final exam lectures Flashcards
(128 cards)
1
Q
most proteins are synthesized where
A
the liver
2
Q
which contains the proteins:
plasma or serum
A
plasma
3
Q
total protein = ___ + ____
A
ALB + GLOB
4
Q
what are the 2 major roles of albumin
A
1) Transport protein
2) Colloidal osmotic pressure
5
Q
which globulins are synthesized by lymphoid
tissue for immunity
A
γ globulins (IgG, IgM, IgA)
6
Q
which globulins are synthesized by the liver for the functions below
- Inflammation
- Coagulation
- Transport proteins
A
α1, α2, β globulins
7
Q
what type of globulin is fibrinogen
A
beta
8
Q
what species do you use fibrinogen as a marker of inflammation
A
Horses, ruminants, camelids
9
Q
what are the two functions of fibrinogen
A
- Coagulation
2. Increase during inflammation (positive acute phase protein)
10
Q
where is fibrinogen synthesized
A
the liver
11
Q
proteins that increase during an inflammatory response
A
POSITIVE acute phase proteins
12
Q
proteins that decrease during an inflammatory response
A
NEGATIVE acute phase proteins
13
Q
which type of acute phase proteins are albumin and globulin
A
alb - negative
glob - positive
14
Q
what unit are measured proteins in
A
g/dL
15
Q
what are your two options for protein measurement
A
- Refractometer (light refraction)
2. Chemistry analyzer (chemical rxn)
16
Q
When the TP is reported as a PCV/TP
and/or when it is reported on a CBC,
it is measured by a ____________
A
REFRACTOMETER
17
Q
what interferes with the refractometer measurements
A
Cholesterol, hemoglobin, urea, glucose,
lipemia
CHUGL
18
Q
movement of particles on electrophorese depends on what factors
A
**Net charge
**Size and shape of the protein
Strength of the electrical field
Type of supporting medium
Temperature
19
Q
which migrates further on electrophoresis alb or glob
A
ALB - smaller and more negative charge
20
Q
Proportional increase in ALB and
GLOB =
A
DEHYDRATION !!
Panhyperproteinemia
21
Q
what are the two differentials for Panhypoproteinemia
A
- blood loss
2. protein losing enteropathies
22
Q
causes of hypoalbuminemia from decreased production
A
- inflammation !! (neg acute phase protein!)
2. liver failure or PSS
23
Q
abnormal causes of hypoalbuminemia
A
- blood loss/hemorrhage if low GLOB too
- intestinal loss (PLE) if low GLOB too
- urinary loss (PLN)
- third space dilution (vasculitis or effusion)
- skin dz / burns
24
Q
if hypoalbuminemia is from hepatic insufficiency, what else will be seen
A
low glucose
low cholesterol
low urea
(high glob)
25
Nephrotic syndrome
1) Proteinuria
2) Hypoalbuminemia
3) Hypercoagulable
4) Hypercholesterolemia
5) Ascites
26
what other chem analytes will be low with protein losing enteropathy besides ALB
↓ Globulin
↓ Cholesterol
+/- ↓ Mg2+
27
Hyperalbuminemia
DEHYDRATION -- regardless of the globs
28
hypoglobulinemia from decreased production
Severe combined immunodeficiency syndrome (SCIDS)
29
inflammations from things such as K9 ehrlichiosis and Feline Infectious Peritonitis (FIP) will do what to the globulins
increase - hyperglobulinemia
30
neoplasias such as Plasma cell tumors / multiple myeloma and B-cell Lymphomas all will do what to the globs
increase - hyperglobulinemia
31
hyperglob... Polyclonal gammopathy =
inflammation
32
hyperglob.. Monoclonal gammopathy
neoplasia
33
Hypofibrinogenemia differentials
```
Liver failure (decreased production)
DIC (consumption)
```
34
pure transudate body cavity fluid due to
hypoalbuminemia
35
modified transudate body cavity fluid due to
Form due to impaired blood or lymph flow
36
exudative body cavity fluid due to
inflammation -- increased vascular permeability
37
T/F
| transudates will have >3 g/dl protein
FALSE -- this is exudates
transudates are <3
38
T/F
| exudates will have >6,000 NCC
TRUE
transudates will have <6000
39
test if you suspect chylous effusion
Triglycerides
40
test if you suspect uroabdomen
CREA
41
stain you wouldnt want to you on mast cell tumors
diff quick -- wont stain the granules (use a wright stain)
42
criteria of malignancy
Variable nuclear size (anisokaryosis)
Large multiple nucleoli
Abnormal mitoses
Nuclear molding
43
High protein, relatively low cell concentration in a cat
FIP
44
T/F
| use formalin with cytology
FALSE
45
>50% lymphoblasts!
lymphoma
46
Mixed bacteria in an abdominal aspirate
GI rupture
47
Bile pigment in cytology
Gut tap, rupture bile duct
48
round cell tumors
```
Lymphoma (lymphosarcoma)
Plasma cell tumors
Histiocytomas
Transmissable venereal tumors
Malignant histiocytosis
```
49
concentration solute per kilogram of SOLVENT (mOsm/kg)
osmolality
50
T/F
| osmolality measures all of the osmoles in the plasma
TRUE
51
the ability of a solution to initiate water movement
effective osmole / tonicity
52
distributed equal through the total body water (TBW) … no H2O movement
permeant solute
--BUN
53
does NOT readily distribute across cell membranes … causes H2O movement
impermeant solute -- effective osmole
Na, Glu, mannitol
54
diuresis occurs when...
occurs when urine flow that is greater than normal.
55
occurs when there is increased urine flow caused by excessive amounts of impermeant solutes within the renal tubules.
osmotic diuresis
**Urine osmolality approaches plasma osmolality
Example: diabetes mellitus (glucosuria)
56
occurs when there is increased urine flow caused by decreased reabsorption of free water
water diuresis
**Urine osmolality may drop below plasma osmolality
Example: diabetes insipidus
57
the ratio of weight of a volume of liquid to the weight of an equal volume of distilled water
specific gravity
58
Extracellular Fluid Volume (ECF) is determined by ___ content
Na
59
high plasma osmolality leads to:
increased thirst and renal water reabsorption
ADH RELEASED
Hyperosmolality —> cells shrink —> stimulates ADH release
60
low plasma osmolality leads to
increaed renal water excretion
Hypoosmolality —> cells swell —> inhibits ADH release
61
main regulator of Na
Aldosterone
62
what are the two functions of aldosterone
conserve Na
| secrete K
63
dehydration type
| water loss > Na loss
Hypertonic dehydration
64
dehydration type
| water loss = Na loss
Isotonic dehydration
65
dehydration type
| water loss < Na loss
hypotonic
66
hypertonic dehydration differentials (high plasma Na)
```
Diabetes insipidus
Diabetes mellitus
Osmotic diuresis
Osmotic diarrhea
Water Deprivation
```
67
isotonic dehydration differentials
Renal disease
| Diarrhea
68
hypotonic dehydration differentials
```
Secretory diarrhea
Vomiting
3rd space loss
Heat stress & sweating in horses:
Often Cl- losses are greater than Na+ losses
```
69
Hyperosmolality with Fluid Shifts can lead to what problems
Leads to cellular dehydration
Cerebral bleeding, subarachnoid hemorrhage,
permanent neurologic damage, death
70
Hypo-osmolality with Fluid Shifts can lead to what problems
Leads to cellular swelling
| Cerebral Edema & Cell Lysis
71
osmole gap > 30
ethylene glycol!! -- toxins
72
Normal osmole gap with increased osmolality
There is an increase in an osmole reported on the chemistry:
| Na, GLU, or BUN.
73
Normal osmole gap with decreased osmolality.
hyponatremia
74
T/F
| hyperglycemia can cause hyponatremia
TRUE
75
The most common cause of hyponatremia
HYPOVOLEMIA:
GIT: vomiting, diarrhea, saliva
Renal loss:Hypoadrenocorticism (Addison’s): ↓ aldosterone
Ketonuria, glucosuria
Prolonged diuresis
Cutaneous: sweating, burns
76
hypernatremia is normally due to
dehydration
| --inadequate water supply
77
A diabetic patient is markedly hyperglycemic.
| What do you expect the sodium concentration to be?
Decreased (Hyponatremia)
78
A diabetic patient is markedly hyperglycemic.
| What is the mechanism that drives the change in Na+?
Water shifts from the ICF to the ECF
79
Controlled by electrochemical gradients AND
| Corresponds to the active transport of sodium
Chloride
80
what can interfere with chloride transport
Furosemide
| GI enterotoxins
81
chloride normally parallels what
Na
82
most common cause of selective chloride loss
hypochloremic metabolic
| alkalosis
83
causes hypochloremia in monogastrics
severe vomiting
84
causes hypochloremia in ruminants
abomasal disorders
| or high GI obstructions
85
what is the urine ph during selective chloride loss
paradoxical aciduria
86
What acid-base abnormality accompanies selective chloride loss
metabolic alkalosis
87
renal excretion of K+ is regulated by..
aldosterone
88
most common cause of hyperkalemia
Failure of renal Excretion:
-Oliguria/ Anuria
-Urethral obstruction
-Ruptured urinary bladder
-Hypoadrenocorticism (Addison’s): ↓ aldosterone
-Drugs that decrease K+ excretion
“Potassium Sparing Diuretics” (i.e., Spirnolactone)
89
cause of pseudohyperkalemia
generally in vitro not in vivo
| EDTA contamination
90
clinical signs of hypokalemia
If [K+] < 2.5 mmol/L
Weakness
Neurologic signs
EKG abnormalities: Flattened T-waves
91
venous or arterial blood to do acid base analysis
venous
92
tube used for acid base analysis
heparin
on ice if >5 min
93
T/F
| TCO2 is bicarb
TRUE
94
2 mechanisms of metabolic acidosis
1. Increase in unmeasured anions = High Anion Gap (KLUE)
| 2. Loss of HCO3 via GI or Kidney = Loss of HCO3
95
2 mechanisms of metabolic alkalosis
1. Loss of H+ from upper GI tract = Selective chloride loss
| 2. Loss of H+ from the kidney = Loss of H+
96
Site of T3 and T4 synthesis
colloid - follicle lumen
97
T/F
| T4 is more potent than T3
FALSE
98
T4 is 100% synthesized by...
thyroid
99
gold standard test to measure total T4
Radioimmunoassay (RIA)
100
mainly the only thyroid function test used in cats
Total T4
101
T/F
| snap ELISA is not reliable for hyperthyroidism
FALSE -- not reliable for hypo
102
how does RIA work to measure total T4
Radioactivity is inversely proportional to [T4]
more radioactivity = less T4
103
what does the free thyroxe FT4 test measure
unbound circulating T4
104
gold standard test for free T4
Equilibrium Dialysis (ED)
105
parathyroid hormone is synthesized and secreted by
chief cells
106
a normal parathyroid patient with a hypercalcemia should have what levels of PTH
decreased
107
Acts on collecting ducts;
| maximizes water reabsorption
ADH . Vasopressin
108
primary differential diagnosis for diabetes insipidus
psychogenic polydipsia
109
central diabetes inspidus
Deficiency of ADH
110
nephrogenic diabetes insipidus
No response to ADH
111
An ADH response test is performed on a patient
being worked up for diabetes insipidus. After being
given ADH, the patient concentrates its urine.
central DI
112
Results from persistent CORTISOL secretion
canine hyperadrenocorticism
113
Pituitary-dependent hyperadrenocorticism
pituitary adenoma is 85% of the cases
there is HIGH ACTH to adrenals to make more and more cortisol but the pituitary does not respond to the negative feedback
bilateral adrenal hypertrophy
114
Adrenocortical tumor
the adrenal tumor produces constant cortisol so there is constant negative feedback on the pituitary and the other adrenal gland atrophies
115
Canine Hyperadrenocorticism:
| Iatrogenic
Glucocorticoid administration
Constant negative feedback
Small amounts of ACTH produced
2 atrophied glands
116
pot bellied, pu/pd, panting, and calcinosis cutis on a dog over 6 years old
cushings -- hyperadrenocorticism
117
```
Canine Hyperadrenocorticism (HAC):
Laboratory Abnormalities
```
```
stress leukogram -- because of the cortisol
↑ ALP
↑ ALT
↑ Cholesterol (90%)
low urine specific gravity
```
118
why is it important to differentiate
| pituitary-dependent from primary adrenal tumor.
PDH can be medically managed
| AT needs surgery
119
ALP screening test for canine hypoadrenocorticism
dog with normal ALP is unlikely to have HAC
120
Urine Cortisol Creatinine Ratio (UCCR)
urine collected at home
| there will be more cortisol accumulation in dogs with HAC
121
Low Dose Dexamethasone Suppression Test (LDDST)
in a healthy dog, when given dex the serum cortisol should drop... if not suppressed = HAC
122
LDDST.. cortisol was not suppressed at 8 hours, but was suppressed at 4 hours
PDH
123
Only test that will identify iatrogenic HAC
ACTH stimulation test --- CORTISOL WILL FLAT LINE
124
T/F
| puppies can get addisons
TRUE
125
pathogenesis of primary hypoadrenocorticism
Immune-mediated destruction of adrenal cortices
126
there is a lack of ____ and ____ in hypoadrenocorticism
aldosterone and cortisol
lack of aldosterone -- hyponatremia and hypovolemia
127
Hypoadrenocorticism:
| Common Laboratory Findings
```
non regenerative anemia
NO STRESS LEUKOGRAM
Pre-renal azotemia (90%)
Increased [BUN]
----1) Dehydration
----2) Gastrointestinal hemorrhage
```
128
glucose in addisons dogs
HYPOGLYCEMIC
