VM 583 - CLINICAL PATHOLOGY NEW EXAM QUESTIONS AND CORRECT
ANSWERS FOR TOP PERFORMANCE
A test contains 26 data points. What is the likelihood that data from at least a
single point is NOT within the reference interval for a clinically normal animal?
a. High probability
b. Low probability
High probability
If an animal has a disease and the test shows positive, is the test sensitive or
specific?
sensitive
If an animal does not have a disease and the test is negative (normal), is the test
sensitive or specific?
specific
How is the concentration of serum globulins routinely determined in a
chemistry profile?
a) By refractometry
b) By a chemical method
c) By serum protein electrophoresis
d) By subtraction of [albumin] from [total protein]
By subtraction of [albumin] from [total protein]
What protein is produced in increased amounts by hepatocytes in response to
inflammation?
a) Albumin
b) Hemoglobin
c) Serum amyloid A (SAA)
d) Immunoglobulin G (IgG)
Serum amyloid A (SAA)
A cat has markedly lipemic plasma. What would be the likely impact on the
refractometric measurement of total protein (TP)?
a) Falsely increase [TP]
,b) Falsely decrease [TP]
c) Lipids will not alter refractometric measurement of TP.
Falsely increase [TP]
What is a likely cause for mild hyperproteinemia characterized by mild
hyperalbuminemia and mild hyperglobulinemia?
a) Dehydration
b) Inflammation
c) Plasma cell neoplasia
Dehydration
What is a likely cause for marked hypoproteinemia, marked hypoalbuminemia,
marked hypoglobulinemia with no other diagnostically useful CBC, routine
chemistry, or urinalysis abnormalities?
a) Blood loss
b) Liver failure
c) Inflammation
d) Protein losing enteropathy
Protein losing enteropathy
If a horse has normoproteinemia, [pTP] within reference limits on CBC and
hypoproteinemia, [TP] decreased on serum chemistry, which one is more
likely?
a. Hypoproteinemia
b. Normoproteinemia
c. Need more information to determine
Hypoproteinemia (CBC uses plasma and the chemistry profiles use serum and
Fibrinogen is found in plasma but not serum, which can explain 0.3 g/dL of a
difference in this case, Chemistry profile measures protein biochemically -
assay less prone to interferents, while CBC measures TP using refractometer -
more prone to interferents)
What does an increased Hgb/Hct on the CBC suggest in a horse? What would
you expect your protein (albumin and globulin) values to be?
Supports hemoconcentration which typically causes hyperproteinemia (elevated
albumin and globulin, protein may decrease with fluid therapy; may also see
azotemia)
9-year-old Friesian mare has a several day history of lethargy, inappetence, and
diarrhea. Three days prior to presentation, treated with oxytetracycline and
,Banamine by rDVM. Continued to worsen and treated by rDVM with
oxytetracycline, banamine paste, and IV fluids on day of admission to MSU.
Physical Exam: Mild fever, mild tachycardia and mild tachypnea. Lethargic.
Mucous membranes purple with toxic line and prolonged CRT. Gastrointestinal
signs increased in all quadrants and fluid sounds noted. Decreased jugular vein
filling and arterial pulse pressures. BW: Hemoconcentrated, severe acute
inflammation (bands > segs), mild azotemia, mild hyponatremia and
hypochloremia, metabolic acidosis, liver enzymes and glucose were normal.
Total protein and albumin were low, globulin was low but within normal limits.
What is the most likely explanation for the protein findings?
PLE (diarrhea and low albumin and globulin) - protein loss into intestines that
may be selective (mostly loss of albumin) or nonselective (concurrent losses of
globulins and albumin), it could also be sepsis in this case (loss of plasma into
tissues - both albumin and globulin low)
How is fibrinogen measured on the CBC in large animals? Why is it included in
CBCs from large animals and not small animals?
a. Immunoassay
b. Thrombin time
c. Heat precipitation
Heat precipitation, commonly included in CBC of large animals because
inflammatory leukogram less consistently found compared to dogs and cats
What is a likely explanation for a mismatch between a [pTP] on a CBC and a
[TP] on a serum chemistry profile?
a. Fibrinogen is present in plasma but not serum
b. There is something in the plasma falsely increasing TP on the CBC
c. There is something in the serum falsely decreasing TP on the serum
chemistry
d. a or b
e. a or c
a or b: Fibrinogen is present in plasma but not serum and There is something in
the plasma falsely increasing TP on the CBC (lot of interference)
7-year-old neutered male mixed breed dog was attacked by a dog 1 day prior to
presentation. Seen by referring veterinarian who cleaned wounds and
administered antibiotics and IV fluids. Condition continued to deteriorate and
referred to MSU. Physical Exam: Mild tachycardia and tachypnea; mucous
membranes pale; prolonged CRT; severely depressed. Multiple full thickness
lacerations and punctures on forelimbs and right hind limb. Severe swelling and
, bruising on right hock and carpus. Severe melena on rectal examination. No
other significant findings on physical examination. BW: Not anemic, low
platelets, inflammatory leukogram (not severe - segs > bands), mild azotemia
but no UA for USG, mild hypernatremia/hyperchloremia, metabolic acidosis,
hypoglycemia, markedly elevated liver and muscle enzyme activities. Low total
protein, albumin, and globulin. What are likely explanations for the
hypoproteinemia?
Dermal loss of plasma via bite wounds and loss of plasma into tissue (severe
swelling/bruising; main explanation), Blood loss (explains melena but not
anemic), liver insufficiency (not long enough history)
4-yr-old neutered female mixed breed dog. Presented to rDVM one month
earlier for vomiting. Treated with antibiotics, probiotics, famotidine, cerenia
and a diet change to i/d and vomiting resolved. Physical examination: TPR
within reference limits, BCS 7/9, BAR. Mucous membranes pink, moist, CRT <
2 secs. Distended, non-painful abdomen. BW: Anemic, mature neutrophilia
(glucocorticoid response), mild hypocalcemia, moderate hypercholesterolemia,
mildly elevated liver enzyme activities, total protein and albumin low.
Urinalysis: proteinuria. What are likely explanations for the hypoproteinemia?
Renal loss or PLN (primarily albumin) - proteinuria, no anemia, no
inflammation (glomerular disease), Loss of plasma into tissues or body cavities
- abdominal effusion
What other protein would we be concerned about if there is low albumin due to
renal loss?
Low antithrombin III (small glycoprotein that can escape with albumin with
glomerular disease - check hemostasis profile, can be at risk for thrombotic
disease or increased clotting)
9-yr old neutered male Golden retriever with a mass on head of 5-6 months
duration. Recently became ulcerated. Has received several courses of antibiotics
with partial improvement. Mass gets worse once off antibiotics. Mass is sore
when touched but dog does not bother it. Physical Exam: Mildly febrile.
Depressed. Approximately 7 cm diameter mass on L side of skull which is
ulcerated. Enlarged L submandibular lymph node. BW: mild non-regenerative
anemia, chronic inflammatory leukogram, low albumin, high globulin. What is
the likely explanation for the hypoalbuminemia?
Mild hypoalbuminemia + hyperglobulinemia pattern consistent with established
inflammation (Albumin is negative acute phase protein - decreased production
ANSWERS FOR TOP PERFORMANCE
A test contains 26 data points. What is the likelihood that data from at least a
single point is NOT within the reference interval for a clinically normal animal?
a. High probability
b. Low probability
High probability
If an animal has a disease and the test shows positive, is the test sensitive or
specific?
sensitive
If an animal does not have a disease and the test is negative (normal), is the test
sensitive or specific?
specific
How is the concentration of serum globulins routinely determined in a
chemistry profile?
a) By refractometry
b) By a chemical method
c) By serum protein electrophoresis
d) By subtraction of [albumin] from [total protein]
By subtraction of [albumin] from [total protein]
What protein is produced in increased amounts by hepatocytes in response to
inflammation?
a) Albumin
b) Hemoglobin
c) Serum amyloid A (SAA)
d) Immunoglobulin G (IgG)
Serum amyloid A (SAA)
A cat has markedly lipemic plasma. What would be the likely impact on the
refractometric measurement of total protein (TP)?
a) Falsely increase [TP]
,b) Falsely decrease [TP]
c) Lipids will not alter refractometric measurement of TP.
Falsely increase [TP]
What is a likely cause for mild hyperproteinemia characterized by mild
hyperalbuminemia and mild hyperglobulinemia?
a) Dehydration
b) Inflammation
c) Plasma cell neoplasia
Dehydration
What is a likely cause for marked hypoproteinemia, marked hypoalbuminemia,
marked hypoglobulinemia with no other diagnostically useful CBC, routine
chemistry, or urinalysis abnormalities?
a) Blood loss
b) Liver failure
c) Inflammation
d) Protein losing enteropathy
Protein losing enteropathy
If a horse has normoproteinemia, [pTP] within reference limits on CBC and
hypoproteinemia, [TP] decreased on serum chemistry, which one is more
likely?
a. Hypoproteinemia
b. Normoproteinemia
c. Need more information to determine
Hypoproteinemia (CBC uses plasma and the chemistry profiles use serum and
Fibrinogen is found in plasma but not serum, which can explain 0.3 g/dL of a
difference in this case, Chemistry profile measures protein biochemically -
assay less prone to interferents, while CBC measures TP using refractometer -
more prone to interferents)
What does an increased Hgb/Hct on the CBC suggest in a horse? What would
you expect your protein (albumin and globulin) values to be?
Supports hemoconcentration which typically causes hyperproteinemia (elevated
albumin and globulin, protein may decrease with fluid therapy; may also see
azotemia)
9-year-old Friesian mare has a several day history of lethargy, inappetence, and
diarrhea. Three days prior to presentation, treated with oxytetracycline and
,Banamine by rDVM. Continued to worsen and treated by rDVM with
oxytetracycline, banamine paste, and IV fluids on day of admission to MSU.
Physical Exam: Mild fever, mild tachycardia and mild tachypnea. Lethargic.
Mucous membranes purple with toxic line and prolonged CRT. Gastrointestinal
signs increased in all quadrants and fluid sounds noted. Decreased jugular vein
filling and arterial pulse pressures. BW: Hemoconcentrated, severe acute
inflammation (bands > segs), mild azotemia, mild hyponatremia and
hypochloremia, metabolic acidosis, liver enzymes and glucose were normal.
Total protein and albumin were low, globulin was low but within normal limits.
What is the most likely explanation for the protein findings?
PLE (diarrhea and low albumin and globulin) - protein loss into intestines that
may be selective (mostly loss of albumin) or nonselective (concurrent losses of
globulins and albumin), it could also be sepsis in this case (loss of plasma into
tissues - both albumin and globulin low)
How is fibrinogen measured on the CBC in large animals? Why is it included in
CBCs from large animals and not small animals?
a. Immunoassay
b. Thrombin time
c. Heat precipitation
Heat precipitation, commonly included in CBC of large animals because
inflammatory leukogram less consistently found compared to dogs and cats
What is a likely explanation for a mismatch between a [pTP] on a CBC and a
[TP] on a serum chemistry profile?
a. Fibrinogen is present in plasma but not serum
b. There is something in the plasma falsely increasing TP on the CBC
c. There is something in the serum falsely decreasing TP on the serum
chemistry
d. a or b
e. a or c
a or b: Fibrinogen is present in plasma but not serum and There is something in
the plasma falsely increasing TP on the CBC (lot of interference)
7-year-old neutered male mixed breed dog was attacked by a dog 1 day prior to
presentation. Seen by referring veterinarian who cleaned wounds and
administered antibiotics and IV fluids. Condition continued to deteriorate and
referred to MSU. Physical Exam: Mild tachycardia and tachypnea; mucous
membranes pale; prolonged CRT; severely depressed. Multiple full thickness
lacerations and punctures on forelimbs and right hind limb. Severe swelling and
, bruising on right hock and carpus. Severe melena on rectal examination. No
other significant findings on physical examination. BW: Not anemic, low
platelets, inflammatory leukogram (not severe - segs > bands), mild azotemia
but no UA for USG, mild hypernatremia/hyperchloremia, metabolic acidosis,
hypoglycemia, markedly elevated liver and muscle enzyme activities. Low total
protein, albumin, and globulin. What are likely explanations for the
hypoproteinemia?
Dermal loss of plasma via bite wounds and loss of plasma into tissue (severe
swelling/bruising; main explanation), Blood loss (explains melena but not
anemic), liver insufficiency (not long enough history)
4-yr-old neutered female mixed breed dog. Presented to rDVM one month
earlier for vomiting. Treated with antibiotics, probiotics, famotidine, cerenia
and a diet change to i/d and vomiting resolved. Physical examination: TPR
within reference limits, BCS 7/9, BAR. Mucous membranes pink, moist, CRT <
2 secs. Distended, non-painful abdomen. BW: Anemic, mature neutrophilia
(glucocorticoid response), mild hypocalcemia, moderate hypercholesterolemia,
mildly elevated liver enzyme activities, total protein and albumin low.
Urinalysis: proteinuria. What are likely explanations for the hypoproteinemia?
Renal loss or PLN (primarily albumin) - proteinuria, no anemia, no
inflammation (glomerular disease), Loss of plasma into tissues or body cavities
- abdominal effusion
What other protein would we be concerned about if there is low albumin due to
renal loss?
Low antithrombin III (small glycoprotein that can escape with albumin with
glomerular disease - check hemostasis profile, can be at risk for thrombotic
disease or increased clotting)
9-yr old neutered male Golden retriever with a mass on head of 5-6 months
duration. Recently became ulcerated. Has received several courses of antibiotics
with partial improvement. Mass gets worse once off antibiotics. Mass is sore
when touched but dog does not bother it. Physical Exam: Mildly febrile.
Depressed. Approximately 7 cm diameter mass on L side of skull which is
ulcerated. Enlarged L submandibular lymph node. BW: mild non-regenerative
anemia, chronic inflammatory leukogram, low albumin, high globulin. What is
the likely explanation for the hypoalbuminemia?
Mild hypoalbuminemia + hyperglobulinemia pattern consistent with established
inflammation (Albumin is negative acute phase protein - decreased production
