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Clinical Pathology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

what things interfere with refractometer readings

A

lipids
hemoglobin
bilirubin

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2
Q

what does electrophoresis measure?

A

albumin
𝛼-glob (app)
𝜷-glob (app & ig)
𝛾-glob (ig)

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3
Q

if you want to measure specific proteins (ig, fibrinogen, CRP, etc.) what would you do

A

protein assay

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4
Q

Explain the difference between Serum & Plasma.

A

serum - anticoagulant, albumin & all globulins

plasma - clotted, albumin, globulin minus fibrinogen

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5
Q

mechanisms of hypoalbuminemia

A
  1. decreased albumin production
  2. selective loss of albumin
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6
Q

causes of decreased production of albumin

A
  1. hepatic failure (most common)
  2. starvation/malabsorption
  3. Exocrine Pancreatic Insufficiency
  4. acute phase protein response
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7
Q

causes of selective loss of albumin

A

glomerular disease such as amyloidosis

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8
Q

how do you characterize:
decreased albumin
decreased globulin

what are your DDx?

A

panhypoproteinemia

blood loss (most common)
GI disease, severe exudative skin dz/severe burns

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9
Q

how do you characterize:
decreased albumin
increased globulin

what are your DDx?

A

hypoalbuminemia
hyperglobulinemia

  1. decreased production of albumin due to hepatic failure (most common), starvation, malabsorption, EPI or APP response
  2. selective loss of albumin due to glomerular disease (amyloidosis)
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10
Q

how do you characterize:
increase albumin

what are your DDx?

A

hyperalbuminemia

always dehydration

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11
Q

how do you characterize:
decreased globulins

what are your DDx?

A

hypoglobulinemia

failure of passive transfer or immunodeficiency diseases

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12
Q

Samples to submit when testing for monoclonal gammopathy/monoclonal immunoglobulin or free light chains/Bence-Jones proteinuria.

A

monoclonal gammopathy/monoclonal immunoglobulin = SERUM

free light chains/Bence-Jones proteinuria = URINE

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13
Q

Explain the Concepts of Positive & Negative Acute Phase Proteins.

A

(+) APP = increase with inflammation

(-) APP = decrease with inflammation

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14
Q

positive acute phase proteins

A

haptoglobin
SAA
alpha1 acid glycoprotein
fibrinogen
C-reactive protein (CRP)

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15
Q

negative acute phase proteins

A

albumin
transferrin

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16
Q

what does fibrinogen increase with?

A

inflammation & dehydration

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17
Q

what are the suggestive levels of dehydration of the plasma protein:fibrinogen in equine and ruminants?

A

equine pp:fb < 15 inflam
ruminants pp:fb < 10 inflam

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18
Q

causes of prerenal azotemia with increased BUN & creatinine

A

decreased perfusion of the kidney due to dehydration, shock, hypovolemia or cardiac disease

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19
Q

causes of prerenal azotemia with increased BUN and unaffected creatinine

A

increased protein catabolism due to high-protein diet, starvation, fever, GI bleed, massive necrosis or prolonged exercise

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20
Q

causes of renal azotemia

A

kidney inability to excrete BUN/Cr

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21
Q

cause of postrenal azotemia

A

obstruction (blocked, tumor, urethral stones)
uroabdomen (trauma, prolonged obstruction, severe inflam)

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22
Q

how does urine specific gravity determine adequate or inadequate renal function?

what information does USG give?

A

used clinically to decide if kidneys are concentrating urine; measures solute concentration

info on hydration status and the concentrating ability of kidneys

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23
Q

what characterizes “isosthenuria”? what does this suggest? when is this an appropriate response?

A

USG 1.008-1.012

suggestive that neither sig concentration nor dilution of glomerular ultrafiltrate occurred

can be normal under certain hydration conditions

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24
Q

what does a fixed isosthenuric commonly mean?

A

end stage renal disease

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25
Q

if USG is high what is this indicative of?

A

prerenal

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26
Q

if USG is low or isosthenuria what is this indicative of?

A

renal

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27
Q

dog USG

A

> 1.030

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28
Q

cat USG

A

> 1.035

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29
Q

horse and cow USG

A

> 1.025

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30
Q

horse common pattern of renal disease

A

increased BUN
increased Cr
decreased P
increased Ca2+

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31
Q

cat & dog common pattern of renal disease

A

increased BUN
increased Cr
increased P
decreased Ca2+

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32
Q

what abdominal fluid creatinine value is indicative of a uroabdomen

A

abdominal fluid:serum creatinine ratio > 2-fold

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33
Q

UPC > 5 with clean/quiet sediment (no WBC or RBC) is indicative of what?

A

glomerular disease

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34
Q

3 types of proteinurea and where the increased protein arises

A
  1. preglomerular - outside urogenital tract - hyperproteinemia, fever, exercise
  2. glomerular - glomerular membrane
  3. post-glomerular - renal tubule, inflammation or hemorrhage
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35
Q

utility of UPC

A

measure urinary protein excretion because creatinine is excreted in uniform quantities

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36
Q

when to use UPC

A

interpreted in light of a urine specific gravity test and sediment

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37
Q

pros and cons of voided sample

A

pros: easy, cheap, owner can do it
cons: contamination

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38
Q

pros and cons of cystocentesis

A

pros: best for culture, bypass repro tract in females, mainly used in SA
cons: enterocentesis or RBC

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39
Q

pros and cons of catheter sample

A

pros: best for culturing LA
cons: requires sterile technique and risk of iatrogenic UTI

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40
Q

best container for urine samples

A

completely sealed, hard plastic container, label as urine with patient ID, name, date and species

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41
Q

storage technique for urine samples

A

keep at room temp if testing within 30-60min
if refrigerated warm to room temp for 20min

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42
Q

4 steps of performing a complete UA

A
  1. appearance (color & clarity)
  2. concentration (refractometer & USG)
  3. biochemistry
  4. microscopy
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43
Q

for urine sediment prep, how much do you want to decant

A

10-fold

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44
Q

first step of a urine sediment wet-mount exam

A
  1. lower the condensor
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45
Q

what obj do you use to scan for epithelial cells, larger crystals and casts

A

10x

46
Q

what obj do you use to scan for RBC, WBC, bacteria, yeast, and smaller crystals

A

40x

47
Q

do you ever add oil to a urine sediment wet mount exam

A

NO

48
Q

List which dipstick tests are used?

A

pH
protein
bilirubin
blood/hemoglobin
glucose
ketones

49
Q

sources of error for dipstick tests

A

handling - sunlight, aging, uncapped urine
strip interference - peroxide/bleach, formaldehyde, moisture, expired strips, cold urine, strip contamination with hand

50
Q

normal pH for carnivores, herbivores and dairy cattle

what does prolonged room temp cause pH to do? what crystals form?

A

carnivores 5.5-7.5
herbivores 7+
dairy cattle 6-7

false alkaline pH due to prolonged room temp, struvites

51
Q

when would ketones be found in the urine

is (+) or (-) for ketones accurate?

A

(-) energy balance - diabetic ketoacidosis, cattle ketosis, low carb diet, low glucose, prong fast

(+) likely
(-) doesn’t rule out

52
Q

what ketone is detected with the dipstick? what ketone needs to be measured in the serum?

A

acetoacetic acid with strip
BHB in serum??

53
Q

presence of bilirubin in the urine

A

male dogs
liver disease, hemolytic disease, prolong fast, starvation, fever

54
Q

what amount of blood in the urine is normal

A

hematuria < 5 cells/hpf

55
Q

squamous epithelial cells contaminants

A

common from genital tract, distal urethra, prepuce

56
Q

transitional cell contaminants

A

inflammation or neoplasia

57
Q

renal tubular cell contaminants

A

renal tubular injury

58
Q

normal WBC in urine

A

0-5/hpf

59
Q

lipid droplets present in urine?

A

normal in cat urine
renal tubular cell degeneration
nephrotic syndrome

60
Q

cellular casts are indicative of…

A

some level of acute renal tubular pathology
gives concurrent info not amount of damage

61
Q

granular casts are indicative of…

A

some level of renal pathology - cellular, Hgb, Myoglobin, bilirubin

62
Q

waxy casts are indicative of…

A

chronic renal pathology
most concerning

63
Q

hyaline casts are indicative of…

A

rehydration post dehydration
glomerular or myeloma-related proteinuria
fever

64
Q

how can you confirm bacteria in urine?

A

wright’s or quick stain

65
Q

struvites (magnesium ammonium phosphate) can be due to…

A

urine retention
infection with urease-producing bacteria
uroliths
prolonged room temp

66
Q

most common crystal in healthy animals

A
  1. struvites
  2. calcium oxalate dihydrate
67
Q

calcium oxalate dihydrate crystals due to…

A

urolith
hypercalcemia

68
Q

calcium oxalate monohydrate crystals due to…

A

ethylene glycol (antifreeze) toxicity

69
Q

bilirubin in urine can be due to…

A

normal in concentrated male dog urine
hemolytic disease
liver disease
starvation
bilirubinemia

70
Q

calcium carbonate crystals due to…

A

normal in horses/herbivores
uroliths in small ruminants/steers

71
Q

amorphous crystals due to…

A

uroliths
mimic cocci bacteria - stain and verify

72
Q

ammonium biurates due to….

A

normal in healthy Dalmatians & english bulldogs
liver disease (portosystemic shunt)
uroliths

73
Q

cystine crystals due to…

A

always abnormal
many pure and mix breed dogs
metabolic disorder of cystine metabolism - prone to uroliths

74
Q

best test for dogs for hypothyroidism

A

tT4, fT4 & cTSH

75
Q

best test for horses for hypothyroidism

A

TSH or TRH response test

76
Q

best test for cats for hyperthyroidism

A

tT4 (single test OK), if normal-high do 2nd test
fT4

77
Q

majority of dogs have what type of acquired hypothyroidism (primary, secondary or tertiary)

A

primary - thyroid gland itself

78
Q

majority of cats have what type of hyperthyroidism (primary, secondary or tertiary)

A

primary - one or both thyroid glands

79
Q

a cat with weight loss, polyphagia, PUPD, hyperactivity, restlessness, diarrhea, vomiting, skin changes, resp signs, “sick cat”, 12 year old cat acting young

A

hyperthyroidism

80
Q

a dog with …
dermatologic (endocrine alopecia, pyoderma, otitis, demodicosis, facial myxoedema)
metabolic (lethargy, inactivity, weight gain)
neuromuscular (weakness, ataxia)

A

hypothyroidism

81
Q

most common cause of hypothyroidism in foals? adults?

A

foals - I def or ingestion of goitrogen
adults - neoplasia

82
Q

foals that are affected at birth, and have goiter, weakness, incoordination, poor suckle reflex, ossification/tendon defects

A

hypothyroidism

83
Q

dog lab abnormalities with thyroid disease (hypothyroidism)

A

hypercholesterolemia
mild nonreg anemia

84
Q

cat lab abnormalities with thyroid disease (hyperthyroidism)

A

increased liver enzymes (ALT, ALP) most consistent
erythrocytosis
excitement leukogram
decrease cholesterol
increased BUN
false decrease in fructosamide

85
Q

most common endocrinopathy in cats

A

hyperthyroidism

86
Q

most common endocrinopathy in dogs

A

hypothyroidism

87
Q

what is euthyroid sick syndrome

A

decrease total T4
normal fT4 and TSH

88
Q

majority of dogs have what type of cushing’s (hyperadrenocorticism)

A

pituitary-dependent - resulting in bilateral adrenocortical hyperplasia

89
Q

cause of equine cushing’s (hyperadrenocorticism)

A

pituitary adenoma

90
Q

majority of cats have what type of cushing’s (hyperadrenocorticism)

A

pituitary-dependent

91
Q

dog addison’s (hypoadrenocorticism) primarily due to

A

adrenocortical failure from destruction of adrenal cortex from immune-mediate, granulomatous disease, infarct, neoplasia or idiopathic

92
Q

what test is often used to rule out Cushing’s in dogs and cats

A

urine cortisol:creatinine ratio

93
Q

LDDST in dogs - what is indicative of…
decreased cortisol response?
4hr & 8hr not suppressed?
4 hr suppressed, 8hr not?

A

decreased cortisol response = normal
4hr & 8hr not suppressed = PDH or ADH
4 hr suppressed, 8hr not = PDH

94
Q

only test for iatrogenic cushings?

A

ACTH stim test

95
Q

ACTH stim test - what is indicative of..
mild increase in cortisol?
marked increase in cortisol?
no change in cortisol?

A

mild increase in cortisol = normal
marked increase in cortisol = PDH or ADH
no change in cortisol = iatrogenic

96
Q

endogenous ACTH
normal-increased?
low-undetectable?

A

normal-increased? PDH
low-undetectable? ADH

97
Q

dog with PUPD, polyphagia, pendulous abdomen, panting, hepatomegaly, muscle weakness, lethargy, lameness, endocrine alopecia, pyoderma, demodex, calcinosis cutis

A

hyperadrenocorticism “Cushing’s”

98
Q

dog lab abnormalities with Cushing’s

A

stress leukogram
thrombocytosis, erythrocytosis
hypercholesteralemia
hyperglycemia
increased ALP
low USG

99
Q

equine with hirsutism and inability to shed winter coat has?

A

pituitary pars intermedia dysfunction (PPID)

100
Q

lab abnormalities in equine with Cushing’s

A

stress leukogram
anemia
hyperglycerma, hyperlipidemia
increased liver enzymes

101
Q

most common equine endocrinopathy

A

PPID

102
Q

why do you not want to use a dexamethasone suppression test in horses?

A

increased risk of laminitis

103
Q

recommended testing for Cushing’s in horses

A

endogenous ACTH
TRH stim

104
Q

a cat with uncontrollable diabetes mellitus, PUPD, polyphagia, weight loss, lethargy, weakness, dermatopathies

A

Cushing’s

105
Q

lab abnormalities in cats with Cushing’s

A

stress leukogram
normal liver enzymes and cholesterol
concurrent DM
usually inconsistent

106
Q

recommened test in cats with Cushing’s

A

LDDST

107
Q

a young-middle aged dogs, females > males, vague clinical signs, intermittent illness, GI (vomit/diarrhea), lethargy, anorexia, polyuria, shaking, abdominal pain, addisonian crisis

A

hypoadrenocorticism “addisons”

108
Q

lab abnormalities in a dog with hypoadrenocorticism

A

lack of stress leukogram
non-regenerative anemia
azotemia & hyperphosphatemia
hyponatremia, hypochloremia, hyperkalemia (Na:K < 27:1)

109
Q

recommended test for suspected dog with Addison’s

A

baseline cortisol < 2 ug/dL then ACTH stim = no/low cortisol <2 ug/dL

110
Q

what is the gold standard test for Addison’s

A

ACTH stim

Clinical Pathology (7 decks)

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