Hemolytic anemia will have more of the prescursors for RBCs and more protein. 

This is because all components of whole blood are lost in hemorrhage (albumin, reticulocytes, etc) 

Hemorrhage VS Hemolytic incident

Which would be more regenerative 4 days after significant loss?

This occurs in extravascular hemolysis because membrane is pitted by the splenic macrophages in the spleen. Extravascular hemolysis occurs within spleen - abnormalities get detected as they pass through.

In intravascular hemolysis RBCs are lysed in the bloodstream, and removed by the liver.

Heinz body anemia can be caused by what type of hemolysis?

A) Intrasvascular

B) Extravascular

C) Both 

Answer: Both 

this depends on the severity of the incident 

When its massive: its intravascular 

When its mild : extravascular and taken out by the spleen

Secondary nephrosis is typically a risk in:

A) Intravascular hemolytic anemia

B) Extravascular hemolytic anemia

C) Both 

Answer: A) intravascular

This is because hemoglobin from RBC metabolism will cause free radical damage to the renal tubules. 

The haptaglobin can be overwhelmed and excess hemeglobin molecules are small enough to be filtered through the glomerulus. 

Hypocellular 

This is because there is no erythropoeitin being produced by the kidney as it loses function, so there would be no stimulation of bone marrow. 

"Port wine" colored urine suggests all of the following EXCEPT:

A) the presence of hemoglobinuria

B) A likely possibility of free radical damage to renal epithelial cells 

C) That haptoglobin recovery system is overhelmed with hemoglobin 

D) That the MCH and MCHC are falsely increased due to poor sample handling 

ANSWER: D) the MCH and MCHC are falsely elevated from poor sample handling.

The presence of Heinz bodies suggests all of the following EXCEPT:

A) Oxidative damage to the red cells 

B) Disulfide linkages between hemoglobin molecules 

C) Precipitated hemoglobin with RBCs, which is an irreversible change

D) Autoimmune disease with autoantibodies directed against normal RBCs 

ANSWER: D) autoimmune

Heinz bodies indicate there is some sort of oxidation of hemeglobin occurring.  Electrophilic compounds cause disulfide bonds between hemoglobin molecules, and it preciptates to the surface. 

What effect does epinephrine release have on the segmented neutrophil count?

A) Increase 

B) Decrease 

C) Stay the same

ANSWER: A) Increased

it washes the neutrophils out of marginal neutrophil pool and into circulation 

What effect does epinephrione release have on the band neutrophil count?

A) Clinically insignificant left shift 

B) Moderate left shift 

C) No change 

ANSWER: C) No change

Mature neutrophilia without a release of bands - - there is no stimulation of bone marrow 

Which statement is INCORRECT, in health, of the multipotential stem cell...

A) Divides and one daughter cell replaces itself 

B) The other daughter cell becomes differentiated 

C) Has the potential to become any of the white cell, red cell, or platelets

D) Undergoes 2 divisions, resulting in 4 neutrophils 

ANSWER: D) because it undergoes 5 divisions and results in 32 neutrophils 

Which statement is INCORRECT in the bone marrow (in health)?

A) Cells are mitotically active in the proliferation pool 

B) Cells spend around 2.5 days in the proliferation pool 

C) Cell in the proliferation pool have round nuclei

D) Proliferation pool myelocytes either mature to form metamyelocytes to re-differentiate into stem cells

In health, which statement is incorrect regarding bone marrow?

A) Cells are mitotically active in the storage pool 

B) Cells spend around 2.5 days in the maturation and storage pool 

C) Cells in teh maturation and storage pool have indented nuclei 

D) Maturation and storage pool cells are released at the band or segmented neutrophil stage into the circulating neutrophil pool

ANSWER: A) 

Once in the storage pool the cells are no longer mitotically active 

In the peripheral blood (in health) ...

A) Circulating pool neutrophils travel with the red cells in the central portion of vessels 

B) Marginal pool neutrophils intermittently stick down to the vessel endothelium 

C) Under resting conditions only neutrophils from the marginal pool are sampled during venipuncture

Which statement is INCORRECT?

In health, in the peripheral blood...

A) Neutrophils from the marginal pool use their adhesion molecules to stick to vessel endothelium 

B) Neutrophils live in the tissues for about 2 weeks 

C) Neutrophils crawl through endothelium to enter tissues 

Which is INCORRECT?

What effect do you expect epinephrine release have on segmented neutrophil count?

A) Incerase 

B) Decrease 

C) No Change

What effect do you expect epinephrine to have on banded neutrophil count?

A) Increase

B) Decrease

C) No Change

Answer: C) NO CHANGE 

Because there is no release from the bone marrow

Which statement is incorrect regarding stress induced (corticosteroid) neutrophilia mechanisms?

A) Early release from marrow causes neutrophilia

B) Early release from marrow may cause a mild left shift

C) Down regulation of adhesion molecules causes neutrophils to enter marginal pool

D) Down regulation of adhesion molecules may result in increase circulation time and hypersegmentation

ANSWER: C) there IS a down regulation of adhesion molecules but this causes neutrophils to enter the CIRCULATING pool.  This down regulation causes neutrophils to circulate longer causing hypersegments.

In stress, there is a mild release from the bone marrow so a mild (clinically insignificant) left shift may be noted.  

A clinically insignificant left shift is often found in:

A) instances of excitement

B) instances of corticosteroids

Which is INCORRECT?

Answer: A) Excitement - because in excitement there is no release from the bone marrow.

In stress there will be a mild left shift 

A significant left shift would be trademark of acute inflammation.

What effect does corticosteroids have on tissue defences?

A) Upregulates tissue defenses

B) Supresses tissue defenses 

C) No change

Answer: B) Supresses tissue defenses 

Since there is a down regulation of adhesion molecules, there are less neutrophils in the marginal pool.  This lack of stickiness limits the amount of neutrophils that can enter the tissues.  

Which statement is NOT an appropriate response to significant acute inflammation?

A) Depleted neutrophil maturation and storage pool 

B) Characterized by hyperplastic neutrophil proliferation pool

C) Characterized by a clinically significant left shift

D) Neutrophilia with fewer metamyelocytes than bands 

ANSWER: B)neutrophil hyperplasia - there is not enough time in acute inflammation for the bone marrow to have responded and produce more neutrophils.  

It takes 4 days for the stems cells to ramp up enough to make a difference in the CBC. 

Which is NOT an appropriate response to established acute inflammation?

A) Occurs about 4 days after significant acute inflammatory episode

B) Characterized by partially depleted neutrophil maturation and storage pool 

C) Characterized by hyperplastic neutrophil proliferation pool 

D) Characterized by left shift that is increased over that seen 4 days previous 

Which is an INCORRECT response to chronic inflammation?

A) Occurs 7-10 days after significant acute inflammatory episode 

B) Depleted neutrophil maturation storage pool 

C) Hyperplastic neutrophil proliferation pool 

D) Clinically insignificant left shift or the absence of left shift

Answer: B) 

This is because the marrow has had time to catch up with the demand of the body, so the peripheral pool is hyperplastic.  You would expect neutrophilia with little to no left shift. 

In regards to sequestering neutropenia, which statement is INCORRECT?

A) May occur during bacteria endotoxin 

B) May occur during anaphylaxis 

C) Is a redistribution of neutrophils within circulation 

D) Occurs when marginal pool neutrophils enter the circulating pool 

E) Is less important than neutropenia of excessive tissue demand

Answer: D) 

Just the opposite occurs, the neutrophils increase margination thus causing a slight neutropenia

Which statement is INCORRECT regarding a degenerative left shift:

A) Implies a guarded to poor prognosis 

B) Occurs when immature neutrophils outnumber segmented neutrophils 

C) Occurs when there is a neutrophilia and the segmented neutrophils outnumber the band neutrophils 

Answer: C)

Since a degenerative left shift is often seen in cases of severe septicemia, the bacteria release cytokines that chemotactically draw up all the neutrophils from the blood. Since all the mature cells have left the blood, there are only immature cells left.  

Which statement is INCORRECT regarding neutropenia of excessive tissue demand (like gut rupture)?

A) Occurs with an overwhelming inflammatory process in the tissues 

B) Occurs when bone marrow storage pool is depleted and the tissues still demand more neutrophils 

C) Occurs when more neutrophils are being released by the marrow than can emigrate into the tissues

D) Implies a poor prognosis 

Answer: C) 

Because if there were more neutrophils being released by the marrow then there would be a neutroPHILIA. 

Which is INCORRECT regarding reduced production neutropenia?

A) Its often caused by bone marrow depletion 

B) May be caused by proliferation of neoplastic lymphoid cells in the marrow

C) Occurs when marginal pool neutrophils enter the circulating pool 

D) Implies a guarded to poor prognosis 

Answer: C) 

The problem of reduced production lies in the bone marrow (neoplastic crowding, toxic depression, organism like panleukopenia) 

Also if more neutrophils were to enter the circulating pool, there would be a neutrophilia.  

What is the PP/Fibrinogen ratio in a normal patient?

6 g/dl protein 

300 mg/dl fibrinogen

ANSWER: 20 

6/.3 (since it needs to be converted from mg to g) 

= 20 

In simple dehydration, what is the PP/Fibrinogen ratio?

How does this differ from normal?

8 g/dl protein

400 mg/dl fibrinogen

Answer: 20 

There is no change from normal 

(dont forget to convert to grams)

What is the PP/Fibrinogen ratio in inflammatory disease?

How does this differ from normal?

7.5 g/dl protein

1500 mg/dl fibrinogen

Answer: 5 

This is decreased from normal 

(Don't forget to convert to grams) 

What effect would a damaged/blocked thoracic duct have on blood lymphocyte count?

A) Lymphocytosis 

B) Lymphopenia

C) No effect

Answer: B) lymphopenia

All the lymphocytes would be sequestered in the thorax -

chylothorax 

What effect would an impaired lymphopoeisis or congenital defect have on blood lymphocyte count?

A) Lymphocytosis 

B) Lymphopenia

C) No effect

Answer: B) lymphopenia

not enough lymphocytes are being produced 

What effect would acute stress or acute inflammation have on blood lymphocyte count?

A) Lymphocytosis 

B) Lymphopenia 

C) No change 

Answer: B) Lymphopenia 

The leukocytes are held up in the lymph nodes 

What effect chronic corticosteroid release have on the blood lymphocyte count?

A) Lymphocytosis 

B) Lymphopenia 

C) No change 

Answer: B) Lymphopenia 

Because the lymphocytes are being lysed 

What effect would excercise and epinephrine had on the blood lymphocyte count?

A) Lymphocytosis 

B) Lymphopenia 

C) No change 

Answer: A) Lymphocytosis 

This is from thedown regulation of adhesion molecules causing an increased in circulating neutrophils.

What effect would chronic inflammation have on the blood lymphocyte count?

A) Lymphocytosis

B) Lymphopenia 

C) No change 

Answer: A) Lymphocytosis 

This is because in chronic inflammation the bone marrow has had time to respond and there is an increased production of neutrophils.

What would the megakaryocyte number on marrow aspirate 10 days after a severe generalized toxic insult to the bone marrow?

A) Megakaryocytic hyperplasia 

B) Megakaryocytic hypoplasia 

C) Normal megakaryocytic numbers

Answer: B) Megakaryocytic hypoplasia 

The toxins wipe out the megakaryocyte precursors, and after only 5 days the stored precursors are gone.

What would you predict the megakaryocyte number on bone marrow aspirates be after several days after your patients platelets were being consumed in disseminated intravascular coagulation?

A) Megakaryocyte hyperplasia 

B) Megakaryocyte hypoplasia 

C) Normal megakaryocyte numbers

Answer: A) Megakaryocyte hyperplasia

The platelets were taken away, and more bound, which stimulates thrombopeoisis by megakaryocytes . 

Predict the megakaryocyte numbers on a bone marrow aspirate several days after your patients platelets were being destroyed by anti-platelet antibodies

A) Megakaryocyte hyperplasia 

B) Megakaryocyte hypoplasia 

C) Normal megakaryocyte numbers

Answer: A) megakaryocyte hyperplasia

peripheral destruction (extramarrow) so you would expect the marrow to respond to the decrease in platelets. 

What would the megakaryocyte number on marrow aspirate several days after development of a thrombocytopenia from barbituate induced splenomegaly?

A) Megakaryocyte hyperplasia

B) Megakaryocyte hypoplasia

C) Normal megakaryocyte numbers 

Answer: C) Normal megakaryocyte numbers

The platelets are still in the body, some still in the enlarged spleen, but many are still in circulation.  The thrombopeoitin will still find platelets in the spleen.  

Scenario: Your patient is bleeding all over the place.

Lab results: normal platelet count, prolonged ACT, APTT, normal PT.

Where is the problem?

A) Primary hemostasis 

B) Intrinsic system 

C) Extrinsic system 

D) Common system 

Answer: B) Intrinsic system

Normal platelets rule out primary hemostasis

Normal PT rules out the common system, and the extrinsic 

Since ACT and APTT were abnormal there was most likely a problem with the intrinsic system.

Scenario: Your patient is bleeding all over the place

Lab Results: normal platelets, normal ACT, APTT, prolonged PT.  Where is the problem?

A) Primary hemostasis 

B) Intrinsic system 

C) Extrinsic system 

D) Common system 

Answer: C) Extrinsic system

Normal platelets rule out primary hemostasis 

ACT and APTT rule out the common and intrinsic 

The PT measured the extrinisic (and common, which we already eliminated) 

Answer: BLUE, and its used for clotting tests 

(stops the clotting process, but allows it to be restarted at the laboratory for measurement) 

Bleeding patient, Lab results: Normal platelets, Prolonged ACT, APTT, PT, normal TCT, and FDP.

Where is the problem?

A) Primary hemostasis 

B) Intrinsic system 

C) Extrinsic system 

D) Common system 

E) More than one of the above

Answer: E) More than one of the above

The only thing it is not is primary hemostasis because the platelets were normal 

Most likely there is an issue with both the intrinsic and extrinsic pathways, but not the common because the TT is normal (and common system defects are rare).

This is a likely set of results for warfarin poisoning or end stage liver failure. 

Bleeding patient lab results: Thrombocytopenia, Prolonged ACT, APTT, PT, TT, increased FDP's @ 1:20 dilution, decreased ATIII.

Where is the problem?

A) Primary hemostasis 

B) Intrinsic system 

C) Extrinsic system 

D) Common system 

E) More than one of the above

Answer: E) more than one of the above 

FDP present from clot breakdown

ACT, APTT intrinsic and common 

PT extrinsic and common 

TT common 

Thrombocytopenia is primary hemostasis 

ALL of the pathways are being effected. 

Celery experiment: celery cell in pure water 

Which way does the water move?

A) Intracellularly 

B) Extracellularly 

C) No movement 

Answer: A) Intracellularly 

The nature of the celery - still crisp and teeming with water

Celery experiment: Celery cell in salt water.

Which way does the water move?

A) Intracellularly 

B) Extracellularly 

C) No change 

Answer: B) Extracellularly 

The nature of the celery is shriveled and soft.

This occurs because of osmosis - the celery cell is a semi-permable membrane so the water moves with the osmotic gradient.

Na+ MW = 23 

Cl-   MW = 35 

Albumin MW = 69,000

What has a higher osmolality when dissolved in an wqual amount of water?

A) 1 gram of NaCl

B) 1 gram of albumin 

Answer: A) 1 gram of NaCl 

There are a lot more particles per gram of NaCl

What happens to the osmolality when you salt icy roads?

A) Increases 

B) Decreases 

Answer: A) Increases 

There are more particles per gram so the osmolality is increased 

What happens to the freezing point when you salt icy roads?

A) Increases 

B) Decreases 

Answer: B) Decreases 

There are more particles, which lowers the amount of heat that is needed to melt the ice.

What happens to the boiling point when you add salt to pasta water?

A) Raises 

B) Lowers 

In simple dehydration, what would happen to the extracellular concentration of Na?

A) Increases 

B) Decreases 

C) No effect 

Answer: A) increases 

The sodium concentrates (just like blood and everything else in cases of dehydration)

In simple dehydration, what effect does simple water loss have on the concentration of Na+?

A) Decreases (Hypoconcentrated)

B) Increases (Hyperconcentrated) 

C) No change 

Answer: B) increases (hyperconcentrated) 

In simple dehydration, what effect is had on the concentration of plasma?

A) Increases (Hyperosmolal)

B) Decreases (Hyposmolal) 

C) No change (Normoosmolal) 

What effect does dehydration have on the pituitary gland?

Answer: It causes a release of ADH 

This is in response to the increased osmolality, but also the decreased blood pressure from hypovolumia. 

ADH acts on the last segment of the renal tubules to retain water. 

What effect does dehydration have on blood volume and pressure?

A) Increase 

B) Decrease 

C) No change

Answer: B) decrease

There is not as much water, thus not as much volume

Answer: B) decreases 

Because of the hypovolumia.  The heart will try to compensate, but there is still only a little blood that is being output. 

Answer: B) Decreased 

The contraction of the blood volume limits the amount of blood perfusing the kidneys.

Answer: B) decreases 

There is less blood getting to the kidneys, so there is less filtrate being presented to the glomerulus, so less ends up in the tubules.

Answer: B) decreased 

The filtration is minimized because of the decreased amount of blood reaching hte kidneys. 

Answer: A) Increased 

AZOTEMIA (prerenal) 

Answer: A) increased stimulation

This is a survival advantage that will increase the blood volume by restoring the amount of water in the blood when it is available (better water retention) 

Why is the osmolality of the medullary interstitium so high?

A) Urea is absorbed by the CD

B) Na+ is absorbed by the LoH and CD

C) Cl- is absorbed by the LoH

D) Glucose is absorbed by the LoH 

Which statement is incorrect ?

Answer: A) increased 

The lab results would show hyperproteinemia

Answer: A) increased 

Because of hemoconcentration there would be hyperalbuminemia present

Answer: A) prerenal azotemia 

There is not enough blood getting to the kidneys, so there is less for them to filter.  The kidneys are still working properly and there is nothing blocking elimination, which rules out the other two options.

Answer: A) increased 

Because it is not being filtered out of the blood by the kidneys.

Answer: A) increased 

There is decreased filtration from the blood by the kidneys. 

Answer: A) Increased 

There is less being filtered from the blood by the kidneys

Answer: A) increased 

Hypersomolality 

Answer: C) No change

Examples of things that would cause a increased in the value of the gap would be ethylene glycol poisoning and drugs.

Answer: A) increased 

(stress leukogram) 

Answer: A) increased

This is because of the increased blood volume

Which data element does NOT provide evidence that the bone marrow erythroid line is regenerative?

A) An increased MCV

B) An increased reticulocyte count 

C) A decreased RBC count

D) Anisocytosis

E) Polychromasia

Answer: C) a decreased RBC count. 

All anemias have a decreased RBC count, this does not determine if its regenerative.  All other choices are elements of immature and regenerating RBCs.

Which statement does NOT explain why an MCH value may be within reference interval, but the MHCH can be below?

A) There is a reticulocytosis

B) Some of the hemoglobin is outside of the red cells

C) The hemoglobin is distributed in larger cells than normal

D) The average amount of hemoglobin within each red cell is within normal limits

Answer: B) The hemoglobin is outside of the red cells

The cells are lysed when these test are preformed, so it would not be effected if there was hemoglobin outside the cell. 

In a case of simple dehydration where water is lost, but there is no Na+ loss, how would it be characterized?

A) Hyponatremic dehydration 

B) Normonatremic dehydration 

C) Hypernatremic dehydration

Answer: C) hypernatremic dehydration 

There is a lot of water being lost, so the relative concentration of sodium will be increased.

In simple dehydration, where sodium and water are lost in equal proportions, how can it be characterized?

A) Hyponatremic 

B) Normonatremic

C) Hypernatremic 

Answer: B) Normonatremic

If both sodium and water are lost in equal proportions, there would not be an electrolyte imbalance, and will look normal on data sheets. 

This is an unusual loss. 

In simple dehydration, where sodium loss is greater than water loss, how would it be characterized?

A) Hyponatremic dehydration

B) Normonatremic dehydration

C) Hypernatremic dehydration

Answer: A) hyponatremic dehydration

This is what happens in severe dehydration

When a patient has dehydration with equal sodium and water loss then drinks water, how would it be characterized?

A) Hyponatremic

B) Normonatremic

C) Hypernatremic

Answer: A) hyponatremic dehydration

This makes it difficult to maintain extracellular fluid

What is the comparison of plasma and urine concentration of sodium ?

A) Plasma > Urine

B) Plasma < Urine

C) Plasma = Urine 

Answer: A) the concentration of sodium is higher in plasma than in urine. 

Answer: A) higher in plasma than in urine

Sodium and chloride are reabsorbed together 

Answer: B) higher in urine than in plasma

Answer: B) higher in urine than in plasma 

Both are constantly being made, and freely filtered by the kidneys but not readily reabsorbed.  

They are made when the body is getting rid of ammonia and during muscle metabolism - enter plasma 

Following urinary bladder rupture:

What is the serum concentration of Urea (BUN)?

A) Decreased 

B) Increased 

C) No Change 

Answer: B) Increased

Urea goes with the concentration gradient, so it is reabsorbed through the peritoneum.  

Following urinary rupture:

What is the serum concentration of creatinine?

A) Decreased 

B) Increased 

C) No change

Answer: B) Increased

Following urinary bladder rupture:

Whay is the serum concentration of potassium?

A) Decreased 

B) Increased 

C) No change

Answer: B) Increased 

Following urinary bladder rupture: 

What is the serum concentration of sodium?

A) Decreased 

B) Increased

C) No change

Following urinary bladder rupture:

What is the plasma concentration of chloride?

A) Decreased 

B) Increased 

C) No change 

Answer: A) decreased 

In alkalemia, what is the H+ concentration?

A) Decreased 

B) Increased 

C) No change 

Answer: A) Decreased 

In acidemia, what is the H+ concentration?

A) Decreased 

B) Increased 

C) No change

What would the blood concentration of CO₂ be in a hyperventilating patient?

A) Increased CO₂

B) Decreased CO₂

C) Normal CO₂ 

Answer: B) Decreased 

The increased breathing rate expells more CO2 out, thus decreasing the CO2 in the blood. 

In a hyperventilating patient, which way does the hydration equation go?

A) Driven to the left 

B) Driven to the right 

C) No change 

Answer: A) driven to the left

This is the buffer trying to reach equilibrium since there is a decrease of CO₂ 

In a hypoventilating patient, what would the blood concentration of CO₂ be?

A) Increased CO₂

B) Decreased CO₂

C) Normal CO₂ 

Answer: A) increased CO2 

In a hyperventilating patient,

what happens to the blood pH?

A) Increased H+

B) Decreased H+

C) No change 

Answer: B) decreased H+

More hydrogen ions are being combined as the hydration equation is moves to the left, thus a lower pH from less H+ ions.

In a hypoventilating patient, which way is the hydration equation driven?

A) To the right

B) To the left

C) No change 

Answer: A) to the right

In a hypoventilating patient, what happens to the pH of the blood?

A) Decreased pH (H+)

B) Increased pH (H+)

C) No change 

Answer: B) increased pH

Increased hydrogen ion concentration because the shift to the right (of the hydration equation) there is a dissociation of bicarbonate in an attempt to reach equilibrium. 

In a hyperventilating patient,

what happens to the arterial PCO₂?

A) Decreases 

B) Increases 

C) No change 

In a hyperventilating patient, which way is the hydration equation driven?

A) Shifts to the right

B) Shifts to the left 

C) No change

Answer: B) shifts to the left

In a hyperventilating patient, what happens to the hydrogen ion concentration?

A) Increases 

B) Decreases 

C) No change 

Answer: B) Decreases

initally the blood buffers will compensate for this, but if it persists = respiratory alkalosis

In a hypoventilating patient,

what happens to the arterial PCO₂?

A) Increases 

B) Decreases 

C) No change 

In a hypoventilating patient, which way is the hydration equation driven?

A) To the right 

B) To the left 

C) No change

Answer: A) to the right

In a hypoventilating patient, what happens to the hydrogen ion concentration?

A) Increases 

B) Decreases 

C) No change

Answer: A) increases

Initially the blood buffers will dampen this change, but if it persists = respiratory acidosis 

If you give a patient an IV with too much bicarbonate, which way is the hydration equation driven?

A) To the right 

B) To the left 

C) No change 

Answer: B) to the left

This causes metabolic alkalosis because of the decreased concentration of hydrogen ions.

What type of disturbance is seen in a patient with:

pH 7.22, PCO2 76, Hgb 13.5, BE 0 

A) Simple respiratory acidosis 

B) Primary respiratory acidosis with partial metabolic compensation 

C) Simple respiratory alkalosis 

D) Primary respiratory alkalosis with partial metabolic compensation 

E) Simple metabolic acidosis 

F) Primary metabolic acidosis with partial respiratory compensation

G) Simple metabolic aklalosis 

H) Primary metabolic alkalosis with partial respiratory compensation

I) Mixed primary aklalosis and primary metabolic aklalosis 

J) Mixed primary respiratory acidosis and primary metabolic acidosis 

Answer: A) Simple respiratory acidosis 

BE indicates that there has been no metabolic compensation, and the pH is acidic in the same way as the PCO2 = respiratory acidosis

What type of disturbance is seen in a patient with:

pH 7.6, PCO2 19.5, Hgb 14.1, BE -1

A) Simple respiratory acidosis 

B) Primary respiratory acidosis with partial metabolic compensation 

C) Simple respiratory alkalosis 

D) Primary respiratory alkalosis with partial metabolic compensation 

E) Simple metabolic acidosis 

F) Primary metabolic acidosis with partial respiratory compensation

G) Simple metabolic aklalosis 

H) Primary metabolic alkalosis with partial respiratory compensation

I) Mixed primary aklalosis and primary metabolic aklalosis 

J) Mixed primary respiratory acidosis and primary metabolic acidosis 

Answer: C) Simple respiratory alkalosis 

The pH is alkaline as is the PCO2 indicating that it is primarily a respiratory alkalosis, and the BE is normal so there has been no metabolic compensation.

What type of disturbance is seen in a patient with:

pH 7.05, PCO2 38, Hgb 15, BE -20 

A) Simple respiratory acidosis 

B) Primary respiratory acidosis with partial metabolic compensation 

C) Simple respiratory alkalosis 

D) Primary respiratory alkalosis with partial metabolic compensation 

E) Simple metabolic acidosis 

F) Primary metabolic acidosis with partial respiratory compensation

G) Simple metabolic aklalosis 

H) Primary metabolic alkalosis with partial respiratory compensation

I) Mixed primary aklalosis and primary metabolic aklalosis 

J) Mixed primary respiratory acidosis and primary metabolic acidosis 

Answer: E) Simple metabolic acidosis 

 Because both the pH and the BE are acidic, it is a metabolic acidosis.  Since the PCO2 is normal, there has been no respiratory compensation.

What type of disturbance is seen in a patient with:

pH 7.54, PCO2 42, Hgb 16, (BE +12) 

A) Simple respiratory acidosis 

B) Primary respiratory acidosis with partial metabolic compensation 

C) Simple respiratory alkalosis 

D) Primary respiratory alkalosis with partial metabolic compensation 

E) Simple metabolic acidosis 

F) Primary metabolic acidosis with partial respiratory compensation

G) Simple metabolic aklalosis 

H) Primary metabolic alkalosis with partial respiratory compensation

I) Mixed primary aklalosis and primary metabolic aklalosis 

J) Mixed primary respiratory acidosis and primary metabolic acidosis 

Answer: G) Simple metabolic alkalosis 

The pH and BE are both indicating alkaline, so the distubance in in metabolism.  The PCO2 is normal, so there has been no respiratory compensation. 

What type of disturbance is seen in a patient with:

pH 7.52, PCO2 50, Hgb 12.9, BE +16 

A) Simple respiratory acidosis 

B) Primary respiratory acidosis with partial metabolic compensation 

C) Simple respiratory alkalosis 

D) Primary respiratory alkalosis with partial metabolic compensation 

E) Simple metabolic acidosis 

F) Primary metabolic acidosis with partial respiratory compensation

G) Simple metabolic aklalosis 

H) Primary metabolic alkalosis with partial respiratory compensation

I) Mixed primary aklalosis and primary metabolic aklalosis 

J) Mixed primary respiratory acidosis and primary metabolic acidosis 

Answer: H) Primary metabolic alkalosis with partial respiratory compensation

The pH and BE are both alkaline, indicating a primary issue with metabolism.  The PCO2 is acidic, indicating the respiratory system is compensating. 

What type of disturbance is seen in a patient with:

pH 7.49, PCO2 19.5, Hgb 14, BE -6

A) Simple respiratory acidosis 

B) Primary respiratory acidosis with partial metabolic compensation 

C) Simple respiratory alkalosis 

D) Primary respiratory alkalosis with partial metabolic compensation 

E) Simple metabolic acidosis 

F) Primary metabolic acidosis with partial respiratory compensation

G) Simple metabolic aklalosis 

H) Primary metabolic alkalosis with partial respiratory compensation

I) Mixed primary aklalosis and primary metabolic aklalosis 

J) Mixed primary respiratory acidosis and primary metabolic acidosis 

Answer: D) primary respiratory alkalosis with partial metabolic compensation

The pH and PCO2 are both alkaline, so it indicates a respiratory disturbance. The BE is acidic so metabolism is compensating. 

What type of disturbance is seen in a patient with:

pH 7.33, PCO2 23, Hgb 13.8, BE -13 

A) Simple respiratory acidosis 

B) Primary respiratory acidosis with partial metabolic compensation 

C) Simple respiratory alkalosis 

D) Primary respiratory alkalosis with partial metabolic compensation 

E) Simple metabolic acidosis 

F) Primary metabolic acidosis with partial respiratory compensation

G) Simple metabolic aklalosis 

H) Primary metabolic alkalosis with partial respiratory compensation

I) Mixed primary aklalosis and primary metabolic aklalosis 

J) Mixed primary respiratory acidosis and primary metabolic acidosis 

Answer: F) primary metabolic acidosis with partial respiratory compensation 

The pH and BE are both acidic so the primary disturbance is metabolic.  The alkaline nature of the PCO2 indicates there is respiratory compensation.

What type of disturbance is seen in a patient with:

pH 7.35, PCO2 67, Hgb 14, BE +10 

A) Simple respiratory acidosis 

B) Primary respiratory acidosis with partial metabolic compensation 

C) Simple respiratory alkalosis 

D) Primary respiratory alkalosis with partial metabolic compensation 

E) Simple metabolic acidosis 

F) Primary metabolic acidosis with partial respiratory compensation

G) Simple metabolic aklalosis 

H) Primary metabolic alkalosis with partial respiratory compensation

I) Mixed primary aklalosis and primary metabolic aklalosis 

J) Mixed primary respiratory acidosis and primary metabolic acidosis 

Answer: B) Primary respiratory acidosis with partial metabolic compensation

The pH and PCO2 are both acidic indicating a respiratory disturbance.  The BE is alkaline showing there is some metabolic compensation.

What type of disturbance is seen in a patient with:

pH 7.04, PCO2 57, Hgb 12, BE -16 

A) Simple respiratory acidosis 

B) Primary respiratory acidosis with partial metabolic compensation 

C) Simple respiratory alkalosis 

D) Primary respiratory alkalosis with partial metabolic compensation 

E) Simple metabolic acidosis 

F) Primary metabolic acidosis with partial respiratory compensation

G) Simple metabolic aklalosis 

H) Primary metabolic alkalosis with partial respiratory compensation

I) Mixed primary aklalosis and primary metabolic aklalosis 

J) Mixed primary respiratory acidosis and primary metabolic acidosis 

Answer: J) mixed primary respiratory acidosis and primary metabolic acidosis 

Both PCO2 and BE are matching the pH by being acidic in nature, and this indicates a problem of both systems. 

What is the most likely clinical history for a case of simple respiratory acidosis?

A) Chronic vomiting

B) Acute respiratory distress 

C) Chronic pleural effusion 

D) Acute administration of IV fluids rich in NH4Cl

E) Chronic diarrhea

F) Hypoxia from living at high altitude for several days

G) Over enthusiastic bagging of patient by anesthesia

H) Acute administration of IV fluids rich in sodium lactate

I) Overdose of anesthetic causing severe respiratory/cardiac depress

Answer: B) Acute respiratory arrest.

With respiratory arrest, the patient isn't breathing and CO2 would build up in lungs.  This causes a shift to the right of hydration equation so there would be an increase in free hydrogen ions. 

What is the most likely clinical history for a case of simple respiratory alkalosis?

Answer: G) overenthusiatic bagging of patient

Answer: D) acute administration of NH4Cl IV fluids

NH4Cl will act as an acid in solution because it will donate hydrogens.  In the liver, NH4Cl is converted to NH3 (weak base) and HCl (strong acid), with the net effect being a strong acid and gain of free hydrogen. Also, the onset must be acute because there has not been time for respiratory compensation. 

Answer: H) Administration of sodium lactate IV 

Sodium lactate is a conjugate base that will "mop up" free hydrogen ions in solution.  The onset also should be acute because there is no respiratory compensation. 

Answer: A) Chronic vomiting

Chronic vomiting would cause this because of the stomach acids being lost in vomitus.  This would also need to be a chronic situation because there is respiratory compensation.

Answer: F) hypoxia from high altitude for days 

At high altitudes there is less oxygen and you hyperventilate, cause CO2 to decrease.

It also had to be something of long term because there has been metabolic compensation, but not too long here because the body will compensate (kidneys read hypoxia, produce more erythropoietin, more RBCs made to carry more oxygen).  

Answer: E) chronic diarrhea

The diarrhea causes a loss of bases from the body, causing an acidosis.  The chroncicity of this problem has allowed from respiratory compensation.

Answer: C) chronic pleural effusion

If a lab adds a strong acid to a blood sample, which way would the hydration equation shift?

A) To the right 

B) To the left

Answer: A) to the right 

By adding an acid you are increasing the free hydrogen concentration, so the equation would shift to the left to reach equilibrium.  

This is how Blood CO2 is determined - CO2 will bubble out and be detected by an electrode.

Patient A has diarrhea chemistry shows decreased TCO2, what is the correct conclusion can be made?

A) 1' metabolic acidosis

B) 1' metabolic alkalosis 

C) 1' respiratory alkalosis with 2' metabolic acidosis 

D) 1' respiratory acidosis with 2' metabolic alkalosis

Answer: A) Primary metabolic acidosis 

There is no respiratory component shown in the example.

Diarrhea will cause a loss of bicarb, which would cause an acidosis.

Patient A has ketosis and blood chemistry shows a decreased TCO2, what is the correct conclusion that can be made?

A) 1' metabolic acidosis 

B) 1' metabolic alkalosis 

C) 1' respiratory alkalosis with 2' metabolic acidosis 

D) 1' respiratory acidosis with 2' metabolic alkalosis 

Answer: A) primary metabolic acidosis 

Ketosis (from stress, diabetes, starvation) causes an increase of ketones from the breakdown of liver fat stores.  Ketones act as acids and shift the equation causing an acidosis. 

Patient A is vomiting and chemistry reveals an increase in TCO2, what is the correct conclusion that can be made?

A) 1' metabolic acidosis 

B) 1' metabolic alkalosis 

C) 1' respiratory alkalosis with 2' metabolic acidosis 

D) 1' respiratory acidosis with 2' metabolic alkalosis 

Answer: B) Metabolic alkalosis

Patient A has pleural effusion and chemistry shows an increased TCO2, what conclusion can be made?

A) 1' metabolic acidosis 

B) 1' metabolic alkalosis 

C) 1' respiratory alkalosis with 2' metabolic acidosis 

D) 1' respiratory acidosis with 2' metabolic alkalosis 

D) primary respiratory acidosis with secondary metabolic alkalosis.

The pleural effusion is a primary respiratory issue, which causes a decrease in gas exchange where not enough CO2 is being blown off.  This causes the equation to move to the right and increase the hydrogen ion concentration. Compensation occurs where the kidneys excrete acidic urine.

Which is incorrect regarding a titration metabolic acidosis?

A) Can be caused by the addition of fixed acids 

B) Is often caused by Ketoacidosis 

C) Can be caused by bicarbonate loss in diarrhea

Which is incorrect regarding a secretion metabolic acidosis?

A) Can be caused by a loss of base

B) Is caused by bicarbonate loss in diarrhea

C) Is often caused by hypephosphatemia from decreased GFR

Which typically causes an increase in the anion gap?

(Which is correct)

A) Titration acidosis 

B) Secretion acidosis 

C) Both titration and secretion acidosis 

D) Neither titration nor secretion acidosis 

In a case of failure of passive transfer in a foal, which is missing?

A) Alpha globulins

B) Beta globulins

C) Gamma globulins

D) Albumin

Answer: C) Gamma globulins 

This is shown as hypogammaglobulinemia

In a case of Feline Infectious Peritonitis, predict what a typical electrophoregram show?

A) Monoclonal gammopathy

B) Polyclonal gammopathy 

C) No anormalities

Answer: B) Polyclonal gammopathy

The virus has a capsid with many antigenic determinants, and the body amounts plasma cells to make a lot of different types of antibody against them.  There is a systemic disease with a lot of other things going on.

Where there is vomiting, Cl- is no longer present, and the body is set up for which of the following?

A) Hypochloremic metabolic acidosis 

B) Hypochloremic metabolic alkalosis 

C) Hyperchloremic metabolic acidosis 

D) Normochromic metabolic acidosis 

E) Hyperchromic respiratory alkalosis 

In a case of diarrhea, where HCO3 is no longer available as it is being lost in the feces, which of the following is the body set up for?

A) Hypochloremic metabolic acidosis 

B) Hypochloremic metabolic alkalosis 

C) Hyperchloremic metabolic acidosis 

D) Normochromic metabolic acidosis 

E) Hyperchromic respiratory alkalosis 

Answer: C) Hyperchloremic metabolic acidosis 

This shifts the equation to the right causing an acidosis, the kidneys are retaining more chloride.  

A patient is experiencing extravascular hemolytic crisis due to autoimmune hemolytic anemia. Which would NOT happen next?

A) Splenic macrophages phagocytize abnormal RBCs 

B) Hemoglobin is released into circulation and combine with haptoglobin 

C) Splenic macrophages digest RBCs and recycle iron and globin

D) Splenic marcophages metabolize heme remnant into unconjugated bilirubin and release into systemic circulation.  

Answer: B) 

Hemoglobin released into circulation with INTRAvascular hemolysis, as the hemolysis is occurring in vessels and RBC components are released into circulation. 

A patient with extravascular hemolysis crisis, which statement is wrong?*********

A) Albumin carries unconjugated bilirubin through systemic circulation of the liver sinusoids.

B) Albumin passes unconjugated bilirubin to its sinusoidal receptors 

C) Receptors are internalized and quickly saturated 

D) Primary conjugated hyperbilirubinemia occurs

Answer: D) 

This is wrong because the bilirubin has not been conjugated yet

In a patient with extravascular hemolysis from autoimmune disease, which statement is incorrect?

A) Unconjugated bilirubin is passed from the internalized sinusoidal receptor to ligandin 

B) The receptor returns to the sinusoidal membrane surface to take up more unconjugated bilirubin 

C) Ligandin passes unconjugated bilirubin to the ER for the conjugation to glucuronic acids

D) Conjugated bilirubin is now water soluble

Answer: D) 

The conjugated bilirubin needs to be soluble for it to pass into the urine and be eliminated from the body

In a patient with extravascular hemolysis from an autoimmune disease, which statement is incorrect?

A) Water soluble conjugated bilirubin is excreted into the bile canaliculus 

B) Conjugated bilirubin can be excreted faster that it can be conjugated

C) Conjugated bilirubin "regurgitates" into the liver sinusoid 

D) There starts to be a conjugated hyperbilirubinemia

Answer: B) 

In a patient with extravascular hemolysis from an autoimmune disease, which statement is incorrect?

Answer: A) 

Unconjugated bilirubin is too big and cannot be filtered through the kidneys

In a patient with extravascular hemolysis from an autoimmune disease, which statement is incorrect?

Answer: A) 

The blood bilirubin will be more and more conjugated to get it water soluble so it can be eliminated from the body.

In a patient with extravascular hemolysis from an autoimmune disease, which statement is incorrect in comparison to a patient with intravascular hemolytic anemia?

A) The haptoglobin is released into circulation during the hemolytic crisis 

B) Haptoglobin binds hemoglobin and the hemoglobin-haptoglobin complexes are taken up by the spleen

C) The liver breaks down hemoglobin, recycles iton and globin 

D) The liver releases unconjugated bilirubin to the systemic circulation

Answer: B) 

The hemoglobin-haptoglobin complexes are processed by the liver in intravascular hemolysis NOT the spleen. 

With a diffuse infiltrative periportal lesion, put the following structures in order with which would collapse first. 

A) Bile ductule 

B) Branch of portal vein 

C) Lymphatic vessel 

D) Branch of hepatic artery 

Order of first to collapse to the most stable = A, C, B, D

Bile ductule is least resistant to collapse, 

then the lymphatic vessels

then branches of the portal vein 

And branches of the hepatic artery are most resistant to collapse.

You have a patient with intrahepatic cholestasis, what is the typical hematocrit compared to severe hemolytic disease?

A) Higher 

B) Lower 

C) Same (normal)

In liver cirrhosis, which statement is incorrect?

A) Fibrous connective tissue surrounds portal triads

B) Fibrous connective tissue collapses the bile ductules

C) Unconjugated bilirubin is regurgitated into the systemic circulation 

D) Bile acids and cholesterol esters are regurgitated and are toxic to the sinusoidal membrane bilirubin receptors

In small animals, which is incorrect about liver cirrhosis?

A) The sinusoidal membrane receptors increase their uptake of inconjugated bilirubin 

B) There is about an equal mixture of conjugated and unconjugated hyperbilirubinemia

C) Conjugated bilirubin is filtered by the glomerulus 

D) You would expect a bilirubinuria

Answer: A) 

Scarring compresses the functional hepatocytes so there is a backup through the portal system.  Receptors are destroyed because the bile acid and cholesterol acids are toxic to them.  The bile acid is regurgitated with conjugated bilirubin, and destroys the receptors on contact, making them decrease their uptake.  

If the common bile duct is blocked by a tumor in a small animal, which is incorrect?

A) Conjugated bilirubin cannot be excreted into the biliary system

B) The bile cannot enter the intestine

C) Bacteria cannot metabolize 

D) Feces will become more brown

Answer: D) 

Feces will become more gray 

If the common bile duct is blocked by a tumor in a small animal, which is incorrect?

A) Conjugated bilirubin is regurgitated into the systemic circulation in large quantities 

B) Bile acids and cholesterol esters are regurgitated 

C) Bile acids and cholesterol acids are soothing to the sinusoidal membrane receptors

D) Unconjugated bilirubin is not taken up

Answer: C) 

bile acids and cholesterol esters are very much NOT soothing to sinusoidal membrane receptors 

If the common bile duct is blocked by a tumor in your small animal:

Which is incorrect?

1. You would expect a predominantly conjugated hyperbilirubinemia
2. Expect a more minor unconjugated hyperbilirubinemia
3. Conjugated bilirubin enters the urine
4. Unconjugated bilirubin enters the urine 

Answer: D)

It doesn’t enter the urine because it is stuck to albumin, making it not able to pass through the glomerulus.

What will enter the urine - - lots of conjugated bilirubin

Your canine patient has a traumatic lesion to the liver. Which of the following enzymes will leak out of the cytosol ?

1. ALT
2. ALP
3. AST
4. SDH

Answer: B)

because it is not free floating and is bound to ER

Dog with diffuse periportal lesion that is backing up biliary ducts. 

All of the following will typically increase as a result of the cholestasis except:

1. ALT
2. ALP
3. GGT
4. Total bilirubin

Answer: A) ALT

Bile acid regurgitation causes ALP and GGT

Bilirubin is not getting excreted into the bile duct, so it backs up and regurgitates into the sinusoids. 

Canine patient has diffuse periportal lesion backing up

What is most sensitive?

1. ALT
2. ALP
3. GGT
4. Total bilirubin

Canine patient has diffuse periportal lesion backing up. 

What is next sensitive after ALP activity?

a. ALT

b. GGT

c. Total bilirubin

Answer: C) Total bilirubin 

Bilirubinuria will occur, because the renal threshold for bilirubin is really low 

In ruminant check for hepatocellular leakage/necrosis. Which is most selective ?

1. ALT
2. AST
3. GGT
4. SDH

Answer: D) SDH -

SDH indicates liver leakage

GGT is inducible

ALT can indicate muscle too, so its not specific for liver

Which analyte is more stable (better to ship to a reference laboratory overnight or longer)

1. Ammonia
2. Bile acids 

Answer: BILE ACIDS

Ammonia lets off gas really easily (volatile), ammonia is not effected by cholesis that bile acids are.  

Which is incorrect?

Which of the following are characteristically found due to muscle necrosis?

1. Hyperkalemia
2. Increased serum creatinine
3. Increased serum asparate aminotransferase
4. Myoglobinuria

Answer: B) it would have to be CREATINE KINASE, serum creatinine is steadily released muscle damage doesn’t speed it up, it is a waste product of muscle contraction.  It is used to determine glomerular filtration 

Which is the most muscle specific ?

1. Hyperkalemia
2. Increased serum ceratine kinase
3. Increased serum alanine aminotransferase
4. Increased serum asparate aminotransferase

Answer: B)

Muscle doesn’t have ALT function, it is just liver.  And AST is both liver and muscle.  ALT - not seen in cows or any other large animals, useful only for small animals and people. Has a longer half life than CK, so used in tandem.  Hyperkalemia - high in the muscle cytosol, but also in just about all cell cytosols 

Equine has hyper AST - which is not the origin ?

1. Muscle necrosis
2. Liver necrosis
3. Both muscle and liver necrosis
4. Renal necrosis 

Occult blood pad on urinalysis dipstick which would NOT be found in muscle necrosis?

1. Intact rbc
2. Hemoglobinuria
3. Myoglobinuria
4. Bilirubinuria

Answer: D) 

Bilirubinuria would NOT be seen in muscle necrosis

Which way does the hydration equation drive when CO2 bubbles out of urine?

Does this alkalinize or acidify the urine?

To the left, and it will alkalinize the urine

Your patient has a 3+ glycosuria, which would you not expect to accompany it?

1. Urine specific gravity that underestimates osmolality
2. Hyperglycemia
3. Polydipsia
4. Inability to concentrate urine 

Answer: A)

Urine specific gravity will OVERestimate the osmolality 

Your patient has increased BUN and creatinine, which of the following helps determine if it is prerenal or primary renal azotemia??

1. Serum TCO2
2. Serum phosphorus
3. Serum potassium
4. Urine specific gravity 

Patient has increased BUN without an increase in creatinine, three of the following are possible differentials, which is the UNLIKELY cause?

1. End stage liver disease
2. GI bleeding
3. High Protein meal
4. Starvation 

Answer: A) End stage liver disease

There would be no increased BUN because the liver is not working so it is not able to process the urea cycle - decreased functional hepatocyte which convert ammonia to urea - so you cant make urea.  You may actually make a increased creatinine, without a BUN increase.  GI bleeding is not because the bacteria digest the protein from the red cells, and you get an elevated ammonia (from deamination by bacteria).  Then goes to the liver and goes through the urea cycle and increased urea than creatinine.  Which is similar to the high protein meal.With starvation, you might be using your muscle, and its broken down and deaminated and ammonia is produced, which goes through the urea cycle.  The rest of the muscle is made into glucose using gluconeogenesis in the liver.

Highest BUN would be from the GI bleed.

Which is incorrect regarding the function of the tubule?

1. Concentration or dilution of the filtrate (depending on the need)
2. Filtering out small molecules like urea and creatinine and letting them escape into the renal filtrate
3. Absoption of glucose, aa, and vitamins from the filtrate 

Answer: B) 

this is the job of the glomerulus 

How does the systemic circulation get rid of the majority of urea and creatinine

1. Breakdown by the liver
2. Glomerular filtration
3. Secretion though the GI tract
4. Renal tubular secretion 

Answer: B)

Urea and creatinine are filtered out into the urine, when GFR is decreased it will show elevated levels in the serum (azotemia).  

How does the medullary interstitium normally maintain its high osmotic pressure which is incorrect?

1. Urea, which is supplied by the liver
2. Sodium, which is reabsorbed in response to aldosterone
3. Chloride, which is reabsorbed in the loop of Helne
4. Potassium, which is reabsorbed in the distal tubule in response to aldosterone

Answer: D) potassium

Potassium is secreted in the distal tubule in exchange for sodium

Aldosterone causes reabsorption of sodium and excretion of potassium 

How is water reabsorbed in the kidney ? Which is incorrect?

1. It is an energy requiring process controlled by water pumps
2. It is a passive process depending on osmotic gradients and ADH
3. It can only happen if the medullary interstitium is supplied with urea
4. It can only happen if the medullary interstitium is supplied with Na+ 

Answer: A)

It doesn’t require energy it is a passive process

Your patient has ingested ethylene glycol , which is the incorrect answer>

1. Ethylene glycol increases plasma osmolality
2. Ethylene glycol is converted into oxalic acid by the liver
3. Oxalic acid dissociates into oxalate ion and H+ and thereby acidifies the blood
4. The plentiful oxalate ions cause hypercalcemia

Answer: D) 

Your patient has ingested ethylene glycol , Which is incorrect ?

1. Renal epithelial cells die and are sloughed into tubular lumen
2. The renal tubule secretes proteins
3. Epithelial casts form
4. Casts speed up the flow of filtrate 

Your canine patient has ingested ethylene glycol and 1/3 of the tubules are damaged and not blocked by cellular casts.  If these tubules die (but no more) will you see a decrease in concentrating ability of the kidney?

Yes or No?

If  you canine patient has ingested ethylene glycol and 1/2 of the tubules are blocked by casts, and die, will you see a decrease in concentrating ability?

Yes or No? 

What happens to effected and unaffected tubules when there is renal tubular damage? 

Your patient has ingested ethylene glycol and greater than 2/3 tubules are damaged and blocked.  Do you expect loss of concentrating ability

Yes or No?

Your patient has ingested ethylene glycol and greater than 2/3 tubules are damaged and blocked.

Why is there a loss of concentrating abilities?

There is loss of concentrating ability (although there are supernephrons)

Remaining tubules are overwhelmed and the solutes cannot be reabsorbed.

Overwhelmed reabsorptive capacity 

Your patient has ingested ethylene glycol and greater than 2/3 tubules are damaged and blocked.

Is there azotemia? 

NO

The rule of thumb, azotemia occurs when there is more than 3/4 of the tubules are blocked

At this point the GFR is not decreased just the reabsorption.  There MAY be a PRE renal azotemia from dehydration, but not primary 

When more than 3/4 of the tubules are blocked by casts, will you see azotemia? Why or why not?

Yes!

There is so much blocked that there is decreased GFR - the supernephrons that are left are still filtering, but the TOTAL GFR is decreased because there is so little left as functional.

When more than 3/4 of the tubules are blocked by casts, would you expect to see oliguria or polyuria?

Oliguria - not filtering enough to produce sufficient urine

More than 3/4 tubular damaged/blocked, what increased in the peripheral blood?

1. Urea and creatinine
2. K+
3. Phosphates and sulfates
4. Anion gap
5. All of the above 

Answer: E) All of the above

These are all filtered and eliminated through the kidneys 

What would cause the anion gap increase that occurs in renal failure?

1. Urea and creatinine
2. K+
3. Phosphates and sulfates
4. Anion gap
5. All of the above 

Answer: C) phosphates and sulfates 

because they are not part of the measured equation

In a urinary bladder rupture

What would the serum Urea be (BUN)?

1. Increased
2. Decreased 

Products of carbohydrate and protein digestion go into:

A) portal blood 

B) lacteals 

Digestion of lipids are absorbed into 

A) Portal blood 

B) Lacteals 

Answer: Lacteal 

lipid is broken down into triglycerides that are wrapped ina thin protein shell by enterocytes. 

They are then released into the lymph as chylomicrons

Cholesterol is the sum of cholesterol in all serum lipoproteins.

Hypercholesterolemia is increase in any or all lipoproteins.

What are likely culprits to contribute the most to total cholesterol value?

1. Cylomicrons only
2. VLDL only
3. LDL only
4. HDL only
5. A  and B only
6. C and D only 

Answer: F) LDL and HDL 

They are both high in cholestrols, where the VLDL and Chylomicrons are primarily triglycerides. 

Hypertriglyceridemia is increase in any or all lipoproteins.

What are likely culprits to contribute the most to total triglyceride value?

1. Cylomicrons only
2. VLDL only
3. LDL only
4. HDL only
5. A  and B only
6. C and D only 

Answer: E) chylomicrons and VLDL are composed 

primarily of triglycerides (90% and 70% respectively), where LDL and HDL are mostly cholesterol and have lower amounts of triglyceride. 

You have a patient with diarrhea, you administer oral dose of corn oil.  At 2 hours, the serum is clear.  What is most likely the problem?

1. This finding is consistent with health
2. Your patient has maldigestion
3. You patient has malabsorption
4. You patient has either malabsorption or maldigestion 

D) it is either malabsorption or maldigestion

you would be able to rule one out by adding enzymes that digest the lipids.  If the serum is still clear, then the patient is unable to absorb the lipids. If it is cloudy and turbid than the patient is somehow lacking in the enzymes needed to digest the lipids (pancreatic). 

You have a patient with diarrhea, you administer oral dose of corn oil and DIGESTIVE ENZYMES .  At 2 hours, the serum is turbid.  What is most likely the problem?

1. This finding is consistent with health
2. Your patient has maldigestion
3. You patient has malabsorption
4. You patient has either malabsorption or maldigestion 

Answer: B) Maldigestion 

When the digestive enzymes were added the lipids were broken down and able to be absorbed into circulation as noted by the turbidity of the serum.  Since this was not the case before the enzymes, the patient is lacking digestive enzymes needed to break the lipids down.

What color tube top would you use to measure calcium?

1. Red
2. Purple
3. Green
4. Blue

Answer: D) BLUE 

The blue top contains Citrate which reversibly binds to calcium.  The purple top contains EDTA which will bind to calcium irreversibly. 

Predict the renal effect of PTH on a high phosphorus, low calcium diet?

1. Calcium excretion, P excretion
2. Calcium resorption, P resorption
3. Calcium excretion, P resorption
4. Calcium resorption, P excretion

Answer: D) 

Phosphorus is being lost 

Predict the renal effect of PTH on a high calcium, low phosphorus diet?

1. Calcium excretion, P excretion
2. Calcium resorption, P resorption
3. Calcium excretion, P resorption
4. Calcium resorption, P excretion

Answer: C) calcium excretion, Phosphorus resorption

What is the action of PTH on bone?

1. Calcium and phosphorus mobilization and resorption
2. Calcium and phosphorus deposition
3. Calcium deopisition and phosphorus mobilization/resoprtion
4. Calcium mobilization/resorption

Predict the effects of parathyroidectomy on Ca and P?

1. Hypocalcemia, hyperphosphatemia
2. Hypercalcemia, hypophosphotemia
3. Hypercalcemia, hyperphosphatemia
4. Hypocalcemia, hypophosphatemia

Answer: A) 

the proximal convoluted tubule of the kidney would have increased retention

You have a patient with either pseudo or primary hyperthyroidism, how does this effect the GI?

1. Enhanced calcium, phosphorus absorption
2. Decreased calcium and phosphorus absorption
3. Enhanced calcium phosphorius absorption but decreased phosphorus absorption
4. Decreased calcium absorption but enhanced phosphorus absorption

Your patient has hyperparathyroidism, predict the blood Ca and P early in the course?

1. Hypercalcemia, hypophosphatemia
2. Hypocalcemia, hyperphosphatemia
3. Hypercalcemia, hyperphosphatemia
4. Hypocalcemia, hypophosphatemia

Answer: A) 

More PTH is being released - 

the first effect would be seen in the kidney and this would be shown as hypercalemia and hypophosphatemia.

Predict effects of MegaVitamin D dose?

1. Enhanced calcium and phosphorus absorption
2. Decreased calcium and phosphorus absorption
3. Enhanced calcium absorption but decreased phosphorus absorption
4. Decreased calcium absorption but enhanced phosphorus absorption 

Answer: A) 

Overdose can cause soft tissue mineralization

PTH will be decreased - the normal protective mechanisms

(like calcitonin) are overwhelmed

Your patient has hyperparathyroidism predict the bone ALP activity?

1. Hyperphosphateasemia
2. Hypophosphatasemia
3. No effect on ALP

Answer: A) 

Your patient has hyperparathyroidism predict the bone strength

1. Increased
2. Decreased      

Answer: Decreased 

the bone will be more likely to fracture

Hyperparathyroidism, later in the course, what would you expect the blood [P] to be?

1. Hyperphosphatemia
2. Hypophosphatemia
3. No effect on P 

Predict insulin's action on hormone sensitive lipase:

a) promotes 

b) impedes

Predict insulin's action on lipoprotein lipase:

a) promotes

b) impedes

Predict insulin's effect on triglyceride synthesis:

a) Promotes 

b) impedes

Answer: Promotes 

Insulin acts at the adipocyte

In the liver it inhibits the endothelial lipase which breaks down triglycerides to fatty acids. 

Predict insulin's action on gluconeogenesis from glycerol:

a) promotes

b) impedes

Answer: Impedes 

it DECREASES blood glucose

Predict the action of glucagon on gluconeogenesis:

a) promotes 

b) impedes

Predict glucagons action on glycolysis :

a) promotes

b) impedes

Answer: impedes

The main action of glucagon is to increase GLUCOSE, 

and since glycolysis is the break down of glucose into pyruvate, this would need to be impeded.

Predict the action of glucagon on glycogenesis (in liver and muscle):

a) promotes

b) impedes

Answer: Impedes

Glycogen is the storage form and by impeding this, there is an increase in blood glucose.

Predict the action of glucagon on glycogenolysis:

a) promotes

b) impedes

Answer: promotes

By increasing the breakdown of glycogen (storage form) to glucose, there will be an increase in glucose, which is the function of glucagon.

Predict the action of glucagon on protein breakdown to form glucose:

a) promote

b) impede

Answer: Promote

this will act on free floating amino acids - breakdown down and liver promotes gluconeogenesis

Predicts glucagons action on protein synthesis from glucose:

a) promotes

b) impedes

Answer: Impedes

The function of glucagon is to increase glucose in the blood, so it would impede this because the more glucose that is used to synthesize proteins, the less there will be in the blood. 

Predict the action of glucagon on fat synthesis:

a)promotes

b) impedes

Predict glucagons action on fat breakdown:

a) promotes

b) impedes

Predict the effect of excessive insulin on blood K:

a) increase 

b) decrease 

c) no effect

Answer: B) decrease 

this is because insulin drives potassium into the cell, and out of the blood.

What thyroid hormone predominates in circulation?

1. T3- bound with protein
2. T4-bound with protein
3. TSH
4. T4 - free 

Answer: B) t4-bound with protein

99% of them are bound (to plasma proteins)

What thyroid hormone predominates in circulation?

1. T3- bound with protein
2. T4-bound with protein
3. TSH
4. T4 - free 

Answer: D) Free T4 is the ACTIVE FORM 

Where is most of the T3 made in the body:

a) thyroid gland 

b) Circulation 

c) Tissue 

Answer: Tissue 

Formed from the T4 (acts as precursor hormone)

only 20% is made in the thyroid gland 

Your patient has the following blood work: predict the condition

T4 - increased

fT4 - N

TSH - N

TAA - N

1. Euthyroid sick
2. Hypothyroidism
3. Hyperthyroidism 

Answer: C) hyperthyroidism 

Predict the action of glucocorticoids on blood glucose:

a) increase

b) decrease

Answer: Increase

Because more gluconeogenesis is occurring, there would be more glucose in the blood, (may not be increased by that much- but there still may be hyperglycemia)

Predict the action of glucocorticoids on muscle protein breakdown:

a) promote

b) inhibit

Answer: Promote

this mobilizes the amino acids for gluconeogenesis in the liver.

Predict the action of glucocorticoids on peripheral fat breakdown:

a) promote

b) inhibit

Answer: Promote

Cortisol breaks down to get fatty acids to the liver to make glycerol

Predict the action of glucocorticoids on fat deposition on and around the liver:

a) promote

b) inhibit

Patient presented as "marshmallow on legs".

Has exaggerated blood cortisol response to ACTH injection, High dose was suppressed. 

Diagnosis?

1. Adrenal dep hyperadrenocorticism
2. Pituitary dependent hyperadrenocoritcism
3. Iatrogenic Hyperadrenocorticism
4. Hypoadrenocorticism 

Answer: B 

Pituitary dep hyperadrenocorticism

Low does isnt enough to supress benign tumor but the high dose is enough to stimulate receptors

Patient presented: fails to respond (has exaggerated) low and high dose ACTH stimulation.

Diagnosis?

1. Adrenal dep hyperadrenocorticism
2. Pituitary dependent hyperadrenocoritcism
3. Iatrogenic Hyperadrenocorticism
4. Hypoadrenocorticism

Answer: A) 

Patient presents with normal resting cortisol, no increase in cortisol to ACTH injections.  Clinically appears as a "marshmallow on toothpicks".

Diagnosis?

1. Adrenal dep hyperadrenocorticism
2. Pituitary dependent hyperadrenocoritcism
3. Iatrogenic Hyperadrenocorticism
4. Hypoadrenocorticism

Answer: C)