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71 Cards in this Set
- Front
- Back
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Think about what hormone is missing or in excess
DM |
hormone
- insulin - absolute or relative lack physiologic role - promotes uptake of glucose into tissues - inhibits gluconeogenesis & ketogenesis - activates lipoprotein lipase CBC/ Chem Analytes DIRECTLY Affected - glucose - cholesterol - triglyceride - ketones - USPG - urine glucose |
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Think about what hormone is missing or in excess
hyperadrenocorticism |
hormone
- cortisol (excess) physiologic role - carb & lipid metabolism - maint of vascular tone - lymphocyte mitosis - anti-inflammatory CBC/Chem Analytes DIRECTLY Affected - leukoctyes - ALP - triglycerides - cholesterol - glucose |
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Think about what hormone is missing or in excess
hypoadrenocorticism |
Hormone
- cortisol (lack) - aldosterone (lack) Physiologic role cortisol - carb/ lipid metabolism - maintenance of vascular tone - lymphocyte mitosis - anti-inflammatory aldosterone - K+ excretion - Na+ retention CBC/Chem Analytes DIRECTLY Affected - leukocytes - glucose - electrolytes |
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Think about what hormone is missing or in excess
hyperthyroidism |
hormone
- thyroid (T4) - excess physiologic role - many - skeletal and neural development - virtually all aspects of metabolism - carb & lipid metabolism - cardiac fxn - erythropoiesis - bone turnover CBC/Chem Analytes DIRECTLY Affected - RBC - liver enzymes |
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Think about what hormone is missing or in excess
hypothyroidism |
hormone
- thyroid (T4) - lack physiologic role - many - skeletal and neural development - virtually all aspects of metabolism - carb & lipid metabolism - cardiac fxn - erythropoiesis - bone turnover CBC/Chem Analytes DIRECTLY Affected - rbc - cholesterol - triglycerides |
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Think about what hormone is missing or in excess
hyperparathyroidism |
hormone
- PTH (excess) Physiologic Role - mobilizes Ca2+ from bone - decreases urinary excretion of Ca2+ - increases GI absorption - increases urinary excretion of phosphate CBC/Chem Analytes DIRECTLY Affected - Calcium - Phosphate |
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Think about what hormone is missing or in excess
hypoparathyroidism |
hormone
- PTH (lack) Physiologic Role - mobilizes Ca2+ from bone - decreases urinary excretion of Ca2+ - increases GI absorption - increases urinary excretion of phosphate CBC/Chem Analytes DIRECTLY Affected - Calcium - Phosphate |
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Pattern recognition - clinicopathologic abnormalities
DM (uncomplicated) |
Classic Clinicopathologic Abnormalities
- hyperglycemia with glucosuria - increased fructosamine - +/- increased ALP/ ALT (mild) - +/- Ketonemia/ ketonuria - +/- hyperlipidemia (TG & Cholesterol) - Low USG Associated Clinical Signs and PE Findings - PU/PD - Polyphagia - Wt loss - polyneuropathy (plantigrade stance in cats) |
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clinicopathologic abnormalities
DKA |
Classic Clinicopathologic Abnormalities
- hyperglycemia with glucosuria - increased fructosamine - +/- increased ALP/ ALT (mild) - Ketonemia/ ketonuria - +/- hyperlipidemia (TG & Cholesterol) - Low USG - metabolic acidosis with increased anion gap - electrolyte imbalances - pre-renal azotemia Associated Clinical Signs and PE Findings - PU/PD - Polyphagia - Wt loss - polyneuropathy (plantigrade stance in cats) - ADR/ sick/ depressed/ weak - dehydrated - vomiting |
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clinicopathologic abnormalities
hyperadrenocrticism |
Classic Clinicopathologic Abnormalities
- stress leukogram - +/- erythrocytosis - increased ALP - hypercholesterolemia - hypertriglyceridemia - +/- low USPG & asymptomatic UTI (bact w/o marked pyuria) *if there, they are secondary* Associated Clinical Signs and PE Findings |
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pattern recognition - clinicopathologic patterns
hyperthyroidism |
Classic Clinicopahtologic Abnormalities
- increased ALT - increased ALP - low USG - BUN/CRE variable - PCV *usually norm but may have mild erythrocytosis* Assoc Clinical Signs & PE Findings - PU/PD - polyphagia - wt loss - restless/ cranky - GI signs (V/D) - thin skin - other skin probs - panting - heat intolerance - neck ventroflexion |
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pattern recognition - clinicopathologic patterns
hypoadrenocorticism |
Classic Clinicopahtologic Abnormalities
-normocytic, normochromic, nonregen anemia - reverse stress leukogram - high K/ low Na - low NA+:K+ ratio - hypercalcemia - hypoglycemia - azotemia with mild met acidosis - low USG Assoc Clinical Signs & PE Findings - intermittent GI (V/D - may be bloody) - weakness - tremors/ seiz (if low glu) - abd pain - shivering/ collapse/ shock |
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pattern recognition - clinicopathologic patterns
hypothyroidism |
Classic Clinicopahtologic Abnormalities
- normocytic, normochromic nonregen anemia - hypercholesterolemia - hypertriglyceridemia Assoc Clinical Signs & PE Findings - lethargic - wt gain - mental dullness - heat seeking - hair loss & other skin probs - neuro signs - infertility/ anestrus |
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pattern recognition - clinicopathologic patterns
hyperparathyroidism |
Classic Clinicopahtologic Abnormalities
- hypercalcemia - hypophosphatemia - (low USG) Assoc Clinical Signs & PE Findings - some asymptomatic - weakness - PU/PD - signs related to urolithiasis - mental dullness |
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pattern recognition - clinicopathologic patterns
hypoparathyroidism |
Classic Clinicopahtologic Abnormalities
- hypocalcemia - hyperphosphatemia Assoc Clinical Signs & PE Findings - weakness - musc tremors/ twitching/ fasciculations - facial rubbing - seiz - musc cramping or pain - stiff gait - restless/ anxious behavior - licking or biting at paws |
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pattern recognition - clinicopathologic patterns
being a vet student |
Classic Clinicopathologic Abnormalities
- cerebral explosion - leakage of necrotic brain sloughage from the ears - mental dullness - inability to hold a normal conversation - a pathological need to discuss bodily fluids at the dinner table Associated Clinical Signs & PE Findings - anxiousness - irritability - narcolepsy - caffeine intoxication - compulsive behavior - ridiculously dirty home |
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3 types of lab error
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preanalytical
- improper collection - improper storage - improper labeling analytical - problems with actual measurement (instrument/ reagents/ operator) post-analytical - transcription errors - results reporting |
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lab tests
measures of analytical performance |
are we measuring what we think we are
error analytical properties of tests quality assurance quality control reference intervals |
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lab tests
measures of diagnostic performance |
how well can we detect dz
sensitivity specificity predictive values dz prevalance |
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Clinical pathology is more related to _______
(analytical performance or diagnostic performance) |
analytical performance
- error - analytical properties of tests - QA - QC - RI |
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epidemiology is more related to _______
(analytical performance or diagnostic performance) |
diagnostic performance
- sens - spec - PPV - NPV - Dz Prev |
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QA vs QC
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Quality Assurance
- minimizes all types of error - common sense - written SOPs - proper personnel training - proper sample handling - routine checks (of instruments/ equip/ patient data) - accurate data transcription Quality Control - analytical error - use of QCM - analysis of QCM data |
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4 analytical properties of assays
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accuracy
- degree of closeness b/w a measurement and the analyte's true value precision - reproducibility - repeatibility - random error - the ability to get the same result if a sampe is analyzed mult times analytical specificity - refers to the assay's ability to measure teh substance (analyte) of interest and only that substance detection limit - the smallest possible concentration (quantity) of substance (analyte) that can be detected with reasonable certainty |
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_____ is the only way to assess proper fxn of the entire analytical system (instrument/ reagents/ operator)
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Quality Control
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______ refers to all procedures and systems that are in place to minimize all 3 types of error (pre-analytical/ analytical/ post-analytical)
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Quality assurance
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_______ refers to the ability to get the same result if a sample is analyzed multiple times
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precision
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______ is the degree of closeness b/w a measurement & the analyte's true value
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accuracy
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_______ refers to the assay's ability to measure the substance of interest and only that substance
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analytical specificity
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______ refers to the smallest quantity of substance that can be detected by an assay with reasonable certainty
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detection limit
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when should assay validation be performed
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anytime there is a maj change in the circumstances under which the assay will be operating (new reagent/ new species/ plasma vs whole blood)
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categories of analytical error
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random error (imprecision)
systematic error (bias) - constant bias - proportional bias |
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true or false
you can have good correlation and constant and/or proportional bias |
true
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true or false
a test with constant and proportional bias should not be used |
false
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a reference interval is defined by ______
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a lower and upper reference limit
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steps for determining RI
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decide on inclusion and exclusion criteria for reference individuals
select reference sample group(at least 120) obtain quality sample from each individual process the samples for each analyte - determine the data distribution - investigate outliers for accuracy - decide on RI (encompass the central 95% of individuals in the reference sample group |
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regarding RI determination
True or false if an outlier is accurate, it is left in the data set |
true
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RI should encompass what portion of the reference sample group
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the central 95%
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for any given analyte, there is a ____% chance that a test result will be outside the RI
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5%
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all changes must be interpreted in light of _____
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a patient's clinical condition and history
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______ is the true positive rate
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diagnostic sensitivity
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______ is the true negative rate
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diagnostic specificity
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random error vs systematic error
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random error
- imprecision systematic error - bias |
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true or false
a good laboratory test has no random error |
false
all lab tests have some inherent degree of random error, but in validated tests, the random error isn't enough to impact clinical decision making |
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what does each of the following mean
true pos false pos true neg false neg |
true pos
- the test result is pos - the patient really has dz in question - the test can correctly identify a diseased individual false pos - the test result is pos - the patient does not have dz in question - the test incorrectly identifies a dz free individual as being diseased true neg - test result is neg - patient really does not have dz in question - test can correctly id dz free individual as being diseased false neg - test result neg - patient does have dz in question - test fails to id diseased individual |
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how do sens and specif relate TP/ FP/ TN/ FN and probability that patient has dz
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High Sens = high true pos rate = low false neg rate
- neg or normal result = high probability that pt does not have dz |
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1. If a test has a high ______ and you get a pos result = high probability that patient has dz
2. If a test has a high ______ and you get a neg result = high probability that patient does Not have dz 3. ______ is good at ruling dz out 4. _____ is good at ruling dz in 5. _____ is most impt for screening tests 6. ______ is most impt for confirmatory tests |
1. specificity
2. sensitivity 3. sensitivity 4. specificity 5. sensitivity 6. specificity |
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predicitive values are influenced by _______
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prevalence
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prevalance influences
a. sensitivity b. specificity c. PPV d. NPV |
C & D
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if prevalence is high then ______ will be good
if prevalence is low then _____ will be good |
high prev = good PPV, not good NPV
low prev = good NPV, not good PPV |
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formulas for Sens/ Spec/ PPV
NPV |
Sens
TP / (TP + FN) Specif TN / (FP + TN) PPV TP / (TP + FP) NPV TN / (TN + FN) PPV (with prevalence) (Sens x prev) / [(spec x 1-prev) + (1-sens x prev)] NPV (with prev) (spec x 1 - prev) / [(specif x 1 - prev) + (1 - sens x prev)] |
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what things may interfere with analytical specificity
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hemolysis (Hgb)
lipemia (triglycerides/ cholesterol) icterus (bilirubin) |
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interpreting patient results (2 ways)
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longitudinal
- trends in 1 patient over time cross sectional - population based reference intervals (may be wide RI) - pretty safe assumption for most veterinary analytes |
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for statistical analysis of data for RI what percentiles can you use as limits
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if n > 120 and normal distribution
use 2.5th and 97.5th percentiles as limits if n < 120, use special statistical methods |
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if you have 20 analytes, there is a ____% chance of at least 1 abnormality
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64%
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what does TP mean?
TN? FP? FN? |
TP = dz
TN = no dz FP = no dz but test pos FN = dz but test neg |
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______ is influenced by prevalence
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predictive values
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a positive (abn) test result in a test with high specificity = ?
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high prob the animal DOES have the dz
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a neg (normal) test result in a test with a high sensitivity = ?
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high prob the animal does NOT have the dz
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if you are concerned that a dog has brucellosis (zoonotic dz) do you want a test with a high sens or spec?
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high sens
ability to identify dz free individual correctly |
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if you are concerned that a dog has cancer (owner may euth based on your dx), do you want a test with a high sens or spec?
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high spec
ability to id diseased individual correctly |
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who is sick of clin path
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me!
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Small animal
enzymes associated with liver dz (and where they come from / half life) |
ALT
- from hepatocytes / myocytes - leakage from cytosol - inducible - 2-3 days AST - hepatocyte / myocyte / erythrocyte - leakage from cytosol and mitochondria - less than 1 day ALP - hepatocyte / biliary cells / bone / placenta - synthesis from cell membrane - 3 days dog - <8 hrs cat CK - myocytes - leakage from cytosol - 6hrs Lipase - pancreatic acinar cells - hepataic tumors - leakage from cytosol - 2 hrs Amylase - pancreatic acinar cells - leakage from cytosol - 5 hrs |
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large animal
enzymes associated with liver dz (and where they come from / half life) |
SDH
- hepatocytes - leakage from cytosol - , 12 hrs AST - hepatocyte / myocyte / erythrocyte - leakage from cytosol and mitochondria - 7-8 d GGT - hepatocyte / biliary cells / mammary - synthesis from membrane - 3 days CK - myocytes - leakage from cytosol - 2 hrs |
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types of hepatic dz
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hepatocellular dz
biliary dz (cholestasis) hepatic insufficiency |
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increased bile acids is seen with
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PSS
loss of hepatocyte fxn cholestasis |
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what lab results are used to look at the 3 types of hepatocellular inj
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hepatocellular inj
- AST - ALT - SDH - GDH Biliary excretion/ flow - ALP - GGT - Chol - Bilirubin - BA hepatic fxn - Glu - Chol - bilirubin - albumin - alpha/ beta globulin - fibrinogen - ammonia - bile acids - coag factors - BUN |
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muscle enzymes
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CK
- cytosol - faster AST - cytosol and mitchondria - slower |
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enzyme levels are dependent on
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rate of release from damaged cells
rate of enzyme production rate of removal from blood (half life) ingestion and absorption (colostrum) |
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cholesterol may be changed with what form of hepatic dz
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cholestasis
hepatic insufficiency |
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ALT is a marker for what form of hepatic dz
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hepatocellular injury
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GGT is a measure of what form of liver dz
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cholestasis
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