01 - serum chem

Question 1

4 ↑BUN

Answer 1

1. pre-renal (dehydration, ↓ CO, shock)
2. renal (↓GFR): inflam/degen/cancer/toxic
3. post-renal: urinary outflow obstruction
4. GI bleeding

Question 2

2 ↓BUN

Answer 2

1. ↓hepatic: shunt, ↓hepatic mass, anorexia
2. ↑urea excretion: PU/PD, diuresis

Question 3

↑ creatinine

Answer 3

1. ↓GFR (pre/renal/post)
2. ↑ muscle mass

Question 4

↓ creatinine

Answer 4

1. low BCS/muscle wasting

Question 5

5 ↑Phosphorus

Answer 5

1. ↓GFR (pre/renal/post)
2. hypoparathyroidism
3. ↑ intestinal absorption
4. osteolysis
5. normal bone growth

Question 6

7 ↓Phosphorus

Answer 6

1. ↑ renal excretion
2. anorexia
3. intestinal malabsorption
4. hypovitaminosis D
5. hypercalcemia of malignancy
6. 1° hyperparathyroidism
7. ↑insulin

Question 7

7 ↑ Calcium

Answer 7

1. malignancy
2. addison’s
3. 1° hyperPTH
4. osteolysis
5. granulomas
6. ↑ vit D
7. renal failure

Question 8

7 ↓ Calcium

Answer 8

1. ↓ albumin
2. renal failure
3. pancreatitis
4. hypoparathyroidism
5. EPI
6. malabsorption
7. ethylene glycol

Question 9

1 ↑ Magesium

Answer 9

1. ↓ GFR

Question 10

4 ↓ Magnesium

Answer 10

1. ↓ protein
2. diuresis
3. ↓ GI absorption
4. endocrine dz

Question 11

2 ↑ total protein

Answer 11

1. dehydration
2. hyperglobulinemia

Question 12

5 ↓ total protein

Answer 12

1. hemorrhage
2. ↓ albumin
3. liver failure
4. overhydration
5. starvation

Question 13

5 ↓ albumin/↓ globulin

Answer 13

1. overhydration
2. 3rd space
3. GI dz (PLE, maldigestion/absorption)
4. cutaneous (deep pyoderma/burns)
5. external blood loss

Question 14

1 ↓ albumin/normal globulin

Answer 14

1. PLN

Question 15

3 ↓ albumin/↑ globulins

Answer 15

1. inflammation
2. cancer: lymphoma/mult myeloma
3. liver failure

Question 16

1 ↑ albumin/↑↓ globulins

Answer 16

dehydration

Question 17

5 ↑ sodium

Answer 17

1. ↓ water intake
2. panting
3. vomiting
4. diarrhea
5. renal diuresis

Question 18

3 ↓ sodium (sub categories)

Answer 18

1. dilutional
2. loss of Na > water (diarrhea, renal dz, addisons)
3. loss of Na=water, replaced by water (hemorrhage, 3rd space loss, exudative skin lesions, diarrhea)

Question 19

chloride

Answer 19

moves with sodium
if not something acid/base

Question 20

4 ↑ potassium

Answer 20

1. ↑ intake
2. translocation: acidosis, ↓ insulin
3. acute renal failure
4. bladder rupture/outflow obstruction

Question 21

4 ↓ potassium (sub categories)

Question 22

1. loss in urine (CKD, postobstructive diuresis)
2. loss in GI (vomiting, diarrhea)
3. translocation: alkalemia, insulin
4. diet

Question 23

1 ↑ bicarbonate

Answer 23

1. loss of acid (GI or renal)

Question 24

2 ↓ bicarbonate

Answer 24

1. low albumin
2. ↑ cationic proteins (rare, gammopathy)

Question 25

3 ↑ T. Bili (sub)

Answer 25

1. pre-hepatic (cholestasis) 2. hepatic: anorexia, sepsis, lepto, ↓ liver fxn 3. post-hepatic cholestasis

Question 26

4 ↑ ALP

Answer 26

1. post-hepatic cholestasis 2. bone growth/disease 3. drugs: steroids/phenobarb 4. metabolic: DM, hyperT4

Question 27

3 ↑ GGT

Answer 27

1. post-hepatic cholestasis 2. biliary hyperplasia 3. drugs: steroids, phenobarb

Question 28

2 ↑ ALT (sub)

Answer 28

1. 1° liver dz (inflam/infectious, neoplastic, toxic, trauma, fatty) 2. 2° liver dz (↓ perfusion, post-hepatic cholestasis, pancreatitis, endocrine: DM, hyperT4)

Question 29

2 ↑ AST

Answer 29

1. +↑ ALT = hepatocellular dmg 2. +↑ CK = skeletal muscle dmg

Question 30

3 ↓ cholesterol

Answer 30

1. liver failure 2. addison's 3. PLE

Question 31

4 ↑ cholesterol (sub)

Answer 31

1. post-prandial 2. pancreatitis 3. post-hepatic cholestasis 4. endocrine (hypothyroidism, cushings, DM)

Question 32

4 ↑ glucose (sub)

Answer 32

1. post-prandial 2. pancreatitis 3. stress 4. endocrine: DM, Cushing's, hyperT4

Question 33

5 ↓ glucose

Answer 33

1. liver failure 2. sepsis 3. addison's 4. insulin overdose 5. paraneoplastic

Question 34

6 causes of regen anemia

Answer 34

1. IMHA 2. parasites (bartonella, babesia, cytauxzoon) 3. fragmentation (DIC, vasculitis, hemangiosarcoma) 4. copper tox 5. oxidative injury 6. blood loss

Question 35

5 non-regen anemia

Answer 35

1. chronic dz/inflammation 2. renal failure 3. endocrine (addisons, hypoT4) 4. aplastic anemia 5. myelodysplasia/fibrosis

Question 36

5 neutrophilia

Answer 36

1. inflammation (infectious or non) 2. corticosteroids (stress) 3. epinephrine (excitement) 4. neoplastic 5. IMHA

Question 37

3 neutropenia

Answer 37

1. inflammation (intense) 2. endotoxemia 3. decreased production (myelophthisis)

Question 38

3 lymphocytosis

Answer 38

1. inflammatory dz (esp infectious w/ antigenic stim) 2. neoplasia 3. addison's

Question 39

4 lymphopenia

Answer 39

1. glucocorticoids (stress) 2. acute inflam (esp viral) 3. disruption of lymphatic flow (chylothorax) 4. immunodeficiency

Question 40

monocytosis

Answer 40

pretty much same as neutrophils

Question 41

4 eosinophilia

Answer 41

1. allergies/hypersensitivity 2. parasites 3. addison's 4. paraneoplastic (mast cell)

Question 42

leukogram pattern for stress (neut, left shift, lympho, monocytes, toxic)

Answer 42

↑ no ↓ ↑ no

Question 43

leukogram pattern for mild/chronic inflammation (neut, left shift, lympho, monocytes, toxic) ↑↓

Answer 43

↑ +/- no/↓ ↑ no

Question 44

leukogram pattern for acute inflammation (neut, left shift, lympho, monocytes, toxic) ↑↓

Answer 44

↑ ↑ ↓ N/↑ usually

Question 45

leukogram pattern for overwhelming inflammation (neut, left shift, lympho, monocytes, toxic)

Answer 45

↓ ↑ ↓ normal yes

Question 46

what is a left shift? what is a degenerative left shift? indicating what?

Answer 46

band neutrophils over reference band neutrophil higher than mature neutrophil severe inflammation

Question 47

what qualifies as a regenerative anemia?

Answer 47

reticulocyte count above ref interval