Clin Path

Question 1

lymphopenia

Answer 1

usually stress, can be acute inflammation

Question 2

mild normocytic, normochromic, non-regenerative anemia

Answer 2

anemia of chronic disease/inflammation, end stage renal disease

Question 3

selective hypoalbuminemia

Answer 3

hepatic failure, PLN, inflammation, less likely PLE

Question 4

hyperglobulinemia

Answer 4

dehydration, inflammation, neoplasia

Question 5

how can you rule out renal azotemia

Answer 5

USG>1.035 = concentrating urine well

Question 6

what electrolyte abnormalities are seen with urinary bladder rupture

Answer 6

low sodium, low chloride, high potassium

Question 7

hyperphosphatemia

Answer 7

decreased GFR from dehydration is by far most likely
in horses, may be diffuse intestinal dz

Question 8

decreased anion gap

Answer 8

not clinically significant, usually due to hypoalbuminemia

Question 9

elevated TCO2

Answer 9

metabolic alkalosis
can be compensatory for a respiratory acidosis or secondary to hypoalbuminemia

Question 10

hyperglobulinemia with hypoalbuminemia

Answer 10

inflammation

Question 11

hyperglycemia

Answer 11

glucocorticoid stress, epinephrine excitement, sepsis (may be high or low), diabetes mellitus

Question 12

elevated GGT

Answer 12

cholestasis (expect increased direct bilirubin), biliary hyperplasia, intestinal dz in horses

Question 13

elevated indirect bilirubin in horses

Answer 13

fasting/anorexia

Question 14

how do you calculate corrected chloride

Answer 14

(avg Na RI/measured Na) x measured CL

Question 15

hyponatremia and hypochloremia

Answer 15

volume overload, excessive water intake, hypertonic fluid loss (secretory diarrhea), hypotonic fluid loss (GI, renal, 3rd space)

Question 16

high anion gap

Answer 16

titrational metabolic acidosis (ketones, lactate, uremic acids, ethylene glycol)

Question 17

decreased TCO2

Answer 17

metabolic acidosis

Question 18

what is the cause of lactate formation

Answer 18

poor perfusion, hypovolemia, dehydration

Question 19

neutrophilia, monocytosis, lymphopenia, eosinopenia

Answer 19

stress leukogram

Question 20

hypercalcemia

Answer 20

neoplasia (lymphoma), idiopathic, hyperparathyroidism, addison’s (expect low Na, high K), renal disease, vitamin D toxicosis (expect high P), granulomatous inflammation, osteolysis

Question 21

what is PTHrP

Answer 21

parathyroid hormone related protein is the cause of a significant amount of hypercalcemia associated with malignancy

Question 22

how can ketosis be ruled out

Answer 22

no ketones on urinalysis

Question 23

describe a pure transudate

Answer 23

<2g/dL protein, <1500 cells/mL

Question 24

pure transudate differentials

Answer 24

PLN, PLE, liver failure, causes of modified transudate

Question 25

describe a modified transudate

Answer 25

>2g/dL protein, <5000 cells/mL

Question 26

modified transudate differentials

Answer 26

hypertension, heart failure, heartworm disease, lymphadenopathy, FIP, obstruction of Ca vena cava or hepatic vein, neoplasia, lung dz/torsion, diaphragmatic hernia, long standing transudates, many others

Question 27

describe a septic exudate

Answer 27

>2g/dL protein, >5000 cells/mL, degenerate neutrophils, infectious agents

Question 28

septic exudate differentials

Answer 28

pleuropneumonia, esophageal perf, GI perf or necrosis, ruptured bladder, penetrating wound, foreign body, hematogenous

Question 29

describe a sterile exudate

Answer 29

>2g/dL protein, >5000 cells/mL, non-degenerate neutrophils, no infectious agents

Question 30

sterile exudate differentials

Answer 30

anything that causes inflammation in body space; pancreatitis, enteritis, colitis, displaced organs/tissues, ruptured bladder, FIP, neoplasia

Question 31

describe a hemorrhagic effusion

Answer 31

>1,000,000 RBCs, erythrophagia, hemosiderin (brown and mostly in macrophages) on microscopic exam

Question 32

hemorrhagic effusion differentials

Answer 32

trauma, displaced organs/tissues, hemorrhaging neoplasms, coagulation disorders, idiopathic

Question 33

describe a chylous effusion

Answer 33

>2g/dL protein, triglycerides > 100mg/dL almost pathopneumonic, small lymphocytes

Question 34

chylous effusion differentials

Answer 34

idiopathic, trauma, heart dz (leading cause in cats), displaced organs/tissues, lymphadenopathy, neoplasms

Question 35

describe a urinary effusion

Answer 35

creatinine higher in effusive fluid than plasma

Question 36

urinary effusion differentials

Answer 36

uroliths, mucus plugs, trauma, neoplasm

Question 37

describe a biliary effusion

Answer 37

>2g/dL protein, >5000 cells/mL, bile (amorphous green/brown, extracellular and in macrophages) on microscopic exam, bilirubin higher in effusive fluid than plasma

Question 38

biliary effusion differentials

Answer 38

choleliths, mucocele, trauma, neoplasm

Question 39

describe a neoplastic effusion

Answer 39

neoplastic cells on microscopic exam

Question 40

eosinophilia

Answer 40

worms - heartworm, lung worms, ascarids, any worm with tissue migration of larval stages wheezes - asthma, allergy, hypersensitivity reaction weird diseases (moderate to severe elevation) - GI eosinophilic dz, hypereosinophilic syndrome, primary eosinophilic leukemia, paraneoplastic eosinophilia with mast cell or lymphoma

Question 41

what do changes in pH on blood gas indicate

Answer 41

primary acidemia (low) or alkalemia (high) compensatory processes cannot bring the pH back into normal range

Question 42

high PCO2

Answer 42

respiratory acidosis (CO2 is a resp acid)

Question 43

low PCO2

Answer 43

respiratory alkalosis (CO2 is a resp acid)

Question 44

what does TCO2 represent on bloodwork

Answer 44

bicarb

Question 45

low TCO2

Answer 45

metabolic acidosis

Question 46

low pH, low PCO2, low TCO2

Answer 46

primary metabolic acidosis with compensatory respiratory alkalosis

Question 47

high bicarb

Answer 47

metabolic alkalosis

Question 48

low bicarb

Answer 48

metabolic acidosis

Question 49

hypochloremia (relative to Na)

Answer 49

vomiting

Question 50

what acid/base abnormality occurs with true hypochloremia

Answer 50

to compensate for loss of Cl, bicarb increases, causing a metabolic alkalosis

Question 51

increased Cl with normal Na

Answer 51

Cl is increased in response to loss of bicarb in diarrhea = secretional metabolic acidosis

Question 52

what do you expect K to do with an acidosis

Answer 52

increase b/c it exits cells as H+ enters cells

Question 53

what do you expect K to do with an alkalosis

Answer 53

decrease b/c it enters cells as H+ exits cells

Question 54

mild thrombocytopenia

Answer 54

platelet clumping, splenic sequestration, infectious cause, drug reaction, DIC (would also see RBC fragments)

Question 55

mild hyperalbuminemia

Answer 55

dehydration

Question 56

severe anemia with mild reticulocytosis (inappropriate regeneration)

Answer 56

chronic low grade anemia with acute anemia OR something wrong with bone marrow so unable to produce adequate reticulocytes OR early anemia

Question 57

macrocytic, hypochromic anemia

Answer 57

regeneration

Question 58

microcytic, hypochromic anemia

Answer 58

iron deficiency

Question 59

acanthocytes

Answer 59

liver disease or erythrocyte fragmentation

Question 60

keratocytes

Answer 60

iron deficiency, liver disease, myelodysplastic syndrome, erythrocyte fragmentation

Question 61

schistocytes

Answer 61

erythrocyte fragmentation due to: severe iron deficiency, microangiopathic hemolytic anemia, myelofibrosis, heart failure, glomerulonephritis, lots of other things

Question 62

fragmented RBCs and thrombocytopenia

Answer 62

DIC or microvascular disease

Question 63

elevated ALT

Answer 63

hepatocellular injury (not uncommon with hypoxic injury to liver secondary to anemia)

Question 64

at what platelet count do we worry about spontaneous hemorrhage

Answer 64

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