | purpuric |
| diffusely roughened sometimes with defects, it looks like someone chewed on it | ragged |
| gritty | sabulous |
| divided into parts | segmental |
| shaggy | scabrous |
| isolated or away from a normal position shut off from other parts or systems | sequestered |
| divided by fibrous walls | septate |
| attached by a broad base | sessile |
| snake like looping | serpiginous |
| saw like notches | serrated |
| intercellular edema of epidermis | spongiosis |
| adhesive, sticky | tenacious |
| not clear but light passes through | translucent |
| light passes through clearly | transparent |
| a break in skin or mucous membrane with loss of surface tissue disintegration and necrosis of epithelial tissue and often pus | ulcer, ulcerated |
| integrated different colors and streaks | varigated |
| soft with a thick pile or surface | velvety |
| wart like | verrucoid |
| small fluid sacs | vesicular |
| sticky, tenacious | viscid |
| any internal organ within a cavity | viscus |
| more than one | multiple |
| worm shaped often in reference to appendix | vermiform |
| blister like lesion | vesicle |
| areas of previous surgery or injury that have healed to a normal state | well healed |
| concentric rings or a curled spiraled focus | whorled |
| thick walled thickened muscle bundles chronic obstruction | trabecular |
| blue, common mucin stain | alcian blue |
| purple black stain used to stain beta cells in the pancreas, elastic fibers, mast cells, and pituitary granules | aldehyde fuchsin |
| red blue stain, used for endothelial tissue | alkaline phosphate |
| black stain used for neural plaques and tangles, Alzheimer | bielshowsky stain |
| red stain typical for staining amyloid fibers | congo red |
| violet stain, glia and cell body of neurons | crystal violet |
| pink orange red typical for general staining when combined with hematoxylin, cytoplasm | eosin |
| black pink or red stains, melanin and neuroendocrine cells | fontana masson |
| blue violet pink stain commonly used in blood or bone marrow smears, nucleic acid stain | geisma |
| blue purple stain standard for general staining when combined with eosin | hematoxylin |
| purple black stain can stain, mast cells and elastin | luna stain |
| blue stains the rough endoplasmic reticulum in neurons | nissl |
| red magenta used to stain glycogen basement membranes, reticular fibers cartilage, glycoproteins glycolipids and mucins in tissue, crypotcoccus | periodic acid schiff PAS |
| red used to stain fat emboli | red oil 3 |
| blue black stain reticular fibers | reticulin stain |
| brown black stain myelin tissue | Sudan black |
| blue stains mast cell granules | toluidine blue |
| red blue yellow used to stain collagen | van gieson |
| a substance or tissue element usually acidic in nature that is easily stained with basic dye | basophilic |
| a substance or tissue element usually basic in nature that is easily stained with acid dyes | acidophilic |
| the specific chemical grouping that bestows the property of a color on a compound | chromophore |
| having a positive electrical charge attracted to the negative electrode in electrolysis or electrophoresis | cationic |
| having a negative electrical charge which attracts cations to a positive electrode in an electrolytic cell | anionic |
| a regent used to link a stain to a tissue | mordant |
| # of patient identifiers for specimens | 2 |
| what are acceptable patient identifiers | full name, MRN, and DOB |
| list parameters for proper transport of specimens and steps to avoid drying of tissue that are not immediately placed in formalin at the time of collection | wrap solid tissue in gauze to put into container and add formalin |
| additional information needed for test to ensure accurate and timely results specific patient, relevant to specimen | clinical history |
| time measured form when blood supply was cut off to when tumor was excised by surgeon | warm ischemic time |
| time from when tissue was excised to when it was placed in fixative | cold ischemic time |
| time from when tissue collected in OR to when it is received in path lab for processing | transport time |
| warm and cold ischemic and transport time specimen held before putting into cassette, time tissue spends in cassette, and fixation time on processor | total fixation time |
| recommended fixation time for breast specimens ER/PR Her2neu | 6-72 hours |
| why is it important to avoid thermal injury in tissue | caused by medical driven instrument driven by heat, cautery creating artifacts affecting diagnosis |
| why is it important to avoid crush injury in tissue | before tissue is fixed, and most fragile creating artifacts and affecting diagnosis |
| a process used to track the movement and control of an asset through its lifecycle by documenting each person and organization who handles an asset, the date/time it was collected or transferred, and the purpose of the transfer. | chain of custody |
| 2 methods of chain of custody for specimens | • The external chain of custody initiated at the collection site to record Sample’s custody from collection to the delivery to the Laboratory • The Laboratory Internal Chain of Custody from Sample receipt to disposal. |
| why would a specimen get rejected? | wrong name, site, identifiers, state of specimens |
| 6 quality assurance parameters for acceptable specimens | sample label, requisition, specimen container, type and volume fixation, transport packing, temp method, and special instruction |
| 2 practices suggested to avoid error in specimen accessioning | don't accession like specimens back to back, separate specimen by size, only have 1 specimen out inferno of you |
| injuries that were caused by medical management/staff and are unrelated to patient illness | adverse event |
| failure for medical task to be completed as planned, following wrong plan to achieve aim | medical error |
| error that caused permanent, short term, or life threatening harm | serious error |
| error that causes impermanent and non life threatening harm | minor error |
| error with potential to cause harm that did not because of chance or timely intervention | near miss |
| Tissue section has lots of round clear holes seen on microscopy. Cause and solution? | Excess fluid in tissue causes holes in tissue due to ice crystal artifact. Dry off tissue prior to embedding, Tissue that arrives in lab in saline” prominent ice crystal artifact, Amount of time tissue is submerged , Allow tissue to sit on paper towel a |
| Perpendicular lines or scratches are visible on the cut sections cause and solution? | Blade is dull or nicked Use a new blade (or new part of the blade) • Blade is wider than the OCT block – move blade to side and use an area of the blade that is sharp • Make sure blade is locked down tightly after changing • Change or move blade if yo |
| Tissue won’t cut at all, no matter what I do cause and solution? | No blade in the microtome • Solution: Put in a blade • Make sure the sharp part of the blade faces towards the chuck |
| Tissue thickness is very inconsistent cause and solution? | Something is loose • Check entire cryostat (specimen holder, microtome) to ensure that everything is locked down tight |
| Tissue folds up and sticks to microtome stage cause and solution? | 1) warm cryostat, 2) warm tissue, 3) dirty stage • Check chamber temperatures and make liberal use of freezing spray • Carefuly) clean cryostat stage with gauze (always wipe parallel to blade edge, keep fingers away from blade) |
| Horizontal “chatter” in tissue when cutting cause and solution? | 1) Tissue too cold, 2) turning handle at inconsistent speed • Solution: • Warm tissue on chuck with thumb • Turn handle at consistent speed when cutting frozen • Try again |
| Holes developing in tissue when sectioning cause and solution? | 1) fatty tissue, 2) clotted blood, 3) necrosis, 4) gaps between tissue and OCT • Seal any gaps between tissue and OCT by “spackling” • Add extra OCT to frozen tissue on chuck • Hold freezing block against fresh OCT to freeze • Face block |
| fungal infection stain | GMS |
| collagen, fibers stain | massons trichome |
| Define the relationship of formaldehyde and formalin in relation to pathology. | Formalin is used in pathology- it’s formaldehyde gas dissolved in water. 10% formalin is used which is 3.7% formaldehyde |
| List the uses of formalin. | Tissue fixative, produce “killed vaccines”, cosmetics, embalming agent, disinfectant |
| Recite the limits for airborne exposure to formalin for 8 hours and 15 minute intervals. | 8 hour exposure limit: 0.75 ppm 8 hour action level: 0.5 ppm 15 minute exposure limit: 2 ppm |
| List the Spill Classifications and how to properly handle each occurrence. | Minimal, less than 10 ml: paper towels Small, 10ml-1L: clear room, locate formalin spill kit, use proper PPE (gown, gloves [thick rubber ones in spill kit], shoe covers, eye protection), use towels and vermiculite to contain spill, apply absorb-f to spil |
| Recite the variables that effect the rate of formaldehyde gas formation from formalin solution. | Surface area, temperature, ambient humidity |
| Describe the proper post-exposure actions if there is formalin exposure to eyes. | Flush eyes for 15 mins at eyewash station; if corneal injury seek medical attention |
| Describe the proper post-exposure actions if there is formalin exposure to the skin. | Remove clothing or PPE from contaminated area, wash area with soap and water, seek medical attention if rash/skin irritation occurs |
| List the proper steps to help identify a clear fluid that comes in with no label indicating what it is. | Histology can perform test with schiff’s reagent. Liquid will turn bright pink if aldehyde is present/is formalin; little to no reaction will be seen if not. |
| Should be stored in clean, organized and well ventilated area. | • specimen set-up, post accessioning |
| Follow site specific documentation. Should be kept in labeled container at room temp unless there is delay. Then refrigerate. | • immediate gross exam specimens |
| Containers should be sealed and assembled in orderly fashion with cassettes and paperwork readily available. | • specimens in fixative |
| Residual tisssue is processed into paraffin for comparison with frozen section interpretation. | • frozen section/intraoperative consultation |
| List the important operation procedures for H&E staining in intra-operative consultation. | Reagents to be used (concentration and vol), staining schedule for each staining program, rotation or change schedule for reagents, disposal and/or recycle process for reagents. |
| List the adequate facility requirement guidelines for gross examination and specimen storage. | Should have adequate lighting, ventilation with formalin levels being assessed yearly, photographic equipment, dictation system, access to an anatomic path lab information system, access to diagnostic imaging PACS system if in hospital. |
| List two parameters required for the dissection, description, and histologic sampling of complex specimens. | Ensures proper microscopic eval for specimens dissection and histologic sectioning, app parameters of CAP cancer checklists can be assessed by pathologist |
| List the important procedure policies that must be in place regarding radioactive specimens. | Should be a policy regarding specimens with low (lymph nodes) and high radioactivity (implant devices). Handling, storage and disposal should also be covered. |
| Discuss the parameters for a policy regarding specimens exempt from submission to pathology and give examples. | Should be approved by staff/committee. Examples are prosthetic Devices, tonsils and add adenoids in children below a certain age, foreskin in children, varicose veins, Cataracs and pannus |
| Define, briefly, the Safe Medical Devices Act of 1990 (an acceptable medical or govt. reference provided- Wikipedia is NEVER acceptable). | Policy for handling specimens that are unlabeled, have no requisition, unfixed/unrefrigerated for extended period, contaminated container. |
| Define "time of retention" for surgical specimens. | Minimum of two weeks after results reported before disposal. |
| List the seven parameters for tissue sections for histologic examination, for small biopsies, and for larger tissues. | Sample should be 3-4 mm thin, small enough to fit in cassette and allow space for fluids to pass through, bloody or friable tissue should be wrapped, all samples flat and within the same plane, specialized embedding instructions should be documented. |
| List the 5 requirements for slide identification. | Specimen accession number,block identifier, slide level number, patient name, stain identifier |
| cell type, peritoneum, vascular endothelium | simple squamous |
| cell type, has microvilli, proximal convulated tubule, and collecting tubule of kidney | simple cuboidal |
| cell type, microvilli small intestine, surface cilia fallopian tube, psuedostratified respiratory tract, goblet cell small and large bowel, and sterocilia vas defrens | simple columnar |
| cell type, oral cavity, keritinzation epidermis of skin | stratified squamous |
| cell type, exocrine gland ducts | stratified cuboidal |
| cell type, bladder | stratified transitional |
| what is missing in Hirschsprung disease? | mesenteric plexus auebach, submuccous plexus meissner |
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