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Questions and Answers

Which of the following best describes the initial step in a problem-based approach to veterinary diagnosis?

  • Immediately performing advanced imaging techniques such as MRI or CT scans.
  • Identifying and defining the abnormal finding(s) presented by the animal. (correct)
  • Administering broad-spectrum treatment based on common symptoms.
  • Consulting with specialists before conducting a physical exam.

An animal presents with elevated albumin and globulin levels on a CBC/chemistry panel. Which of the following is the MOST likely underlying cause?

  • Failure of passive transfer of antibodies
  • Inflammation due to an infectious disease (correct)
  • Hemodilution due to congestive heart failure
  • Significant blood loss from a parasitic infection

A veterinarian notes differences in gastrointestinal anatomy when treating different species. Why is it so important to understand these anatomical variations for effective clinical practice?

  • Anatomical differences only affect surgical procedures; medical treatments are unaffected.
  • Anatomical variances across species has little effect on veterinary practice.
  • Different species have various digestive processes and susceptibilities due to differences in anatomy. (correct)
  • All species respond similarly to treatments, regardless of GI anatomy.

A foal is diagnosed with failure of passive transfer. What change would you MOST expect to see on its CBC/chemistry as a direct result of this condition?

<p>Decreased globulin (A)</p> Signup and view all the answers

A dog presents with panhypoproteinemia. Which of the following conditions should be considered as a primary differential?

<p>Non-selective protein loss due to hemorrhage (D)</p> Signup and view all the answers

A large animal veterinarian is treating a horse with suspected colic. Why is a detailed understanding of equine gastrointestinal anatomy particularly critical in this situation?

<p>Specific anatomical features in horses predispose them to certain types of colic. (C)</p> Signup and view all the answers

Which of the following conditions is MOST likely to cause hypoproteinemia as a result of decreased protein production?

<p>Hepatic insufficiency (C)</p> Signup and view all the answers

Which of the following is the correct sequence of steps in a problem-based approach to cases?

<p>Baseline Data → Problem List → Ddx List → Dx Plan → Working Dx → Tx Plan (C)</p> Signup and view all the answers

Sadie, a 10-year-old spayed female Sheltie, presents with vomiting and anorexia of 3 days duration. Which of the following steps would be the MOST appropriate FIRST step in her physical examination?

<p>Triage to assess vital parameters. (A)</p> Signup and view all the answers

In a dog experiencing an inflammatory condition, which of the following acute-phase proteins (APPs) would you expect to see increase MOST significantly?

<p>Serum Amyloid A (SAA) (D)</p> Signup and view all the answers

Which of the following acute phase proteins is considered a NEGATIVE acute phase protein?

<p>Albumin (D)</p> Signup and view all the answers

Which acute phase protein(s) (APP) is considered the major APP in a cat?

<p>Serum amyloid A (SAA) (A)</p> Signup and view all the answers

A blood sample from a cow with an active inflammatory process is analyzed. Which of the following acute-phase proteins would be expected to show a significant increase?

<p>Haptoglobin (A)</p> Signup and view all the answers

During protein electrophoresis, an increase in which globulin fraction is MOST indicative of an acute inflammatory response?

<p>Alpha-globulins (B)</p> Signup and view all the answers

Which of the following statements accurately describes the role of haptoglobin (Hpt) as an acute-phase protein (APP)?

<p>Haptoglobin is a major APP in cattle and pigs, increasing significantly during inflammation. (C)</p> Signup and view all the answers

Which of the following would be the MOST likely cause of an increased concentration of positive acute-phase proteins (APPs)?

<p>Parvovirus infection (D)</p> Signup and view all the answers

Which of the following is a characteristic of a transudate?

<p>Low cellularity and low protein concentration. (A)</p> Signup and view all the answers

Increased vascular permeability leads to which type of fluid accumulation?

<p>Exudate. (B)</p> Signup and view all the answers

What change in serum electrolyte concentrations is expected with upper gastrointestinal obstruction?

<p>Decreased chloride relative to sodium. (C)</p> Signup and view all the answers

A patient presents with diarrhea. Which acid-base abnormality is most likely to develop as a result?

<p>Metabolic acidosis. (C)</p> Signup and view all the answers

If a fluid sample has a bilirubin concentration greater than twice the serum bilirubin, what is the most likely diagnosis?

<p>Bile peritonitis. (B)</p> Signup and view all the answers

Which electrolyte is predominantly found in the intracellular fluid (ICF)?

<p>Potassium (K+). (C)</p> Signup and view all the answers

Which of the following is a characteristic feature of chylous effusion?

<p>Triglyceride concentration &gt;100mg/dL and &gt;2x serum triglyceride. (B)</p> Signup and view all the answers

How do corticosteroids affect calcium absorption in the intestines?

<p>Inhibit calcium absorption. (B)</p> Signup and view all the answers

Which hormone directly opposes the action of parathyroid hormone (PTH) on calcium levels?

<p>Calcitonin. (B)</p> Signup and view all the answers

An alpaca presents with elevated globulin levels and normal albumin levels. Which of the following is the MOST likely underlying cause?

<p>Inflammation (B)</p> Signup and view all the answers

A veterinarian is evaluating a blood panel from a puppy and notes panhypoproteinemia. Which of the following differentials is the MOST likely if the puppy has no evidence of external bleeding?

<p>Protein-losing enteropathy (B)</p> Signup and view all the answers

A dog presents with severe burns covering a large surface area of its body. What specific type of protein change is MOST likely to be observed on a chemistry panel?

<p>Decreased albumin due to protein-losing dermatopathy (B)</p> Signup and view all the answers

A foal is suspected of failure of passive transfer. What change would you MOST expect to see on its CBC/chemistry as a direct result of this condition?

<p>Decreased globulins (D)</p> Signup and view all the answers

A cat presents with cirrhosis. What type of change in protein levels is MOST likely to be noted on a chemistry panel?

<p>Decreased albumin (A)</p> Signup and view all the answers

A veterinarian is presented with a horse exhibiting signs of colic. Utilizing a problem-based approach, what should be the veterinarian's immediate next step after identifying abdominal pain as a key problem?

<p>Develop a comprehensive list of differential diagnoses based on the identified problem. (A)</p> Signup and view all the answers

During a necropsy of a deceased sheep, a veterinary student is tracing the flow of ingesta through the gastrointestinal tract. Which compartment would ingesta enter immediately after leaving the rumen?

<p>Reticulum (B)</p> Signup and view all the answers

A veterinary surgeon is preparing to perform a liver biopsy on a dog. A thorough understanding of the regional anatomy is essential to avoid complications. Which anatomical landmark is MOST critical to identify accurately during this procedure to minimize the risk of hemorrhage?

<p>The caudal vena cava. (C)</p> Signup and view all the answers

A mixed animal practitioner is examining a fecal sample from a horse and a cat. What is the MOST significant anatomical difference in their gastrointestinal tracts that would explain why horses are more prone to fiber fermentation than cats?

<p>Cats lack a cecum, while horses have a large cecum and colon that facilitates microbial fermentation. (B)</p> Signup and view all the answers

A dog presents with elevated levels of Serum Amyloid A (SAA) and C-reactive protein (CRP). Based on this information, which of the following is the MOST likely condition?

<p>Acute inflammatory response (B)</p> Signup and view all the answers

In a horse experiencing an inflammatory condition, which acute phase protein would be expected to increase the MOST significantly?

<p>Serum Amyloid A (SAA) (D)</p> Signup and view all the answers

In which species would haptoglobin (Hpt) be considered a major acute phase protein (APP)?

<p>Horse (B)</p> Signup and view all the answers

Which of the following acute-phase proteins (APPs) is classified as a NEGATIVE acute-phase protein and would therefore decrease during an inflammatory response?

<p>Albumin (C)</p> Signup and view all the answers

A protein electrophoresis is performed on a sample from an animal experiencing chronic inflammation. What changes would you expect to see in the protein fractions?

<p>Decreased albumin, increased gamma-globulins (D)</p> Signup and view all the answers

In which clinical scenario would monitoring acute phase proteins provide the MOST useful information?

<p>Monitoring the response to antibiotic treatment in a septic patient (A)</p> Signup and view all the answers

Why is it important to perform a triage exam on an emergency patient before a complete physical exam?

<p>To identify and address any immediately life-threatening issues. (A)</p> Signup and view all the answers

Which of the following situations would MOST likely result in a pure transudate?

<p>Severe hypoalbuminemia due to protein-losing nephropathy. (C)</p> Signup and view all the answers

In a patient with upper gastrointestinal obstruction, which electrolyte imbalance is MOST likely to occur due to the sequestration of gastric contents?

<p>Hypochloremia (A)</p> Signup and view all the answers

What is the primary compensatory mechanism for metabolic acidosis?

<p>Increased ventilation by the lungs. (B)</p> Signup and view all the answers

A patient presents with severe, chronic diarrhea. Which acid-base disturbance is MOST likely to develop as a result of this condition?

<p>Metabolic acidosis. (B)</p> Signup and view all the answers

Which of the following hormones directly increases calcium absorption in the intestines?

<p>Vitamin D3. (D)</p> Signup and view all the answers

What effect does hyperventilation typically have on acid-base balance?

<p>Respiratory alkalosis (A)</p> Signup and view all the answers

Following a severe burn injury affecting a large surface area of the body, which of the following fluid and electrolyte shifts is MOST likely to occur in the initial acute phase?

<p>Hypovolemia with hyponatremia due to increased vascular permeability and fluid loss. (C)</p> Signup and view all the answers

Flashcards

What is a Problem?

An abnormal finding identified through history, physical examination, or diagnostics.

Problem-Based Approach

A method using abnormal findings to diagnose a condition.

"Nose to tail" Anatomy

Examining anatomy from cranial to caudal.

Gastrointestinal Tract & Hepatobiliary System

The digestive organs and liver/gallbladder system.

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Importance of Anatomy

Anatomy informs surgical approaches and understanding disease.

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Hyperproteinemia

Increased protein concentration in the blood, often due to hemoconcentration or increased globulin synthesis.

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Hypoproteinemia

Decreased protein concentration in the blood, caused by protein loss, reduced synthesis or increased breakdown.

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Non-Selective Hypoproteinemia

Loss of both albumin and globulin, often due to hemorrhage or protein-losing enteropathy.

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Selective Hypoproteinemia

Primarily albumin loss, often due to glomerular damage in the kidneys.

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Hypoproteinemia: ↓ Production

Reduced albumin production due to liver disease/failure. Concurrent lab abnormalities often present.

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Baseline Data

Initial data collection to establish a patient's baseline health status.

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Problem List

A list of the patient‘s current health issues or abnormalities.

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Ddx List

A list of possible diagnoses that could explain the patient's problem list.

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Dx Plan

The plan for confirming a diagnosis, including tests and procedures.

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Working Dx

The leading diagnosis based on current evidence.

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Tx Plan

The strategy for managing the patient's condition, including medications and supportive care.

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Acute-Phase Proteins (APPs)

Proteins whose concentration changes in response to inflammation. Positive APPs increase, Negative APPs decrease.

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Positive APPs

Proteins that increase in concentration during inflammation. Examples: Fibrinogen, CRP, SAA.

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Negative APPs

Proteins that decrease in concentration during inflammation. Examples: Albumin, Transferrin.

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Protein Electrophoresis

Separation of serum proteins based on their electrophoretic mobility. Used to identify abnormal protein patterns.

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Malabsorption/Maldigestion

Reduced absorption of nutrients in the small intestine or impaired digestion.

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Body Water Distribution

Water equals 60% of body weight, split between intracellular (2/3) and extracellular (1/3) fluids.

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Starling Forces

Oncotic and hydrostatic pressure differences between plasma and interstitium.

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Abnormal Fluid Distribution Manifestations

Interstitial edema, cavitary effusion, intracellular edema, and hypervolemia.

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Abnormal Fluid Distribution Mechanisms

Increased vascular permeability, increased hydrostatic pressure, decreased oncotic pressure, decreased lymphatic drainage.

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Transudate

Fluid leakage due to increased hydrostatic pressure or decreased oncotic pressure. Low protein and cells.

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Exudate

Fluid leakage due to increased vascular permeability and inflammation. High protein and cells.

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Electrolyte Abnormalities Causes

Change in free water, decreased/increased intake, ICF shifts, increased retention/loss via kidney/GI/skin/airways.

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Serum Sodium

Sodium concentration relative to water in the extracellular fluid.

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Na-Cl Difference >40

A disproportionate >40 difference. Indicates loss or sequestration.

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Metabolic Alkalosis

Increased HCO3.

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Metabolic Acidosis

Decreased HCO3, Loss of HCO3 or buffering of organic acids.

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Respiratory Acidosis

Increased pCO2.

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Anion Gap

Unmeasured anions in plasma (e.g., sulfates, phosphates, lactate, ketones).

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Calcium Absorption/Excretion

Mediated by vitamin D, absorption influenced by acidity, intestinal epithelium health. Excretion via kidney >>> feces.

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Gastrointestinal & Hepatobiliary System

The digestive organs, liver, gallbladder, and pancreas.

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Hemoconcentration

Concentration of blood components becomes elevated due to decreased plasma volume.

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↑ Protein Loss

Increased protein loss from the body, such as through the kidneys or intestines.

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↓ Protein Synthesis

Reduced production of proteins, often due to liver dysfunction.

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↑ Protein Catabolism

Increased breakdown of proteins in the body.

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Failure of Passive Transfer

Failure of a newborn animal to receive adequate antibodies from its mother's colostrum.

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Collect Baseline Information

The first step in a problem-based approach, involving gathering signalment, history, and physical exam findings.

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Signalment

Age, breed, sex, and reproductive status of the animal.

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History (Medical)

Details of the current and previous health issues.

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Triage

A quick assessment to prioritize patients.

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Physical Examination (PE)

A systematic and thorough examination.

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Positive Acute Phase Proteins (inflammation)

Increased production of acute phase proteins due to inflammation.

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Cause of Malabsorption

Intestinal issues or EPI.

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Inflammation's Effect on Albumin

Negative acute-phase response decreases albumin.

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Causes of Lymphoid Hypoplasia

Immunodeficiency(congenital, acquired).

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Causes of Cachexia

Severe chronic diseases, neoplasia, malnutrition, or starvation.

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Role of Albumin

Albumin retains fluid in blood vessels; loss leads to edema.

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Causative factors of Transudate

Increased hydrostatic pressure or decreased oncotic pressure.

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Causative factors of Exudate

Increased vascular permeability due to inflammatory mediators.

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Causes of Hemorrhagic Effusion

Trauma, neoplasia, hemostatic defects.

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Causes of Lymphorrhagic Effusion

Cardiac disease, trauma, neoplasia, or idiopathic causes.

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Causes of Uroperitoneum

Trauma, urolith, neoplasia.

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Causes of Bile Peritonitis

Trauma, cholelith, inflammation, neoplasia.

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Causes of Septic Effusion

Perforation, obstruction, ischemia, trauma, neoplasia, or abscess.

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Metabolic Component in Cursory Acid-Base Review

Kidney regulates; measured by HCO3-.

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Respiratory Component in Cursory Acid-Base Review

Lungs regulate; measured by pCO2.

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The hormones that balance caclcium

PTH, Vitamin D3. Calcitonin.

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Study Notes

Test Yourself - Routine Clinical Pathology

  • Routine clinical pathology can reveal information about postprandial status, hemoconcentration/dehydration, and inflammation.
  • Also vomiting, diarrhea, hepatocellular injury, cholestasis, and liver dysfunction/failure.
  • Helpful tests include:
    • Albumin, ALP, ALT, AST, Bicarbonate, Bilirubin, and BUN. They are part of basic chemistry.
    • Calcium, Chloride, Cholesterol, Creatine Kinase, Creatinine, GGT, Globulin, Glucose, Potassium, Phosphorus, SDH and Triglyceride.

Test Yourself - Ancillary Clinical Pathology

  • Can aid in diagnosis of pancreatitis, exocrine pancreatic insufficiency (EPI), or protein-losing enteropathy.
  • Useful tests include α-1 protease inhibitor, cobalamin, folate, PLI, and TLI.
  • Can also indicate small intestinal bacterial overgrowth (SIBO), small intestinal dysbiosis, antibiotic-responsive diarrhea, or tylosin-responsive diarrhea.
  • Aids in localizing small intestinal disease (proximal vs. distal vs. diffuse).

Important Proteins

  • Albumin.
  • Globulins (= Total Protein – Albumin).
  • Acute-phase proteins.
  • Coagulation proteins/factors (hemostasis!).
  • Many coagulation proteins/factors (pro- and anti-) are made by the liver.
  • Several require Vitamin K.
  • Calcium.

Importance of Vitamin K

  • Vitamin K is a fat-soluble vitamin from diet that is related to intestinal bacteria.

Role of Globulins

  • Globulins are all proteins in serum other than albumin.
  • There are 3 fractions:
  • α and β are mostly synthesized by the liver and include lipoproteins, acute phase proteins, and some immunoglobulins.
  • γ = immunoglobulins are made by B lymphocytes and plasma cells.

Positive vs. Negative Acute-Phase Proteins for Clinical Evaluation

  • Positive APPs (increase during inflammation) include:
  • Fibrinogen.
  • C-reactive protein (CRP).
  • Serum amyloid A (SAA).
  • Haptoglobin (Hpt).
  • Ceruloplasmin (Cp).
  • α2-macroglobulin (A2MG).
  • α1-acid glycoprotein (AGP).
  • Complement (C3, C4).
  • Negative APPs (decrease during inflammation) include albumin and transferrin.

Albumin vs Globulins

  • Albumin Bands or fractions do not include Alpha and beta groups.

Electrolyte Review With Sodium

  • Has a relationship in blood volume and plasma osmolality balance levels.
  • Electrolyte is influenced by water, while water influences serum and volume.

Acid Base Balance

  • Can be achieved by balancing out by Carbon dioxide and levels.
  • Inversely, higher CO2 mean lesser electrolytes.

Mineral G/I Levels

  • Dependent on Vitamin D, liver, kidney, and digestive health.
  • Has multiple factors which influence the digestive health.

Bone Disorders

  • Is influenced by many factors in digestive level.

Changes In Kidney Readings

  • Kidneys are disrupted by imbalance of Magnesium to other level.

BUN balance

  • BUN dependent on creatine influences through GFR, with many proteins related.

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