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Clinical Pathology Final > Exam 4 Review > Flashcards

Exam 4 Review Flashcards

1
Q

what method of urine collection is best for culture?

A

cystocentesis: avoids external orifice
- may add RBCs, possible accidental enterocentesis
- BUT not good for large animal culture- catheterization is best for culture in large animals

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2
Q

you wish to collect urine from a mare with the intent to culture. what is the best method of collection?

A

catheterization - best for culturing in large animals
- requires sterile technique
- risk of iatrogenic UTI

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3
Q

urine collected this am is brought in still warm. delay for evaluation will be more than an hour. what should be done with the urine until testing can be done?

A

refrigerate, then rewarm to room temperature for testing

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3
Q

what comprises a minimum database?

A

CBC, chem panel, UA

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4
Q

what chemical strip tests are NOT reliable?

A
  • SG: high range of values
  • leukocytes: esterases in granulocytes
  • nitrites: bacteria
  • urobilinogen: usually don’t need to worry about
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5
Q

sources of erroneous dipstick results

A
  • sunlight: bilirubin breakdown
  • aged urine: bacterial breakdown, higher pH
  • uncapped urine: ketones dissipate
  • strip interference: peroxide, formaldehyde, outdates strips, cold urine
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6
Q

your tech comes to you saying that he last distilled water check on a refractometer read 1.003 on the USG scale. four urinalyses were already performed, each with numbers increasing. what is the correct next step?

A

calibrate the refractometer to read 1.000 with distilled water and test the stored supernatants.

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7
Q

pH variation on a urine dipstick

A
  • varies with acid-base status and diet
  • carnivores: acidish: 5.5-7.5
  • herbivores: neutral to alkaline: 7+
  • dairy herds kept at >6.7
  • false alkaline: pH > 7.5 in small animals
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8
Q

what would cause a false alkaline pH in small animals? (>7.5)

A

prolonged storage at room temperature: aging of sample

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8
Q

protein on urine dipstick

A
  • normal is negative
  • trace-+1 in highly concentrated
  • most sensitive for ALBUMIN - light chains (bence jones) not detected
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8
Q

what comes first, ketonuria or ketonemia?

A

ketonuria
happens when a patient is in a negative energy balance: fasting, increased gluconeogenesis, low carb diet, cattle ketosis

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9
Q

you are reviewing a 10 year-old dog’s record after a long day and read a pH on a urinalysis of 8. what is your best interpretation of the pH?

A

it is falsely high! a pH above 7.5 in small animals is falsely alkaline

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10
Q

what ketone detection component is at its highest concentration in the urine, but low sensitivity on dipstick?

A

BHB: beta hydroxybutyrate
strip is most sensitive for acetoacetic acid, which gets converted to acetone and BHB

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10
Q

you have an adult cat with diabetes mellitus and are concerned she has ketoacidosis. the urinalysis is +1 for ketones. what is your best interpretation of the cat?

A

the cat is in a negative energy balance

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11
Q

what causes bilirubinuria in dogs?

A
  • normal is negative
  • BUT in male dogs, 1+ if USG >1.030
  • liver dz, hemolytic dz, prolonged fasting, starvation, fever
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12
Q

you are reading a urinalysis on an adult dog. the color is dark red, cloudy, and the blood/Hgb is +3. what are you differentials for the results?

A

hemoglobinuria, hematuria, myoglobinuria

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13
Q

what epithelial cells are normal to see in urine?

A

squamous epithelial cells: skin contaminants
flat, polygonal, angular

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14
Q

describe urinary cast formation

A
  • mucoprotein produced by tubular epithelial cells
  • casts form when urine flow is LOW
  • expelled when urine flows
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14
Q

lipid fat droplets are common to see in what species’ urine?

A

cats
lipid FLOATS, other elements SETTLE

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15
Q

hyaline casts

A
  • homogenous, color transparent
  • scope setup for contrast!
  • low numbers insignficant
  • rehydration post dehydration, glomerular proteinuria, fever
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16
Q

cellular casts

A
  • named for content
  • epithelial cell cast, WBC cast, RBC cast
  • some level of ACUTE renal tubular pathology - but not whole kidney involvement!
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17
Q

granular casts

A
  • some level of RENAL PATHOLOGY
  • source may not be apparent; cellular, hemoglobin, myoglobin, bilirubin
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18
Q

waxy casts

A
  • dull, waxy appearance, more defined borders
  • RARE
  • some level of CHRONIC RENAL PATHOLOGY
    MOST CONCERNING CAST
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19
Q

what is the most concerning cast?

A

waxy casts!! would have had to be in the tubule for a long period of time

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19
Q

cast mimicry

A

plant material, fibers, mucus

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20
Q

ID of crystals in urine

A

SIZE NOT IMPORTANT
color helpful but not required
- can form before or after collection!

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21
Q

what causes crystal formation?

A

over-saturation with crystallogenic substances
influenced by: pH, rate of urine flow, diet, cold temp, drugs, species/breed

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22
Q

calcium oxalate dihydrate crystals

A
  • square but 3D
  • envelope or “maltese cross
  • any pH
  • healthy animals: 2nd most common
  • pathology: uroliths, hypercalcemia
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23
Q

struvite crystals

A
  • most common in healthy animals!
  • in a dog/cat: likely abnormally alkaline pH; old sample, UTI
  • pathology: urine retention, infection, if urolith present, may suugest stone contents
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24
Q

calcium oxalate monohydrate

A
  • ETHYLENE GLYCOL TOXICITY!!!!
  • flat picket fence, pointy
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25
Q

calcium carbonate crystals

A
  • alkaline pH, golden brown clumps
  • normal in herbivores! horse, guinea pigs, bunnies
  • RARE in dog or cat
  • uroliths: small ruminants, steers
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26
Q

ammonium biurate crystals are normally seen in what breeds?

A

DALMATIONS AND ENGLISH BULLDOGS!!!!
- golden brown “thorny apple” or sphere
- any pH
- rare in other dogs and cats
- LIVER DISEASE OR UROLITHS

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27
Q

you are examining a urinalysis and see hyaline casts present. what is the best interpretation?

A

hyaline casts from dehydration (rehydration post dehydration)

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28
Q

hematuria may produce a positive dipstick reading for blood/hemoglobin but have no erythrocytes present in sediment because of

A
  • very low USG <1.005
  • pH >8 (HIGHLY ALKALINE)
  • aged sample (lysed RBCs)
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29
Q

a 9 year old MI dalmation is evaluated for increased water consumption and a normal physical exam. a urine sample was collected. crystals are present, and strongly resemble ammonium biurate. what is your interpretation of the analysis?

A

no disease present- this is a dalmation! same if in a bulldog.
- if in other dogs and cats,

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30
Q

causes of pre-renal azotemia

A
  • decreased perfusion of kidney
  • increased BUN from protein catabolism or high-protein diet)
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31
Q

causes of renal azotemia

A

kidneys inability to excrete BUN/Cr

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32
Q

causes of postrenal azotemia

A
  • obstruction of urinary tract
  • leakage/rupture of bladder
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32
Q

what is clinically used to decide if kidneys are concentrating urine appropriately?

A

SPECIFIC GRAVITY

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32
Q

what is istosthenuric urine USG?

A

1.008-1.012
same concentration as serum! super low

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33
Q

dehydration, shock, and cardiac disease are all cause of what type of azotemia?

A

pre-renal: has nothing to do with kidney
> 1.030 in dog

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34
Q

dehydrated dog USG is greater than

A

> 1.030

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35
Q

dehydrated cat USG is greater than

A

> 1.035

36
Q

dehydrated horse and cow USG is greater than

A

> 1.025

37
Q

what is the most common cause of pre-renal increase in BUN?

A

decreased GFR: dehydration, shock
also increased protein catabolism

37
Q

BUN (urea) process

A

protein breakdown, absorbed from gut, ammonia (NH4) sent to liver, then urea is a waste product and freely filtered into urine

38
Q

you see a cat that presents with a mid-abdominal mass. BUN is high, creatinine is normal, and the USG is 1.045. what is your analysis of the type of azotemia?

A
  • pre-renal! normal creatinine, high USG
  • intestinal adenocarcinoma was causing GI hemorrhage
39
Q

fixed isosthenuria is normal in what disease state?

A

end stage renal disease: if you always have a USG of 1.010, worry about early renal disease even without azotemia

40
Q

what is often the first indicator of renal disease?

A

impaired concentrating ability- owner may report PU/PD

41
Q

you see a cat for PU/PD for several months. BUN, Creatinine, and Phosphorus are all high. USG is 1.011. PCV is 26%, retics are 1,100. what is your explanation for this data?

A
  • chronic renal failure: isosthenuric urine!!
  • non-regenerative anemia is common with CKD: kidney not producing EPO
42
Q

what chemical changes are often seen in horses with renal failure?

A
  • HIGH calcium, LOW phosphorus
    calcium builds up: horse diets are so high in Ca2+
  • causes phosphorus to decrease
43
Q

what are some diseases that can cause dilute urine without renal injury?

A

DM, pyometra, liver failure, hypercalcemia, diabetes insipidus
correct endocrine issue and then the kidney can concentrate properly

44
Q

what are causes of post-renal azotemia?

A
  • obstruction to urinary outflow: decreased GFR from pressure like blocked cat, stones, tumor
  • disruption of bladder, urethra: trauma, inflammation, urine leaks into abdomen
45
Q

you are examining a horse that has azotemia, concentrated urine, and an abdominal fluid creatinine of 8.6. there are large amounts of WBC and RBC in the urinalysis. what best explains the azotemia?

A
  • post renal secondary to urine leakage into the abdomen
46
Q

what diagnostic value is very highly SPECIFIC for uroabdomen in dogs, cats, foals, and calves?

A

abdominal fluid to serum creatinine ratio > 2.1

47
Q

urine protein concentration

A
  • glomerulus normally excludes most proteins, exclusions based on size and charge
  • repels NEGATIVELY charged molecules like albumin!
    small amts of albumin and smaller proteins normally pass into ultrafiltrate and are reabsorbed within the tubules
    end result = urine normally is free of protein
48
Q

purpose of urine/creatinine ratio

A
  • gives a quantitative value to protein in urine
  • more practical approach than 24 hr collection
49
Q

what value of UPC (urine protein:creatinine ratio) is indicative of glomerular disease?

A

UPC >5.0 with a clean/quiet sediment is indicative of glomerular disease

50
Q

what are the categories of proteinuria?

A
  1. preglomerular: transient overflow proteinuria
  2. glomerular: damage to glomerulus and filtering selectivity
  3. postglomerular: renal tubular dysfunction: inflammation/hemorrhage within kidneys, ureters, bladder, urethra or genital tract
    ^ all of these can cause hematuria
51
Q

what abnormalities on a urinalysis would lead you to suspect postglomerular proteinuria? what are some causes?

A
  • RBCs, WBCS
  • hemorrhage, inflammation, tubular dysfunction
52
Q

lyme disease is a cause of what type of proteinuria?

A

glomerular: immune-complex deposition within glomerulus

53
Q

urine protein to creatinine ratio (UPC) is useful to

A

quantify protein loss relative to urine concentration

54
Q

what is the most active thyroid hormone?

A

T3: free T3 is what is actually turning on cells and metabolism
- produced by deiodination of T4

55
Q

most common endocrinopathy in dogs

A

hypothyroidism!
middle aged, mid-large size breeds

56
Q

lab abnormalities of canine hypothyroidism

A

hypercholesterolemia
mild, nonregenerative anemia

57
Q

95 % of hypothyroidism cases are

A

primary: thyroid gland not producing enough hormone
secondary would be that the pituitary gland doesn’t produce TSH

58
Q

what thyroid test is the most accurate in canine testing?

A
  • free T4!
    not affected by concurrent illness
    total T4 is frequently low with normal thyroid function. good for excluding hypothyroidism
59
Q

what should TSH be interpreted with?

A

fT4 or tT4; not good as single test. can have overlap in results
look at 3 together to make concrete diagnosis

60
Q

if a patient is hypothyroid, what would you expect the TSH to be?

A

low! pituitary trying to make and stimulate more

61
Q

you see a dog with history of lethargy and weight gain. you notice dental disease and alopecia. total T4 is 1.01 (RI 1.2-3.1). what additional testing do you recommend?

A

serum TSH and free T4

62
Q

how do you diagnose canine hypothyroidism?

A
  • measure thyroxine: low
  • measure TSH: high
63
Q

equine hyperthyroidism is more likely to occur in

A

foals, rare condition in adults

64
Q

clinical signs of equine hypothyroidism

A
  • goiter! enlarged thyroid glands
  • weakness, incoordination
  • poor suckle reflex
  • *ossification/tendon sheaths!
65
Q

pathogenesis of equine hypothyroidism

A

foals: dietary iodine deficiency, ingestion of goitrogen by mare
in adults, would be neoplasia

66
Q

with hyperadrenocorticism, what would the Urine Cortisol:Creatinine ratio be?

A

increased
cortisol excretion in the urine increases as blood cortisol concentration increases from stress or HAC
creatinine is excreted at a constant rate

67
Q

85% of dogs have what type of hyperadrenocorticism?

A

pituitary dependent: production of excess ACTH
- bilateral adrenocortical hyperplasia

15% have adrenal tumors: unilateral adrenal enlargement
sometimes can be iatrogenic from chronic steroid use

68
Q

basis of a LDDS

A

giving steroid like Dex, steroid normally will suppress pituitary release of ACTH and stress/reduce cortisol secretions

69
Q

in a healthy animal, the LDDST should result in?

A

a decrease in cortisol

70
Q

in a dog with HAC, the LDDST should result in

A

no change in cortisol

71
Q

how do you interpret LDDST?

A
  • suppression is lower than RI OR <50% of baseline cortisol
  • adrenal tumors never suppress
  • if the 8 hour cortisol is not suppressed: diagnose cushings!!
  • if the 4 hours cortisol IS suppressed but the 8 hour is not: diagnose PDH: pituitary-dependent HAC. enough to shut down for a little bit, and then came back
72
Q

you see an 8-year old spayed female with a pot-bellied appearance and poor hair coat. you did a LDDST and these were the results:
pre-LDDS: 8.1 (1.0-6.2)
4-hr post dex: 1.0 (<1.5)
8-hr post dex: 6.0 (<1.5)
what is your diagnosis?

A

pituitary-dependent hyperadrenocorticism

73
Q

what does ACTh do to cortisol?

A

stimulates production of cortisol
draw baseline sample, administer ACTH, draw second sample 1-2 hours later, and measure cortisol

74
Q

in a healthy animal, what will the ACTH stim test cause?

A

a mild increase in cortisol

75
Q

in a dog with PDH or ADH, the ACTH stim test should result in

A

a marked increase in cortisol

76
Q

with iatrogenic cushing’s, the ACTH stim test should result in

A

no change in cortisol: adrenals already atrophied and not making much

77
Q

how do you interpret an ACTH stim?

A
  • mild increase = normal
  • exaggerated increase = cushing’s
  • no increase = iatrogenic cushing’s
78
Q

what cushing’s test WILL differentiate between PDH and ADH?

A

LDDST may differentiate. ACTH does not, but it is the only test to test for iatrogenic cushing’s
LDDST has higher sensitivity, ACTH has better specificity

79
Q

if you have a high clinical suspicion of cushing’s but equivocal results from an LDDST, what test should you do?

A

ACTH stim

80
Q

if you have a high clinical suspicion of cushings but lack of exaggerated cortisol response from an ACTH stim, what test should you do?

A

LDDST

81
Q

PPID

A

equine cushing’s: pituitary pars intermedia dysfunction

82
Q

clinical signs of PPID

A

> 7 yrs, hirsutism, poor hair coat, laminitis, lethargy, muscle wasting, dermatophytes
CBC: stress leuk, anemia
Biochem/UA: hyperglycemia, hyperlipidemia, glucosuria, increased liver enzymes

83
Q

most common cause of PPID

A

pituitary adenoma
excessive secretion of peptides

84
Q

how do you diagnose PPID?

A

endogenous ACTH
- elevations are suggestive

85
Q

hypoadrenocorticism

A

decreased glucocorticoid (cortisol)- normally stimulated by ACTH
decreased mineralocorticoid (aldosterone) normally stimulated by reduced renal BF, hypotension, increased potassium
clinical signs vague, females>, young-middle aged

86
Q

CBC abnormalities in an addison’s dog

A

lack of stress leukogram in an ill dog: lack of lymphopenia, lack of decreased neutrophils
normocytic, normochromic anemia

87
Q

a poodle presents for bilateral alopecia. ALP is very high on CBC, and you recommend ACTH testing. here are the results:
cortisol pre: 16.8 (1.0-6.2)
cortisol post: 58.5 (10.5-20.0)
what is your diagnosis?

A

hyperadrenocorticism; can’t tell if adrenal or pituitary in origin

88
Q

how do you diagnose addison’s?

A

baseline cortisol
if cortisol >2, rules out addison’s
if cortisol <2, need to perform ACTH: need to try to stimulate adrenal gland and see if it works. expect to see nothing because the adrenals are not working

89
Q

in a dog with addison’s, an ACTH stim causes

A

no response!

90
Q

a 3-year old female dog presents with intermittent D+ and lethargy. potassium is elevated and sodium is decreased. cortisol was 1.3 (1.0-6.2). what additional test should be performed?

A

ACTH stimulation test

91
Q

urine cortisol:creatinine is used for what disease?

A

hyperadrenocorticism
ratio will be increased: cortisol increasing in urine with stress or HAC

92
Q

you see a 1-year-old dog for weight loss despite increased appetite. he is PU/PD. on CBC, he has a stress leukogram with a neutrophilia, monocytosis, and lymphopenia. on biochem, he has an increased ALP. the USG is 1.004. what additional testing needs to be done to further evaluate the patient?

A

ACTH stimulation test- showing signs for Cushing’s!

93
Q
A
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Clinical Pathology Final (7 decks)

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