Dr. Sample material exam 2 Flashcards
(164 cards)
1
Q
How are substances identified using the spectrophotometer?(Study guide)
A
the machine directs a beam of light through the solution and measures the amount of light is absorbed.
2
Q
What wavelengths are your ultraviolet light, and which are your infrared light?
A
Shortest is ultraviolet, and longest is infrared.
3
Q
If you have a substance that shows the color green what color does it not absorb?(When it comes to the spectrum of light)
A
Green
4
Q
Look at slide 12/4
A
.
5
Q
How are substances identified using electrophoresis?(Study guide)
What is this commonly used to analyze?
A
It measures movement of charged particles through a solution of under the influence of an electrical field. This movement depends on many characteristics.
It is commonly used to separate and analyze serum proteins.
6
Q
What are the five things that movement depends on in electrophoresis?
A
– Net charge – size and shape of the protein – strength of the electrical field – type of supporting medium – temperature
7
Q
Look at slide 15/4 protein electrophoresis/densitometer
A
.
8
Q
What is the difference between quality controls and calibrators?(Study guide)
A
Quality control ensures the accuracy and precision. Calibrators are used to configure the instruments provide a result for a sample within an acceptable range (used to maintain instruments accuracy).
9
Q
Data interpretation slide 16 – 31/4. Questions to follow this slide. But not on study guide.
A
.
10
Q
What is a reference limit?
A
Is the values at the very end of the reference interval (e.g. 5 – 9)
11
Q
If you find a number outside reference interval what would you consider the number to be?
A
Abnormal value.
12
Q
How do you calculate sensitivity of a test?
A
True positive/true positive+ false-negative
13
Q
How do you calculate specificity?
A
True negative/true negative+ false positive
14
Q
How do you calculate positive predictive value?
A
True positive/true positive+ false positive
15
Q
How do you calculate negative predictive value?
A
True negative/true negative+ false-negative
16
Q
What are pre-analytical factors that may affect you your data interpretation? (5) (slide 29/4)
A
– Medication/drugs – time of day – fasted or nonfasted samples – recent intense exercise – physical or chemical restraint
17
Q
What is the most common source(s) of the laboratory error? (4)
A
Mislabeling or not legal in samples, test ordering and request completion, sample collection, sample handling.
18
Q
Define accuracy.(Study guide)
A
Gauge how close the result is to the true value.
19
Q
Define precision. (Study guide)
A
Gauge how repeatable result is when assaying the same sample.
20
Q
Look at slide 36/4
A
.
21
Q
Introductory material slide 4 – 9/5
A
.
22
Q
What makes up total protein?
A
Albumin and globulins.
23
Q
Where are albumin’s made? What are the two major roles?
A
The liver. Transport protein and colloidal osmotic pressure
24
Q
Where globulins made and what are their functions?
A
The liver (Alpha and beta globulins) and lymphoid tissue (gamma globulins (primary)). Inflammation, coagulation, transport proteins(alpha and beta). Immunity (gamma globulins)
25
Look at slide 9/5
.
26
What are the proteins routinely reported on a biochem profile? (Study guide)
Total protein, albumin, globulin, fibrinogen.
27
What is the difference between plasma protein and serum protein?(Study guide)
Plasma protein contains all protein and is the liquid portion of blood that has not clotted.
Serum protein does not contain fibrinogen. It is the liquid portion of blood that remains after clotting.
28
Look at slides 12 – 15/5 to answer how total protein is measured with a CBC and recognized utility in measure plasma fibrinogen in large animals.(Study guide)
.
29
(Study guide)=Interpret abnormal patterns of protein evaluations seen in the protein electrophoresis tracings; explain difference between monoclonal and polyclonal gammopathy (slide 17 – 35/5) questions to follow.(question on this slide)
What are the two causes of hypoalbuminemia?
Decreased production and abnormal loss.
30
What can cause a decreased production leading to a hypoalbuminemia?(Name two most important, rest can be found on slide 18/5)
Inflammation and liver failure
| others= severe malnutrition/maldigestion/malabsorption, intestinal parasites
31
What are the ways that abnormal loss can cause hypoalbuminemia? (Slide 18/5) (5)
Blood loss, intestinal loss (PLE), urinary loss (PLN), third spacing, skin diseases/burns
32
If you have hypoalbuminemia caused by malabsorption/maldigestion what might you see physically on the animal and with other chemistry analytes (3)?
Thin body condition score and ravenous appetite.
| Other chemistry analytes: decreased glucose, decrease cholesterol, decreased urea
33
What might you see if hypoalbuminemia is due to liver failure/hepatic insufficiency? (4) (think of what liver is responsible for making) (slide 20/5)
Decreased glucose, decreased cholesterol, decreased urea, increasing globulins (usually) (the liver is not filtering antigens)
34
What might you see if hypoalbuminemia is due to PLN?
What are the four characteristics of nephrotic syndrome (PLN: protein losing nephropathy)?
Increasing cholesterol
Proteinuria, hypoalbuminemia, hypercholesterolemia, ascites.
35
What might you see if hyper albumin in your is caused by PLE (protein losing entropathy)? (one clinical sign and two things for your chemistry panel)(slide 22/5)
Clinical sign: diarrhea
Chemistry panel: decreased cholesterol, +/- decreased magnesium
36
What would you expect the cause of hyperalbuminemia to be?
Dehydration
37
What can cause hyperglobulinemia? (3) (slide 25/5)
Dehydration, inflammation (infectious=canine ehrlichiosis & FIP, noninfectious), and neoplasia( plasma cell tumors/multiple myeloma, B-cell lymphoma)
38
What causes polyclonal gammopathy?
Inflammation
39
What causes of monoclonal gammopathy?
Neoplasia
40
What are the 2 causes of panhypoproteinemia?()
Blood loss and Protein-losing enteropathy (PLE)
41
Look at slide 30-36/5
.
42
What are the two causes of hypofibrinogenemia?
| Hyperfibrinogenemia?
Liver failure & DIC
Inflammation & Renal dz.
43
Look at slide 4/6 for terminology
.
44
Slides 5 – 10/6 renal function
.
45
At what percent damage does the kidneys stop concentrating urine?
Percent for functionally impaired (azotemia)?
66%
| 75%
46
Look at slide 12/6
.
47
Where is urea made?
The liver.
| *It then moves into the liver and is measured as BUN.
48
Where is the blood urea nitrogen filtered?
The glomerulus (therefore is an indicator of GFR (glomerular filtration rate))
49
What are the three things that can cause variation within the BUN?
Production, reabsorption, excretion
50
What percent of urea is excreted in urine, and what percent is reabsorbed?
60% is excreted and 40% is reabsorbed
51
Look at slide 18/6
.
52
Slide 20 – 21/6 creatinine
.
53
When should you obtain a urine sample and measure USG (urine specific gravity)?(3)(slide 23 – 27/6)
1. Suspected renal disease
2. Geriatric wellness
3. PU/PD
54
What is the minimum USG for a dog, cat, horse and cattle to be considered hypersthenuric?
Horse and cattle: 1.025
Dog: 1.030
Cat:1.035
55
What is the USG range for isothenuria?
1.007 – 1.013
56
Look at slides 29 – 34/6
.
57
What are your differential diagnosis for polyuria?(Fall under two different categories: renal and extra renal)
Renal: renal failure, pyelonephritis
ExtraRenal: diuresis, medullary washout, endocrine (diabetes, hypoadrenocorticism), pyometra
58
What are the three major causes of azotemia?
| What is azotemia?
pre-, post, renal
an increase in BUN and an increase in creatinine
59
Would you expect to see what prerenal azotemia?
Increase in BUN, creatinine, SpGr
60
What are the differential diagnosis is for prerenal azotemia? (2 list most important example for each) (slide 38/6)
– Decreased renal blood flow leads to decreased GFR (dehydration).
– Increased urea production (upper G.I. bleed)
61
Look at slides 39 – 43/6
.
62
What would you expect to see with renal azotemia?
Increased BUN and creatinine with a isothenuric SpGr
63
What are the six differentials for a cause of renal azotemia? (Gen. not specific examples (e.g. hydronephrosis= don't want as answer))(slide 47/6 for specific examples)
```
– infectious
– toxins
– hypoxia
– neoplasia
– congenital
– miscellaneous
```
64
Look at slide 48/6
.
65
Look at slides 52–56/6
.
66
What might you find with post renal azotemia on the physical exam? (3)
Straining to urinate, large turgid bladder, distended abdomen (uroabdomen)
67
Look at slide 58 – 61/6
.
68
List what you expect to be the cause of protein urea for prerenal, renal, and post renal cases.
Prerenal: increased protein in blood
Renal: glomerular and tubular
Postrenal: hemorrhagic/inflammatory
69
Look at slide 5-7/7
.
70
In what animal do you estimate the quantity of urinary protein excreted per day?
Give the amounts for normal, borderline, tubular or glomerular, and glomerular.
Which type of protein ureas tend to be more severe?
In dogs.
Normal 0.5; glomerular > 1.0
Glomerular proteinurias tend to be more severe.
71
What is the biochemical profile of renal failure?
Hypercalcemia, hyperphosphatemia, metabolic acidosis, hypochloremia, potassium (hypokalemia, normokalemia, hyperkalemia), uroabdomen and electrolyte imbalances.
72
What is a problem with hyperalcemia when it comes to urine concentrating ability?
It impairs during concentrating ability causing primary polyuria (affects ADH receptors)
73
What can a hypercalcemia lead to involving renal failure?
Commonly leads to mineralization of renal tubules -> nephron (kidney) dysfunction
74
What came first, hypercalcemia or kidney disease?
95% of the time of hypercalcemia has caused the kidney disease.
75
In what animals will you see mild hypocalcemia with renal failure? (3) (slide 10/7)
Dogs, cats and cattle
76
Look at slide 12/7 for hyperphosphatemia
.
77
When will you see metabolic acidosis in regards to renal failure?
What causes this? (HCO3 & H)
After severe renal disease.
Increase urinary loss of HCO3 and a decrease in tubular secretion of hydrogen ions
78
In what animal will you see hypochloremia?
Cattle with renal failure
79
Look at slide 14/7 for potassium(hypokalemia, normokalemia, hyperkalemia)
.
80
What is the biggest concern about hyperkalemia?
It is life-threatening and acute renal failure and/or post renal conditions.
81
How is potassium in chronic renal failure? (hypokalemia, normokalemia, hyperkalemia)
normokalemia
82
Can hyperkalemia happen in cattle?
No.
83
Look at slide 15-16/7 uroabdomen and electrolyte imbalance
.
84
Would you expect to see on physical exam in a patient with acute renal failure? (Body condition score, G.I. related, renal, neurological)
They will have a good body score. May be anorexic or have vomiting, diarrhea, halitosis (NH3) (G.I.). Maybe oliguric to anuric (renal). May look depressed, obtunded, nonresponsive, seizures (neuro)
85
What is acute renal failure commonly associated with? (3)
Toxicants, renal ischemia, or infection.
86
What are the features of acute renal failure?(2)
Marked decrease in GFR leading to easily anemia. May be reversible or irreversible.
87
What are your laboratory findings for bloodwork and urinalysis? (2 and 4) (slide 21 – 22/7)
Bloodwork: azotemia, +/- hyperkalemia and academia
Urinalysis: Oliguria/anuria, Urine SpGr is variable, +/- proteinuria, +/- cellular cast (insult kills tubular epithelial cells)
88
In what animals will you see chronic renal failure?
Usually geriatrics (but not always) frequently cats.
89
What is the difference in the physical exam between a patient in chronic renal failure and one in acute renal failure? (Just say it was different when it comes to the body score, G.I, renal, neuro, & CV)
Poor body score (ARF: good)
G.I.: anorexia, vomiting, diarrhea, halitosis (NH3) (ARF: same)
Renal: PU (ARF: OU, anuric)
Neuro:depressed (ARF: same plus more signs)
CV: hypertension (ARF: N/a)
90
What are the features of chronic renal failure? (5)
```
– irreversible kidney injury
– renal function is inadequate to maintain patient health
– decreased GFR
– azotemia
–isosthenuria
```
91
What will you see with your blood work and urinalysis with chronic renal failure (GFR less than 20 to 25% of normal)? (6 and 1)
```
Bloodwork
• Nonregenerative anemia (why?) EPO
• Evidence of dehydration - kidneys cannot regulate body H2O
• Azotemia
• +/- Hyperphosphatemia (85%)
• Metabolic acidosis - kidneys cannot regulate electrolyte and A/B balance
• Normokalemia to Hypokalemia
Urinalysis
• Polyuria, isosthenuria
```
92
What will you see with your blood work and urinalysis with chronic renal failure (GFR less than 5% of normal=end stage renal disease)? (6 and 2)
```
Bloodwork
• Nonregenerative anemia
• Marked dehydration
• Marked azotemia (patients are uremic)
• Hyperphosphatemia
• Metabolic acidosis
• Hyperkalemia
Urinalysis
• Isosthenuria
• Oliguria to anuria
```
93
What are the two causes of renal glomerular damage that the to glomerulonephritis?
What can either cause? (2)
What can this lead to?
Immune complex deposition and amyloid deposition.
Retraction of podocytes and loss of selective permeability of the glomerular basement membrane.
Proteinuria and hypoproteinemia
94
What are your lab findings when you have an animal with glomerulonephritis? (3)
• mild to marked hypoproteinemia
– hypoalbuminemia
– normoglobulinemia
• moderate to marked proteinuria (albuminuria
• +/- evidence of renal insufficiency (azotemia, isosthenuria)
95
What is nephrotic syndrome?
| Look at slide 32/7
Protein losing nephropathy leading to abdominal transudation.
96
Look at slide 33/7 for a summary of acute renal failure versus chronic renal failure
.
97
What are biomarkers?(Slide 35/7)
They are any substance, structure or process that can be measured in the body work is products and influence for predicted that incidents of alcohol or disease. (Definition by world health organization)
98
What are your conventional biomarkers in renal disease?(Slide 35/7)
BUN and creatinine
99
What are some disadvantages to using BUN and creatinine as biomarkers for renal disease? (4)(36/7)
‐ Variance in biomarker production rate
‐ Variance in extrarenal factors that ↓ GFR
‐ Renal handling is not consistent (esp. BUN)
‐ Provide general estimates of renal tubular function
100
look at slide 37/7.
| Referring to biomarkers what is clinically applicable(Important?)?
Accurate, easy to measure, noninvasive (and inexpensive)
101
Look at slides 38 – 40/7
.
102
Look at slides 42 – 45/7
.
103
What is a good test to rule out chronic renal failure in cats?
SDMA
104
All cards with a number in front are learning objectives/study guide.()is set.
(8)1. Know the general advantages and disadvantages of the 3 means of urine collection
Cystocentesis:
• Advantages
– avoid contamination, avoid iatrogenic urinary tract infection, good for culture.
• Disadvantages
– risk of spreading local pyoderma, coagulopathy, or neoplasia.Can induce microscopic hematuria.
Voided urine/ Free catch:
• Advantages
– acceptable for urinalysis and sediment exam
• Disadvantage
– Contamination, hard to get
Catheterization:
• Advantages
–
• Disadvantages
– trauma, technically difficult (especially in females), blood or epithelial cell contamination, bladder infection
105
(8)2. Know the basic urine sample handling procedures
Slides 14
106
(8)3. Understand and interpret relevant dipstick findings
Slides 26 –49/8
107
(8)4. Know the significance of the various findings in a sediment: cells, crystals, casts, bacteria
.
108
(8)5. Be able to interpret and apply urinalysis data to cases
.
109
*What are the three ways to collect urine?
– Cystocentesis
– Voided urine/Free catch
– Catheterization
110
What is needed to perform Cystocentesis? (3)
• 22-25 g needle, 11⁄2" to 3" (depending on patient size)
• 3-12 cc syringe for diagnostic cystocentesis
*• Change needle before transferring to the red top tube*
111
What are the indications for using Cystocentesis? (4)
* Avoid contamination from the lower urogenital tract
* Minimize iatrogenic urinary tract infection caused by catheterization
* Aid in localization of hematuria, pyuria, and bacteriuria
* Therapeutic cystocentesis in blocked cats – early as part of management
112
What are the contraindications for Cystocentesis? (4)
* Local pyoderma, coagulopathy, neoplasia (risk of seeding)
* Insufficient volume of urine in the urinary bladder
* Patient resists restraint and abdominal palpation
* No redirecting the needle! If you don’t get urine on the first stick – get a new needle!
113
Look at slide 9/8
.
114
Why can't you use voided urine for a culture sample? (10/8)
It can't be used because of contamination.
115
What are the issues associated with catheterization? (5)
• Blood or epithelial cell contamination
• Trauma
• Technically difficult, especially in females
• Track materials into bladder and cause bladder infection
• Perform re-check UA to check for UTI after catheterization

116
Ideally when should you evaluate urine within time wise?
| What should you do if you can't do it within that time?
30 minutes
| refrigerate
117
What can a low urine specific gravity cause? (Referring to sample handling)l
Cellular lysis
118
How long it can urine be kept in refrigeration? After taking it out of refrigeration how long should you let urine stay outside to warm up?
Up to 12 hours.
| 20 minutes
119
On your gross inspection of a dogs urine UC of yellow orange color, what does this mean?
What does a yellow green/yellow brown color mean?
Red?
Red brown?(Slides 17 – 19/8)
YO:bilirubin
YG/YB: bilirubin & biliverdin
R: RBCs, Hb, Mgb
RB: RBCs, Hb, Mgb, MetHgb
120
Look at slides 21-24/8
.
121
What should you do prior to reading a urine specific gravity? (4)
– Centrifuge the sample
– Remove the supernatant
– Read the SpGr off of the supernatant
– Measure on room temperature urine only
122
What is the glucose level in a healthy puppy (milligrams/deciliter)?
The premise is false. You will not see glucose in a healthy puppies urine.
123
Give the Renal threshold of glucose (mg/dL) in dogs, cats, horses, and cattle.
Dogs: 180
Cats: 280
Horses: 180
Cattle: 100
124
List some differential for hyperglycemic glucoseuria. (Slide 31/8) (listed are the ones that we should know) (5)
* Diabetes mellitus – glucose
* Hyperadrenocorticism – cortisol
* Drugs – dextrose, glucocorticoids
* Postprandial
* Acute pancreatitis
125
List the differentials for Normoglycemic Glucosuria.(Slide 32/8) (listed are the ones that we should know) (3)
* Transient stress
* Reversible tubular damage: drugs, hypoxia, infection, toxins
* Cats with urethral obstruction
126
Look at slide 34-36/8
.
127
What ketones are tested using a dipstick? (2) (36-38/8)
Acetoacetic acid and acetone
128
What are the possible causes of ketoneuria? (3)
– negative energy balance
– diabetic ketoacidosis
– insulinoma
129
Look at slides 39 – 51/8
.
130
Look at slide 4-16/9
.
131
What is the significance of seeing epithelial cells in your urine sediment?
Seen in free catch urine. Rarely pathological. (Sertoli cell tumors causing squamous metaplasia and male dogs)
132
What is the significance of seeing transitional epithelial cells in the urine sediment?
Seen with hyperplasia associated with inflammation. It is also seen in transitional cell tumors (benign and malignant).
133
What is the significance of caudate cells in the urine sediment? What do they look like?
Pyelonephritis.
Cone shaped
134
What is the significance of finding renal cells in your urine sediment?
It is seen with renal tubular injury (e.g. infectious, toxic, and ischemic injury)
135
Look at slides 19-25/9
.
136
What is the significance of finding red blood cells in your urine sediment?
It could mean hemorrhage, or inflammation
137
What is the significance of finding white blood cells in your urine sediment?
Inflammation (infectious and noninfectious)
138
Which sex is more predisposed to finding bacteria in the urine sediment?
Females
139
Look at slide 27-35/9
.
140
Look at slide 39/9
.
141
What is the significance of finding lipids in the urine sediment?(43/9)
Likely from the degeneration of sloughed cells. Usually an isolated finding (normal). Could be renal tubular injury if finding is consistent.
142
```
Select all that apply when it comes to debris found in urine.
A. Pollen
B. Fat droplets
C. Fungal spores
D. Glove powder
E. Fibers
F. Sperm
G. D. immitis
H. Rbc's
```
```
A. Pollen
B. Fat droplets
C. Fungal spores
D. Glove powder
E. Fibers
F. Sperm
```
143
What are the four in vivo factors that contribute to a urine crystal formation?
– Concentration solubility of crystalline material.
– Urine pH
– Diet
– Excretion of drugs or diagnostic imaging agents
144
What are the three in vitro factors that contribute to urine crystal formation? (47/9)
– Temperature
– Evaporation
– Urine pH
145
What are the five common crystals you will see in urine?
```
– Struvite
– Bilirubin
– Calcium carbonate
– Amorphous
– Calcium oxalate dihydrate
```
146
```
Which of the following is the most common crystal found in dogs and cats?
A. Struvite
B. Bilirubin
C. Calcium carbonate
D. Amorphous
E. Calcium oxalate dihydrate
```
A. Struvite
147
What is the significance of finding Struvites in an animal's urine? (49/9)
Found in normal patients (nothing significant)
148
What is the significance of finding Bilirubin crystals in an animal's urine?
What are the color of these crystals?(52/9)
In every species except for dogs you should look for icterus.
Orange to copper granules
149
Should you be worried if you see calcium carbonate crystals in a rabbit's urine? (54/9)
No. It is normal in horses, rabbits, guinea pigs, and goats.
150
What is the clinical significance of amorphous crystals in the urine sediment?
What is the color of these crystals?(57/9)
There is no significance.
Yellow to yellow-brown
151
What animal is predisposed to getting Calcium oxalate dihydrate crystals?
Miniature schnauzers
152
If you see Calcium oxalate dihydrate in a miniature schnauzer what could be the cause of this? (2)
Increased calcium excretion due to hypercalcemia (e.g. hyperparathyroidism).
Acute renal failure.
153
If you see Calcium oxalate dihydrate in any animal but a miniature schnauzer, what is the significance?
Nothing, normal in domestic animals or a possible storage artifact.
154
What is the significance of seeing calcium oxalate monohydrate crystals in small animals? (61/9)m
Ethylene glycol toxicosis.
155
Look at slides 64 – 65/9
.
156
What is the significance of finding Ammonium biurate (urate) in urine? (2) (66/9)
Is normal in Dalmatians and English bulldogs.
| In other animals it could suggest liver disease.
157
What is the significance of finding cystine in urine? (68/9)
Defective renal tubular reabsorption.
158
Look at slide 70/9
.
159
Look at slide 74/9
.
160
What are the five different types of casts you may see in the urine? (76/9)
```
‒ Hyaline casts
‒ Cellular casts
‒ Granular casts
‒ Fatty casts
‒ Waxy casts
```
161
True or false:
| Finding a rare Hyaline or Granular cast is very severe and can show possible renal disease/injury.
False. Finding a rare Hyaline or Granular cast is normal. Renal disease/injury is suspected with the presence of numerous casts. But the absence of casts does not rule out renal disease.
162
Look at slide 79/9
.
163
What is the significance of finding cellular casts in the urine? (3) (slide 81-84/9)
‒ Active tubular degeneration or necrosis
‒ Renal ischemia, or toxic nephrosis
‒ NOT evidence of extent or reversibility of injury
164
What is the significance of finding waxy casts in the urine?(86/9)
Always of pathologic significance! Associated with chronic renal disease.
