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Clin Path > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What can increase your red cell concentration? (Causes for hemoconcentration and redistribution)

A

Hemoconcentration: dehydration (H2O loss) and fluid shifts
redistribution: excitement, exercise

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2
Q

What are the two ways to have polycythemia? (Neither are actual answers, think more like permanent or nonpermanent)

A

Relative and absolute

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3
Q

What are the two causes of absolute polycythemia?

A

Increased erythropoietin and primary (polycythemia vera)

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4
Q

Give two examples of increased erythropoietin?

A

– Appropriate (chronic hypoxia (increased erythropoietin))

– Inappropriate (EPO secretion, renal cysts, tumors)

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5
Q

What can cause primary polycythemia?

A

Myeloproliferative disorders

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6
Q

Define leukemia.

A

Presence of neoplastic cells in peripheral blood and/or bone marrow or spleen

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7
Q

How do you diagnose leukemia?

A

Finding characteristic cell in blood/bone marrow/other organs and/or associated hematologic abnormalities.

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8
Q

What are the four ways to traditionally identify cell types?

A

– Morphologic appearance
– cytochemical staining properties
– electron microscopic appearance
– monoclonal anti-body binding antigens

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9
Q

What are the three classifications of leukemia and what would you see with each?

A

– leukemic leukemia: neoplastic cells are in circulation
– subleukemic leukemia: some blasts are in circulation but not a lot
– aleukemic leukemia: bone marrow is full of neoplastic cells, but they aren’t being released

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10
Q

True or false: Acute leukemias survival time is usually longer than chronic leukemias.

A

False: acute leukemias survival time is usually short.

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11
Q

Which of the following is WRONG about chronic leukemias?
A. it has immature neoplastic cells (blasts)
B. “mature” well differentiated cells predominate.
C. Patient survival time is usually long.

A

A. it has immature neoplastic cells (blasts)

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12
Q

Where are your neoplastic cells? (5)

A

Blood, bone marrow (usually), spleen (maybe), liver, lymph nodes.

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13
Q

What is the name associated with neoplasms of lymphocytes and plasma cells?

A

Lymphoproliferative disorders

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14
Q

What is the name associated with neoplasms arising from bone marrow stem cells and involve neutrophils, monocytes, erythrocytes, and rarely eosinophils and basophils?

A

Myeloproliferative disorders

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15
Q

What are the two general categories that lymphoproliferative disorders split into?

A

– B or T or other cell neoplastic processes

– specific B-cell neoplastic process plasma cell differentiation

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16
Q

What are the two categories that B or T or other cell neoplastic processes split into?(22/1)

A

– lymphosarcoma or lymphoma

– lymphocytic leukemia

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17
Q

Look at slide 23/1

A

.

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18
Q

What percentage of dogs that present with multicentric lymphoma are leukemic?
What percentage of dogs with acute lymphoblastic leukemia will have lymphadenopathy? (Slide 24/1)

A

65%

50%

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19
Q

What are the CBC abnormalities associated with acute lymphoblastic leukemia (ALL)? (4)

A

Anemia, thrombocytopenia, lymphocytosis (usually), lymphoblasts in blood

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20
Q

What is the prognosis of acute lymphoblastic leukemia? (Slide 26/1)

A

Poor

*cats are usually younger and FeLV positive

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21
Q

True or false:

Chronic lymphocytic leukemia is more common in cats than dogs.

A

False, is more common in dogs.

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22
Q

What is the number that if you have greater than when it comes to lymphs you will have leukemia?

A

35,000

*however the number can be lower and still be leukemia

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23
Q

How do you differentiate excitement lymphocytosis from leukemia in cats?

A

Excitement lymphocytosis usually does not have greater than 20,000

common causes are bartonella henselae(cat scratch fever)

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24
Q

How do you differentiate chronic ehrlichiosis and excitement lymphocytosis from lymphocytosis? (Slide 29/1)

A

In chronic ehrlichiosis you will see large granular lymphocytes. Excitement lymphocytosis is rare in a dog.

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25
Q

Look at slide 30-33/1

A

.

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26
Q

Expression of CD __ predicts a poor outcome when immunophenotyping for chronic lymphocytic leukemia (CLL). (Slide 34/1 for more info)

A

CD 34

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27
Q

What does polymerase chain reaction (PCR) detect? What is it used to identify?

A

Detects antigen receptor rearrangements.
It is used to identify a clonal, neoplastic population of cells. It also differentiates non-neoplastic lymphoproliferative disorders from those that are neoplastic.

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28
Q

Look at slide 36,38/1 for multiple myeloma

A

.

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29
Q

With multiple myeloma with percent of the bone marrow is plasma cells? (slide 39/1)

A

20%

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30
Q

What are your typical laboratory findings in multiple myeloma? (3)

A

– Monoclonal or bicalonal gammopathy
– usually IgG or IGA, occasionally IgM (referred to as paraproteins)
– Bence-Jones proteins in urine

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31
Q

What can happen to platelet function due to the presence of protein? (Slide 42/1)

A

Platelet function will be abnormal

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32
Q

Look at slide 45-47/1

A

.

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33
Q

Which of these is false regarding bleeding disorders?
A. It occurs in 1/4 of all dogs
B. Associated with thrombocytopenia
C. Platelet function defects due to immunoglobulins
D. All of the above are true
E. All of the above are false

A

A. It occurs in 1/4 of all dogs

*It occurs in 1/3 of all dogs

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34
Q

What will you see with multiple myeloma in cats? (4) (slide 49/1)

A

– atypical plasma cell morphology
– anemia
– bone lesions
– organ involvement (very common in cats)

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35
Q

What is myeloid neoplasms considered to be?

A

Cancers of hematopoietic cells

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36
Q

How will myeloid neoplasms manifest?

A

Manifest as either lack of normal cells in the blood or presence of neoplastic cells.

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37
Q

How do you distinguish acute from chronic cancer? (Slide 57/1)

A

By the percentage of blast cells in Morrow is used to distinguish acute and chronic.

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38
Q

What are the two type of myeloid cancers with gradual progression?

A

Myelodysplastic syndromes and myeloproliferative neoplasms

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39
Q

What are myelodysplastic syndromes? (Define/describe) (slide 59/1)

A

Variable manifestations, usually with subtle morphologic abnormalities. Usually some form of cytosine that may be single or in combination, including non-regenerative anemia, neutropenia, and/or thrombocytenia. Marrow may be hypocellular, of normal cellularity or hypercellular.

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40
Q

Where the morphologic abnormalities associated with myelodysplastic syndrome?(3)

A

– Erythrocytes and rbi precursors are usually abnormally large and very variable in size leading into macrocytosis and anisocytosis (widening of RBC histogram).
– Platelets and neutrophils may also be abnormally large.
– Dysynchrony of nuclear and cytoplasmic maturation events.

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41
Q

Which one of the following is not true of myelodysplasia (MDS)?
A. Reported in dogs, cats, rarely enforces
B. Usually FeLV induced in cats
C. Often post-leukemic
D. All of the above are true
E. None of the above are true

A

C. Often post-leukemic

*it is often a pre-leukemic

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42
Q

What are the three clinical signs of MDS, and what often happens to the animal?

A

– lethargy, anorexia, weight loss

– Often died within weeks of diagnosis, often progress to leukemia.

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43
Q

What is typical for acute myeloid leukemia? (Percent of specific cells in bone marrow and blood)

A

20% or greater blast cells in the bone marrow. But the percent of blasts in the blood is variable.

44
Q

Look at slide 67-68/1

A

.

45
Q

If you have myeloblastic leukemia, would you expect to see in the bone marrow?

A

> 90% Blasts in BM;

<10% more differentiated granulocyte precursors

46
Q

Would you expect to see in the bone marrow of myeloblastic leukemia with differentiation?

A

–

47
Q

Look at slide 78/1

A

.

48
Q

Would you expect to see in the bone marrow of myelomonocytic leukemia?

A

– Myeloblasts and monoblasts >20% in BM

– Monocytes and granulocytes > 20%

49
Q

What would you expect to see in the bone marrow with monocytic leukemia?(2 separate groups)

A

– M5a Promonocytes and monoblasts >80% of non erythroid cells

– M5b >20% to < 80% promonocytes and monoblasts

50
Q

What you expect to see in the bone marrow with erythroleukemia?

A

– Erythroid > 50%, myeloblasts and monoblasts <20%

– M6ER if most blasts are erythroid (previously called erythremic myelosis)

51
Q

What would you expect to see in the bone marrow with Megakaryoblastic leukemia?

A

– >20% megakaryoblasts, also in blood Increased megakaryocytes

– May need immunocytochemistry to detect reactivity for factor VII-related atigen and platelet glycoprotein IIIa

– Thrombocytopenia or thrombocytosis

52
Q

Look at slide 88-89/1 for chronic myeloproliferative neoplasms in people

A

.

53
Q

Chronic myeloproliferative neoplasms in animals is _____ & difficult to distinguish from ______.

A

rare

hyperplasia

54
Q

What is false about Chronic granulocytic (myelogenous) leukemia?
A.“CML” in animals is more like CNL, since rarely basophilia and eosinophilia.
B. More common in cats than in dogs
C. Manifest as marked neutrophilia, left shift, and often monocytosis.
D. Hypersegmented nuclei, giant metamyelocytes, bands
E. All the above is true

A

B. More common in cats than in dogs

*More common in dogs than in cats

55
Q

How is myeloproliferative neoplasms differentiated from Myelodysplastic syndromes? (slide 93/1)

A

MDS by marked leukocytosis.

*Marrow exam may not be helpful as orderliness of maturation may appear disrupted with inflammation

56
Q

How do you get a definitive diagnosis of myeloproliferative neoplasms?(2)(slide94/1)

A

Eventually develop disorderly left shift and “blast crisis”

Usually much more anemic than patients with inflammatory disease

57
Q

What animal do you see Eosinophilic leukemia most commonly in? (slide 95-96/1)

A

FeLV

58
Q

What animal(s) is Chronic basophilic leukemia reported in? (Is rare but can happen)(slide97/1)

A

Dogs and Cats

59
Q

look at slides 99,101/1

A

.

60
Q

What do you look at during a fluid analysis?(4)(slide 4/2)

A
    • Color, clarity, odor
    • Total protein - refractometry
    • Cell count (manual system, Electronic cell counter)
    • Sediment cells if count < 5,000/μl
61
Q

What are the important components to look at in Body Cavity Fluid Analysis?(6)

A

– Cell Concentration
(Electronic cell counter or hemocytometer)
– Protein concentration (estimated by refractometer)
– Types of cells present? – Inflammatory?
– Organisms?
– Neoplastic?

62
Q

What causes Pure Transudates?

A

Form due to hypoalbuminemia.

63
Q

What causes modified transudates?

A

Form due to impaired blood flow for lymph flow

64
Q

What causes exudates?

A

Form due to increased capillary permeability (inflammation)

65
Q

What is the difference between transudates and exudates? (appearance, total protein, NCC, clotform)

A 
T verse E
appearance: clear; cloudy
TP: less than 3 g/dL; greater than 3 g/dL
NCC: less than 6000; greater than 6000
clot form: no; yes
66
Q

What should you look for in the fluid taken from the abdomen if you suspect your abdomen?
Chylous effusion?
Bile leakage?

A

Creatinine
Triglyceride
Bilirubin

67
Q

What type of cells would you see is suppurative inflammation?
Mixed inflammation?
Mononuclear inflammation?

A

Predominantly neutrophils.
Segs, lymphs, macs, maybe eos.
Macrophages and lymphs.

68
Q

Look at slide 37 – 38/2

A

.

69
Q

Which cell are you more likely to see in neoplastic effusion, lymphoblasts or carcinoma cells?

A

Lymphoblasts

70
Q

What is the criteria for malignancy? (4)

A

– variable nuclear size (anisokaryosis)
– large multiple nucleoli
– abnormal mitoses
– nuclear molding

71
Q

Look at the slides 111 – 112/2

A

.

72
Q 
The following describes which of the below? High cell count, usually not degenerate neutrophils, typically do not see the infectious agent, usually single joint.
A. immune mediated
B.Trauma
C. Infectious
D. can be all of the above
E. Is none of the above
A

C. Infectious

73
Q 
The following describes which of the below? Low to high cellularity, increase in non-degenerate neutrophils, usually multiple joints.
A. immune mediated
B.Trauma
C. Infectious
D. can be all of the above
E. Is none of the above
A

A. immune mediated

74
Q

What are the three types of cytologic samples?

A

Fluids, needle aspirates, solid tissue imprints

75
Q

What are the three advantages of cytology to the clinician/practitioner?

A

Economical, rapid, profitable to practice

76
Q

What are the three advantages of cytology over histopathology?

A

Round cell tumors, detection/identification of microorganisms, no shrinkage artifact

77
Q

What are some of the disadvantages of cytology? (3) (look at slide 5/3)

A

Nondiagnostic samples, no tissue architecture, small sample size

78
Q

What are the three basic rules to specimen evaluation with cytology?(6 – 11/3)

A
  1. Understand what normal looks like for various collection sites
  2. Examine the entire specimen at low magnification
  3. Only evaluate intact cells, avoid areas that are sick, understained
  4. Recognize artifacts and contaminats
79
Q

Look at slide 16,21/3

A

.

80
Q

What are the reasons for non diagnostic samples (only blood on slide)? (3)

A

Needle too large, lesion is vascular, lesion is mesenchymal tissue (connective tissue)

81
Q

What are all possible causes for non-diagnostic sample? (4) (slide 23, 25, 28, 31-33/3)

A

Blood on slide, all broken cells, cells too thick to interpret, nothing on slide

82
Q

What is the issue with an imprint instead of an aspirant? (Think about what you would see on the slide)

A

Also rated lesions may not have represent themselves on imprint. Neutrophils and bacteria almost always present.

83
Q

Look at slide 37, 43/3 for summary

A

.

84
Q

Look at slide 73/3

A

.

85
Q

What are the three classification of tumors?

A
  1. Round (discrete) cell tumors
  2. Tremors of epithelial origin
  3. Tumors of connective tissue origin
86
Q

What type of tumors fall under round (discrete) cell tumors? (5)(slide 80 – 81/3)

A
  1. Lymphoma (lymphosarcoma)
  2. Plasma cell tumors
  3. histiocytomas
  4. Transmissible venereal tumors
  5. Malignant histiocytosis
87
Q

Look at slide 82-84/3

A

.

88
Q

look at slide 111/3

A

.

89
Q

Which of the following about epithelial tumors is not true?
A. Cells form in sheets but not clusters
B. Usually many cells present and have distinct cytoplasmic borders (+/-)
C. Cells are often large with abundant cytoplasm
D. Sometimes shows signs of differentiation

A

A. Cells form in sheets but not clusters

*cells form in sheets and clusters

90
Q

Look at slides 137,139/3

A

.

91
Q

What are the four causes of lymphadenopathy (enlargement of the lymph nodes)?

A

– hyperplasia/reactive LN (antigenic stimulation)
– lymphadenitis
– metastatic neoplasia
– primary neoplasia (lymphoma)

92
Q

What are the three different types of lymphadenitis?

A

Suppurative, mixed, and mononuclear (macrophagic or granulomatous)

93
Q

When you have suppurative lymphadenitis in a horse or cat what most likely the cause?

A

Horse: strangles
Cat: plague

94
Q

What are the most likely causes of the three different types of lymphadenitis (Suppurative, mixed, and mononuclear)?

A

Suppurative: neutrophila

mixed: fungal diseases (neutrophilia and macrophages or esinophils)
mononuclear: microorganisms

95
Q

What are the types of cells seen in lymph nodes? (8)

A 
Small lymphocytes
Intermediate-sized lymphocytes 
Lymphoblasts
Plasma cells
Macrophages
Eosinophils
Mast cells
Abnormal cells (metastatic neoplastic cells)
96
Q

What you expect to see in hyperplasia/reactive lymphadenopathy? (Cells)

A

Increased plasma cells

97
Q

What do you expect to see in lymphadenitis? (Cells)

A

Neutrophils or macrophages

98
Q

What do you expect to see in metastatic neoplasia lymphadenopathy? (Cells)

A

Clumps of neoplastic cells such as mast cells, epithelial cells, mesenchymal cells.

99
Q

What type of cells do you expect to see in lymphoma (type of lymphadenopathy)?

A

50% lymphoblasts

100
Q

What cells is predominate in your normal lymph node?

A

Small cells

101
Q

What is lymph node hyperplasia due to?

A

Proliferation of lymphoid cells

102
Q

What would you see if you aspirated a hyperplastic lymph node? (3) (10/10)

A

– predominantly small lymphocytes
– plasma cells increased (key to diagnosis)
– medium and large lymphocytes increase but lymphoblasts still less than 20%
– macrophages, neutrophils, mast cells are variable
*common in lymph nodes draining G.I. tract

103
Q

True or false: with reactive lymph nodes you can find the cause of the reactive node in the cytologic specimen.

A

False, you do not find the cause for the reactive node in the cytologic specimen. (14/10)

104
Q

Look at slide 15/10

A

.

105
Q

If you see greater than 50% lymphoblasts on a LN aspirate, what are you most likely looking at?

A

Lymphoma

106
Q

Look at slide 26-32/10

A

.

Clin Path (4 decks)

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