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Exam 2 Flashcards

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1
Q

What is polycythemia?

A

Increased red cell concentration

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2
Q

What causes relative polycythemia?

A

Hemoconcentration (dehydration, fluid shifts), and

redistribution (excitement, exercise)

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3
Q

What causes absolute polycythemia?

A

Increased EPO;

Primary (myeloproliferative disorders, etc)

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4
Q

Is increased EPO secretion from renal cysts or tumors appropriate or inappropriate?

A

Inappropriate

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5
Q

Is increased EPO due to chronic hypoxia appropriate or inappropriate?

A

Appropriate

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6
Q

If you see increased PCV and TP, what will you think?

A

Dehydration

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7
Q

True or false: decreased albumin = dehydration

A

FALSE!

INCREASED Albumin means dehydration

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8
Q

If arterial oxygen is normal, is an increased EPO appropriate or inappropriate?

A

Inppropriate

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9
Q

If arterial oxygen is decreased, is an increased EPO appropriate or inappropriate?

A

Appropriate

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10
Q

What is leukemia?

A

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

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11
Q

What kind of leukemia has immature neoplastic cells, with a typically short survival?

A

Acute

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12
Q

What kind of leukemia has mature, well differentiated cells, with a longer patient survival time?

A

Chronic

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13
Q

Specific B cell neoplastic process; plasma cell differentiation

A

Multiple myeloma

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14
Q

Neoplastic process confined to solid tissues

A

Lymphosarcoma or lymphoma

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15
Q

Neoplastic process in marrow and/or blood

A

Lymphocytic leukemia

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16
Q

In dogs, a lymph conc of >35k means:

A

Leukemia

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17
Q

In dogs, lymph conc of <15k and Ehrlichia negative:

A

Leukemia

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18
Q

True or false: all dogs w/ ALL have lymphadenopathy

A

FALSE

Only about 1/2 the time

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19
Q

Clinical signs of ALL?

A 
Pale MM
Splenomegaly
Hepatomegaly
Lethargy 
Weight Loss
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20
Q

CBC readings of ALL?

A

Anemia
Thrombocytopenia
Lymphocytosis (usually)
Lymphoblasts in blood

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21
Q

ALL Prognosis?

A

Poor

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22
Q

What do lymphs look like in CLL?

A

Small, well differentiated

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23
Q

How can you confirm CLL?

A

Flow cytometry

PCR

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24
Q

DDx for CLL in cats?

A

Excitement lymphocytosis

Bartonella henselae

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25
DDx for CLL in dogs?
Chronic ehrlichiosis Antigen stimulation rare Excitement lymphocytosis rare Hypoadrenocorticism rare
26
CLL clinical signs?
May be asymptomatic; if ill-lethargy, anorexia, pale MM, lymphadenopathy, splenomegaly, hepatomegaly possible
27
Lab findings in CLL?
Lymphocytosis Possible anemia, thrombocytopenia Inc small lymphs in BM Rarely monoclonal gammopathy
28
Are most CLL cats Fe-LV positive or negative?
Negative
29
Multiple myeloma:
Proliferation of plasma cells at various sites in the BM, and eventually other tissues
30
What are the clinical signs of multiple myeloma due to?
Neoplastic plasma cells in the marrow and other tissues; and the immunoglobulins that they produce, which can result in hyperviscosity of the blood
31
What are the lab findings of multiple myeloma?
>20% plasma cells in bone marrow Monoclonal or biclonal gmmopathy IgG or IgA usually Bence-Jones protein in urine
32
What are Bence-Jones proteins?
Light chains of immunoglobulins that can pass through the glomerulus and end up in urine
33
Clinical signs of multiple myeloma?
``` Lethargy, anorexia, lameness, bleeding from the nares, PU/PD Fundoscopic changes Paralysis possible Renal dz possible Bleeding disorders in 1/3 of dogs ```
34
Multiple myeloma in cats?
Atypical plasma cell morphology Anemia Bone lesions Organ involvement common in cats
35
Myeloid cancers with gradual progression
Myelodysplastic syndromes | Myeloproliferative neoplasms
36
What % blast cells in the BM constitute an acute myeloid leukemia?
20% or greater
37
What morphologic abnormalities might you see with myelodysplastic syndromes?
Cytopenia common; may be single or in combo w/ non-regenerative anemia, neutropenia, and/or thrombocytopenia. Marrow cell counts vary. Dysynchrony of nuclear and cytoplasmic maturation
38
Are myelodysplastic cats usually Fe-LV positive or negative?
Positive
39
Clinical signs of myelodysplastic syndromes?
Lethargy Anorexia Weight loss Often progress to leukemia; die w/in wks of Dx
40
Undifferentiated leukemia:
Almost all cells in BM are blasts that can't be classified easily. More common in cats
41
Myeloblastic leukemia
>90% blasts in BM | <10% more differentiated granulocyte precursors
42
Myeloblastic leukemia w/ differentiation
Between 20 and 90% blasts in BM | >10% differentiated granulocytes
43
Myelomonocytic leukemia
Myeloblasts and monoblasts >20% in BM | Monocytes and granulocytes >20%
44
Monocytic leukemia
Promonocytes and monoblasts >80% of non-RBCs | or between 20 and 80%
45
Erythroleukemia
Erythroid >50%; myeloblasts and monoblasts <20%
46
Megakaryoblastic leukemia
>20% megakaryoblasts; inc megakaryocyes | Thrombocytopenia or thrombocytosis
47
Chronic granulocytic (myelogenous) leukemia
More common in dogs. Marked neutrophilia, left shift, often monocytosis. Hypersegmented nuclei, giant metamyelocytes, bands
48
DDx for chronic granulocytic leukemia?
MDS (marked leukocytosis differentiates) | Inflammatory responses
49
What can help definitively diagnose chronic granulocytic leukemia?
Disorderly left shift and eventual "blast crisis" | Usually much more anemic than patients w/ inflammatory dz
50
Are eosinophilic leukemia cats usually Fe-LV positive or negative?
Negative
51
Clinical signs of eosinophilic leukemia?
Similar to MPDs, also: | Thickened bowel loops, darrhea, vomiting
52
Clinical signs of chronic basophilic leukemia?
Basophilia, orderly left shift, thrombocytosis possible, organ infiltration
53
Platelets over a million may represent....
Essential thrombocytopenia. It's pretty uncommon. DDx include things that can cause thrombocytosis
54
Important components of body cavity fluid analysis?
Cell concentration Protein concentration Types of cells present
55
Pure transudates form due to _________
Hypoalbuminemia | lack of oncotic pressure?
56
Modified transudates form due to ____________
Impaired blood or lymph flow
57
Exudates form due to _______
Increased capillary permeability | inflammation from cytokines due to MCOs, etc
58
Transudate
Clear Protein < 6k/ul No clot
59
Exudate
Cloudy Protein >3 g/dl NCC >6k/ul Clot formation
60
What value should you look at if you suspect uroabdomen?
Creatinine
61
What value should you look at if you suspect chylous effusion?
Triglyceride
62
What value should you look at if you suspect bile leakage?
Bilirubin
63
What cells constitute suppurative inflammation
Predominantly neutrophils
64
What cells constitute a mixed inflammation?
Segs, lymphs, MPs, maybe eosinophils
65
What cells constitute a mononuclear inflammation?
MPs, lymphs
66
Cell types encountered in neoplastic effusions:
Lymphoblasts, carcinoma cells
67
Criteria of malignancy
Variable nuclear size Large multiple nucleoli Abnormal mitoses Nuclear molding
68
What cells predominate joint fluid?
MPs and synovial lining cells
69
What could suppurative inflammation joint fluid be caused by?
Usually immune-mediated dz; possibly septic | Could be mononuclear- degenerative dz or trauma
70
If an animal has an infection, what will you normally see in joint fluid analysis?
High cell count Usually non-degenerate NPs Don't usually see the infectious agent Usually only a single joint is infected
71
If an animal has an immune-mediated dz, what will you normally see in joint fluid analysis?
Low to high cellularity Increase in non-degenerate NPs Usually multiple joints are affected
72
Cytology advantages over hisopathology
Round cell tumor ID Detection, ID of MCOs No shrinkage artifact
73
Cytology disadvantages
Non-diagnostic samples No tissue architecture Small sample size
74
Basic rules to specimen evaluation
1. Understand what normal should look like 2. Examine the entire specimen at low magnification 3. Only evaluate intact cells, avoid areas that are thick, understained 4. Recognize artifacts and contaminants
75
Reasons for "non-diagnostic" samples:
``` Only blood on slide All cells are broken Cells are too thick to interpret There's nothing on the slide Formalin contamination Aged sample ```
76
How can we recognize malignancy?
Variability | Cells are somewhere they don't belong
77
Nuclear criteria of malignancy
``` Anisokaryosis Abnormally clumped chromatin Abnormal nucleoli Abnormal mitotic figures Micronuclei Variable sized nuclei in the same cell Nuclear molding ```
78
Tumor classification
Round (discrete) Epithelial CT
79
Types of round cell tumors
``` PHMLT (Please Help Me Learn This): Plasma cell tumors Histiocytomas Malignant histiocytosis Lymphoma TVTs ```
80
Round cell tumor description:
Cells usually individual Plenty of cells present Circular cells w/ round nuclei, distinct cytoplasmic borders May be well differentiated
81
Malignant histiocytosis, histiocytic sarcoma description:
Abundant vacuolated cytoplasm, many multinucleated cells, look like MPs w/ malignant criteria
82
Epithelial tumor description:
Cells in sheets or clusters; distinct cytoplasmic borders; cells often large w/ abundant cytoplasm; can show signs of differentiation
83
Mesenchymal tumor description:
Spindle cells; fewer in number; can be in clusters but are normally individual
84
Absorption spectrum:
Pattern in which a substance absorbs light at various wavelengths
85
Photometry
Measures the intensity of light passing through or emitting from a test chamber
86
Spectrophotemetry
Instrument directs a beam of light through a solution; measures the amount of light absorbed
87
Reflectance photometry
Fluid is placed on dry fiber pad--> chemical rxn ensues --> product formed is proportional to teh conc of the analyte
88
Electrophoresis:
Movement of charged particles through a solution under the influence of an electrical field; Used commonly to separate and analyze serum proteins
89
Movement of particles in electrophoresis depends on:
``` Net charge Size and shape of the protein Strength of the electrical field Type of supporting medium Temp ```
90
Reference limits =
Mean +/- 2 standard deviations
91
Reference interval:
the values between the reference limits
92
Sensitivity:
True Positive/ (True positive + false negative) x 100
93
Specificity
True negatives /(true negatives + false positives) x 100
94
Predictive value of a test:
Reliability of a test to detect whether or not an animal has a dz
95
Accuracy:
How close the result is to the true value
96
Precision:
How repeatable the result is when assaying the same sample
97
Where are proteins synthesized?
Mainly in the liver, some by the immune system
98
What is total protein composed of?
Albumin | Globulins
99
Major roles of albumin:
Transport protein | Colloidal osmotic pressure
100
Alpha and Beta globulin functions
Inflammation Coagulation Transport proteins
101
Fibrinogen
Subset of globulin (beta) Synthesized by liver Coagulation Increases during inflammation
102
Plasma
Liquid portion of blood that hasn't clotted | Contains all the proteins
103
Serum
Liquid portion of blood that remains after clotting | No fibrinogen
104
How is TP measured?
Spectrophotometry
105
How is albumin measured?
Spectrophotometry
106
How is globulin measured?
TP - Albumin = Globulin
107
What can cause decreased production of albumin?
Inflammation and liver failure are the big ones; also, severe malnutrition, maldigestion, or malabsorption, and intestinal parasites
108
What can cause an abnormal loss of albumin?
Blood loss; PLE; PLN; 3rd spacing; skin dzs, burning
109
If hypoalbuminemia is caused by malabsorption/maldigestion, what chemistry analyses might you see?
Dec glucose, cholesterol, and urea
110
If hypoalbuminemia is caused by liver failure or insufficiency, what chemistry analyses might you see?
``` Dec glucose, cholesterol, and urea Increased globulins (the liver isn't filtering Ags) ```
111
If hypoalbuminemia is caused by a protein-losing nephropathy (PLN), what chemistry analyses might you see?
Increased cholesterol
112
Nephrotic syndrome
Proteinuria Hypoalbuminemia Hypercholesterolemia Ascites
113
If hypoalbuminemia is caused by PLE, what chemistry analyses might you see?
Decreased cholesterol | Decreased Mg
114
Why would an animal have hyperalbuminemia?
It's dehydrated
115
What can cause a decreased production of globulin?
Severe combined immunodeficiency syndrome (SCIDS)
116
What can cause an abnormal loss of globulin?
Hemorrhage | PLE
117
What are the categories of things that can cause hypoglobulinemia?
Decreased production Abnormal loss Failure of passive transfer in neonates
118
Infectious inflammatory dzs that can cause hyperglobulinemia?
K9 ehrlichiosis | FIP
119
Polyclonal gammopathy =
Inflammation
120
Monoclonal gammopathy =
Neoplasia- multiple myeloma
121
What can cause panhypoproteinemia?
Blood loss | PLE
122
What are the big categories of things that can cause hyperglobulinemia?
Dehydration Inflammation Neoplasia
123
What can cause panhyperproteinemia
Dehydration
124
What can cause hypofibrinogenemia?
Liver failure | DIC
125
What can cause hyperfibrinogenemia?
Inflammation | Renal disease
126
Isosthenuria
1.008-1.012 | The kidney is incapable of altering the amount of water leaving the body
127
Hyposthenuria
Dilute; USG <1.007 | The kidney is actively diluting the urine
128
Oliguria
Decreased urine production
129
Anuria
No urine produced
130
Pllakiuria
Increased frequency of urination
131
Azotemia
Increased urea nigrogen with/without increased creatinine
132
Uremia
Excessive urea in blood w/ clinical signs of renal failure
133
Functions of the kidney
``` Produce EPO and renin Activate Vit. D Regulate BP Excrete waste products Conserve important substrates ```
134
Waste products excreted by the kidneys:
Urea, creatinine, NH4 K, H, PO4 Water soluble drugs Hormones and enzymes
135
Substrates the kidney conserves
Na, Cl, HCO3, Ca, Mg, glucose, AAs, water
136
Renal insufficiency means the kidney has lost how many nephrons?
66% have ceased to function
137
Azotemia
75% of nephrons are functionally impaired
138
Renal disease
Retain UN and CREA Can't dilute or concentrate urine >75% of nephrons are affected
139
Major lab tests used to evaluate kidne function
Serum BUN and CREA | USG
140
In what species is BUN not a good indicator of GFR?
Ruminants. Salivary and blood urea go to the rumen
141
Is BUN reabsorbed in the kidney?
Yes, about 40% is
142
Is CREA reabsorbed in the kidney?
No
143
If CREA is increased in blood, it implies:
A decrease in GFR; | Possibly altered kidney (nephron) function
144
Why do we want to collect blood and urine at the same time?
We want to see what's happening before the kidney (in the blood), and after the kidney (in the urine)
145
When should you obtain a urine sample and measure USG?
Suspected renal dz Geriatric wellness History of PU/PD
146
What is USG influenced by?
ADH, concentration gradient
147
What constitutes the concentration gradient of urine??
Medullary hypertonicity Production of urea Production of aldosterone (Not 100% on this....:/)
148
How is urine diluted?
By resorbing Na and Cl
149
Is any water removed by the collecting tubule?
Not really
150
What's the relative osmolality of urine at the beginning and end of the renal tubules?
It starts out isosmolar, ends up hyperosmolar
151
What hormones are going to influence the resorption of Na, Cl, and urea in the descending tubule?
Aldosterone and ADH
152
Is it normal for a dog to have some protein in concentrated urine?
Yes, just a little probably. It's usually albumin
153
How do we measure urine protein concentration, and in what specific cases may we want to look at it?
Measure w/ a reagent strip. Look at it w/ PLNs, glomerulonephritis, and uroliths
154
What is polyuria?
Inability to concentrate urine; implies loss of 2/3 of nephrons; will probably see low USG. Don't confuse w/ Diabetes
155
What are the renal related differentials for PU?
Renal failure | Pyelonephritis
156
What are the extra-renal differentials for PU?
Diuresis Medullary washout Endocrine Pyometra
157
What will the lab tests reveal w/ a pre-renal azotemia?
Inc BUN +/- inc CREA Inc SpGr
158
What can caused a decreased renal flow, leading to a decreased GFR?
Dehydration Shock Cardiac insufficiency (dec CO)
159
What can cause increased urea production?
Upper GI bleed High protein diet Endogenous protein catabolism In ruminants, decreased ruminal motility
160
2 analytes affected by GFR?
BUN | CREA
161
What are the sources of AAs?
GI tract and endogenous protein catabolism
162
In what animals might you see a normally increased CREA?
Greyhounds (inc muscle mass) and neonatal foals (dysfunctional placenta, prevents normal clearance of fetal CREA)
163
What will the lab tests show for renal azotemia?
Increased BUN and CREA | Decreased SpGr
164
After the kidney has lost 75% of nephrons (renal azotemia), what will the rest of the nephrons do?
Undergo functional hypertrophy to try to keep up
165
What are the infectious differentials for renal azotemia?
Pyelonephritis | Leptospirosis
166
What are the toxin differentials for renal azotemia?
Ethylene glycol, drugs, grapes, asiatic liles, melamine, pigments
167
What are the hypoxic differentials for renal azotemia?
Decreased renal perfusion, infarction
168
Is an animal with azotemia and low USG always in renal failure?
NOOOOO! | There are tons of things that can cause similar effects
169
What will the lab tests show in postrenal azotemia?
Inc BUN and CREA | Variable SpGr
170
2 major causes of postrenal azotemia:
Block | Uroabdomen
171
T or F: Azotemia occurs before polyuria
FALSE!!!!!! Polyuria occurs before azotemia. Better know that, fool
172
Clinical signs of postrenal azotemia
Straining to urinate Large turgid bladder Distended abdomen (uroabdomen)
173
What does decreased CREA mean?
Nothing! | It's not clinically significant
174
What can cause prerenal proteinuria?
Hypertension | Hyperproteinemia
175
Prerenal proteinuria
Increase in a small protein in blood | Ex: paraproteinuria; hemoglobinuria; myoglobinuria; post-colostral proteinuria
176
What are the 2 types of renal proteinuria?
Glomerular and tubular
177
What can cause glomerular proteinuria?
Hypoalbuminemia (PLNs, etc) | Diseases that damage filtration barriers
178
Tubular proteinuria
Normal or inc serum albumin Usually assoc. w/ acute or congenital renal dz Proximal tubules are defective Loss of low MW proteins
179
What can cause postrenal proteinuria?
Hemorrhage into the genitourinary tract; | Inflammation (will see pyuria in this case)
180
Urinary protein: creatinine ration
Estimates quantity of urine protein excreted per day. | Normal is <0.5
181
Are glomerular or tubular proteinurias more severe?
Glomerular
182
Biochemical profile of renal failure
Hypocalcemia (hyper in horses) Hyperphosphatemia Metabolic acidosis Hypochloremia (in cattle)
183
Number one reason for hyperphosphatemia
``` Decreased GFR (except in horses, Phos will be dec) ```
184
If there's been a uroabdomen, what will the urine in the peritoneum consist of?
Increased CREA, urea, K | Decreased Na and Cl
185
If there's been a uroabdomen, what will the blood plasma levels look like?
Decreased CREA, urea, K | Increased Na and Cl
186
What is diagnostic of uroperitoneum?
Peritoneal [CREA] 2x serum [CREA]
187
Clinical signs of Acute Renal Failure
Good BCS Anorexia, V/D, halitosis Oliguric to anuric Depressed->obtunded->nonresponsive->seizures
188
Some common causes of ARF?
Toxins Renal ischemia Infection
189
Lab findings of ARF?
Azotemia Possible hyperkalemia and acidemia Oliguria or anuria Possible proteinuria; celular cysts
190
Clinical signs of chronic renal failure?
``` Poor BCS Anorexia, V/D, halitosis Polyuric Depressed Hypertension ```
191
CRF bloodwork
``` Non-regenerative anemia Dehydration Azotemia Probable hyperphosphatemia Metabolic acidosis Normo to hypokalemia ```
192
CRF urinalysis
Polyuria | Isosthenuria
193
What can cause glomerular damage?
Immune complex deposition | Amyloid deposition
194
T or F: hypoproteinemia is seen w/ glomerulonephritis?
True. Protein loss exceeds production. | It's typically albumin that's getting lost
195
What constitutes nephrotic syndrome?
``` Glomerular disease Hypoalbuminemia Hypercholesterolemia Edema/abdominal effusion Hypercoagulable state ```
196
What is nephrotic syndrome?
PLN leading to abdominal transudation
197
When will symmetric dimethylarginine (SDMA) increase?
When there's ~40% loss of renal tubular function. | Great test to rule out CRF in cats!
198
Cystocentesis contraindications
Local pyoderma, coagulopathy, neoplasia Insufficient urine volume in the bladder Patient resists restraint and abdominal palpation
199
If you've refrigerated a urine sample for 12 hrs, what do you need to do before you evaluate it?
Warm to room temp for 20 minutes, then gently swish to remix and resuspend the sediment
200
What does a complete urinalysis involve?
Gross visual assessment of urine sediment and USG Chemical evaluation Microscopic examination of sediment
201
Yellow-orange urine indicates what?
Bilirubin
202
Yellow-green/yellow-brown urine indicates what?
Bilirubin and biliverdin
203
Red urine indicates what?
RBCs, Hemoglobin, Myoglobin
204
What will a urine sample w/ excess hemoglobin look like?
Red-brown urine; serum will be red/pink
205
What will a urine sample w/ excess myoglobin look like?
Red-brown urine; serum will be clear
206
What will a urine sample w/ excess MetHgb look like?
Red-brown urine; serum is brown/black
207
Brown-black urine indicates what?
MetHgb
208
What can cause red urine in horses?
Storage, or snow | Not necessarily indicative of hematuria
209
What can cause cloudiness or turbidity in urine?
"formed elements" | Cells, crystals, bacteria, casts, and lipid droplets
210
What values do you ignore when reading a dipstick?
Leukocytes USG Nitrite Urobilinogen
211
Major differentials for hyperglycemic glucosuria?
``` Diabetes mellitus-glucose Hyperadrenocorticism-cortisol Drugs: dextrose, glucocorticoids Postprandial Acute pancreatitis ```
212
Major differentials for normoglycemic glucosuria?
Transient stress Reversible tubular damage (drugs, hypoxia, toxins, infection) Cats w/ urethral obstruction
213
What comes first in a dog, bilirubinuria or bilirubinemia?
Bilirubinuria | Worry less if the USG is higher
214
What are some major differentials for bilirubinuria?
Liver dz Bile duct obstruction Hemolysis
215
What can cause false negative bilirubin readings on a dipstick?
Old sample Light exposure Nitrites Ascorbic acid
216
What are the true ketones?
Acetoacetic acid | Acetone
217
What can cause ketonuria?
Negative energy balance DKA Insulinoma
218
What will happen to dipstick blood if it's due to hematuria?
It will clear with centrifugation
219
Major differentials for hematuria?
Infection, inflammation, calculi
220
What can cause an alkaline pH of urine?
UTI Low protein diet Respiratory alkalosis, metabolic alkalosis Alkalinizing drugs
221
What can cause an acidic pH of urine?
``` High protein diets Respiratory and metabolic acidoses Hypochloremic metabolic alkalosis + severe dehydration Hypokalemia Furosemide ```
222
Dipstick primarily detects which protein?
Albumin
223
What are the sources of squamous cells seen in urine sediment?
Distal urethra, vaginal tract, skin
224
What are the sources of transitional cells seen in urine sediment?
Renal pelvis, ureter, bladder, proximal urethra
225
What is the source of caudate cells seen in urine sediment?
Renal pelvis
226
What is the source of renal cells seen in urine sediment?
Renal tubules

Clin Path (2 decks)

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