Clinical Pathology Exam 2

Front 1

Substances with ____MW have more particles?

Back 1

low

Front 2

What are the 3 ions in the extracellular compartment?

intracellular?

Back 2

EC= Na, Cl, HCO3

IC = K, Mg, HPO4

Front 3

The ICF composes what percent?

Back 3

2/3

Front 4

Hypernatremia always = what?

Back 4

hyperosmolality

Front 5

What is lab evidence of hypernatremia dehydration?

Back 5

Increased Hct, TP, BUN/Creatinine, Na, Cl, AG, hypersthenuria

Front 6

What are causes of hypernatremia + dehydration?

Back 6

1 - adpsia due to lack of water (concentrated urine, thirsty)
2 - adipsia due to abnormal thirst mechanism (concentrated urine, not thirsty)
3 - diabetes insipidus with lack of water (dilute - hyposthenuria with thirst)

Front 7

Is central or nephrogenic diabetes insipidus responsive to ADH?

Back 7

central

Front 8

What is the value for isothenuria?

Back 8

1.008-1.012

Front 9

What is an appropriate renal response in dehydration?

Back 9

hyperththenuria

Front 10

What are causes of hypernatreimia + normal hydration (normovolemia)?

Back 10

-salt poisoning
-consumption of sea water
-primary hypernatremia (don't want to drink)
-increase in Na and CL only

Front 11

What are causes of hypernatremia + normal hydration (hypovolemia - increased ICF)?

Back 11

Osmotic agents

Front 12

What is the formula for estimating osmolality?

Back 12

2 (Na + K) + (Glucose/18) + (BUN/2.8)

-significant if greater than 10-15 of measured value

Front 13

If an osmolar gap is identified, what could be possible active substances?

Back 13

-lactate, ketones, ethylene glycol , drugs

-will not be anything that is in the formula

Front 14

What is a cause of normonatremic dehydration?

Back 14

feces>intake
(Na and water are lost in equal proportions)

Front 15

What are some important causes of Hyponatremic dehydration?

Back 15

Na loss> water loss
-due to disease
-renal loss
-GI (foals)
-lactating dairy cow
-horses sweating
-uroperotoneum
-hypoaldosteronism
-hyperglycemia
-muscle damage

Front 16

What is a major cause of relative hypokalemia? (shifting from ECF to ICF)

Back 16

-alkalosis - vomiting

-insulin Rx

Front 17

What are caused of absolute hypokalemia?

Back 17

-decreased intake
-increased loss - renal (diuresis, ketonuria, metabolic alkalosis)
-hyperaldosteronism
-GI - vomiting, diarrhea, sequestration, saliva loss, sweat

Front 18

What can happen with hyperkalemia?

Back 18

cardiac arrest

Front 19

What are causes of relative/spurious increases in K? (5)

Back 19

-thrombocytosis
-hemolysis
-oriental breeds
acidemia
-massive tissue necrosis

Front 20

What are causes of absolute increase in K?

Back 20

-decreased renal excretion (ruptured urinary bladder, acute renal failure, post renal obstructive disease)
-hypoaldosteronism

Front 21

What are other signs of hypoaldosteronism?

Back 21

-hyperkalemia
-hyponatremia and hypochloridemia
-Na/K ratio<23
-hypercalcemia
-inappropriately concentrated urine with azotemia
-looks like renal failure

Front 22

When is hypochloridemia seen without hyponatremia?

Back 22

vomiting of pure stomach contents - because gastric fluids are rich in HCl

Front 23

What values are see with a urinary bladder rupture?

Back 23

decreased Na and Cl
increased K, BUN and Creatinine

-plasma values look like urine values

Front 24

What does plasma look like?

Back 24

increased Na and Cl
decreased K, BUN and Creatinine

Front 25

What are the arterial pH limits?

Back 25

7.36 - 7.44

Front 26

What 3 ways does the body control pH?

Back 26

-buffer system (weak acid and salt of its conjugated base)
-lungs (works fast)
-kidneys (slowest, but do most of the work)

Front 27

What types of buffer systems are there is the body?

Back 27

bicarb buffer system
-phosphate (can't be manipulated by the lungs)
-protein (can't be manipulated by the lungs)

Front 28

What is the hydration equation?

Back 28

CO2 +H2O <--> H2CO3 <--> H(+) + CO3(-)

Front 29

How does the kidney restore balance in an acidosis condition?

Back 29

-gets rid of H+ (acidic urine)
-keeps HCO3-

Front 30

What makes a carnivore's pee acid?

Back 30

methionine and cystein

Front 31

What makes an herbivores pee alkaline?

Back 31

malate in plant materials

Front 32

How do the lung keep balance in an acidosis condition?

-in an alkalotic condition?

Back 32

shift to left and blows of CO2 (H+ decreases)

-shift to the right and conserve CO2 (hold breath) (H+ increases)

Front 33

What does hypoventilation, or pneumonia cause?

Back 33

respiratroy acidosis
-drives equation to the right

Front 34

What does hyperventilation or panic attack cause?

Back 34

respiratory alkalosis
-drives equation to the left

Front 35

What two types of metabolic acidosis are there?

-what do you see with each?

Back 35

titration acidosis (associated with a increased AG - KLUE)

secretion acidosis = diarrhea, salivation in ruminants

Front 36

What are causes of metabolic alkalosis?

Back 36

-loss of H+ (gastric vomiting, abomasal reflux)

-gain base (ammonia/urea toxicant; bicarb fluids)

Front 37

What are the steps to determining acid base problems?

Back 37

-pH
-PCO2
-BE
-whatever agrees with pH is the primary problem with compensation in the other direction

Front 38

What does total CO2 tell you?

Back 38

BE or HCO3-

-does not always indicate a primary change therefore must use with clinical data to differentiate

Front 39

What types of acid base disturbances are there?

Back 39

-simple
-compensated
-mixed

Front 40

What are 4 predisposing factors to paradoxical aciduria?

Back 40

1 - metabolic alkalosis (increased HCO3-)
2 - hypovolemia (often due to dehydration so therefore have hyponatremia)
3 - severe hypochloremia (vomiting)
4 - hypokalemia

Front 41

What is the formula for anion gap?

Back 41

UA - UC

(Na + K) - (Cl + HCO3-)

Front 42

What are the unmeasured anions and cations in an anion gap?

Back 42

anions - phosphate, sulfates, albumin, lactate

cations - Ca, Mg, gammaglobulins

Front 43

What are caused of increased anion gap and decreased AG?

Back 43

increased - KLUE

decreased - hypoalbuminemia, hypercalcemia, hypermagnesemia

Front 44

What two things are needed to diagnose a mixed acid base disturbance?

Back 44

-increased AG
-increased or normal HCO3

(metabolic acidosis (titration acidosis like dehydration, renal failure, diabetic ketoacidosis) with metabolic alkalosis - vomiting)

Front 45

Does Cl increase or decrease with secretion acidosis?

Back 45

increase

Front 46

What are the four main markers of cellular leakage?

-what are 2 others

Back 46

AST
K
CK
Mgb

other - LDH and ALT

Front 47

Which is the most specific indicator for muscle damage?

is there a long or short half life?

Back 47

CK

-short half life therefore may return to reference level before measured

Front 48

What does CK do in the body?

Back 48

it makes ATP available for use in the body and in the process makes creatinine

Front 49

How is creatinine eliminated and what does this estimate?

Back 49

via the urine and therefore estimates glomerular filtration

Front 50

What are conditions that can cause an increase in CK?

Back 50

-myositis (infectious or immune mediated)
-trauma
-equine rhabdomyolysis
-strenuous exercise
-maybe secondary to arthritis

Front 51

What artifacts could cause an increase in CK?

Back 51

-hemolysis
-traumatic venipuncture

Front 52

How much higher is CK in neonates?

Back 52

5 x higher

Front 53

AST is an injury enzyme of what?

Back 53

skeletal muscle and liver

Front 54

What are causes of hyperkalemia?

Back 54

-acidosis
-muscle necrosis
-secondary to rhabdomyolysis
-diabetes mellitus
-oleander toxicity
-obstruction of urine outflow
-addisons disease

Front 55

What are causes of hypokalemia?

Back 55

-renal disease
-gereatric cats
-marginal dietary intake

Front 56

What are the three types of hypokalemic myopathies?

Back 56

1 - rhabdomyolysis secondary to K depletion (weakness -> increased CK -> necrosis --> myoglobinuria
2 - diabetic animals
3 - bovine post-partum ketosis (downers)

Front 57

What are three rule outs with a positive occult blood?

Back 57

1 - hematuria (sediment at bottom)
2 - hemoglobinuria (red plasma)
3 - myoglobinuria (clear plasma)

Front 58

With myoglobinuria, what does the plasma look like and what does the urine look like?

Back 58

plasma - clear
urine - brown

Front 59

Bacteria have urease. This can make the urine....

Back 59

alkaline

-produces CO2 (drives equation to the left) and ammonia (combines with free H+ ions)

Front 60

What are artifacts of alkaline urine?

Back 60

-causes cells to lyse
-casts to dissolve
-changes crystal formation
-false positive on urine dipstick for protein

Front 61

If you want to confirm presence of protein on a urine dipstick with alkaline urine, what test do you need?

Back 61

Bumin test

Front 62

What happens if a dilute urine sits too long?

Back 62

cells lyse and it is difficult to determine if there is hemoglobin or RBC

Front 63

What does light do to bilirubin and urobilinogen?

Back 63

are degraded by light

Front 64

How do you describe ketones?

Back 64

volatile - therefore escape form urine

Front 65

What could brown urine mean?

green-brown

Back 65

hemoglobinuria, myoglobinuria

bilirubinuria

Front 66

What does a refractometer measure and what does it infer?

Back 66

RI --> SG --> osmolality

Front 67

What two things overestimate osmolality?

Back 67

glucose and protein

Front 68

What is the measured bilirubin on a dipstick?

what does it mean?

Back 68

conjugated

cholestasis

Front 69

What is the order of sensitivity of tests for cholestasis in dogs?

-cats

Back 69

ALP>GGT>urinine bili>serum bili

GGT>ALP>serum bili>urine bili

Front 70

Bilirubin is degraded to what in the large intestine by bacteria?

Back 70

urobilinogen and sterobilinogen

Front 71

What does decreased urobilinogen mean?

Back 71

biliary obstruction

Front 72

Once protein is detected on a dipstick, what should you evaluate it for?

Back 72

hematuria or cystitis (look at RBC and WBC)

-if not that, may be glomerular or tubular disease

Front 73

What does the urine P:C ratio mean?

Back 73

>3 often means glomerular injury

<3 often means tubular injury

Front 74

What does glucosuria mean and what is the renal threshold?

Back 74

-hyperglycemia
-180 for most
-100 more ruminants

Front 75

When would you see ketones in the urine?

Back 75

with increased lipolysis (starvation, bovine ketosis, diabetic ketoacidemia, ovine preg. toxicosis)

Front 76

What is normal for RBC or WBC on sediment on 40x?

Back 76

5 cells

-greater than this means hematuria or pyuria

Front 77

What are conditions that increase BUN only?

Back 77

1 - endogenous protein break down
2 - high protein meal
3- GI bleeding

Front 78

What are the 2 causes of prerenal azotemia?

Back 78

-decreased GFR (dehydration and decreased CO)

-increased nitrogen load (where BUN increases without Creatinine)

Front 79

What are the characteristics of prerenal azotemia?

Back 79

-decreased GFR
-hypersthenuria (at least 1/3 of nephrons are still functioning)
-azotemia

Front 80

What is the order of abilities lost with renal failure?

Back 80

1 - ability to concentrate or dilute urine
2- Ability to eliminate nitrogenous wastes
3- Ability to produce EPO

Front 81

If the kidneys can't concentrate or dilute urine how many nephrons are lost and what does this reflect function of?

Back 81

- >2/3 of nephrons are lost (with fixed SG)
- measure of tubular function

Front 82

Other than isothenuria, what are some other indicators of tubular damage?

Back 82

-increased fractional excretion of Na
-increased GGT
-increased NAG
-increased retinal binding protein
-P:C ratio is greater than 1-3
-greater than 3 casts/LPF

Front 83

Once the kidneys have lost the ability to eliminate N wastes, how many functioning nephrons are lost?

What is this a function of

Back 83

>3/4 are lost

-measure of glomerular function

Front 84

What is the exception to azotemia appearing before loss of concentrating ability?

Back 84

cats and primary glomerular disease

Front 85

With primary glomerular disease, what is seen?

Back 85

-proteinuria
-retain limited ability to concentrate
-microalbuminemia
-urine P:C ratio is >1-3

Front 86

What are findings of post-renal azotemia?

Back 86

-anuria
-lg or ruptured urinary bladder (decreased Na and CL) (increased K, P, BUN, and Creatinine)
-pronounced azotemia
-titration acidosis

Front 87

What are the species difference of renal failure with horses?

Back 87

-increased Ca
increased P

Front 88

What are the species differences of renal failure with ruminants?

Back 88

-decreased Ca
-decreased Na and Cl
-increased fibrionogen

Front 89

What is lost with a protein loosing nephropathy?

Back 89

albumin with hypocalcemia
ATIII
-hypercholesterolemia
-edema
-metabolic acidosis

Front 90

What conditions cause PU/PD?
-list 8

Back 90

-renal failure
-diabetes mellitus (osmotic diuresis)
-Cushings
-Addisons
-liver failure
-psychogenic
-hypercalcemia
-Diabetes insipidus

Front 91

jeder (jedes, jede ...)

Back 91

each, every
(uses case endings)

Front 92

After a dehydration, what causes concentrated urine?

Back 92

thirst center
psycogenic (medullary washout)

Front 93

hyposthenuria is typically what type of problem?

Back 93

ADH

Front 94

After a dehydration test, what causes hyposthenuria?

Back 94

diabetes insipidus

Front 95

In an animal with Diabetes Insipidus, after administration of ADH, central causes...

Back 95

concentrated urine