which of the following is incorrect
DESCRIPTION
1. Which of the following is incorrect. A Resting stem cells are resistant to the toxic effects of chemotherapy drugs B Stem cells give rise to all blood cells C Stem cells are capable of self-renewal D Stem cells are large multinucleated cells. 2. - PowerPoint PPT PresentationTRANSCRIPT
Which of the following is incorrect.
• A Resting stem cells are resistant to the toxic effects of chemotherapy drugs
• B Stem cells give rise to all blood cells
• C Stem cells are capable of self-renewal
• D Stem cells are large multinucleated cells
1
Which of the following is true of neutrophils?
• A They circulate for 8 days
• B They have round nuclei and granular cytoplasm
• C In blood vessels they are equally distributed between the marginal pool and the circulating pool in dogs
• D They synthesise globulins
2
Erythropoiesis is stimulated by
• A GM-CSF
• B Thrombopoietin
• C Erythropoietin
• D Deep sea diving
Which is true of Reticulocytes?
• A They are immature red cells which stain blue-pink on Diff-Quick
• B Released in large numbers following excitement
• C smaller than normal red cells
• D contain small round nuclei
6
Which of the following is incorrect
• A Bilirubin may be found in normal cat urine
• B Urobilinogen may be found in normal cat urine
• C Bilirubin increases in horses following anorexia
• D Bilirubin is found in urine in animals with biliary obstruction
7
Which film comment is correct?A spherocytes ++ B hypochromic cellsC marked polychromasiaD Babesia organisms seen
9
Which film comment is correct?A Spherocytes ++B hypochromic cellsC SchistocytesD Babesia organisms seen
10
These abnormal red cells are seen inA regenerative anaemiaB iron deficiency anaemiaC vascular neoplasia eg haemangiosarcomaD aged samples
11
9 Yr old GSDHistoryDog was normal until previous nightFound collapsed this morning.
P exam T 98 F, P 152/min and irreg. R 12/minvery pale mucus membranescranial/mid abdo mass palpated.
red cells 3.73 x 1012/l 5.5 - 8.5Haemoglobin 8.3 g/dl 12.0 - 18.0PCV 0.24 /l 0.32 - 0.55MCV 67.6 fl 59.0 - 77.0MCH 22.8 pg 20 - 26MCHC 34.2 g/dl 30 - 36
Film commentNormocytic normochromicMany schistocytes and acanthocytes
PP 52 g/l 60 - 80
Which is the most likely differential ?
• A Hypoadrenocorticoid (Addisons)crisis
• B Acute internal haemorrhage from abdominal mass (?tumour)
• C Aplastic anaemia
• D Acute cardiac failure
12
Why is dog so white with PCV of 24%?
• A PCV performed incorrectly
• B Dog has cardiac failure
• C Dog is acutely bleeding/hypovlaemic so reduced peripheral perfusion + PCV does not reflect severity of blood loss in acute haemorrhage
• E Clinician is colourblind
13
What would you do next?
• A Urine analysis
• B Serum iron
• C Xrays + Ultrasound abdo
• D go down the pub
14
Red cells 3.86 x 1012/l 5.5 - 8.5Haemoglobin 8.0 g/dl 12.0 - 18.0PCV 0.24 l/l 0.32 - 0.55MCV 61.2 fl 59.0 - 77.0MCH 20.7 pg 20 - 26MCHC 31.8 g/dl 30 - 36Reticulocytes 13.5 % < 2
9 year old Bull Terrier with maelena9 year old Bull Terrier with maelena
Red cells are hypochromic and microcytic2+ polychromasia
Plasma protein 51 g/l 60 - 80
555
This anaemia is:
• A microcytic hypochromic
• B microcytic hyperchromic
• D normocytic normochronic
• E macrocytic normochromic
15
9 yr old Bull Terrier with maelena
What does the pattern of low PCV and low PP suggest?
• A dehydration
• B haemorrhage
• C non-regenerative anaemia
• D haemolytic anaemia
16
What is the most common cause of low MCV
• A Aged sample
• B regenerative anaemia
• C iron deficiency anaemia
• D beetroot ingestion
17
• A Urine/faecal analysis
• B Abdominal radiography
• C Coombs test
• D Bone marrow aspirate
9 yr old Bull Terrier with maelena Which test would you perform next?
18
9 yr old Bull Terrier with maelena
• Urine analysis - no haematuria
• Faecal analysis - no parasites
• Ultrasound exam - solitary mass in intestine
Ultrasound revealed a solitary SI mass. Would you:
• A recommend euthanasia
• B go down the pub
• C dispense iron tablets and go down the pub
• D give a blood transfusion followed by ex-lap and surgically remove the mass
19
3 yr old Irish Setter
• Became unwell over last 7 - 10 days
• Depressed,lethargic, exercise intolerance
• Pale mucus membranes
• Not jaundiced
• T 40.2oC, P 135, R 20
• Splenomegaly
Increased RCDW signifies
• A Variation in haemoglobin concentration
• B numerous nucleated red cells
• C Increased red cell size
• D variation in red cells size due to large and/or small red cells
1
3 year old F Irish Setter
• Polychromasia 3+
• Anisocytosis 2+
• Spherocytes 3+
• Reticulocytes 26%
• Absolute retic count
= 26 x 1.22 x 10 = 317 x 109/l
Likely Diagnosis?
• A IMHA
• B Onion toxicity
• C Babesia canis
• D microangiopathic haemolytic anaemia, likely secondary to a tumour
3
red cells 3.51 x 1012/l 5..00 Š 10.5HB 6.88 g/dl 8.0 - 15.0PCV 0.185 l/l 0.24 Š 0.46MCV 52.8 fl 40 - 60MCH 19.6 pg 11 - 17MCHC 37.1 g/dl 30 - 36
4 yr old local Holstein 3 weeks post-calving Depression, jaundice and haemoglobinuria
Pl pr 80 g/l 60 - 80
Film comment
Anisocytosis 3+Polychromasia 2+Basophilic stipplingHowell-Jolly bodies
What is the most likely cause of the anaemia
• A Babesia bovis
• B Hypophosphataemia
• C Bladder neoplasia / haemorrhage
• D Immune-mediated haemolytic anaemia
4
red cells 1.08 g/dl 7.0 – 11.0Hb 2.80 g/dl 11.5 – 19PCV 0.069 l/l 0.32 – 0.48MCV 64.2 fl 37 - 58MCH 26.0 pg 13 - 19MCHC 40.5 g/dl 31 – 38RDW 36.8 % 11.6 – 14.8
7 yr Welsh Bay Gelding Weight loss, anaemia, jaundice
Pl pr 78 g/l 60 - 80Fibrinogen 3 g/l 2 - 4.5
Red cell morphology
• 2+ Anisocytosis
• No polychromasia
• A few Howell-Jolly bodies
• A few nucleated red cells
Is the anaemia
• A Regenerative
• B Non-regenerative
• C Not possible to say
6
Is the anaemia most likely due to
• A Haemorrhage
• B Haemolysis
• C Primary bone marrow disease
• D renal failure
7
What would you do next?
• A Slide agglutination test and Coombs test
• B Bone marrow aspirate
• C faecal occult blood
• D abdominal radiography
8
4 month old GSD with skin problem• red cells 5.16 x 1012/l 5.5 - 8.5• Hb 12.20 g/dl 12.0 - 18.0• PCV 0.35 l/l 0.37 - 0.55• MCV 68.7 fl 59.0 - 77.0• MCH 23.6pg 20 - 26• MCHC 34.5 g/dl 30 - 36• Pl pr 57 g/l 60 - 80
What is going on?
• Chronic GI haemorrhage due to parasitism
• Acute GI haemorrhage
• Hypothyroid
• All normal for a dog of this age
4 month old GSD
• White cells 17.8 x 109/l 6.0 - 15.0
• neutrophils 10.5 x 109/l 2.5 - 12.5
• bands 0 x 109/l 0.0 - 0.4
• Lymphs 5.8 x 109/l 0.5 - 4.8
• monocytes 0.7 x 109/l < 0.8
• eosinophils 0.7 x 109/l 0.05 - 0.8
4 month old GSD
• Biochemistry• Total protein 57.0 g/l 60 - 80• Urea 6.1 mmol/l 2.5 - 6.7• Creatinine 1.0.0 umol/l 20 - 150• ALT 10 IU/L 5.0 - 60.0• ALP 376 IU/L < 130• Gamma GT 5.0 IU/L 0.1 - 9.0
• Phosphorus 3.48 mmol/l 0.8 - 1.6
• Calcium 3.35 mmol/l 2.40 - 2.90
• These are all age-related normal findings
3 yr entire male labrador
• Scavenged in dustbin 2 days previously
• Well until yesterday
• Now lethargic / depressed
• Clinical exam pale / ?icteric
• Mild splenomegaly
• Dark urine noted by owner
3 yr old greedy Labrador
• red cells 3.6 x 1012/l 5.5 - 8.5• haemoglobin 6.9 g/dl 12.0 - 18.0• PCV 0.20 l/l 0.37 - 0.55• MCV 67.2 fl 60 - 77• MCH 23.7 pg 19.5 – 24.5• MCHC 32.3 g/dl 32 – 36• Pl pr 78 g/l 60 - 80
Film exam
• Mild anisocytosis
• Mild polychromasia
• Clear areas on one side of cell
• NMB smear made
What is the cause of the anaemia
A Gi haemorrhage
B AIHA
C Zinc toxicity
D Onion toxicity
E Copper toxicity
3 yr Old G. Ret 3 weeks depression and weight loss
and more recently pyrexia• Red cells 3.02 x 1012/l 5.5 - 8.5• Hb 7.3 g/dl 12.0 - 18.0• PCV 0.24 l/l 0.32 - 0.55• MCV 66 fl 60 - 77• MCH 23 pg 19.5 – 24.5• MCHC 36 g/dl 32 - 27• Pl Pr 72 g/l 60 - 80
Red cells normocytic normochromic
Comments so far?
• A Severe regenerative anaemia
• B Moderate non-regenerative anaemia ? Chronic dx or 10 bone marrow dx
• C Suggestive of recent blood loss
9
White cells and platelets
• white cells 7.12 x 109/l 6.0 - 15.0• neutrophils 1.2 x 109/l 0.8 - 4.8• lymphocytes 5.3 x 109/l 1 – 4.8• monocytes 0.1 x 109/l 0.2 – 1.5• eosinophils 0 x 109/l 0.05 - 0.8• platelets 90 x 109/l 150 - 450
Now most likely
• A Anaemia of chronic dx
• B 10 bone marrow dx
• C IMHA with concurrent IMTP
• D acute blood loss
10
Blood film exam
• Atypical lymphocytes
• Irreg nuclei
• Some nucleoli
• Thrombocytopenia
What is at the top of your differential list?
• A Plasma cell myeloma
• B Acute lymphoid leukaemia
• C Aplastic anaemia
• D myelofibrosis
12
Which test would be most useful?
• A Epo assay
• B Ultrasound spleen
• C Bone marrow aspirate
• D Lymph node aspirate
13
8 yr Mn Boxer1 cm cutaneous hairless mass
• A excise and send for histopath
• B advise revisit in 6 weeks
• C dispense Synulox
• D take a fine needle aspirate
1
What would you use to take a fine needle aspirate?
• A 18 ga needle
• B Trucut needle
• C 23 ga needle
• D Jamshidi needle
2
Which is true of sampling thoracic masses
• A Large mediastinal masses can be aspirated if the no aerated lung in penetrated
• B if the needle is long enough, any mass may be sampled safely
• C Needle aspiration of lung/chest masses is highly risky and should not be performed
• D A large bore 14 - 18 ga needle should be used
3
Which statement is incorrect
• A adding a coverslip increased clarity when examining smears
• B The condenser should be positioned low for cytology / haematology film exam
• C Diff-Quick is a suitable stain for cytology
• D Haematology is my favourite subject
4
In normal cows the predominant cell type is
• A lymphocyte
• B neutrophil
• C monocyte
• D eosinophil
5
Which of the following is not a toxic change seen in neutrophils
• A basophilic cytoplasm
• B foamy cytoplasm
• C hypersegmented nuclei
• D Dohle inclusions
6
In early acute inflammation the neutrophilia results from
• A prolonged neutrophil circulation time
• B release of neutrophils form the marginating pool to the circulating pool
• C release of neutrophils from the storage/maturation pool
• D shift of neutrophils from the tissues into the circulation
7
13 y6r old entire female cocker spaniel
6 yr Female JRT
White cells % 85 x 109/l 6.0 - 15.0neutrophils 78 67 x 109/l 0.8 - 4.8bands 20 17 x 109/l < 0.4lymphocytes 0.9 0.8 x 109/l 1 Š 4.8monocytes 0.2 0.2 x 109/l 0.2 Š 1.5eosinophils 0 0 x 109/l 0.05 - 0.8
Which is the most likely cause of these white cell abnormalities
• A stress leucogram
• B acute inflammatory response
• C physiological / adrenaline induced neutrophilia
• D chronic granulocytic leukaemia
8
6 year F Labrador with depression and fever
White cells % 85 x 109/l 6.0 - 15.0neutrophils 2 2.1 x 109/l 0.8 - 4.8bands 0 0 x 109/l < 0.4lymphocytes 0.6 0.5 x 109/l 1 Š 4.8monocytes 1.6 1.7 x 109/l 0.2 Š 1.5eosinophils 0 0 x 109/l 0.05 - 0.8atypical mononuclear 96 80 x 109/lcellsPlatelets 39 x 109/l 200 Š 500PCV 21 % 36 -55
What is the likely cause of the neutropenia
• A Increased demand due a focus of severe infection
• B Aplastic anaemia eg due to oestrogen toxicity
• C Reduced neutrophil production due to leukaemic infiltrate
• D Blood loss
9
Which describes the stress leucogram
• A neutrophilia, lymphopenia, monocytosis, eosinopenia
• B neutrophilia, lymphocytosis, monocytopenia, lymphopenia
• C neutrophilia, lymphopenia, monocytopenia, eosinophilia
• D neutropenia, lymphocytosis, eosinopenia, monocytosis
10
1 Which is not a potential cause of increased PCV
• A Renal tumour
• B Chronic renal failure
• C Severe pulmonary dx
• D Dehydration
• E Polycythaemia rubra vera
2 Which test would not be useful in establishing the cause of polycythaemia
• A Serum proteins
• B Ultrasound of kidneys
• C Bone marrow aspirate
• D Chest X ray
• E EPO assay
3 Which of the following is true of immunosuppressive therapy?
• A Cyclosporin blocks T cell activation and does not
suppress neutrophil production
• B Hi dose prednisolone can be used with minimal side
effects in dogs
• C Azathioprine is a suitable drug for IMHA in cats
• D Danazol works by reducing anti-body production
• E Human IG is a cheap alternative to cyclophosphamide
4 Which is true of feline blood groups?
• A Most DSH cats are type B• B Most BSH cats are type A• C All type A cats have hi titres of anti-B
antibody• D All type B cats have hi titres of anti-A
antibody• E All type AB cats have low titres of anti-A
antibody
5 Which statement is true of Cross matching
• A always do prior to any transfusion in dogs• B In the major cross match donor cells are mixed with
recipient serum• C No agglutination or haemolysis means the donor
and recipient are the same blood type• D Rouleaux formation in a cross match is regarded a
positive result• E A positive minor cross match is not significant
6 A dog with severe AIHA is deteriorating in spite of therapy. The PCV is now 8% and dog very weak. What would you give this dog?
• A Whole blood
• B Oxyglobin
• C Packed red cells
• D Fresh-frozen plasma
• E Platelet-rich plasma
7 Which is not present in fresh frozen plasma
• A Albumin
• B Vit K dependant factors
• C Factor VIII
• D Von Willebrands factor
• E Platelets
9 Which is true of blood groups in horses
• A Blood typing is not available in the UK• B Most TBs are Qa and Aa -ve• C Naturally occurring isoantibodies to Aa
are common• D Foals of Aa -ve mares are at risk of
developing NI• E Ka and Pa are the most immunogenic
blood types
10 Which would be best for a very anaemic foal with NI
• A sire’s whole blood
• B mare’s whole blood
• C sire’s washed red cells
• D mare’s washed red cells
• E mare’s plasma
1. Which of the following is not involved in primary haemostasis
• A fibrinogen
• B calcium
• C platelets
• D vWF
2. Which factors are Vitamin K dependant
• A II, V, IX, X
• B II, VII, IX, X
• C V, VII, IX, X
• D II, VIII, IX, X
3. Which signs in unlikely in a disorder of 2ndry haemostasis
• A haematoma
• B haemarthrosis
• C petechial haemorrhage
• D haemothorax
4. Which of the following would be unaltered in an animal with a 10
haemostatic disorder
• A Buccal mucosal bleeding time
• B Clot retraction
• C WBCT
• D OSPT
5. You are presented with a dog with epistaxis. To attribute this to
thrombocytopenia what is the maximum number of platelets you would see on a
x100 field
A < 15B < 3C < 6D < 30
6. Which of the following deficiencies would not prolong
OSPT
• A X deficiency
• B VIII deficiency
• C VII deficiency
• D V deficiency
7. Which of the following findings would not be consistent with immune-
mediated thrombocytopenia
• A Marked thrombocytopenia
• B regenerative anaemia
• C neutropenia
• D Large platelets seen in blood film
3 month old G Ret presents with dyspnoea due to pleural effusion and a large haematoma over the elbow. In the previous history there had been bleeding
associated with teething
• Platelet count 110 x 109/l (200 - 500)
• OSPT 10 secs, (control 9 seconds)
• APTT 210 seconds (control 18 seconds)
• FDPs negative
8. What is the most likely cause of this dog’s clinical signs
• A Immune-mediated thrombocytopenia
• B Warfarin poisoning
• C Haemophilia A
• D Von Willebrands disease
Mild thrombocytopenia likely d/t blood loss
10 yr male Lab
• Appeared normal till last night when began bleeding profusely from both nostrils. Bleeding will not stop and dog now collapsed.
• Clin exam - petechiae on gums, hypothermic, tachycardic and vv pale
• Cranial abdominal mass palpable
10 yr male lab
• PCV 24% (36 - 55)
• Platelets 48 x 109/l (200 - 500)
• APTT 72 seconds (15 - 25)
• OSPT 32 seconds (7 - 10)
• FDP +
• Fibrinogen 1 g/l (2 - 4)
9. What is the cause of the epistaxis
• A nasal tumour
• B warfarin poisoning
• C immune-mediated thrombocytopenia
• D DIC
10 yr male Doberman
Severe epistaxis 18 hours duration
No previous spontaneous bleeding, BUT bled ++ at tooth extraction 2 months previously
No history of nasal disease
Dog depressed, weak and tachycardic
10 yr old Doberman
• Platelet count 133 x 109/l (200 - 500)
• WBCT 4 mins (< 6)
• OSPT 9 seconds (control 8 seconds)
• APTT 20 seconds (control 16 secs)
• Clot retraction poor
10 What is the most likely cause of the bleeding
• A nasal tumour
• B Factor VIII deficiency
• C von Willebrands disease
• D DIC
1. Artefacts occur in “old“ urine Which would not occur?
• A crystals form
• B casts break down
• C pH decreases
• D red cell lyse
2. Hyposthenuric urine would not occur in which of these?
• A diabetes insipidus
• B Hypercalcaemia
• C Cushings syndrome
• D Chronic renal failure
9 year old DSH with PD/PU, ascites
• Ascitic fluid - true transudate• Urine analysis Sediment exam
– SG 1.012 hyaline casts– Protein 3+ RBC < 5 / hpf– pH 7 WBC < 5 / hpf
– Blood -ve UPCR = 9– WBC -ve– Glucose -ve
Is this a significant proteinuria?
Biochemistry
• Albumin 12 g/l (25 - 40)
• Globulin 33 g/l (20 - 45)
• Cholesterol 10 mmol/l (2 - 5)
• ALP 30 iu/l (< 60)
• ALT 35 iu/l (< 65)
3. What is the cause of the proteinuria and low serum albumin
• A Glomerular proteinuria
• B Preglomerular proteinuria
• C Post-glomerular proteinuria due to inflammation in LUT
• D Post-glomerular proteinuria due to Fanconi syndrome
4. Which of the following is not a potential cause glucosuria
• A Diabetes melitus
• B Stressed cat
• C Fanconi syndrome
• D IV fluids containing glucose
• E None of the above (I.e. they all could cause glucosuria)
11 year old Labmarked icterus, vomiting
• pH 7 Urine dark orange/yellow
• Protein trace
• Glucose -ve
• Ketones -ve
• Bilirubin +++++
• Urobilinogen -ve
• Blood/Hb -ve
5. What is the most likely cause of the icterus/bilirubinuria
• A IMHA
• B Intra- hepatic disorder
• C Complete post-hepatic biliary obstruction
• D contamination of collection vessel with antiseptic
6. A urine sample has 2+ Blood/Hb, SG 1.005, sediment no red cells seen
Animal’s plasma is clear
• Which can be ruled out?
• A haemoglobinuria due to intravascular haemolysis
• B haematuria
• C myoglobinuria
7. Chronic haematuria in aged bitch. Diagnosis?
• A cystitis
• B urolithiasis
• C Neoplasia
• D Idiopathic renal H++
8. What are these crystals from a bitch’s urine?
pH 8.5
Sediment – WBC 15 / hpf
– Bacteria seen
– RBC 30 / hpf
• A oxalate• B struvite• C cystine• D urate
9. Which of the following crystals are not seen in normal
urine
• A triple phosphate / struvite
• B oxalate
• C CaCO3
• D Cystine
10. Which is incorrect of casts
• A Formed in kidney tubules but not always seen in renal disease
• B Hyaline casts may be seen in normal urine
• C White cell casts may be seen in normal urine
• D Red cells casts are fragile and break up rapidly
7 yr old BSH cat, tachycardia dyspnoea, muffled heart sounds,
pleural effusion
• Creamy pink fluid
• Protein 32 g/l
• Cell count 6500 / ul
• Triglyceride 8 mmol/l (< 1.2)
3 Which statement is correct
• A The fluid is a exudate and likely due to bacterial infection
• B the fluid is a transudate and likely due to congestive heart failure
• C the fluid is chyle and most likely due to congestive heart failure
• D the fluid is chyle and most likely due to traumatic rupture of the thoracic duct
3 yr DSH cat pyrexia, V+ depression ascites
• Fluid is turbid and yellow
• Cell count 120,000/ul
• Protein 45 g/l
4. What would you do next?
• A Inject amoxycillin and send home on oral antibiotics
• B ultrasound heart
• C administer antibiotic and fluids to stabilise then perform ex lap
• D perform urine analysis
8 yr G Ret with pericardial effusion
• PCV 28%
• Nucleated cell count 5600/ul
• Protein 48 g/l
5 Which is not a possible cause
• A Coagulopathy
• B Intra-pericardial neoplasia
• C idiopathic benign haemorrhage
• D congestive heart failure
6 Which of the following is not a potential cause of modified
transudate• A protein loosing nephropathy
• B congestive heart failure
• C non-exfoliating neoplasia
• D Liver disease
. 1 yr DSH rescue catascities, pleura effusion, wt loss
• Protein 70 g/l
• Albumin 22 g/l
• Globulin 48 g/l
• Cell count 6800 / ul
• Mostly neutrophils
• Some macrophages
7. What is the likely diagnosis?
• A Lymphocytic cholangitis
• B Neoplasia
• C FIP
• D Congestive heart failure
5 yr GSD with pyrexia, weight loss and generalised stiffness
• X rays show ST swelling
• Joint taps from both carpii and hocks were similar
• Viscosity reduced• Fluid turbid• Cell count 20,000 / ul
8 What is the likely diagnosis
• A septic arthritis seeding from septic focus elsewhere
• B rheumatoid arthritis
• C degenerative joint disease
• D non-erosive IMPA
9.Which is true of CSF
• A Normal CSF is clear amber fluid
• B ideally samples should be taken cranial to the site of the lesion
• C Cell counts should be performed using a haematology analyser
• D analysis should be performed quickly because cells degenerate fast
2 yr old BMD marked pyrexia, neck pain. CSF analysis:
• Slightly turbid
• Cell count 1200 /ul
• Protein 0.6 g/l
• Cytology 85% neutrophils, 15% monocytes
• No bacteria seen
10. What is the most likely diagnosis
• A cervical disc protrusion
• B bacterial meningitis
• C spinal cord neoplasia
• D steroid-responsive meningitis