ACVP CERTIFICATION EXAMINATION GROSS AND HISTOPATHOLOGY REVIEW
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1 ACVP CERTIFICATION EXAMINATION GROSS AND HISTOPATHOLOGY REVIEW December 16, 2015 Dr. Andrew D. Miller, DVM, Dipl. ACVP Cornell University College of Veterinary Medicine
2 Webinar 2016 exam and beyond This webinar is not about the redesign process Redesign info on ACVP website, more soon Clinical pathology webinar is on Dec. 18 th
3 Webinar In lieu of review at ACVP meeting Format will be slightly different Cannot show as many examples Overview of 2016 format with select examples from gross and histology Multiple choice examples are on the website Q&A session Being recorded Webinar recording and ppt will be on ACVP website for review
4 2015 Anatomic Pathology Dan Rudmann (chair) Dalen Agnew Richard Luong Brian Porter Andrew Miller Paco Uzal Leslie Woods Denise Schwahn (P) Duncan Russell (P) Jario Nunes Inge Langhor (P) Mandy Fales-Williams (P) Tim Morgan
5 2016 Anatomic Path EC Andrew Miller, Cornell University (chair) Richard Luong, IDEXX Laboratories Brian Porter, Texas A&M Dalen Agnew, Michigan State University Paco Uzal, UC Davis Leslie Woods, UC Davis Denise Schwahn, University of Wisconsin Jario Nunes, WiL research Tim Morgan, Mississippi State University Christiane Lohr, Oregon State University Dan Rissi (P), University of Georgia Brigid Troan (P), North Carolina State University Denise Imai (P), UC Davis Simon Priestnall (P), Royal Veterinary College
6 ACVP Certifying Exam (2016) Two phase exam Phase I Formerly known as General Pathology Phase II Gross pathology Histopathology Clinical pathology Elective sections: NEWZ, Lab, Small animal, Large animal
7 Phase I (General Pathology) 100 MCQs covering general pathology NO species-specific questions Reading list is online Computer-based, Castle testing centers March 10 th, 2016 MUST pass to proceed to Phase II Can take and pass in same year as Phase II Cut-score = 62%, pass rate in 2015 = 87%
8 Phase II Three sections Pass/fail each section Hand-written Scheman Center, Iowa State U., Ames September 13 th and 14 th, 2016 Updated schedule is on the website Eligible after 36 months of training
9 Gross Pathology Review
10 Preparation Timeline Nov-Dec: Examination Committee (EC) meets Mar-Apr: Cases sent to section leader from EC Apr-May: Section leader reviews all cases and prepares exam materials Jun: Draft exam selected by entire EC in Fort Collins Final 100 images are selected based on the matrix Points are allocated for each question Keys are drafted
11 Tissue from a dog: Morphologic diagnosis (2)
12 Morphologic Diagnosis: Choroid plexus carcinoma; Hydrocephalus
13 Tissue from a horse: Pathogenesis
14 Failure of passive transfer (or omphophlebitis)-- insufficient immune protection-- bacteremia/septicemia-- osteomyleitis
15 Tissue from a dog: Morphologic Diagnosis; Serum biochemical changes (2)
16 Morphologic diagnosis Parathyroid adenoma with contralateral atrophy Associated serum biochemical findings hypercalcemia, hypophosphatemia
17 Tissue from a horse: Etiologic Diagnosis
18 Etiologic Diagnosis: Mycotic dermatitis
19 Tissue from a hawk: Histologic features (3)
20 Histologic characteristics (3) Proliferative dermatitis with ballooning degeneration and cytoplasmic inclusion bodies (Bollinger bodies) in keratinocytes
21 Tissue from a fish: Morphologic Diagnosis
22 Morphologic diagnosis Branchial telangiectasia/thrombosis or lamellar telangiectasia
23 Tissue from a horse: Morphologic Diagnosis Cause
24 Morphologic diagnosis Cerebrocortical leukoencephalomalacia Cause: Fumonisin B1 produced by Fusarium verticillioides (F. moniliforme)or F. proliferatum on corn
25 Tissue from a dog: Morphologic Diagnosis
26 Morphologic Diagnosis: Multiple myeloma
27 Tissue from a cat: Morphologic Diagnosis; Cause
28 Multifocal pyogranulomatous meningitis; FIP
29 Tissue from a dog: Cause
30 Dracunculus insignis
31 MICROSCOPIC SECTION REVIEW
32 Preparation Timeline Nov-Dec: Examination Committee (EC) meets Mar-Apr: Cases sent to section leader from EC Apr-May: Section leader reviews all cases and prepares exam materials Jun: Draft exam selected by entire EC in Fort Collins Final 20 cases are selected Points are allocated for each question Keys are drafted
33 Case Selection Test value/quality of the lesion(s) Quality of the slide Diversification matrix for cases - Process - Tissue - Cause - Species - Contributor
34 Case Selection Pathologic Process Infectious/inflammatory/immunologic Degeneration/necrosis Disturbance of growth (includes neoplasia) Genetic/metabolic/nutritional Chemical/toxic
35 Case Selection Organ System Cardiovascular Digestive Endocrine Hemolymphatic Liver/Pancreas Musculoskeletal Reproductive Respiratory Integumentary Urinary Eye/Special senses Nervous
36 Case Selection Etiology Bacteria Fungi Parasite Virus Circulatory Toxic/chemical Deficiency Genetic disorder Multiple etiologies Other
37 Case Selection Species Small animal (dog and cat) Large animal (ox, sheep, goat, pig and horse) Laboratory animal Non-mammalian, exotic, wildlife and zoo animals (NEWZ)
38 Case Section Glass slide cases - usually 18 total Special cases - usually 2 total Electron photomicrographs Cytology images/slides Immunohistochemistry/special stain images Blood smear Composite/mixed image panel Other
39 Organization/Clarity (OC) Points Three specific categories of O/C points 1. Logical and clear description of the microscopic features that leads to the correct diagnosis 2. Appropriate use of anatomic pathology and/or scientific terminology 3. Clear differentiation between a primary and secondary process - Not used in every case - Determined by EC consensus - If used, typically one point; maximum of two points
40 Tissue From a Cat Histopathologic Description (14 points): Morphologic Diagnosis(es) (2 points): Cause(s) (4 points):
41 Tissue From a Cat: Skin Pyogranulomatous inflammation expands dermis and panniculus, adnexal atrophy/loss
42 Tissue From a Cat: Skin Epitheliod macrophages, neutrophils, lymphocytes and plasma cells
43 Tissue From a Cat: Skin Multinucleated macrophages Fungal yeast - size, shape, wall, budding
44 Tissue From a Cat: Skin Necrosis, tissue tracts, hemorrhage, fibrin
45 Tissue From a Cat: Skin Morphologic Diagnosis (2 points): Pyogranulomatous dermatitis and panniculitis with intra-lesional yeast Cause(es) (4 points): Blastomyces dermatitidis
46 Tissue From a Horse Histopathologic Description (14 points): Morphologic Diagnosis(es) (6 points):
47 Tissue From a Horse Cauda equina, ganglia/nerves/nerve sheaths, inflammation
48 Tissue From a Horse Cauda equina, ganglia/nerves/nerve sheaths, inflammation
49 Tissue From a Horse Lymphocytes, plasma cells, macrophages, multinucleated giant cells
50 Tissue From a Horse Dilated myelin sheaths/vacuolation, axonal degeneration/loss, fibrosis
51 Tissue From a Horse Ganglia, neuronal vacuolation, chromatolysis, and necrosis/loss, gliosis
52 Tissue From a Horse Morphologic Diagnosis(es) (6 points): Lymphoplasmacytic/granulomatous ganglioneuritis with axonal/myelin degeneration
53 Tissue From a Mouse Histopathologic Description (16 points): Morphologic Diagnosis(es) (4 points):
54 Tissue From a Mouse: Kidney Corticomedullary, tubular necrosis, tubular dilation, hyaline protein casts in medulla
55 Tissue From a Mouse: Kidney Tubular necrosis, sloughing/cellular casts, tubular dilation, epithelial flattening
56 Tissue From a Mouse: Kidney Tubular regeneration, basophilia, hypertrophy, cell piling, mitoses, nuclear changes
57 Tissue From a Mouse: Kidney
58 Tissue From a Mouse Morphologic Diagnosis(es) (4 points): Renal corticomedullary tubular necrosis with regeneration
59 Tissue From a Baboon Histopathologic Description (16 points): Name the disease (4 points):
60 Tissue From a Baboon Small intestine, mass, effacing muscularis, transmural/serosa to submucosa
61 Tissue From a Baboon Branching glands, variably size/ectatic, contents, cuboidal to columnar cells, apical blebs
62 Tissue From a Baboon Proliferative stroma, surrounding epithelium, cellularity, organization, spindle cell shape, mitoses, with eosinophils
63 Tissue From a Baboon Name the disease (4 points): Endometriosis
64 Tissue From a Fish Description (16 points): Cause(s) (2 points): Name the disease(s) (2 points): Format: Mixed Panel
65 Tissue From a Fish Phase Contrast Wet Mount
66 Tissue From a Fish Phase Contrast Wet Mount A) Phase Contrast Wet Mount: Encapsulated microorganisms/lymphocysts/hypertrophic cells, describe granular internal structure
67 Tissue From a Fish B) and C) Histology (H&E): Skin/epithelial surface, dermal connective tissue, hypertrophic fibroblasts, cyst wall and contents, collapsed cysts, inflammation
68 Tissue From a Fish D) Electron Microscopy: Portion of a hypertrophied cell, central nucleus, heterochromatin/condensed chromatin, viral particles, cytoplasm, icosahedral/hexagonal
69 Tissue From a Fish Cause(s) (2 points): Lymphocystis disease virus / Iridovirus Name the disease(s) (2 points): Lymphocystis
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