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78 Cards in this Set
- Front
- Back
T or F:
It is appropriate to use hospital patients to calculate "normal" reference intervals. |
False!
You want NORMAL HEALTHY individuals |
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How can age affect reference intervals of liver enzymes?
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High alk phos in young animals;
High GGT in neonates from colostrum |
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How can gender affect a reference interval (PCV and Ca)?
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Males have higher PCV;
Females have lower PCV than normal during pregnancy; Pregnancy depresses Ca |
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How many healthy animals should NORMALLY be outside the boundaries of a reference interval?
a) none - all normal animals are within the interval b) 1% c) 5% d: 10% |
c) 5%; calculation is a 2-tailed t-test w/a 95% CI
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Can you ever make a diagnosis solely from a lab result?
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NOOOOOOOOOOOOO
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Choose sensitivity or specificity...
...measures the frequency of the test being positive in animals having the disease. |
Sensitivity
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Choose sensitivity or specificity...
...involves the proportion of animals with disease remaining undetected. |
Sensitivity
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How many false negatives would be expected on a test with 99% sensitivity?
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only 1%
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Choose sensitivity or specificity...
...measures the frequency of a test being negative in undiseased animals. |
Specificity
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Choose sensitivity or specificity...
...involves the certainty that a positive test means actual disease. |
Specificity
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How many false positives would be expected on a test with 88% specificity?
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12% false positives
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What test metric is better to use than sensitivity/specificity?
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Predictive values
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Which test metric takes into account the prevalence of disease?
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PRedictive value
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What are 3 reasons to separate serum from cells?
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Prevent glycolysis
Cells may leak AST, K, and P Cells produce lactate |
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What are two main differentials for chronic diarrhea and/or weight loss?
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Maldigestion
Malabsorption |
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What is the most common cause of maldigestion?
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Exocrine pancreatic insufficiency
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What is the significance of decreased enzymatic activity?
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none usually
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What tests are available in evaluation of the pancreas?
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Seurm amylase
Serum lipase Pancreatic lipase immunoreactivity Trypsin-like immunoreactivity |
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Which enzyme is responsible for hydrolysis of starch? Glycogen? Triglycerides?
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Amylase (starch & glycogen)
Lipase (TGs) |
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What are some possible causes for increased serum amylase?
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Pancreatic injury
Obstruction of pancreatic ducts Chronic renal insufficiency Intestinal dz. Hepatobiliary dz. |
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What are some causes of increased serum lipase?
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Pancreatic injury
Obstruction of pancreatic ducts Chronic renal insufficiency Intestinal dz. Glucocorticoids Hepatobiliary dz. |
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What levels of serum amylase/lipase are generally indicative of pancreatitis?
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increases of 3 to 4x above normal and NO azotemia
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Choose horses, cats, or dawgz...
...generally have normal or slightly increased serum amylase in cases of pancreatitis. |
Horses and cats
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When will a major increase in serum lipase first be seen after a pancratic injury? When is the peak noted?
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Increases after 24h; peaks at 2-5d.
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What is the likely diagnosis of an azotemic dog with serum lipase and amylase increased by a factor of 3 above normal?
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Renal dz (reduced GFR)
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Which test measures lipase of pancreatic origin only?
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Pancreatic lipase immunoreactivity
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T or F:
Both PLI and TLI tests are species specific. |
True!
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What will the relative levels of PLI tests return in cases of pancreatitis? With EPI?
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PLI (pancreatic lipase immunoreactivity) is high in pancreatitis and low in EPI (exocrine pancreatic insufficiency)
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What test is the most sensitive/specific for pancreatitis? For exocrine pancreatic insufficiency?
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Pancreatitis = PLI
EPI = TLI |
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What conditions in cats will give false positives in the TLI test?
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Cats with hepatic or GI disease
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Which of the following are NOT common lab findings with pancreatitis?
a) neutrophilia & left shift b) hypolipidemia c) renal azotemia d) increased liver enzymes e) hyperglycemia |
b) hypolipidemia (should be HYPER)
c) renal azotemia (should be prerenal) |
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What is a fluid besides serum that can be evaluated for pancreatitis?
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Peritoneal fluid (kinda flaky...works in camelids)
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In which dog breed is EPI common? What is a good test to confirm this?
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Exocrine pancreatic insufficiency is common in German Shepherds. Use TLI (Trypsin-like Immunoreactivity) to test
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What are some less commonly used tests of malabsorption?
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Serum folate
Cobalamin (vit B12) Oral D-xylos absorption test Feal exam/cytology Fecal alpha-1 protease inhibitor |
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T or F:
A dog with EPI will have a very high TLI value. |
False!
VERY LOW TLI with EPI |
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What conditions may give abnormally low cobalmin tests? Abnormally high values?
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EPI
Bacterial overgrowth Small intestinal dz. (supplementation will give high values) |
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What conditions may give low serum folate values? High values?
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low - decreased absorption
high - SIBO (small int bacterial overgrowth); EPI, excessive acid; supplementation |
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What would relative values of folate and cobalamin be with EPI?
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Folate - high;
Cobalamin - low |
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Which test of GI integrity can have false positives due to a meat diet?
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Fecal occult blood; very sensitive for Hgb and myoglobin can give false positives
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What are the BIG TWO regarding muscle enzymes?
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CK (creatine kinase)
AST (aspartate aminotransferase) |
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T or F:
CK is found in skeletal, cardiac and smooth muscle. |
True!
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When will CK peak? What is its half life?
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Peak 6-12h post injury;
2-4h half-life |
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When will AST peak?
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24-36h post injury
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T or F:
ALT is found in cardiac, skeletal, and smooth muscle. |
FALSE!
NOT IN SMOOTH MUSCLE. This is mostly a liver enzyme. |
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T or F:
AST is found in muscle and liver. |
True!
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Predict the relative CK and AST values for...
...very acute muscle injury. |
High CK
normal AST |
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Predict the relative CK and AST values for...
...recent or active muscle injury. |
High CK and high AST
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How is myoglobinuria diagnosed? How is this distinguished from hemoglobinuria?
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dipstick test (tests for myo and Hgb); can't reliably differentiate the two! if serum or plasma are hemolyzed, it denotes Hgb usually
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What would you expect the relative Ca values to be with severe acute muscle injury?
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hypocalcemic
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How can primary vs. secondary liver hepatopathy be differentiated through blood chemistries?
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THEY CAN'T
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T or F:
Liver failure occurs with irreversible destruction of 70-80% of the liva. |
Tru dat!
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T or F:
In cases of liver failure, serum enzyme activity will always be elevated. |
False!
If there is no active damage, enzymes may be normal. |
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What is the test of choice for hepatocellular injury in small animals.
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ALT (alanine aminotransferase)
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What are some extrahepatic factors that can affect ALT values?
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Massive hemolysis (some ALT in RBCs);
Feline hyperthyroidism; Steroid/phenobarb administration |
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T or F:
ALT is a good test of hepatocellular injury in small and large animals. |
False! ALT activity is usually too low in large animals (use AST or SDH instead)
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T or F:
SDH is a good test of hepatocellular injury in small and large animals. |
True!
ALT and SDH both work for small animals; SDH works best for large animals. |
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Which liver specific enzyme test might some loser from Barcelona order?
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GLDH (glutamate dehydrogenase)
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Which of the following enzymes are associated with leakage?
AST, ALP, ALT, SDH, GGT |
AST, ALT, SDH
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Which enzyme is most often elevated in instances of cholestasis?
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GGT (gamma glutamyltransferase)
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Which enzyme is used to assess passive transfer in cattle?
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GGT (high in colostrum; high in neonatal nursing calves)
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What are the three major isoenzymes of ALP?
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Liver
Bone Drug-induced |
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T or F:
Both dogs and cats show an increase in ALP liver isoenzyme in times of cholestasis. |
True!
Remember that only dogs will be ALP elevated with corticosteroids and anticonvulsants too! |
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T or F:
ALT increase indicates hepatocellular damage and, thus, reduced hepatic function. |
False!
ALT = hepatocellular damage but is not indicative of function |
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What is a major (general) pre-hepatic cause of bilirubinemia?
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erythrolysis
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What is a major (general) hepatic cause of bilirubinemia?
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hepatopathy (hepatocytes not taking-up bilirubin)
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What is a major (general) post-hepatic cause of bilirubinemia?
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Bile obstruction
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How is unconjugated bilirubin measured?
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Total bilirubin - conjugated bilirubin = unconjugated bilirubin
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T or F:
Increased conjugated bilirubin would likely indicate a patient with hepatopathy. |
True
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T or F:
Increased unconjugated bilirubin would likely indicate a patient with hepatopathy. |
False! It would indicate increased hemolysis
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At what level can bilirubeinemia cause icterus?
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>2-3mg/dl
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T or F:
Due to the low renal threshold for bilirubin, bilirubinuria is commonly seen before bilirubinemia. |
True!
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What is a common cause of bilirubinemia in horses?
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Anorexia
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Which is more clinically significant; bilirubinemia in a cat or in a dog?
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Cat!
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What tests are commonly used to assess liver function?
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Bilirubin (total, conjugated, unconjugated)
Bile Acids Blood ammonia |
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What factors are important to maintain enterohepatic circulation and serum bile acid concentrations?
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good portal circulation
functional hepatocytes w/normal blood flow unimpaired bile flow |
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T or F:
Most bile acids are reabsorbed in the cecum and then returned to the liver. |
False! Most are reabsorbed in the ileum!
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T or F:
Regarding liver function, testing bile acids is more sensitive than testing bilirubin. |
True!
Bile acids increase before bilirubin |
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Which of the following values can commonly be affected by non-congenital hepatopathy?
a) BUN b) Albumin c) PCV d) Urea e) Cholesterol f) PTT |
everything except for PCV
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