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Which of the following is incorrect.

Which of the following is incorrect.

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Which of the following is incorrect.

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  1. 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. 2 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

  3. Erythropoiesis is stimulated by • A GM-CSF • B Thrombopoietin • C Erythropoietin • D Deep sea diving

  4. 6 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

  5. 7 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

  6. 9 Which film comment is correct? A spherocytes ++ B hypochromic cells C marked polychromasia D Babesia organisms seen

  7. 10 Which film comment is correct? A Spherocytes ++ B hypochromic cells C Schistocytes D Babesia organisms seen

  8. 11 These abnormal red cells are seen in A regenerative anaemia B iron deficiency anaemia C vascular neoplasia eg haemangiosarcoma D aged samples

  9. PP 52 g/l 60 - 80

  10. 12 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

  11. 13 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

  12. 14 What would you do next? • A Urine analysis • B Serum iron • C Xrays + Ultrasound abdo • D go down the pub

  13. 9 year old Bull Terrier with maelena 55 5 Plasma protein 51 g/l 60 - 80 Red cells are hypochromic and microcytic 2+ polychromasia

  14. 15 This anaemia is: • A microcytic hypochromic • B microcytic hyperchromic • D normocytic normochronic • E macrocytic normochromic

  15. 16 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. 17 What is the most common cause of low MCV • A Aged sample • B regenerative anaemia • C iron deficiency anaemia • D beetroot ingestion

  17. 9 yr old Bull Terrier with maelena Which test would you perform next? 18 • A Urine/faecal analysis • B Abdominal radiography • C Coombs test • D Bone marrow aspirate

  18. 9 yr old Bull Terrier with maelena • Urine analysis - no haematuria • Faecal analysis - no parasites • Ultrasound exam - solitary mass in intestine

  19. 19 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

  20. 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

  21. 1 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

  22. 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

  23. Likely Diagnosis? 3 • A IMHA • B Onion toxicity • C Babesia canis • D microangiopathic haemolytic anaemia, likely secondary to a tumour

  24. 4 yr old local Holstein 3 weeks post-calving Depression, jaundice and haemoglobinuria Pl pr 80 g/l 60 - 80

  25. Film comment Anisocytosis 3+ Polychromasia 2+ Basophilic stippling Howell-Jolly bodies

  26. 4 What is the most likely cause of the anaemia • A Babesia bovis • B Hypophosphataemia • C Bladder neoplasia / haemorrhage • D Immune-mediated haemolytic anaemia

  27. 7 yr Welsh Bay Gelding Weight loss, anaemia, jaundice Pl pr 78 g/l 60 - 80 Fibrinogen 3 g/l 2 - 4.5

  28. Red cell morphology • 2+ Anisocytosis • No polychromasia • A few Howell-Jolly bodies • A few nucleated red cells

  29. 6 Is the anaemia • A Regenerative • B Non-regenerative • C Not possible to say

  30. 7 Is the anaemia most likely due to • A Haemorrhage • B Haemolysis • C Primary bone marrow disease • D renal failure

  31. 8 What would you do next? • A Slide agglutination test and Coombs test • B Bone marrow aspirate • C faecal occult blood • D abdominal radiography

  32. 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

  33. What is going on? • Chronic GI haemorrhage due to parasitism • Acute GI haemorrhage • Hypothyroid • All normal for a dog of this age

  34. 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

  35. 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

  36. These are all age-related normal findings

  37. 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

  38. 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

  39. Film exam • Mild anisocytosis • Mild polychromasia • Clear areas on one side of cell • NMB smear made

  40. What is the cause of the anaemia A Gi haemorrhage B AIHA C Zinc toxicity D Onion toxicity E Copper toxicity

  41. 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

  42. 9 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

  43. 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

  44. 10 Now most likely • A Anaemia of chronic dx • B 10 bone marrow dx • C IMHA with concurrent IMTP • D acute blood loss

  45. Blood film exam • Atypical lymphocytes • Irreg nuclei • Some nucleoli • Thrombocytopenia

  46. 12 What is at the top of your differential list? • A Plasma cell myeloma • B Acute lymphoid leukaemia • C Aplastic anaemia • D myelofibrosis

  47. 13 Which test would be most useful? • A Epo assay • B Ultrasound spleen • C Bone marrow aspirate • D Lymph node aspirate

  48. 8 yr Mn Boxer1 cm cutaneous hairless mass 1 • A excise and send for histopath • B advise revisit in 6 weeks • C dispense Synulox • D take a fine needle aspirate

  49. 2 What would you use to take a fine needle aspirate? • A 18 ga needle • B Trucut needle • C 23 ga needle • D Jamshidi needle