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RUSVM Clinical Pathology 2016 > *Differentials* > Flashcards

*Differentials* Flashcards

1
Q

Relative Polycythemia

A

Dehydration
Fluid Shifts
Redistribution: Excitement or Exercise

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2
Q

Absolute Polycythemia

A

Chronic Hypoxia
Renal Cysts
Tumors

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3
Q

Primary Polycythemia

A

Myeloproliferative disorder

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4
Q

Pure Transudate

A

Hypoalbuminemia

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5
Q

Modified Transudate

A

Impaired Blood or Lymph Flow

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6
Q

Exudates

A

Inflammation

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7
Q

Triglyceride in the fluid

A

Chylus Effusion

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8
Q

Round Discrete Cell tumors

A 
Lymphoma
Plasma cell tumors
Mast cell tumors
Histiocytomas
Transmissible Venereal tumors
Malignant histiocytosis
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9
Q

Mesenchymal tumors

A 
Lipomas
Hemangiopericytomas
Hemangiosarcomas
Osteosarcomas
Chondrosarcomas
Fibrosarcoma
Neurofibrosarcoma
Peripheral nerve sheaath tumor
Poorly differentiated sarcoma
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10
Q

Epithelial tumors

A

Basal cell tumors
Squamous Cell carcinomas
Thyroid carcinoma

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11
Q

Hypoalbuminemia

A 
Inflammation
Liver Failure 
Chronic Liver Disease
Reduction in liver mass : Portosystemic shunt 
Blood loss: Hemorrhage or GI Parasites
Protein Losing Enteropathy
Protein losing nephropathy 
Effusions or vasculitis
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12
Q 
Proteinuria 
Hypoalbuminemia
Hypercoagulable
Hypercholesterolemia
Ascites
A

Nephrotic Sydrome

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13
Q

Hypoglycemia
Hypocholesterolemia
Decreased Urea
Hyperglobulinemia

A

Hepatic Insufficiency

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14
Q

Hypercholesterolemia

A

Protein losing nephropathy

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15
Q

Hypoglobulinemia
Hypocholesterolemia
+/- Hypomagnesium

A

Protein losing enteropathy

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16
Q

Hyperalbuminemia

A

Dehydration

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17
Q

Hypoglobulinemia

A 
Severe combined immunodeficiency syndrome (SCIDS)
Hemorrhage 
Protein Losing Enteropathy
Failure of passive transfer in neonates
Chronic Liver Disease
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18
Q

Hyperglobulinemia

A

Dehydration
Inflammation
Neoplasia: Multiple Myeloma or B cell Lymphoma

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19
Q

Hypoalbuminemia

Hyperglobulinemia

A

Polyclonal gammopathy: Inflammation

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20
Q

Increased Gamma Globulins

A

Monoclonal gammopathy: Neoplasia

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21
Q

Panhypoproteinemia

A

Blood loss

Protein losing enteropathy

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22
Q

Panhyperproteinemia

A

Dehydration

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23
Q

Hypofibrinogenemia

A

Liver Failure

DIC

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24
Q

Hyperfibrinogenemia

A 
Inflammation
Renal Disease (Cats and Cattle)
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25
Increased BUN
High Protein Diet Upper GI Bleed Increased Catabolism
26
Decreased BUN (Pre-Renal)
Low Protein Diet Portosystemic Shunt Liver insufficiency Protein losing enteropathy
27
Decreased BUN (Renal)
Diuresis
28
Increased Creatinine
High Muscle Mass Decreased GFR Renal insufficiency
29
Decreased Creatinine
Not significant
30
Increased SDMA
Renal Tubular Disease
31
Isosthenuria
Renal Failure Medullary Washout Diabetes Mellitus Diuresis
32
Polyuria
``` Renal Failure Pyelonephritis Diuresis Medullary Washout Diabetes Hyperadrenocorticism Pyometra ```
33
``` Increased BUN Increased CREA Increased SpGr Hyperphosphatemia Hypermagnesemia ```
Dehydration Shock Cardiac Insufficiency
34
Increased CREA
Increased Muscle Mass | Dams with dysfunctional placentas prevent normal clearance of fetal CREA
35
Increased BUN Increased CREA Decreased SpGr Hyperphosphatemia
``` Renal DAMAGE!! Infectious Toxic Hypoxia Neoplasia Congenital ```
36
Increased BUN Increased CREA Decreased SpGr
``` NOT ALWAYS RENAL DAMAGE!! Diabetes Insipidus Endocrine: Cortisol, glucose Fanconi syndrome Diuresis Medullary washout ```
37
Increased BUN Increased CREA Variable SpGr
Obstruction of urinary outflow: Urolithiasis Uroabdomen Trauma
38
Pre-Renal Proteinuria
Paraproteinuria Hemoglobinuria Myoglobinuria Post-colostral proteinuria
39
Glomerular Proteinuria
Hypoalbuminemia
40
Tubular Proteinuria
Normal Albumin | Loss of low molecular weight proteins
41
Post Renal Proteinuria
Hemorrhage/Inflammatory Trauma Neoplasia
42
Hypercalcemia with signs of Renal Disease
Mineralization of the renal tubules caused by hypercalcemia
43
Hypercalcemia Polyuria Low concentrating ability
Impairs urine concentrating ability by affecting ADH receptors
44
Hypocalcemia
Decreased in Vitamin D
45
Hyperphosphatemia and renal disease
Renal failure due to mineralization of soft tissues
46
Normalkalemia
Chronic Renal Failure
47
Hypokalemia
Decreased intake | Hypokalemia nephropathy in cats
48
Hyperkalemia
Acute Renal Failure
49
Hyperkalemia Hyponatremia Increased urea in the blood Peritoneal creatinine 2x serum creatinine
Uroabdomen
50
``` Good BCS Anorexia Vomiting Diarrhea Halitosis Oliguric or anuric Neuro: Depressed or seizures Azotemia Hyperkalemia Acidemia Proteinuria Cellular Casts in the urine Variable SpGr ```
Acute Renal Failure
51
``` Geriatric - frequently in cats Poor BCS Anorexia vomiting Diarrhea Halitosis Polyuric Neuro: Depressed Hypertension Azotemia Isosthenuria ```
Chronic Renal Failure
52
``` GFR less than 20-25% Nonregenerative anemia Dehydration Azotemia Hyperphosphatemia Metabolic Acidosis Normal to Hypokalemia Polyuria Isosthenuria ```
Chronic Renal Failure
53
``` GFR less than 5% of normal Nonregenerative anemia Marked dehydration Marked Azotemia Hyperphosphatemia Metabolic Acidosis Hyperkalemia Isosthenuria Oliguria to anuria ```
Chronic Renal Failure
54
Proteinuria Hypoproteinemia: Hypoalbuminemia and Normalglobulinemia Azotemia Isosthenuria
Glomerulonephrits
55
Hyperglycemic glucosuria
``` Diabetes Mellitus Hyperadrenocorticism Drugs Postprandial Acute pancreatitis ```
56
Normalglycemic glucosuria
Transient stress Reversible tubular damage: Drugs, Hypoxia, infection, toxins Urethral obstruction
57
Bilirubinuria
Liver disease Bile duct obstruction Hemolysis
58
Ketonuria
Negative energy balance DKA Insulinoma
59
Hemoglobinuria
Intravascular hemolysis
60
Hematuria
``` Trauma Infection Inflammation Infarction calculi neoplasia coagulopathy ```
61
Myoglobinuria | Increased CK and AST
Myocyte damage
62
Alkaline urine
low protein diet UTI Respiratory or Metabolic Alkalosis Alkalinizing drugs
63
Acidic urine
``` High protein diets Respiratory and Metabolic Acidoses Hypochloremic metabolic alkalosis + severe dehydration Hypokalemia Furosemide ```
64
Pre-Renal Proteinuria
Fever Hypertension Seizures
65
Renal Proteinuria
Glomerulonephritis | Renal damage
66
Post-Renal Proteinuria
Hemorrhage | Infection
67
Transitional epithelial cells in urine
Hyperplasia with inflammation | Transitional cell tumors
68
Caudate cells in urine
Pyelonephritis
69
Renal Cells in urine
Renal tubular injury: Infectious, toxic, and ischemic injury
70
RBCs in the urine
Hemorrhage | Inflammation
71
WBCs in the urine
Inflammation: infection and noninfectious
72
Lipids in urine
Degeneration of sloughed cells | Renal tubular injury
73
Struvites in urine
Normal | Urease positive bacteria promote formation
74
Bilirubinuria
Normal in dogs | In other species: Hemolysis, heptaobiliary disease
75
Calcium carbonate in urine
Normal in horses, rabbits, guinea pigs, and goats
76
Calcium oxalate dihydrate in urine
Normal in domestic animals Storage artifact Increased calcium excretion due to hypercalcemia
77
Calcium oxalate monohydrate in urine
``` Seen in normal animals and horses also associated with: Urolithiasis Hypercalciuric disorders Hyperoxaluric disorders Ehtylene glycol toxicosis ```
78
Ammonium biurate in the urine
Normal in dalmations and english bulldogs Liver failure Congenital or acquired shunts
79
Cystinuria
Inherited disease - renal function is normal
80
Hyponatremia
``` GI loss: Vomiting, diarrhea, saliva Renal: Hypoadrenocorticism, Ketonuria, Diuresis Effusions: Peritonitis, Ascites, Chylothorax, Uroabdomen, GI sequestration Sweating CHF Cirrhosis Nephrotic syndrome Body fluid shifts: Hyperglycemia Decreased intake Psychogenic Polydipsia Nephrotic Syndrome Hepatic or Renal Failure Edema ```
81
Hypernatremia
Dehydration Increased intake Increased aldosterone
82
Hypochloremia
``` All the causes of Hyponatremia! Hypochloremic metabolic alkalosis --> Paradoxical aciduria Severe vomiting Abomasal disorders High GI obstruction Sweating ```
83
Hyperchloremia
All the causes of Hypernatremia! GI loss of HCO3 - Diarrhea Alkalemia
84
Hyperkalemia
``` Failure of Renal Excretion Hypoadrenocorticism: Aldosterone Inorganic acidosis Insulin deficiency Muscle trauma: Rhabdomyolysis Massive hemolysis Increased intake or administration Potassium Sparing Diuretics ```
85
Hypokalemia
``` Decreased intake Vomiting Diarrhea abomasal disorders Horse sweat Alkalemia Insulin injection ```
86
No difference between calculated osmolality and measured osmolality but increase in measured osmolality?
Increased Sodium or Glucose or Urea
87
No difference between calculated osmolarity and measured osmolarity but there is a decreased in measured osmolality?
Decreased sodium
88
There is a difference between calculated and measured osmolality with an increase in measured osmolality?
Presence of unmeasured osmole (ethylene glycol)
89
Lymphadenopathy
Hyperplasia/Reactive (Antigenic Stimulation) Lymphadenitis Metastatic neoplasia Primary neoplasia
90
Greater than 50% lymphoblast
Lymphoma
91
Increase in plasma cells
Reactive lymph node (hyperplasia)
92
Hematoidin crystal
RBC break down pigment indicating prior hemorrhage
93
Apparent Hypocalcemia
Hypoalbuminemia causes a decrease in calcium bound to albumin
94
Common causes of Hypocalcemia
``` Renal Disease Ethylene Glycol toxicosis Pancreatitis Eclampsia Sepsis ```
95
Uncommon causes of Hypocalcemia
``` Hypoparathyroidism Nutritional secondary hyperparathyroidism inadequate calcium intake inadequate vitamin D intake excess phosphorus Intestinal malabsorption Phosphate containing enemas Citrate toxicity Hypomagnesemia Massive tissue degeneration Hypercalcitonism (C-cell thyroid tumors) ```
96
Causes of Hypercalcemia
``` Hypercalcemia of Malignancy Granulomatous inflammatory disease Renal disease Idiopathic hypercalcemia of cats Vitamin D toxicosis Grape and Raisin Toxicosis Hypoadrenocorticism Primary Hyperparathyroidism ```
97
Causes of Hypophosphatemia
``` Metabolic acidosis Diabetic Ketoacidosis Primary hyperparathyroidism Hypercalcemia of malignancy Vitamin D Deficiency Respiratory Alkalosis Decreased intestinal absorption Renal tubular defects Chronic renal failure in horses ```
98
Causes of Hyperphosphatemia
``` Decreased GFR (Pre renal azotemia or renal disease) Ruptured Bladder or ureter or urethral obstruction Vitamin D intoxication Acute acidosis Excessive P intake Primary Hypoparathyroidism ```
99
Causes of Hypomagnesemia
``` Lost through GI track, kidney, and skin of horses Malabsorption from the GI tract Diarrhea Fluid diuresis Diuretics Renal Disease Grass tetany Milk Tetany Diabetes Mellitus Hypercalcemia Hyperaldosteronism Third space syndrome ```
100
Causes of Hypermagnesemia
Compromised Renal function | Magnesium containing laxatives or antacids with decreased GFR
101
Increased ALP
Cholestasis Corticosteroid Induced High in young animals from bone
102
Increased GGT
Cholestasis (Especially in cats!!) Steroid Induction Hepatic injury
103
Increased AST
Hepatocellular Damage | Rhabdomyolysis (Muscle Damage )
104
Increased ALT
Hepatocellular Damage in dogs and cats!! | Myocardial Cell injury
105
Increased CK
Rhabdomyolysis (Muscle Damage ) | Myocardial cell injury
106
Cause of Myoglobinuria
Rhabdomyolysis (Muscle Damage)
107
Cause of Hemoglobinuria
Hemolysis
108
Increased Serum Natriuretic Peptide
Cardiac dysfunction
109
Causes of Increased Plasma NT-proBNP
``` Ventricular Hypertrophy Tachycardia Hypoxia Expanded Fluid Volume Reduce renal clearance of the peptide ```
110
Increased SDH in Large Animals
Hepatocellular Damage
111
Increased GLDH in Large Animals
Hepatocellular Damage
112
Increased ALP in cats
Cholestasis NO STEROID INDUCTION!! Hyperthyroidism
113
Increased ALP WITHOUT hyperbilirubinemia
steroid or anticonvulsant medication
114
Hyperbilirubinemia
Hemolysis Decreased uptake or conjugation by the liver Blockage of bile (Cholestasis)
115
Increased Bile Acids
Portosystemic Shunt Cirrhosis Decreased hepatic uptake (Inflammation, necrosis, steroid hepatopathy, decreased functional hepatic mass) Decreased bile excretion (Cholestasis, bile duct leakage)
116
Hypercholesterolemia
Cholestasis
117
Hypocholesterolemia
Liver Failure
118
Increased Enzyme Activity Increased Bile Acids Microcytic Anemia (Maybe)
Early Portosystemic Shunt
119
``` Hypoalbuminemia Decreased BUN Hypoglycemia Hypocholesterolemia Decreased Coag factors Increased Bile Acids Cholestasis Microcyctic Anemia ```
Late Portosystemic shunt
120
Causes of Chronic Hepatitis
``` Copper storage disease Infectious (Lepto, ICH, etc) Drugs (Primidone, phenobarbitol, some NSAIDs) Genetic Idiopathic (Immune mediated) ```
121
Decreased TLI
Exocrine Pancreatic Insufficiency
122
Decreased Folate | Decreased B12
Generalized Malabsorption
123
Decreased Folate | Normal B12
Proximal Small Intestine defect
124
Normal Folate | Decreased B12
Distal Small Intestine Defect
125
Increased Folate | Decreased B12
Bacterial Overgrowth
126
``` Mild to Moderate nonregenerative anemia Fasting Hypercholesterolemia Fasting Hypertriglyceridemia Decreased Total T4 Decreased Free T4 Increased TSH ```
Canine Hypothyroidism
127
Decreassed Total T4
Canine Hypothyroidism | Euthyroid Sick Syndrome
128
Decreased Total T4 Decreased Free T4 Decreased TSH
Secondary Hypothyroidism
129
Decreased Total T4 Normal to decreased Free T4 Normal to increased TSH
Euthyroid Sick Syndrome
130
Decreased TSH
Glucocorticoid induced
131
Increased TSH
Early Hypothyroidism
132
Normal Total T4 Normal Free T4 Normal TSH
Canine Thyroid Carcinoma (Nonproductive)
133
``` Tachycardia Hyperactivity Weight loss Polyphagia Diarrhea Polycythemia Heinz Body Formation Stress Leukogram Mild to Moderate ALT Azotemia --> Dehydration Increased Total T4 ```
Hyperthyroidism
134
Hypercalcemia Hypophosphatemia Normal to Increased PTH
Primary Hyperparathyroidism
135
Causes of Hypercalcemia
``` D - Vitamine D Toxicosis R - Renal Failure A - Addison's Disease G - Granulomatous Disease O - Osterolytic Disease N- Neoplasia S - Spurious H - Hyperparathyroidism I - Idiopathic (Cats), Iatrogenic T - Temperature, Toxins ``` DRAGONSHIT!!
136
Hypocalcemia Hyperphosphatemia Normal to decreased PTH
Hypoparathyroidism
137
PU/PD Low USG DDx??
``` Diabetes Insipidus (Central and Nephrogenic) Psychogenic polydipsia (PPD) ```
138
PU/PD | Concentrated Urine after Water Dep test
Psychogenic Polydipsia
139
PU/PD Low USG after Water Dep test Concentrates with Desmospression administration
Central Diabetes Insipidus
140
PU/PD Low USG after Water Dep test NO Concentrating with Desmospression administration
Nephrogenic Diabetes Insipidus
141
``` "Pot Bellied" appearance Panting Muscle Weakness Ligament Weakness Alopecia Calcinosis Cutis Cutaneous Hyperpigmentation Stress Leukogram Increased ALP Increased ALT Hypercholesterolemia Low USG UTI ```
Canine Hyperadrenocorticism
142
Increased Urine Cortisol: Creatinine Ratio
Hyperadrenocorticism
143
Injection of Steroids --> | No Suppression of ACTH
Pituitary Tumor | Adrenal Tumor
144
If decreased ACTH at 8 hours after LDDST
Normal Dog
145
If increased ACTH at 8 hours after LDDST
Hyperadrenocorticism
146
If increased ACTH at 8 hours and 4 hours after LDDST
Hyperadrenocorticism (Primary-dependent Hyperadrenocorticism or Adrenal Tumor)
147
If increased ACTH at 8 hours and decreased at 4 hours
Primary-dependent Hyperadrenocorticism (PPDH)
148
``` Ferret: Alopecia Vulvar enlargement Aggression Muscle Atrophy Lethargy Anemia Pancytopenia ```
Ferret Hyperadrenocorticism
149
``` Lack of Stress Leukogram Hyponatremia Pre Renal Azotemia Dehydration Increased BUN Hypoglycemia Hyperkalemia ```
Hypoadrenocorticism
150
Amylase levels greater than 3-4x upper end of normal
Pancreatic injury
151
Lipase greater than 2x upper end of normal
Pancreatic injury | Corticosteroids
152
Higher levels of peritoneal amylase/lipase
Pancreatitis
153
Increased TLI
Pancreatitis | Corticosteroids
154
Increased Pancreatic lipase immunoreactivity (PLI)
Pancreatic injury | Anticonvulsant drugs
155
C-reactive protein
Acute Pancreatitis
156
Causes of Apparent Hypoglycemia
Glycolysis by erythrocytes due to failure to remove serum from clot within 30 min
157
Causes of Hypoglycemia
``` Insulinoma Insulin overdose Sepsis Hepatic Failure Neonatal/juvenile hypoglycemia Ketosis/ Pregnancy toxemia Neoplasia Starvation/malabsorption Extreme exertion Hypoadrenocorticism Xylitol in dogs Ingestion of Ackee Fruit ```
158
Causes of Hyperglycemia
``` Glucocorticoids Catecholamines Diabetes Mellitus Post-prandial Pancreatitis Hormone Imbalance Ethylene Glycol Drugs (Glucocorticoids and Megestrol acetate in cats) Milk fever in cattle Moribund animals Proximal duodenal obstruction in cattle ```
159
Glucosuria
Diabetes Mellitus | Renal Tubular Disorder (Normal Blood glucose)
160
Increased Fructosamine
Diabetes Mellitus
161
Ketonemia and Ketonuria
Altered Lipid metabolism Starvation Pregnancy toxemia Bovine Ketosis
162
Excitement Leukogram
Lymphocytosis
163
Stress Leukogram
Lymphopenia Neutrophilia Eosinopenia
164
Inflammatory Leukogram
Neutrophilia (2x the upper limit) Band Neutrophils present Sometimes see Metamyelocytes
165
Lymphocytosis
Excitement Neoplastic lymphoproliferative disease Antigenic Stimulation Ehrlichia
166
Neutropenia
Inflammation Immune mediated destruction Lack of production by bone marrow
167
Lymphopenia
Steroid Response Acute viral infections Immunodeficiency
168
Monocytosis
Inflammation | Stress Response
169
Eosinophilia
Parasitism Hypersensitivity Lesions producing eosinophil chemoattractants
170
Basophilia
Accompanies eosinophilia
171
Microcytic Anemia
Iron Deficiency | Portosystemic Shunt
172
Keratocytes Schistocytes Microcytic Anemia
Iron Deficiency
173
Heinz Body Anemia in small animals
Acetominophen Propylene glycol Cats: Lymphoma, Hyperthyroidism, Diabetes Ingestion of Onions and garlic powder Dogs: Cephalosporins and Zinc toxicosis (penny ingestion)
174
Heinz bodies in large animals
Horses: Phenothiazine and wilted red maple leaves Cattle: Kale and Onions Sheep: Copper toxicosis
175
Basophilic Stippling
Normal in ruminants Regenerative anemia in cats and dogs Lead Poisoning
176
Howell Jolly Bodies
Regenerative Anemia Non-functioning spleen or splenectomy Increased Corticosteroids Lead Poisoning
177
Agglutination
IMHA
178
``` Regenerative anemia Spherocytosis Agglutination neutrophilia with left shift thrombocytopenia ```
IMHA

RUSVM Clinical Pathology 2016 (22 decks)

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