If blood glucose <60mg/dL, insulin should drop. If blood glucose <60mg/dL and insulin is still high, what is the most likely differential?
Insulinoma
Insulin-producing tumor
What are the most common causes of hyperglycemia?
- Glucocorticoids
- Catecholamines
- Diabetes mellitus
- Post-prandial
Which of the following is decreased with liver disease?
- Glucose
- Cholesterol
- Urea
- Albumin
All of the above
T/F: PLE is characterized by hypoalbuminemia and hyperglobulinemia
False
Protein Losing Enteropathy (PLE) is characterized by hy_po_albuminemia and hy_po_globulinemia
What are the top two differentials associated with ketones in the urine?
Starvation state and Diabetic ketoacidosis
How does hypomagnesemia contribute to hypocalcemia?
Without Mg, more Ca binds at parathyroid and decreases PTH production
With hyperparathyroidism, you should expect to see hypercalcemia and hypophosphatemia
True
You tried to reason with him, but your dog was acting a fool and feasted on some Warfarin. What coagulation factors are going to be affected?
II, VII, IX, X
- Two, seven, nine, ten*
- 二, 七, 九, 十*
- dos, siete, nueve, diez*
- deux. sept, neuf, dix*
- இரண்டு, ஏழு, ஒன்பது, பத்து*
What is the best way to tell if a horse has a regenerative anemia?
Increased MCV
Remember that horses never release reticulocytes into peripheral blood
What does basophilic stippling indicate in small animals?
Lead poisoning
T/F: Amylase is specific for pancreatic injury
False
Typically if lipase is > 2x upper end of normal, it is indicative of pancreatic injury. What is the exception to this?
Dogs receiving steroids
T/F: Exocrine pancreatic insufficiency results in inadequate food absorption
False
- Exocrine pancreatic insufficiency results in inadequate food digestion*
- Need to differentiate this from malabsorption (Intestinal disease prevents absorption)*
Trypsin-like Immunoreactivity (TLI) is a very sensitive and specific test for:
EPI
- (Exocrine pancreatic insufficiency)*
- In dogs:*
- TLI > 5.0 μg/L is normal
- TLI < 2.5 μg/L is EPI
In cats, TLI levels less than ____μg/L is highly specific for EPI
In cats, TLI levels less than 8 μg/L is highly specific for EPI
T/F: Calcitonin decreases serum Ca2+ concentration
True
- Calcitonin is produced by C cells of the thyroid gland and decreases serum Ca2+ concentration by inhibiting PTH*
- “Calcitonin tones it down”*
T/F: Ethylene glycol toxicosis causes hypercalcemia
False
Ethylene glycol toxicosis is a cause of hypocalcemia
T/F: Hypermagnesemia is seen only when renal function is compromised
True
Hypernatremia is typically due to:
dehydration
Usually either inadequate water intake or pure water loss
T/F: All causes of decreased Na+ are also causes of decreased Cl-
True
What are the most common causes of hyperkalemia?
- Oliguria/anuria
- urethral obstruction
- ruptured urinary bladder
T/F: With hypertonic dehydration, [Na+] & [Cl-] will be decreased
False
With hypertonic dehydration, [Na+] & [Cl-] will be increased
With hypotonic dehydration, [Na+] & [Cl-] will be decreased
For blood gas analysis, which is better for evaluating acid base status:
Venous samples or arterial samples?
Venous samples
What type of blood tube would you use for blood gas analysis?
Heparin (Green top)
With **High Anion Gap Acidosis, **you’ll observe an increase in nonvolatile acids. Name the nonvolatile acids:
KLUE
- Ketones
- Lactate
- Uremic acis (phosphates, sulfates)
- Ethylene glycol metabolites (toxins)
Which ions are taken into consideration when calculation anion gap?
Na+, K+, Cl-, HCO3-
Hyperventilation results in what acid-base abnormality?
Respiratory Alkalosis
“Reich at the campfire”
What would you expect too see with regard to PTH concentration in an animal with normal parathyroid function and hypercalcemia?
[PTH] should be decreased
What test would you use to differentiate Diabetes Insipidus from psychogenic polydipsia?
Water deprivation test
If the animal releases ADH and concentrates its urine, it is psychogenic PD. If not, it is Diabetes insipidus
DO NOT PERFORM THIS TEST IN ANY ANIMAL THAT IS:
- Suspected of having renal disease
- Azotemic
- Dehydrated
T/F: Hyperadrenocorticism is unlikely in a dog with normal urinary cortisol:creatinine ratio (UCCR)
True
What is the only test that will identify iatrogenic HAC?
ACTH Stimulation Test
Which of the following does not have a primary role in maintaining water balance?
- Sodium
- Parathyroid hormone
- Antidiuretic hormone (vasopressin)
- Renin
- Aldosterone
Parathyroid hormone
Which of the following would you not expect to see in a dog with pituitary-dependent hyperadrenocorticism?
- Hypergylcemia
- Increased alkaline phosphatase (ALP) activity
- Increased serum cortisol concentration
- Increased gamma glutamyl transferase (GGT) activity
- Lymphocytosis
Lymphocytosis
What is the most common cause of hyperphosphatemia?
Decreased glomerular filtration rate (GFR)
What would you expect to see happen to sodium and potassium levels in an animal with aldosterone deficiency?
Decreased sodium, Increased potassium
Which organ system most frequently plays a direct role in an animal developing hyperkalemia?
Renal system
What is the best test to differentiate malabsorption from maldigestion in the dog?
Trypsin-like Immunoreactivity (TLI)
Which of the following is not a cause of lymphocytosis in the dog?
- Chronic lymphocytic leukemia
- Addison’s disease
- Cushing’s disease
- Ehrlichiosis
- Recent exercise
Cushing’s disease
T/F: A major crossmatch involves incubation of the patient’s erythrocytes with the donor’s serum
False
A major crossmatch involves incubation of the donor’s erythrocytes with the patient’s serum
If we do a low dose Dex suppression (LDDST) test on a healthy dog, what would we expect to see after 8 hours?
Cortisol < 1.5 μg/dL at 4 & 8 h
Cortisol secretion will decrease
If we do a low dose Dex suppression (LDDST) test on a dog with HAC, what would we expect to see after 8 hours?
cortisol > 1.5 μg/dL at 8 h
Cortisol will not suppress after 8 hours
T/F: Dogs with HAC will not secrete cortisol in response to ACTH stimulation
False
If you do an ACTH Stim test on a dog with HAC, you should see them hypersecrete cortisol in response to that ACTH (> 20 μg/dL)
If you’re doing an ACTH stim test on a dog and there is no change pre- and post- ACTH administration, what is your conclusion?
Iatrogenic HAC
**ACTH Stimulation Test is the only test that can confirm iatrogenic hyperadrenocorticism**
If you’re doing a LDDST on a dog and at 8 hours cortisol is suppressed by more than half the baseline value, where is the lesion?
Pituitary
**If it’s not suppressed by at least half the baseline value, then it is an adrenal tumor**
What is the best interpretation for this data?
Euthyroid Sick Syndrome
All of the following lab data suggests hyperthyroidism except:
- Polycythemia
- ↑ cholesterol
- ↑ ALP
- ↑ ALT
- ↑ free T4
↑ cholesterol
