2019 acvp certifying examination in clinical pathology · 100 1 33 % the next few ... •sample...

2019 ACVP Certifying

Examination in Clinical Pathology

Prepared by:

Melinda Camus, Chair, Examination Assembly & Administration Group (EAAG)

Shelley Burton, Chair, Test Item Writers Group (TIWG)

Modified from the original by:

Julie Webb, ACVP Examination Committee Chair, 2016-2017

This presentation….

Is focused on the 2019 Phase II ACVP

Certifying Examination in Clinical

Pathology held in Tampa, Florida:

• Website resources

• Highlights of the Tampa facility

• Sample essay and multiple choice questions

• Other useful information

Website resource:

www.acvp.org/

Website Information

Under the Exam tab on www.acvp.org/

• Application

• Candidate Handbook

• Important Examination Dates

• Job Task Analysis

• Phase I

• Phase II - Tampa

ACVP Phase II Certifying Examination

in Clinical Pathology

One day examination

August 15, 2019

At the American Board of Pathology (ABP)Testing Center, Tampa, Florida

Computer-based – not hand-written

• Very user friendly

• Short practice test on examination day to familiarize you with how the testing center computers work

• Images can be enlarged on monitors



The day is divided into 3 sessions:

• Essays…including:

Glass slides

Biochemistry

• Interpretation Multiple Choice Questions

• Knowledge Multiple Choice Questions

All sessions contain a mixture of topics,

pathologic conditions and species

Note – although the day is divided into 3

sessions….

All scores are combined into a single

pass/fail result for the entire examination

A total of 203/300 points is needed to pass

More detail on the ACVP website





Species distribution over the whole

examination:

• Domestic animals 70-80 %

• Laboratory animal: 10-20 %

• Non-domestic animals: 5-10 %


in Clinical Pathology: Test Scoring

Session # of

Items

Points per

item

Approximate

contribution to

final score

Essays - Glass Slides

10 20 26 %

Essays - Biochemistry

2 30 8 %

Interpretation Multiple Choice

Questions

100 1 33 %

Knowledge Multiple Choice

Questions

100 1 33 %

The next few slides will provide more detail about and provide examples on these question categories:

Essays:

• Glass Slides

• Biochemistry

Interpretation Multiple Choice Questions

Knowledge Multiple Choice Questions



Essays – General Information

3 hour session

10 glass slides and 2 biochemistry essays

• ~ 12 minutes / glass slide

• ~ 30 minutes / essay

Approximate glass slide categories:

• 40 - 50% cytology

• 30 - 40% blood smears

• 10 - 20% bone marrow (cytology or histology)

• 0 - 10% histology

Essays – Character Limit

Character limit for each case

• Maximum 8000 characters, including spaces

• Roughly = ~ 2 full typed pages in Word

Essays – Carrels & Slide Flats

Solitary carrel

You won’t share a slide flat with a neighbor

But cases are divided into two groups

(A & B) and each candidate will exchange

group A for group B (or vice versa) when

ready

ABP Testing Center

Essays – Microscopes

Microscopes provided but you may bring your own if desired

Provided microscopes have 4, 10, 40 & 100x objectives

Important – regardless of whether you use the provided microscope or bring your own, you need to bring immersion oil, lens tissue and lens cleaner

Essays - Timing

No timers or watches allowed

Time remaining (numbers count down to

zero) is visible on the computer monitor

Essays - Glass Slides - Stains

Unless otherwise indicated, assume that:

• Blood smears and cytology preparations are

stained with Wright-Giemsa

• Histologic sections are stained with

Hematoxylin + Eosin (H+E)

Essays - Glass Slides: Initial Information

This information is provided for you:

• Sample type, full or partial signalment, lesion location +/- description and possibly other clinical information

Examples:

• Blood smear, 9-year-old MC Golden Retriever, presenting for vomiting

• FNA from an enlarged hypoechoic liver, 12-year-old FS DSH cat, presenting for icterus

• Blood smear, 22-year-old Thoroughbred gelding

• Biopsy of skin mass, 9-month-old dog

Essays - Glass Slides

You provide (in point form or paragraph):

• Description

• Interpretation

Total points per case = 20

• Description (10-16 points = 50-80 %)

• Interpretation (4-10 points = 20-50 %)

Glass Slides - Cytology & Histology

Description

Cellularity, background (cytology)

Location, arrangement (histology)

Cell populations (resident, inflammatory, neoplastic), organisms, extracellular material

If neoplastic cells or infectious organisms, describe them in sufficient detail using proper terminology

• Size, shape, color, nuclei, nucleoli, identifying features…

Glass Slides: Cytology & Histology

Interpretation

Diagnosis (or differential diagnoses)

Additional tests (to refine your diagnosis, distinguish between differential diagnoses…)

Be as definitive and specific as possible

Most slides have a definitive diagnosis or very limited number of reasonable differential diagnoses

Listing a long set of unlikely differentials will not get points!

See next few slides for 2 cytology example cases – images and marking templates

Essays – Glass Slides

Images in the example cases in this

presentation may not show all features

that receive points in the marking

templates

But… they would have been seen on the

glass slide !

Essays - Glass Slides - Cytology

Example # 1

Peritoneal fluid,

direct smear, canine,

anorexia, pyrexia

Cellularity is high

Moderate amount of

cellular debris &

erythrocytes

Scattered foci of

amorphous pale

lavender material

Ess

ay –

Gla

ss S

lides

– C

ytolo

gy

Essays - Glass Slides - Cytology

Example # 1

Neutrophils

predominate

Degenerative change

Often contain small

irregular poorly

staining crystalline

material

Few mesothelial cells

Ess

ay –

Gla

ss S

lides

– C

ytolo

gy

Essays – Glass Slides - Cytology

Example # 1

Neutrophils contain

bacteria

Mainly cocci

Ess

ay –

Gla

ss S

lides

– C

ytolo

gy


Example # 1

Lower #s of

macrophages

Also contain

crystalline material

Many cells have

nuclear pyknosis or

karyorrhexis

Ess

ay –

Gla

ss S

lides

– C

ytolo

gy

Essay – Glass Slides – Cytology Example #1

Canine peritoneal fluid (Description)

Points

Highly cellular 1

Non-staining background 1

Moderate amount of cellular debris (ruptured cells) 1

Moderate #s of RBCs 1

Amorphous pale lavender material (mucus) 2

Nucleated cells mainly neutrophils

Are degenerate 1

Contain bacteria 1

Rest of nucleated cells – mainly macrophages 1

Few mesothelial cells 1

Neutrophils & macrophages contain crystalline material 2

Ess

ay –

Gla

ss S

lides

– C

ytolo

gy

Essay – Glass Slides – Cytology Example #1

Canine peritoneal fluid (Interpretation)

Points

Neutrophilic & macrophagic (or pyogranulomatous) inflammation 1

Sepsis 1

Mucoid material = white bile 2

Crystalline material consistent with barium 2

Further tests (any for point):

Measure bilirubin in fluid and serum, abdominal ultrasonography,

exploratory laparotomy

1

Culture & sensitivity 1

Total 20

Important note for grading keys:

All grading keys contain flexibility to accommodate different ways

that different people say the same thing - alternate wording that

demonstrates the same knowledge will be accepted. E

ssay

– G

lass

Slid

es

– C

ytolo

gy


Example # 2

Cat, imprint of

conjunctival mass

Epithelial cells and

inflammatory cells

Ess

ay –

Gla

ss S

lides

– C

ytolo

gy


Example # 2

Neutrophils

predominate

Low numbers of

macrophages

Oval to cigar shaped

yeast in background

and within

neutrophils

Ess

ay –

Gla

ss S

lides

– C

ytolo

gy


Example # 2

Yeast also within

macrophages

3-5 um

Halo/capsule

Ess

ay –

Gla

ss S

lides

– C

ytolo

gy

Essay – Glass Slides – Cytology Example # 2

Feline conjunctival mass (Description)

Points

Highly cellular 1

Small amount blood or stippled eosinophilic background 1

Epithelial cells

Clusters or sheets 1

Basophilic, anisocytosis, binucleated 2

Inflammatory cells

Mostly non-degenerate neutrophils 1

Fewer lymphocytes and macrophages 1

Binucleated and multinucleated macrophages 1

Organism

Numerous 1

Yeast 1

In neutrophils and macrophages 1

Round, oval to cigar-shaped (mention at least two) 1

3-5 um 1

Blue to purple cytoplasm, clear halo/wall 1 Ess

ay –

Gla

ss S

lides

– C

ytolo

gy

Essay – Glass Slides – Cytology Example # 2

Feline conjunctival mass (Interpretation)

Points

Pyogranulomatous inflammation (or similar phrasing) 2

Sporothrix (2) schenckii (1) 3

Hyperplastic epithelium 1

Total 20

Ess

ay –

Gla

ss S

lides

– C

ytolo

gy

Essays – Glass Slides - Histology

Example

Dog splenic biopsy

Multifocal nodules

Poorly demarcated

Non-encapsulated

Sheets of neoplastic

cells

Fine vascular stroma

Ess

ay –

Gla

ss S

lides

– H

isto

logy


Example

Tumor cells causing

compression and

effacement of

normal architecture

Multifocal areas of

necrosis

Ess

ay –

Gla

ss S

lides

– H

isto

logy


Example

Large, round to

polygonal neoplastic

cells

Cytoplasm

eosinophilic and

occasionally

vacuolated

Ess

ay –

Gla

ss S

lides

– H

isto

logy


Example

Open chromatin

Prominent nucleoli

Multinucleation

Low mitotic activity

Anisocytosis &

anisokaryosis

Variable N:C ratio

Ess

ay –

Gla

ss S

lides

– H

isto

logy


Example

Erythrophagocytosis

Gold to black pigment

consistent with

hemosiderin

Ess

ay –

Gla

ss S

lides

– H

isto

logy


Example

Multifocal aggregates

of hematopoietic

precursors

Ess

ay –

Gla

ss S

lides

– H

isto

logy

Essay – Glass Slides – Histology Example

Canine splenic biopsy (Description)

Points

Multifocal nodules 1

Poorly demarcated, non-encapsulated 1

Sheets of neoplastic cells 1

Fine fibrovascular stroma 1

Architecture altered (accept compressed, disrupted or effaced) 1

Hematopoietic precursors 1

Areas of necrosis 1

Neoplastic cells

Large, round to polygonal (some indication of size, shape) 1

Eosinophilic vacuolated cytoplasm 1

Erythrophagocytosis 1

Hemosiderin 1

Nuclei – chromatin pattern – open or similar descriptor 1

Nucleoli – give at least one: prominent, distinct, dark 1

Variation in cell size, nuclear size & NC ratio – note at least 1 1

Low mitotic activity (can state ~1 per 10 HPF or similar) 1 Ess

ay –

Gla

ss S

lides

– H

isto

logy

Essay – Glass Slides – Histology Example

Canine splenic biopsy (Interpretation)

Points

Consistent with histiocytic sarcoma 2

Extramedullary hematopoiesis 1

Test for IHC for macrophage lineage, not dendritic - so

accept MHC II, CD1+ or CD11d+ (not CD11c+). State IHC

(1 point) and at least one appropriate marker (1 point)

2

Total 20

Ess

ay –

Gla

ss S

lides

– H

isto

logy

Essays – Glass Slides - Blood Smears:

Description

Be complete !

RBCs, WBCs, Platelets:

• Mention all 3 cell lines….even if normal

• Comment on density/numbers, cell morphology

Extracellular material, inclusions, organisms,

atypical cells…

If atypical cells or organisms, describe them

in sufficient detail using proper terminology

• Size, shape, color, nuclei, nucleoli, identifying

features…


Description

RBC & Platelet density/number descriptors can be qualitative: “Increase in intercellular RBC space” or “Erythrocyte density is low.”

Or quantitative: “Erythrocyte numbers appear decreased by approximately half (or can say ~50%)”

WBC descriptors can be qualitative “Mainly segmented neutrophils with fewer…”

Or quantitative: “Approximately 85% are segmented neutrophils with the rest….”


Interpretation

RBCs, WBCs, Platelets – comment on all 3,

even if normal

An interpretation is NOT just a repeat or

summary of your description (see next slide)

Include likely causes of abnormalities identified

Include any additional tests recommended to

confirm diagnosis or distinguish between

differential diagnoses


Essays – Glass Slides - Blood Smears

Interpretation

NO, not an interpretation

Anemia with marked polychromasia and many Heinz bodies

Leukocytosis with segmented neutrophils, many bands and toxic change

YES, an interpretation

Regenerative anemia due to oxidative damage/hemolysis (likely causes = …)

Inflammatory leukogram

Essays – Glass Slides: Blood Smears

Examples

See the next few slides for 2 blood smear

case examples

Images and marking templates


Example # 1

Blood smear, 12-year

old MC Dachshund,

lethargic.

Decreased red blood

cell density

Increased

polychromatophils

Microcytosis

Hypochromasia

Ess

ay –

Gla

ss S

lides

– B

lood S

mear

s


Example # 1

Leukocyte #s within

normal limits

Most are segmented

neutrophils

Low #s of bands

Rest are lymphocytes

& monocytes

Mild toxic change

Ess

ay –

Gla

ss S

lides

– B

lood S

mear

s


Example # 1

Thrombocytosis

Most platelets have

normal morphology

Occasional giant

platelets seen

Ess

ay –

Gla

ss S

lides

– B

lood S

mear

s

Essay – Glass Slides – Blood Smear Example # 1

Canine (Description)

Points

Erythron

Increase in intercellular space (or decreased RBC density) 1

Increase in polychromatophils 1

Microcytosis 1

Hypochromasia 2

Occasional schistocytes or nucleated RBCs (point for either) 1

Leukon

Numbers appear normal 1

Majority are segmented neutrophils 1

Low numbers of bands 1

Mild toxic change 1

Remaining leukocytes – monocytes & lymphocytes 1

Thrombon

Increased platelets 1

Occasional giant forms 1

Ess

ay –

Gla

ss S

lides

– B

lood S

mear

s


Example # 2

2 year old FS DSH

cat with anorexia

Decreased RBC

density

Increased WBC with

atypical cells

Ess

ay –

Gla

ss S

lides

– B

lood S

mear

s


Feline (Description)

Points

Background

Basophilic, crescents or proteinaceous 1

RBCs

Decreased 1

No polychromasia 1

Platelets

Decreased 1

WBCs

Marked (1point) increase (1 point) 2

Mostly atypical/immature/neoplastic 1

- Large 1

- Basophilic cytoplasm 1

- Variable nuclei (mention at least two of: indented, bilobed,

binucleated, micro/satellite nuclei)

2

- Nucleoli 1 Ess

ay –

Gla

ss S

lides

– B

lood S

mear

s


Feline blood smear (Interpretation)

Points

Hematopoietic neoplasia 2

- Differentials include acute leukemia (1point) and lymphoma’

(1 point)

2

- Cell characterization (flow cytometry, ICC or cytochemistry) 1

- FeLV testing 1

Non-regenerative anemia and thrombocytopenia 1

- Likely myelophthisis 1

Ess

ay –

Gla

ss S

lides

– B

lood S

mear

s

Essays - Glass Slides – Bone Marrow

• You will be given brief summary of relevant

CBC data or clinical information telling you

why the bone marrow sample was collected

• Examples:

Chronic non-regenerative anemia

Marked leukocytosis with rare atypical cells

Lytic lesion seen on a radiograph

Hypercalcemia

Essays – Glass Slides - Bone Marrow

Description

Cellularity, particles, iron

Mention all 3 cell lines (even if normal):

• Present & appropriately distributed?

• Normal or abnormal maturation or morphology?

M:E ratio estimation

Lymphocytes, plasma cells, macrophages

Atypical cells, organisms, matrix or

extracellular material

If histology: bony changes, fibrosis

Essays – Glass Slides - Bone Marrow

Interpretation

Comment on all 3 lines and any other

diagnosis/abnormality

Include additional tests if relevant - to

confirm diagnosis and/or differentiate

between differential diagnoses


See next few slides for an example case -

images and marking template

Essays – Glass Slides: Bone Marrow

Example

Bone marrow

aspirate smear, 3

year old FS mixed

breed dog with

anemia and possible

inflammation.

Highly cellular

Particles normal to

hypercellular

Ess

ay –

Gla

ss S

lides

– B

one M

arro

w


Example

Iron – small to

moderate amount

M/E ratio – mildly ↓

rough estimate

(~1:3)

Megakaryocytes –

normal to mildly

increased, some

immature forms,

morphology normal

Ess

ay –

Gla

ss S

lides

– B

one M

arro

w


Example

Myeloid series:

Early to mid-stage

maturation is

synchronous

Segmented forms

absent

Cells with mature

cytoplasm have oval

to band shaped

nuclei

Ess

ay –

Gla

ss S

lides

– B

one M

arro

w


Example

Erythroid series:

Normal morphology

Normal maturation

Moderate #s of

polychromatophils

Ess

ay –

Gla

ss S

lides

– B

one M

arro

w


Example

Plasma cells – normal

to mildly increased

Lymphocytes – few

present (normal)

Macrophages - rare

Ess

ay –

Gla

ss S

lides

– B

one M

arro

w

Essay – Glass Slides – Bone Marrow Example # 1

Canine bone marrow aspirate (Description)

Points

General

Highly cellular 1

Small amount of iron 1

M:E ratio approximately 1:3 1

Megakaryocytes

Normal (accept mildly increased) 1

All stages present with normal morphology 1

Erythroid (describe at least two)

Mildly increased

Orderly/synchronous maturation, normal morphology/no dysplasia

2

Myeloid (describe at least two)

Normal numbers

Early to mid-stage orderly/synchronous but no segmented forms

Cells with mature cytoplasm have oval to band nuclei

3

Ess

ay –

Gla

ss S

lides

– B

one M

arro

w

Essay – Glass Slides – Bone Marrow Example # 1

Canine bone marrow aspirate (Description)

Points

Other cells

Plasma cells – normal to mildly increased 1

Lymphocytes – low #s (normal) 1

Rare macrophages 1

Canine bone marrow aspirate (Interpretation) Points

Pelger-Huet anomaly 2

Mild erythroid hyperplasia 1

Megakaryocytic line normal 1

Differential Dx for hyposegmentation – any of these for point:

Pseudo-HPA, immune destruction of segs, incipient recovery

from granulocytic series insult

1

Check blood smear granulocyte morphology 1

PHA clinically insignificant in dogs 1

Total points 20

Ess

ay –

Gla

ss S

lides

– B

one M

arro

w

Essays – Biochemistry

Although called biochemistry essays, they also contain additional data beyond a biochemical panel – such as hematology, endocrine tests, urinalysis, coagulation data, etc.

Biochemistry essay case data is provided on paper as a courtesy • Easier to visualize, scribble notes…

But enter write-ups on computer • Only information entered electronically is graded

• Total points per case = 30


Provided: signalment, +/- brief history

• Case data (CBC, biochemistry, +/- urinalysis,

+/- other)

You provide (point form or paragraph)

• Explanation for the laboratory abnormalities

• Summary of the case and recommended

ancillary tests

30 points/case


Examples of type of information provided:

• 9-year-old Labrador Retriever presenting for

polyuria and polydipsia

• 6-year-old cat with history of weakness,

lethargy and a possible seizure episode


Approach

• Identify abnormalities and group where

appropriate (such as grouping urea and creatinine,

grouping proteins…)

• For each abnormality or group of abnormalities,

provide an explanation, or a limited set of likely

explanations, for the abnormality in this patient

Do not list all possible/general causes!

An explanation may be a specific disease

(hypoadrenocorticism) or a general mechanism

(vomiting)

Essays – Biochemistry Example – explaining thrombocytosis

No, do not list all

possible reasons for

thrombocytosis

Physiologic

Reactive/inflammatory

Recent splenectomy

Iron deficiency

Essential

thrombocythemia

Yes, provide the likely

reason(s) that fit the case!

Reactive/inflammatory

Iron deficiency

Essays – Biochemistry Example – explaining titrational acidosis

No, do not list all possible

reasons fortitrational

acidosis

Ketoacids

Uremic acids

Lactic acid

Ethylene glycol

Yes, provide the likely

reason(s) that fit the case

Uremic acids


Approach

All abnormalities should be addressed

Some normal values may also be important

(example: normal creatinine concentration

with high urea concentration)

No right or wrong order to the write-up

Be sure to address both major and minor

findings

After addressing abnormalities, end by

providing a summary – see next slide


Approach

Summary

• Overall interpretation

• Diagnosis(es) for the patient

• May include specific diseases (leptospirosis) and more generic entities (nephrotic syndrome)

• May be some overlap between your summary and your earlier explanations

• Ancillary tests (to confirm, refine or further investigate)

The next few slides give an example of a biochemistry essay – data and marking template

11-year-old FS Shetland Sheepdog

presenting for dry hair coat and weight loss

Hematology (Units) Patient Flag Reference Interval

Hematocrit (%) 47 39 – 57

Hemoglobin (g/dL) 16.3 14 – 21

RBC (x 106/µL) 6.7 5.6 – 8.4

MCV (fL) 70 61 – 73

MCHC (g/dL) 35 34 – 38

RBC Morphology Within normal limits

WBC (x 103/µL) 14.7 H 5.0 – 14.0

Segmented neutrophils (x 103/µL) 13.0 H 2.6 – 10.0

Band neutrophils (x 103/µL) 0.3 H 0.0 – 0.2

Lymphocytes (x 103/µL) 0.7 0.7 – 4.3

Monocytes (x 103/µL) 0.6 0.1 – 0.9

Eosinophils (x 103/µL) 0.1 0.1 – 1.7

WBC Morphology Few Dohle bodies

Platelets (x 103/µL) 626 H 175 – 500

Plasma protein (g/dL) 8.2 H 5.6 –8.0 Ess

ay –

Bio

chem

istr

y

Serum Biochemical Profile Patient Flag Reference Interval

Na (mmol/L) 148 141 - 150

K (mmol/L) 4.1 3.9 – 5.3

Cl (mmol/L) 116 109 - 119

Total CO2 (mmol/L) 5 L 19 – 30

Anion Gap (mmol/L) 30 H 15 – 25

Calcium (mg/dL) 10.8 9.7 – 12.3

Phosphorus (mg/dL) 15.0 H 2.2 – 7.9

Urea (mg/dL) 110 H 7.0 - 32

Creatinine (mg/dL) 4.6 H 0.5 – 1.5

Glucose (mg/dL) 130 67 - 132

Total Protein (g/dL) 7.5 H 4.8 – 6.9

Albumin (g/dL) 3.5 2.3 – 3.9

Globulin (g/dL) 4.0 H 2.2 – 3.5

CK (U/L) 120 22 - 491

AST (U/L) 49 21 - 53

ALT (U/L) 443 H 14 – 87

ALP (U/L) 1486 H 20 – 157

GGT (U/L ) 33 H 5 – 16

Total Bilirubin (mg/dL ) 0.3 0.1 – 0.8

Cholesterol (mg/dL) >650 H 149 - 319

Triglycerides (mg/dL) 131 32 - 190

Ess

ay –

Bio

chem

istr

y

Urinalysis

Patient

Collection Method Cystocentesis

Color Colorless

Clarity Clear

Specific gravity 1.010

Reagent Strip

pH 6.0

Protein 3+

Glucose Negative

Ketones Negative

Bilirubin Negative

Blood Negative

Sediment Exam

RBC (per hpf) Rare (<1)

WBC (per hpf) 1-5

Epithelial cells Few squamous and transitional

Casts None

Crystals None

Bacteria Many cocci

Ess

ay –

Bio

chem

istr

y

Thromboelastography Patient Flag Reference Interval

R (min) 5.8 3 – 9

K (min) 1.4 1 – 6

Α (degrees) 70.5 34 – 74

MA (mm) 75.5 H 40 – 70

G (d/sec) 15.4 H 3.2 – 10.1

Ess

ay –

Bio

chem

istr

y

Essay – Biochemistry – Example

Canine - Identifying abnormalities

Points

Inflammatory leukogram 1

Thrombocytosis

- reactive/inflammatory 1

- hyperadrenocorticism 1

Metabolic acidosis 1

- titrational 1

- uremic acids 1

Renal azotemia 1

Inflammatory hyperglobulinemia 1

Ess

ay –

Bio

chem

istr

y


Canine - Identifying abnormalities

Points

ALP, ALT and GGT

- Corticosteroids or hyperadrenocorticism

most likely

1

- Other hepatic/post hepatic cause 1

Cholesterol

- Hyperadrenocorticism 1

- Cholestasis 1

- Protein losing nephropathy 1

Glomerular proteinuria 1

Urinary tract infection 1

- Lower UTI (bladder) vs 1

- Pyelonephritis 1

Hypercoagulable (by TEG) 1

- Hyperadrenocorticism 1

- Protein losing nephropathy 1

Ess

ay –

Bio

chem

istr

y


Canine - Summary

Points

Renal disease

-Insufficiency 1

-Infection 1

-PLN/Glomerular disease 1

- Urine culture 1

- Urine protein/creatinine ratio 1

- Other testing (such as abdominal ultrasonography,

renal FNA, leptospirosis testing, blood pressure

measurement)

2

Likely / suspect hyperadrenocorticism 1

- LDDST or ACTH stimulation test 2

Total 30

Ess

ay –

Bio

chem

istr

y

Multiple Choice Questions (MCQ)

(Interpretation or Knowledge)

Asks a question with one best answer to choose

3 to 5 options: • A, B, C

• A, B, C, D

• A, B, C, D, E

Thorough screening process before and after examination to ensure question fairness and quality

Interpretation MCQs

100 image or data-based questions asking you to interpret the findings

Could include these types of images: Blood or bone marrow smears

Thromboelastography tracings

Cytograms & flow cytometry scattergrams

Electron micrographs

Cytology, histology, urine sediment

Special or immunologic stains

Could include hematology, biochemistry and/or other data…

See the next few slides for examples – correct answer is blue

Cutaneous mass aspirate from a dog. What color does the indicated structure stain with Masson’s Trichrome?

A. Red

B. Blue

C. Purple

Inte

rpre

tation M

CQ

Nasal flush (unstained wet mount) from a dog. What is the significance of the findings?

A. Pollen inhalation

B. Eucoleus infection

C. Rhinosporidium infection

D. Oropharyngeal contamination

Inte

rpre

tation M

CQ

Cytology and histology specimens from an 8 cm intra-abdominal mass in a dog. Which is the most likely diagnosis?

A. Seminoma

B. Lymphoma

C. Histiocytic sarcoma

D. Metastatic carcinoma

E. Transmissible venereal tumor

Inte

rpre

tation M

CQ

Data from an African Grey parrot. What condition is most likely?

A. Diabetes mellitus

B. Medullary washout

C. Psychogenic polydipsia

D. Central diabetes insipidus

Test

(units)

Patient

(Baseline)

Flag

(Baseline)

Reference

Interval

(Baseline)

Patient

(at 3 hours

of water

deprivation)

Patient

(post

vasopressin

administration)

Sodium

(mmol/L)

159 H 134 - 152 159 -

Glucose

(mmol/L)

13 H 6 - 9 - -

Urine SG 1.003 1.005 - .020 1.003 1.020

Plasma

osmolality

(mOsmol/kg)

327 H 299 - 313 340 312

Inte

rpre

tation M

CQ

A 5-year-old castrated male Golden Retriever has lethargy, weight loss, diarrhea and regurgitation. What is the most likely diagnosis?

A. Chronic monocytic leukemia

B. Acute lymphoblastic leukemia

C. Chronic lymphocytic leukemia

D. Acute myelomonocytic leukemia

Parameter (units) Result Flag Reference

Interval

Hct (%) 18 L 37 – 55

Retic # (x 103 /uL) 25 0 – 80

WBC (x 103/uL) 52 H 6 - 17

Platelets (x 103 /uL) 98 L 200 - 900

Inte

rpre

tation M

CQ

Knowledge MCQs

100 multiple choice questions on

mechanisms and diagnosis of disease and

principles of laboratory medicine

Mainly text-based questions

Could include some image or data-based

questions that require recognition of the

abnormality to answer

Examples follow on the next few slides

In cats, prolonged aPTT and normal PT

without a bleeding tendency occurs with

deficiency of which factor?

A. Factor IX

B. Factor XI

C. Factor VII

D. Factor XII

Know

ledge

MC

Q

Cytograms from an Advia 120. What is indicated by the circled regions?

A. Lipemia

B. Hemolysis

C. Lymphocytes

D. Platelet clumps

Know

ledge

MC

Q

With what is the presence of extracellular

myelin-like material in canine cerebrospinal

fluid associated with?

A. Necrosis

B. Neoplasia

C. Inflammation

D. Sampling artifact

Know

ledge

MC

Q

Blood smear from a horse. What is the genus and species of the erythroparasite?

A. Theileria equi

B. Babesia gibsoni

C. Neorickettsiae risticii

D. Anaplasma phagocytophilum

Know

ledge

MC

Q

What is plotted on the x-axis and y-axis, respectively, in this Levey-Jennings plot?

A. Time and sensitivity

B. Speed and assay range

C. Precision and accuracy

D. Time and concentration

Know

ledge

MC

Q

Best wishes - keep calm & read

Schalm’s !

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