Immune Mediated, bleeding and hepatic disorders (SA)

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Can you name the Immune Mediated, bleeding and hepatic disorders (SA)

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If antibodies have actually been formed against the patient's own cells, the immune mediated/autoimmune disease is ______
 
If non-self antigens have adhered to normal cell membranes, prompting immune mediated disease, it is ______.
 
If IMHA is non-regenerative, the problem is in the ___ ______
 
Which of the following dog breeds is NOT particularly predisposed to IMHA (though it can occur at any age in any breed)?
a)Cocker Spaniel (American) b)poodle c)Bichon d)Old English Sheepdog e)pug 
Which of the following is probably the MOST likely dog to get IMHA?
a)A 3 year old female b)a 2 year old male c)a four year old male d) a one year old female 
Which of the following clinical signs would you NOT associated with IMHA?
a) bilirubinemia b) hematuria c) hyperactivity d)collapse e)anorexia 
What would the likely etiology be of secondary ALT elevation in a IMHA case?
 
What three things must you find evidence of to diagnose IMHA?
 
 
 
Which is NOT a method of establishing Abs against RBCs exist?
a)gross observation in test tube b)slide agglutination test w/ EDTA blood c)slide agglutination test with unmodified blood d)coomb's test e)none of the above 
Which of the following is NOT detected by Coombs test when on the surface of RBCs?
a)complement b)IgG c)IgM d)none of the above 
True or false: serial SATs may help determine if therapy is working in IMHA?
 
What results from the incomplete phagocyosis of an RBC by a splenic or hepatic macrophage, and is highly suggestive of IMHA?
 
If there are signs of hemoglobinemia and -uria, the hemolysis is ________, whereas if there is icterus and bilirubinemia it is __________
Place a star (*) behind your answer without a space if this is more common. Place a '-' without a space at the beginning if it's more severe. 
Place a star (*) behind your answer without a space if this is more common. Place a '-' without a space at the beginning if it's more severe. 
If your tentative diagnosis is IMHA, what DDx would you rule out with serology and a 4Dx? With thoracic radiographs and abdominal ultrasound?
 
 
Which of the following list is NOT a primary issue that can lead to secondary IMHA?
Anaplasma infection, Babesia infection, Sulfa drug regime, heartworm infection, leptospirosis infection, Beta lactam drugs, lymphosarcoma, Aminoglycoside drugs, hemangiosarcoma, inflammatory disease, bee sting 
True or false: Some IMHA patients have both intra- and extravascular hemolysis simultaneously?
 
Name a cause of direct hemolytic anemia?
 
True or false: corticosteroids are extremely effective treatment for intravascular hemolysis, and can be used in combination with other immunosuppressants?
 
What two drugs would you select to follow OVC immunosuppressive IMHA protocol?
 
 
This drug might be added later if no improvement 
Which of the following is NOT a side effect of corticosteroid therapy?
a)secondary infections due to immunosuppression b)gastric ulceration c)muscle wasting d) panting e)anorexia 
What is the mechanism of action of azathioprine in immunosuppression? What is a side effect?
 
 
Up to 80% of IMHA canine patients develop what complicaiton according to postmortem studies?
 
What might one give a very low dose of aspirin or clopidogrel to inhibit in IMHA patients?
 
True or false: some IMHA patients need medication for life?
 
Which of the following is NOT a side effect of cyclosporine?
a)GI upset b)alopecia c)gingival hyperplasia d)opportunistic infections e)none of the above 
True or false: The prognosis is generally fair for canine IMHA?
 
True or false: feline IMHA patients more regularly have complications and non-regenerative anemia?
 
True or false: Immune thrombopenia has no clinically relevant methods to show immune response against platelets?
 
The platelet count is typically below __000/microlitre in ITP, but it will spontaneously bleed if it falls below __000
 
 
Which of the following is not a cause of thrombocytopenia?
a) Ehrlichia canis b) anaplasma platys c)bone marrow neoplasia d)DIC e)sample error f)all of the aove can cause apparent thrombocytopenia 
What drug might I add to prednisone or dexamethasone in order to stimulate platelet production when treating ITP?
 
How long does it take for transfused platelets to die off?
 
Which of the following is not an appropriate drug to specifically treat GI hemorrhage as a sequela of ITP?
a)sucralfate b)vincristine c)famotidine d)omeprazole 
True or false: the prognosis for ITP is extremely guarded?
 
Name a disease checked for by the 4 Dx?
 
What will typically be found on aspiration of the joints with immune mediated polyarthritis?
Usually in 2 or more joints 
What might one perform to rule out other immune mediated diseases if IMPA is suspected?
 
What two drugs might you use to follow up prednisone with IMPA if no improvement is seen?
 
 
Which of the following is not a reason to avoid vaccination when treating for IM diseases?
a) potential lack of efficacy b)any stimulus may cause IM disease c)potential risk of infection by live vaccines d)rabies isn't that common anywa 
What are the first three questions, in order, you should ask yourself with a bleeding patient in emerg?
 
 
 
What two responses are part of primary hemostasis?
____ and ____ 
What cascade is secondary hemostasis?
 
The intrinsic pathway of coagulation is triggered by exposed collagen. What, in order, are the four factors that activate before the common pathway starts?
roman numerals: _, _, _, _ 
What are the two factors, involved in the extrinsic pathway?
__. __ 
In the common pathway of coagulation, factors _ and _ convert factor II or _____ into _____, which converts ______ (factor I) into _____. Factor ___ then cross links that.
 
 
 
 
 
 
 
Factor IV is actually calcium, which is needed for many coagulation reactions. Hence ____ is an anticoagulant.
 
What is factor VI?
 
What naturally circulating anticoagulant inhibits thrombin? What might we administer to enhance its action? What affects FVIII and V? VII and III?
 
 
 
 
Multiple petechia and ecchymoses on the mucosa most likely indicate a problem in what phase of coagulation?
 
Easy brusing and edema likely indicate a problem at what phase?
 
_____-____ syndrome is an inherited collagen defect which weakens the vasculature. ______ disease and vascultis are acquired.
 
 
 
What breed in particular has a specific inherited platelet function defect?
 
Where is a common site for spontaneous bleed with platelet dysfunction due to ITP?
 
True or false: A doberman with von Willebrand's disease may experience excessive bleeding in estrus?
 
The BMBT on a cat takes _ minutes, and on a dog it takes _ minutes.
 
 
The BMBT tests ______ and ___function.
 
 
What test would you always perform before BMBT?
 
Platelets clump or stick in reaction to what agonists? (name one)
 
Which of the following is the reason why point of care whole blood platelet function testing hasn't taken off in many practices?
a)inconsistent results b)special training required to perform c)too expensive d)necessary to age the samples for too long first 
What rather imprecise and insensitive test probably indicates coagulopathy if it takes longer than 10 minutes?
Tests intrinsic and common pathway 
This test involves silica or kaolin activation of FXII, over 3 minutes to clot is abnormal.
Tests intrinsic and common system, may be prolonged by severe thrombocytopenia, too expensive for most practices. 
This test is for the common pathway only, and typically should take 20-30 seconds.
 
This test measures the extrinsic and common pathways and should take 8-12 seconds
 
This test measures the intrinsic and common pathway and should take 15-30 seconds for normals.
 
The blue top tubes contain what?
 
Which of the following is NOT a test associated with coagulation phase?
a)BMBT b)PTT c)ACT d)TT e)none of the above 
Which of the following is a test that would be used to test vascular phase?
a)platelet coat number b)BMBT c)skin biopsy d)PT e)none of the above 
True or false: 30% of greyhounds will bleed post-op within 2 days?
 
In order for fibrinoysis to occur, ______ must be converted into _____.
 
 
True or false: sample/lab error is always a differential diagnosis with abnormal blood results because sedation has a drastic effect on results?
 
List the reasons for thrombocytopenia in decreasing order of likelihood
 
 
 
 
 
With a pancytopenia, what will the clinical signs be mainly due to?
 
True or false: cats are more likely to bleed spontaneously than dogs at low platelet counts?
 
What companion breed of dog (hint: not a pug : D) may have physiologic thrombocytopenia? (and also mitral valve issues)
 
A dog presents with green stool, indefinitely prolonged ACT, and very prolonged PT and PTT. What does it likely have? What will you treat with?
 
 
Soft food is fed to patients with bleeding tendencies to minimize ______ _____
 
True or false: All NSAIDs must be avoided for a bleeder patient?
 
Vitamin K is necessary for the synthesis of which four factors, in increasing numerical order?
 
Which of the following is NOT a procoagulant?
a)aminocaproic acid b)tranexamic acid c)aprotinin d)DDAVP e) none of the above 
Disease of which organ may affect clotting due to reduced snthesis of coagulation factors or vit K deficiency?
 
Inappetance could lead to a deficiency of K_, antibiotic use could lead to a deficiency of K_
 
 
True or false: PT and ACT are prolonged by inflammation?
 
For this question and the next three, look at the hints and match them up with the factor that is deficient! Hemophilia A
Factor VIII 
Hemophilia B
Factor XI 
Hemophilia C
Factor XII 
Hageman Trait
Factor IX 
Hemophilia A and B are _-____ recessive.
 
Is a prolonged coagulation test an indication for a transfusion in and of itself?
 
Increased FDPs indicate a problem with excessive ______
 
The most specific finding for DIC is ______, but the two most common are increased ___ and decreased ______
Other signs include decreaed fibrinogen and increaed TT, PTT, PT, FDPs and D-dimer 
 
 
Which of the following is not a treatment for DIC?
a) heparin b)coagulation factors c)antithrombin d)vincristine e)fluid therapy 
Which of the following is not a main cause of pulmonary thromboembolism?
 
True or false: primary liver disorders are rare?
 
Which of the following is not characteristic of the more common primary hepatobiliary disease of cats?
a)chronic b)affecting biliary tree c)jaundice is often presenting complaint d)primary liver tumours more common than in canines e)tend not to have ascites 
Which of the following is not characteristic of likely primary hepatobiliary disease in dogs?
a)chronic b)affecting biliary tree c)variable liver size d)hypoalbuminemia e)ascites 
Which of the following is not a common primary hepatobiliary disease of dogs?
a)portosystemic shunting b)chronic hepatitis c)toxic hepatopathy d)cholangiohepatitis e)none of the above 
Diabetes and hyperadrenocorticism both tend to cause ______ hepatopathies secondarily.
 
Which of the following drugs is hepatotoxic in both dogs and cats?
a)TMS b)carprofen c)azathioprine d)ketoconazole and itraconazole e)acetaminophen f)diazepam 
What common ingredient in sugar free gum is hepatotoxic to animals?
 
Decreased functional hepatic mass can expose the brain to more toxins and neurotransmitters that are abnormal, causing _____ _____
Esp. caused by ammonia 
Microcytosis in dogs can be a sign of ________ _____
 
If total solids of blood is low in hepatic disease, it is secondary to ___________
 
True or false: bilirubinuria tends to precede jaundice?
 
Which of the following is not a sign of hepatic encephalopathy?
a)circling b)coma c)seizures d)hypersalivation e)blindness f) none of the above 
Of the Liver enzymes, ___ and ___ are markers of cholestasis, whereas ___ and ___ are markers of hepatocellular damage
 
 
True or false: ALP has a short 6 hour halflife in dogs?
 
True or false: ALP is liver specific?
 
Which of the following does NOT induce Alkaline phosphatase expression?
a)intra-hepatic cholestasis b)lipidosis c)diabetes mellitus d)post-hepatic cholestasis e)none of the above 
L-ALP is the liver alkaline phsophatase. What are G and S ALP induced by? Where is B-ALP from?
 
 
This enzyme is bound to the membranes of bile canaliculi, bile duct and periportal hepatocytes, will not distinguish extra and intrahepatic cholestasis.
More specific than ALP, not as sensitive in dogs. Vice versa in cats, except with hepatic lipidosis when ALP is much more increased. 
This enzyme is found in the cytosol of hepatocytes, is increased with necrosis or increased permeability, and is the most specific liver enzyme.
Also produced by myocardium, skeletal muscle, kidneys. 
This enzyme is a marker of hepatocellular leakage, is also found in muscle, brain, myocardium, etc. and the other isoenzymes are more important.
 
True or false: Less than 5x increase in enzymes is usually not immediate concern in dogs?
 
Which of the following statements is true?
a)changes in enzyme activity parallel change in liver function b)magnitude of change in enzyme levels is not correlated with prognosis c)low enzyme activities are clinically significant as well d)animals with end-stage shunting will always have abnormal liver enzymes 
Total protein will be low with loss of >__% functional liver mass.
 
Protein losing enteropathy and protein losing nephropathy will both have ___ albumin, but enteropathy will present with ___ globulins, and nephropathy with _____.
enteropathy will also have diarrhea and nephropathy high Upc 
 
 
True or false: globulins may be elevated in hepatic failure?
 
Choleterol will be _____ with liver failure and ____ or ______ with cholestasis.
 
 
 
Which of the following parameters will be low in hepatic failure?
a)lipase b)amylase c)glucose d)creatinine 
If bilirubin is elevated and mostly in conjugated form, the problem is likely?
 
Which of the following may be low secondary to hypoalbuminemia on serum biochem?
a)sodium b)calcium c)potassium d) chloride 
Serum bile acid (SBA) tends to increase _-_ fold in helathy animals post-prandial?
Increased fasting or post-prandial levels indicate decreased hepatic function 
True or false: SBA test is not indicated if the animal is hyperbilirubinemic.
 
What breed has a normally increased SBA?
 
______ __________ is the cause of secondary ascities in liver disease.
other contributors include decreased colloidal oncotic pressure and hypoalbuminemia. 
A modified transudate indicates _____ ____ ______ or FIP not chronic hepatic failure.
 
Transplenic and ___ _______ are the two methods of portal scintigraphy.
 
Which of the following is NOT usually diagnosed by FNA alone?
a) fatty liver b)glucocorticoid hepatopathy c)lymphosarcoma d)cirrhosis 
Which of the following is NOT a complication of hepatic biopsy?
a) jaundice b)hemorrhage c)laceration d)perforation of gall bladder e)perforation of biliary tree 
A good screening test should have high _______.
 

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Created Oct 28, 2013ReportNominate
Tags:bleeding, disorder, immune