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Clinical Pathology Final Exam

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pbhati17's version from 2016-12-03 23:55

Section 1

Question Answer
LDDST,HDDST,ACTH stim,Cort/Crt, [ACTH] for PDHPDH is a neoplasm producing ACTH and thus, increased cortisol LDDST-escaped(@8hrs) HDDST-mostly suppressed ACTH stim-Hyperplastic glands==>exaggerated response(>22) Cortisol:CRT: elevated
LDDST,HDDST,ACTH stim,Cort/Crt, [ACTH] for FANFAN is a neoplasm of the adrenocortical cells ==> elevated Cortisol LDDST-no suppression HDDST-mostly not suppressed Cort:CRT: Elevated ACTH: low ACTH stim: 50% respond and 50% don't
LDDST,HDDST,ACTH stim,Cort/Crt, [ACTH] for nonadrenal disordersLDDST-many suppress but most don't HDDST-suppressed ACTH stim-? ACTH-? Cort/crt-?
LDDST,HDDST,ACTH stim,Cort/Crt, [ACTH] for hypoadrenocorticism(Addison's)Hypoadrenocorticism is the bilateral adrenocortical hypoplasia leading to a decrease in cortisol prodx LDDST- suppressed HDDST-suppressed ACTH-low Cort:Crt: low ACTH stim- hypoplastic so no response
At what level would the cortisol:creatinine have to be to rule out hyperadrenocorticism?WRI
What does the CORT:CRT indicate if it's high?It may or may not be cushing's
ACTH conc in PDHHigh ACTH
ACTH conc in FANlow ACTH
ACTH in primary hypoadrenocorticismACTH will be high
ACTH conc in secondary hypoadrenocorticismACTH will be low
ACTH conc in iatrogenic hyperadrencorticismACTH conc will be low
Why doesn't ACTH stim respond in primary hypoadrenocorticism, aitrogenic hypoadrenocorticism or iatrogenic HAC?The cortisol levels are too low/ non responsive to ACTH
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Section 2

Question Answer
What are the tT4,fT4, TSH values in primary hypothryroidism?tT4 is decreased TSH is increased
Primary hypothyroidism mechxThis is a dz in the thyroid glands Thyroiditis==>Thyroglobulin to leave thyroid tissue==>TgAA
Secondary hypothyroidism mechxTSH def due to pituitary gland damge==> bilateral thyroid atrophy
What are the tT4,fT4, TSH values in secondary hypothryroidism?tT4 is decreased TSH is def so it's decreased
Mechx of hyperthyroidismIncreased production via thyroid neoplasm
-thyroid adenoma (cats>horses)
-thyroid adenocarcinoma (cats,dogs)
What are the tT4,fT4, TSH values in hyperthryroidism?tT4 is elevated if it's a thyroid adenoma then the fT4 is also elevated TSH is decreased
What would you expect from a T3 suppression test in healthy cats?Administer T3 for 3.5 days and in a healthy cat this will result in an elevated tT3 with a decrease in tT4 because of decreased T4 production due to negative feedback
What would you expect from a T3 suppression test in hyperthyroid cats?Administer T3 for 3.5 days and in a hyperthyroid cat this will result in increased tT3 with NO decrease in tT4 The T4 continues to be produced by the neoplasm regardless
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Section 3

Question Answer
TLI, PLI, Cobalamin, Folate , glucose absorption results expected for EPITLI-Decreased
Folate-Increased or WRI
Cobalamin-Decreased due to bacterial overgrowth
TLI, PLI, Cobalamin, Folate , glucose absorption results expected for pancreatitisTLI-Increased
PLI-increased
TLI, PLI, Cobalamin, Folate , glucose absorption results expected for malabsorption (diffuse mucosal dz of SI)TLI: WRI Folate: Decreased(prox intx damage) Cobalmine: Decreased (distal intx damage)
If there's alpha-1 protease inhibitor concentrations in the feces then what is it indicative of?Some sort of intestinal swelling/irritation since this is a small protein eliminated in feces during such cases- possible causes are... IBD
Lymphangectasia
Lymphoma
INtx inflammation
congestion
bleeding
Often results in Hypoproteinemia
Conditions that result primarily in hypertriglyceridemia and lipemiaPost-prandial
Acute Pancreatitis
Equine Hyperlipidemia
Diabetes Mellitus
Which conditions result primarily in a hypercholesteremia?Hypothyroidism
Nephrotic syndrome
Cholestasis
Hyperadrenocorticism
How does low insulin effect the lipoprotein lipase activity/lipid processing?Insulin allows the LPL to bind to the cell surface so triglycerides can be lipolyzed and diffuse into muscle/fat storage so low insulin means less LPL activity and less lipid processing
How does low apoprotein effect the lipoprotein lipase activity/lipid processing?Apoliprotein C-II activates LPL so triglycerides can be lipolyzed and diffuse into muscle/fat for storage so less apolipoproteins then less LPL activity and less lipid processing
How does a negative energy state affect HSL and increase mobilization of fats?(Equine hyperlipidemia) Causes release of Glucagon which stimulates HSL to release TGs into circulation for the tissues to use as energy
What are the causes of hypocholesteremia?Portosystemic shunts or liver failure lead to less production of cholesterol, TGs, apolipoproteins, phospholipids
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Section 4

Question Answer
What do you expect for [Gluc], [IRI],[fructosamine] from px with Diabetes mellitus[Glucose] increased [IRI] is low [fructosamine] increased
What do you expect for [Gluc], [IRI],[fructosamine] from px with insulinomaAn insulinoma is a B cell neoplasm that secretes Insulin marked hypoglycemia [Gluc] is decreased [IRI] is high [fructosamine] is decreased
What do you expect for [Gluc], [IRI],[fructosamine] from px with xylitol toxicosisThe body interprets Xylitol to be like glucose and responds by secreting insulin marked hypoglycemia [Gluc] is decreased [IRI] is high [fructosamine] is decreased
What do you expect for [Gluc], [IRI],[fructosamine] from px with post prandia[Glucose] increased [IRI] is decreased [fructosamine] increased
What happens to glucose in a sample in which serum harvest is delayed >1 hr?The WBC and RBC start to consume the glucose and you lose 5-10% of the glucose w/ each hour
ALTmarker of hepatocyte damage in dogs/cats
-hepatopathy caused by glucocorticoids
ASTmarks hepatocyte damage in horses/cattle
measure damage to erythrocytes(in vitro) and muscle fibers
SDHmarker of hepatocyte damage in horses/cattle very tissue specific(unlike AST) involved in sugar conversions of hepatocytes
LPSmarker of pancreatic acinar damage in dogs involved in triglyceride digestion
-need to account for GFR factors
ALPL-ALP is a marker of cholestasis, glucocrticoids,phenobarb high sensitivity in dogs
C-ALP is a marker of glucocorticoids
B-ALP is a marker for osteoblastic activity in growing animals, hyperthyroidism in cats, fracture repair, osteosarcoma
AMSmarker of pancreatic acinar damage in dogs -need to account for GFR factors
CKmarker of muscle damage CK-1:Brain CK-2,CK-3: skeletal, cardiac,+/- smooth muscle
Which enzymes evaluate hepatocellular damage?ALT,AST,LD/LDH,SDH, GMD
Which enzymes evaluate cholestasis?L-ALP,GGT
Which enzymes indicate glucocorticoid use?ALT
L-ALP
C-ALP
Which enzymes indicate muscle damage?AST
CK-2,CK-3
- in horses this is usually due to trailer activity, colic, rolling and in cattle it's generally due to muscles damaged by pressure/weight(downer cows)
Which enzymes are indicative of pancreatic damage/decreased GFR?AMS, LPS
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Section 5

Question Answer
How is bilirubin formed and excreted by the body?It's a product of Hb breakdown ==>unconjugated/indirect is transported to the liver==>conjugated by liver(direct)==>excreted in bile, urine,feces
What are the expected concentrations for fasting hyperbilirubinemia in horses and cattle?Less uptake and less ligand binding leads to the body metabolizing fatty acids- these bind to proteins instead of bilirubin and lead to Higher unconjugated/indirect bilirubin
What are the expected bilirubin concentrations for extravascular hemolysis?Higher indirect bilirubin
Situations that would result in higher levels of indirect bilirubinHemolysis
Fasting/anorexia in horses
Decreased functional mass
What are the expected bilirubin concentrations for cholestasis?Higher Direct
What are the bile acid, NH4,bilirubin,UN,glucose, and protein concentrations during hepatic insufficiency,PSS?Low BUN
low glucose
low albumin/protein
high bile acids
high NH4
High indirect bilirubin
This is a result of production of bile acids being higher than their removal from portal blood
What are the bile acid,NH4,bilirubin,UN,glucose, and protein concentrations during Cholestasis?High GGT and ALP
High direct bilirubin
High bile acids
High cholesterol
What are two types of cholestasis that may lead to elevated levels of everything?Obstructive and Functional
How does obstructive cholestasis work?impaired bile flow==>backs up into hepatocytes and blood
How does functional cholestasis work?TNFalpha causes decreased transport of bile acids into canaliculi
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Section 6

Question Answer
What are the 3 fractions of Calcium in the serum/plasma?FCa2+ or free calcium Ca2+/Pr-: Protein-bound Ca2+ Ca2+/A-: Ca2+ bound to anions other than proteins
How do changes in protein concentrations influence our total/free Ca2+ conc?Changes in protein concentrations will also change the amount of protein-bound calcium- they will change together to change the total Ca2+ conc
How do changes in anion concentrations influence our total/free Ca2+ conc?Changes in anion concentrations will also change the amount ofanion-bound calcium- they will change together to change the total Ca2+ conc
How does acidemia affect the total /free Ca2+ concentration?Acidemia increases the free calcium concentration and thus the total calcium concentration
How does alkalemia affect the total /free Ca2+ concentration?Decrease in free calcium concentration then decrease in total calcium concntration
What are some causes of hypercalcemia?1)Primary hyperparathyroidism
2)Humoral hypercalcemia of malignancy(HHM)
3)Hypervitaminosis D
4)Decreased urinary excretion of Ca2+
-equine renal failure
-canine renal failure
-canine addison's dz
What causes hypercalcemia in renal failure in horses?This is a result of decreased urinary ecretion of Ca2+ renal dz destroys most of the equine nephrons==> decreased GFR==>decreased clearance of Ca2+,Ca2+/A
-==> increased levels of free calcium, Calcium bound to anions(PO4,SO4) resulting in increase in total calcium
What causes hypocalcemia?1)Hypoalbuminemia/hypoproteinemia
2)primary hypoparathryroidism
3)Hypovitaminosis D
4)increased urinary excretion -anions -Furosemide
5)Pregnancy, parturition, lactation
6)Other: Acute pancreatitis, PO4 enema,Blister beetle poisoning, myopathies,Rumen overload
What causes hypocalcemia during chronic renal failure in dogsHypocalcemia during chronic renal failure in dogs is due to Hypovitaminosis D (Vit D helps with formation of calcium) Chronic renal dz==>secondary renal hyperparathyroidism==>secondary hypovitaminosis D
What are some causes of hyperphosphatemia?Increased intestinal absorption
-hypervitaminosis D
Decreased Renal excretion
Shifting from ICF to ECF -hemolysis
How does chronic renal failure in dogs lead to hyperphosphatemia?Chronic renal disease - decreased activation of Vit D and decreased excretion of phosphate
What are some causes of hypophosphatemia?1)Increased urinary excretion -High PTH
2)Decreased intx absorption -prolonged anorexia
3)Shift from ECF to ICF
4)Defective mobilization from bone(post-parturient)
5)Equine renal failure
What are some causes of hypomagnesemia?Hypoproteinemia,
Tetany
What are some causes of hypermagnesemia?Decreased GFR
How do PTH and PTHrp change in conditions where free calcium in increased?Increases in free calcium stimulate Calcitronin to be produced in the thyroid gland -Calcitronin inhibits bone resorption by PTH PTH will be low
How do PTH and PTHrp change in conditions where free calcium in decreased?PTH, Vit D are stimulated with decreased free calcium levels
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Section 7

Question Answer
What is acidemia?A condx in which acidemia tends to occur but due to compensatory mechx the blood pH may be decreased or WRI
What is alkalemia?Alkalemia is an increase in blood pH with an ineviteable decrease in [H+]
What is Alkalosis?A condx in which alkalemia tends to occur but due to compensatory mechx the blood pH may be increased or WRI
What blood gas analytes are altered when the sample is exposed to air?Exposure to air or excess heparin in a sample is going to lead to... increased PO2 Decreased... PCO2 [H+]==>increased pH [HCO3-]
What blood gas analytes are altered when the analysis is delayedIf the analysis is delayed then the blood will go through glycolysis and there will be a decrease in PO2 Increase in [H+](decrease in pH)
What clinical findings would you expect with metabolic acidosis?Decrease in pH Decrease in [HCO3-]
What clinical findings would you expect with metabolic alkalosis?Increase in pH Increase in [HCO3-]
What clinical findings would you expect with respiratory acidosis?Decrease in pH Increase in PCO2
What clinical findings would you expect with respiratory alkalosis?Increase in pH Decrease in PCO2
What clinical findings would you expect from a metabolic acidosis w/ a compensatory resp alkalosis?First look for the metabolic acidosis Decrease in pH Decrease in [HCO3-] Decrease in PCO2
What clinical findings would you expect from a respiratory acidosis w/ a compensatory metabolic alkalosis?Decrease in pH Increase in PCO2 Increase in [HCO3-]
What clinical findings would you expect from a metabolic alkalosis w/ a compensatory resp acidosis?Increase in pH Increase in [HCO3-] Increase in PCO2
What clinical findings would you expect from a respiratory alkalosis w/ a compensatory metabolic acidosis?Increase in pH Decrease in PCO2 Decrease in [HCO3-]
What are the limitations of interpreting a venous blood gas result?Venous blood s adequate for metabolic disorders but we can't use venous PCO2 to assess pulmonary function/ability to remove CO2 from the blood
TCO2- is what?it's basically a measurement of the HCO3-==> these are the same thing (?) essentially measuring amount of CO2 released from serum
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Section 8

Section 9

Section 10

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