HCT 6TH LE (pt.1)

diagnostic cytology

microscopic examination of cells from different body sites for diagnostic purposes

exfoliative cytology

fine needle aspiration

diagnostic cytology is divided into

exfoliative cytology

fine needle aspiration

body fluids

specimens for cytologic examination may be derived from

exfoliative cytology

deals with the microscopic study for cells that have been desquamated (sloughed off) from epithelial cells

FALSE: it is also observed in normal cells, but are more readily observed in malignancies

TRUE/FALSE: spontaneous exfoliation can only be observed in malignancies since the cells are undergoing an increased rate of growth and replacement

scraping

swabbing

aspiration

washing

specimens for exfoliative cytology may be obtained by

detection of:

malignancies

pre-cancerous cervical lesions

infectious agents;

assessment of female hormonal status

determination of genetic sex

exfoliative cytology is recommended for the following situations

barr body

a conglomeration of chromatin in the nuclei of females

female

barr bodies are only present in which gender

buccal or vaginal mucosa

barr bodies are demonstrated in smears from

FALSE: fresh specimen is used

TRUE/FALSE: smear preparation for exfoliative cytology makes use of preserved specimens

name

age

date

type of specimen

lab ID

appropriate labelling for exfoliative cytology consists of

95% ethanol

to preserve the fine structure of chromatin, thin preps for exfoliative cytology is immediately wet fixed in

not recommended

air drying is (recommended/not recommended) for cytological detection of neoplasia

recommended

air drying is (recommended/not recommended) for blood smears

recommended

air drying is (recommended/not recommended) for bone marrow smears

pre-invasive stage

cervical cancer be detected during the (pre-invasive/invasive/post-invasive) stage

endocervix and ectocervix mainly at the transformation zone

cells examined for papsmear/cervical cytology are obtained from

screening test

papsmear/cervical cytology is a (screening/diagnostic/confirmatory) test for cervical cancer

histologically

how is cervical cancer confirmed

1 day abstinence

avoid intravaginal preparations for 1 week

not collected during menstruation

patient preparation for papsmear

FALSE: papsmears collected during menstruation is contaminated by blood, endometrial content and tissue debris

TRUE/FALSE: papsmears should be collected during menstruation since more cells can be collected from the shedding of the endometrium

wooden spatula

cotton swab

cervical brush/cytobrush

instruments used to obtain specimen from the cervix for papsmears

vaginal speculum

inserted into the vagina to dilate it for the visualization of the cervix

dorsal lithotomy position

position of patient during specimen collection for papsmears

wooden spatula, it can collect more material because of its mildly rough surface

which is more preferable to use for specimen collection for papsmear: wooden/plastic spatula

endocervical brush

instrument used to obtain specimens exclusively from the endocervix

drying artifacts

loss of cells

reasons why cotton swabs are discouraged for papsmear specimen collection

FALSE: the smear will contain endocervical cells and blood

TRUE/FALSE: brush biopsies are recommended for pap smears since only endocervical cells are present in the smear

false negative

FALSE POSITIVE/NEGATIVE: excessively thick smear

false negative

FALSE POSITIVE/NEGATIVE: excessively thin smear

21 years old

when should girls start getting papsmears

every 3 years

from age 21-29 papsmears should be done during

30-65 y/o every 5 years

co testing for HPV together with papsmear should be done during

after 65 years old

papsmears are no longer recommended at this age

10

high grade dysplasia

20

papsmears are no longer recommended for women over 65 y/o granting adequate testing for ____ years prior and has not been treated for [disease] [duration] years prior

HIV seropositive women

immunosuppressed

women exposed to diethylstilbestrol (DES) in utero

papsmear testing should not be discontinued at 65 years old in these conditions

impression smear

this is often used for ulcerated surface lesions to allow immediate assessment of the lesion before fixation and processing

recommended

air drying is (recommended/not recommended) for impression smears

tumors of lymph nodes

impression smears are especially indicated in these types of tumors

3 consecutive mornings

when should sputum specimens should be collected

deep cough sputum

induced sputum

types of sputum specimens

saccamano fluid

preservative used for sputum

50% ethanol

2% carbowax

composition of saccamano fluid

induced sputum

specimen collected when the patient cannot produce a deep cough sputum

inhalation of aerosol solution

how is induced sputum obtained

20 minutes

how long should the patient inhale the aerosol solution to produce an induced sputum specimen

presence of mucus and alveolar macrophages

how will you differentiate sputum from saliva

bronchial washing

bronchial brushing

2 ways to obtain bronchoscopy specimens

FALSE: it is done by a bronchoscopy specialist at a bronchoscopy laboratory

TRUE/FALSE: bronchoscopy specimens may only be obtained by medical technologists who have obtained specialized training

spray

type of fixative used for bronchoscopy specimens (spray/immersion)

immediately

when should bronchoscopy specimen be fixed

air drying artifact

effects of delayed fixation in bronchoscopy specimens

bronchial brushing

type of bronchoscopy collection which makes use of a bronchoscope

bronchoscope

instrument used by a bronchoscopist to collect a sample of solid lesions for bronchial brushing

bronchial brushing

type of bronchoscopy collection wherein the actual sample is obtained

bronchial washing

type of bronchoscopy collection wherein an aspirate is obtained

1-2mL NaCl (saline)

what is used to rinse the airways in bronchial washing

glass suction apparatus

instrument used to collect specimens from bronchial washing

gastric juice

collection of gastric secretions/aspirates are difficult because of the presence of this substance

deleterious effect on the morphology of exfoliated cells

effect of gastric juices on cells

simple irrigation

aspiration technique

techniques used to obtain gastric secretions/aspirates

30 minutes

gastric secretions should be fixed within __________ to prevent digestion of cells

8 hour fasting

patient preparation for gastric secretions/aspirates

hormonal imbalance

what causes spontaneous breast discharge in young patients

TRUE

TRUE/FALSE: cytologic exam of nipple discharge has extremely low diagnostic yield for breast cancer

benign intraductal papilloma

bloody breast secretion may be considered clinically as

FALSE: lactation and immediate post-lactation period are exceptions

TRUE/FALSE: all breast discharge is considered abnormal

duct ectasia

papilloma

examples of benign breast lesions

benign breast lesions

endocrine problems

breast discharge could either be

subareolar area and nipple

area stripped by the thumb and forefinger for collection of breast secretions

pull up technique

performed when more than a drop of breast discharge is collected

95% isopropanol or spray fixative

fixative used for breast discharge

TRUE

TRUE/FALSE: if breast secretion is scanty, smears should be restricted to a small area

TRUE

TRUE/FALSE: localized breast lesions should be smeared directly on the slide

fine needle aspiration

study of cellular samples obtain from organs that do not shed cells spontaneously

fine needle aspiration

EXFOLIATIVE CYTOLOGY/FINE NEEDLE ASPIRATION: breast

superficial

SUPERFICIAL/DEEP LESIONS: breast

superficial

SUPERFICIAL/DEEP LESIONS: salivary gland

superficial

SUPERFICIAL/DEEP LESIONS: peripheral lymph nodes

superficial

SUPERFICIAL/DEEP LESIONS: thyroid

superficial

SUPERFICIAL/DEEP LESIONS: skin

superficial

SUPERFICIAL/DEEP LESIONS: subcutaneous soft tissue tumors

deep

SUPERFICIAL/DEEP LESIONS: lungs

deep

SUPERFICIAL/DEEP LESIONS: mediastinum

deep

SUPERFICIAL/DEEP LESIONS: liver

deep

SUPERFICIAL/DEEP LESIONS: pancreas

deep

SUPERFICIAL/DEEP LESIONS: kidneys

deep

SUPERFICIAL/DEEP LESIONS: adrenals

deep

SUPERFICIAL/DEEP LESIONS: lymph nodes

25 gauge

what is the gauge of the needle used for fine needle aspiration

10ml syringe

syringe used for fine needle aspiration

tissues composed of mesenchymal cells (connective tissue)

specimen from this type of tissue requires the use of needles with bigger bores as cells are tightly adhered and will not exfoliate easily

TRUE: to prevent shrinkage

TRUE/FALSE: specimens for fine needle aspiration should be air dried

laparoscopy

this is a minimally invasive procedure wherein very thin instruments are inserted into the skin with the guidance of a CT scan or ultra sound

tip of the needle

part of the syringe in fine needle aspiration which contains most of the diagnostic material

prep 4 slides

drop 1-2 drops of sample

slide pull technique

preserve w/ saccamano fluid

what is done when a bloody lesion is obtain in fine needle aspiration

body effusion specimen

in fine needle aspiration, blood lesions are processed the same way as this type of specimen

creamy consistency with numerous cells, small amount of tissue fluid, without blood

appearance of ideal aspirate for fine needle aspiration

aspiration

how are body fluids obtained for cytological investigation