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Clinical Pathology
Clinical Pathology final study set - UTCVM
84
Veterinary Medicine
Professional
12/07/2013

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Cards

Term
Mnemonic for the causes of hypercalcemia
Definition
Hyperparathyroidism
Osteolysis
Granulomatous disease
Spurious (usually an artifact of lipemia)
Idiopathic (cats)
Neoplasias (lymphosarcoma or anal sac adenocarcinoma)
Young animals
Addison's disease
Renal failure (horses)
hypervitaminosis D
Term
Seven common causes of hypocalcemia
Definition
Hypoparathyroidism
Hypovitaminosis D
Milk fever
Ovine pregnancy toxemia
Acute pancreatitis
Ethylene glycol toxicosis
Chronic renal disease
Idiopathic in dogs
Term
Why does chronic renal disease produce hypocalcemia?
Definition
Decrease in vitamin D
Term
Is ionized calcium higher or lower in acidemia?
Definition
Higher! Ca++ and H+ compete for space on proteins, so acidemia lowers the protein-bound Ca++ fraction.
Term
Insulin's impact on phosphate
Definition
Insulin shifts phosphate into cells, which may cause hemolysis if severe
Term
How is hemoglobin A1c measured?
Definition
Using whole blood!
Term
How is fructosamine measured?
Definition
Blood serum
Term
2 causes of low PO4 & normal Ca++
Definition
Decreased dietary phosphate
Hyperinsulinemia
Term
2 causes of low PO4 & low Ca++
Definition
Hypovitaminosis D
Milk fever
Term
Other than ileal malabsorption, what may cause a cobalamin deficiency in cattle?
Definition
Nutritional COBALT deficiency
Term
3 causes of low Ca++ and normal PO4
Definition
Hypoalbuminemia
Acute pancreatitis
Ethylene glycol toxicosis
Term
THREE test results with a protein-losing enteropathy
Definition
HIGH fecal α1-PI (measured in feces)
Low albumin
Low globulin
Term
What happens to Ca++ and Mg in a citrated or EDTA blood collection tube?
Definition
Both Ca++ and Mg are artifactually lowered
Term
Four causes of high NEFAs
Definition
Hepatic lipidosis (fatty change!!)
Diabetes mellitus
poor nutrition
Obesity
Term
What stimulates ACTH?
Definition
CRH from the hypothalamus
Term
These two processes depend on Mg
Definition
PTH release and function
Renal K+ retention

**Mg loss will result in low Ca and K, and efforts to correct either will be fruitless without magnesium
Term
Calcification of soft tissue may occur when how much of what minerals is high?
Definition
[Ca++] * [PO4] > 70
Term
3 common causes of hypomagnesemia
Definition
Low protein (affects protein-bound fraction)
Low dietary intake (eg grass tetany in cattle)
High renal loss (osmotic diuresis)
Term
2 causes of hypermagnesemia
Definition
Milk fever
Low renal excretion
Term
Proper name for milk fever
Definition
Eclampsia
Term
Decreased bicarb and chloride indicates what A/B disturbance?
Definition
Metabolic alkalosis
Metabolic acidosis (usu renal)
(AKA a mixed A/B disturbance!)
Term
What are the unmeasured anions in renal metabolic acidosis?
Definition
Sulfates & phosphates
Term
Why might there be an increased anion gap if bicarb is normal?
Definition
A mixed metabolic acidosis/alkalosis
Term
Four causes of an increased Ca++ with normal phosphate
Definition
Neoplasia (humoral hypercalcemia of malignancy)
Addison's
Granulomatous disease
Idiopathic (cats)
Term
3 hormones that increase blood glucose
Definition
cortisol & epinephrine
glucagon
growth hormones
Term
4 reasons the liver can't maintain euglycemia in the face of fasting?
Definition

starvation

hepatic lipidosis / liver disease

cachexia

neonates (piglets, toy breed puppies)

Term
5 causes of fasting hyperlipedmia
Definition
1. obesity (metabolic syndrome)
2. diabetes mellitus
3. Cushing's
4. hypothyroidism
5. Schnauzer
Term
What causes a transudate?
What causes an exudate?
Definition
Transuates are caused by disturbances of circulation.
Exudates are caused by infection of pleura/peritoneum.
Term
4 "special" exudative fluids
Definition
Blood
Urine
Chyle
Bile
Term
3 ways to derange fluid circulation
Definition
1. decrease oncotic P
2. increase hydrostatic P
3. decrease lymphatic drainage
Term
Where does a protein-poor transudate originate? What about a protein-rich?
Definition
A protein-rich transudate originates at a site of large capillary fenestrations, like the liver or lungs. Normal capillary bed disturbances produce a protein-poor transudate.
Term
2 ways a protein-rich transudate occurs in the abdomen
Definition
1. impeded liver drainage (liver disease or venous outflow - abdominal)
2. increased hydrostatic P in liver sinusoids (RSCHF - thoracic)
Term
Characterize a:
1. protein-poor transudate
2. protein-rich transudate
3. exudate
Definition
1. TP < 2, TNCC < 1500, mononuclear cells, clear
2. TP < 2, TNCC < 5000, mononuclear cells, light yellow
3. TP > 2, TNCC > 5000, PMN cells, variable
Term
3 causes of bicavitary effusions
Definition
1. Right-sided CHF
2. Generalized disease (cancer, FIP, coagulopathy)
3. [RARE] tear in diaphragm
Term
Will a diaphragmatic tear cause abdominal fluid to enter the thorax or thoracic fluid to enter the abdomen?
Definition
Abdominal effusion leaks into the thorax
Term
Character of acute vs. chronic uroabdomen
Definition
Acute uroabdomen is usually transudative
Chronic uroabdomen is usually exudative
Term
Chyle vs. bile
Definition
Chyle is mildly irritating chronically
Bile is very caustic and irritating

Both produce an exudate
Term
Difference between hemorrhagic effusions and blood
Definition
There are no platelets in hemorrhagic effusions
Term
Lipase levels with pancreatitis
(in blood and in the effusion)
Definition
High in blood
Higher in effusion
Term
Characterize a septic effusion
Definition
Low glucose
High lactate
Term
Characterize an effusion due to a strangulating lesion (like in a horse)
Definition
High lactate
Term
4 causes of high cortisol
Definition
Pituitary- or adrenal-dependent hyperadrenocorticalism
Iatrogenic glucocorticoids
Chronic stress
[RARE] Ectopic ACTH tumor production
Term
3 mechanisms of low cortisol
Definition
Addision's:
1. pituitary gland destroyed
2. adrenal glands destroyed

3. abrupt cessation of corticosteroids
Term
Lots of NaHCO3 indicates what state?
Definition
Hypochloremic metabolic alkalosis
Term
Components of chyle
Appearance of chyle
Definition
Triglycerides + lymphocytes
Milky white
Term
Interpret the various results of a HDDST
Definition
Suppressed at 4 & 8 hours: PD Cushing's
Suppressed at 4 OR 8 hours: probably PD
Never suppressed: dunno
Term
Interpret possible results of ACTH stim test
Definition
No response: Addison's (highly specific!)
Normal response: normal
Exaggerated response: Cushing's
Term
What does EPI cause a decrease in?
Definition
TLI
HCO3-
Term
Effects of calcitonin
Definition
Ca & PO4 absorption into bone
Decreased renal Ca & PO4 resorption
Term
How to test for pancreatitis
Definition
high amylase & lipase
high cPLI or fPLI
[high TLI]
Term
Why do some neoplasias produce high calcium? What is this called?
Definition
PTP-rP

Humoral hypercalcemia of malignancy
Term
This is consistent with insulinoma
Definition
High insulin
High insulin:glucose ratio
Term
Oligoclonal gammopathy
Definition
Some inflammatory reactions, such as Ehrlichia, produce closely spaced gamma globulins that can look almost monoclonal
Term
Proteins that have been permanently bound to glucose
Definition
Fructosamine

This test differentiates prolonged hyperglycemia from stress spike
Term
2 endocrine causes of pancreatitis
Definition
Diabetes mellitus
Cushing's
Term
Severe pancreatitis may lead to what 2 things?
Definition
ARD
DIC
Term
How to diagnose exocrine pancreatic insufficiency
Definition
Low TLI
Term
Low cobalamin
High folate
Low TLI
Definition
EPI & ARD
Term
2 glycolated protein tests
Definition
Fructosamine
Hemoglobin A1c
Term
Low cobalamin
Normal folate
Normal TLI

**TWO causes!
Definition
Ileal malabsorption
[RARE] Congenital cobalamin defect
Term
Lipemia is marked by an excess of one or more of these compounds
Definition
Chylomicrons
Very low density lipoproteins
Intermediate density lipoproteins
Term
What is the cholesterol test a measure of?
Definition
LDL
HDL
Term
Total triglyceride test is a measure of what?
Definition
Chylomicrons, VLDL, & IDL
(these are the biomarkers of LIPEMIA!)
Term
2 ion changes in metabolic alkalosis
Definition
Low Cl-
High HCO3-
Term
Low cobalamin
High folate
Normal TLI
Definition
ARD
Term
2 mechanisms of metabolic acidosis:
1) high anion gap
2) normal anion gap
Definition
1) Increase in unmeasured anions
-lactic acidosis
-renal acidosis
2) Loss of bicarb (with a high Cl)
Term
Machine's formula for the anion gap
Definition
anion gap = Na + K - Cl - HCO3
Term
3 possible things found in the anion gap
Definition
Renal acids (PO4 & SO4)
Organic acids
Exgenous acids
Term
Paradoxical aciduria
Definition
1) Cl is lost -> Na+ is resorbed with BICARB instead of Cl- in PCT
2) K+ is lost -> Na+ is exchanged for H+ instead of K+

Therefore in both cases an alkalotic patient has acidic rather than alkalotic pee!
Term
2 causes of lactic acidosis
Definition
Hypoxia
Massive muscle damage
Term
4 ways bicarb is lost
Definition
1) diarrhea
2) GI obstruction, ileus, sequestration
3) Excessive salivation (cows)
4) Type II renal tubular acidosis (HCO3 not resorbed)
Term
Consequence of inorganic metabolic acidosis
Definition
H+ is taken into cells, and K+ is released -> Hyperkalemia
Term
How does ethylene glycol alter acid/base balance?
Definition
Azotemia + acid production
These mechanisms work together to produce a severely high anion gap!
Term
6 sources for acid accumulation, leading to a metabolic acidosis
Definition
1) lactic acidosis
2) renal acidosis
3) ketosis
4) metabolism of toxins to acid intermediates (e.g. ethylene glycol)
5) hyperalbuminemia
6) type I renal tubular acidosis
Term
Lab findings in pancreatitis (6 categories)
Definition
High amylase, lipase, and PLI
High ALP, CHOL, and T.bili (cholestasis)
Low Ca++
Inflammatory leukogram
Dehydration (high TPP & prerenal azotemia)
Vomiting (hypochloremic metabolic alkalosis)
Term
4 causes of metabolic alkalosis
Definition

1) vomiting

2) abomasal displacement

3) diuretics (with loss of K+ & Cl-)

4) compensation of respiratory acidosis

5) Cl- losing diarrhea

Term
3 screening tests for Cushing's disease
Definition
Urinary cortisol:creatinine ratio
ACTH stimulation test
Low dose dexamethasone suppression test
Term
3 differentiation tests between PDH & ADH
Definition
Endogenous ACTH test
LDDST
HDDST

** imaging also very useful!
Term
2 types of Cushing's syndromes
& which is more common?
Definition
Pituitary-dependent hyperadrenocorticalism -more common!
Adrenal-dependent hyperadrenocorticalism
Term
3 causes of high PO4 & low Ca
Definition
1. hypoparathyroidism
2. phosphate enema
3. rhabdomyolysis
Term
3 causes of high PO4 and normal Ca
Definition
1. Young, growing animal
2. Low GFR
3. Clotted blood sample
Term
2 causes of high PO4 and high Ca
Definition
1. 6-24 week-old puppy
2. Hypervitaminosis D
Term
3 causes of a LOW anion gap
Definition
1. Hypoalbuminemia (decrease in anionic proteins)
2. Monoclonal gammopathy (increase in cationic proteins)
3. Hypercalcemia
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