Classic Lab Findings Flashcards
Anti-desmoglein (epithelial) antibodies
Pemphigus vulgaris
Anti-glomerular basement membrane antibodies
Goodpasture syndrome (glomerulonephritis and hemoptysis)
Anti-histone antibodies
Drug-induced SLE
-Hydralazine, isoniazid, phenytoin, procainamide
Anti-IgG antibodies
RA
-Systemic inflammation, joint pannus, boutonniere deformity)
Antineutrophil cytoplasmic antibodies
Microscopic polyangiitis and eosinophilic granulomatosis w/ polyangiits (Churg-Strauss) = MPO-ANCA or p-ANCA
Granulomatosis w/ polyangiitis (PR3-ANCA or c-ANCA)
Anti-nuclear antibodies (anti-Smith and anti-dsDNA)
SLE
-is a type III HSN
Antiplatelet anibodies
Idiopathic thrombocytopenic purura
Anti-topoisomerase antibodies
Diffuse systemic scleroderma
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Celiac disease
-will see diarrhea and weight loss
“Apple core” lesion on barium enema x-ray
Colorectal cancer
Atypical lymphocytes
EBV
Azurophilic peroxidase (+) granular inclusions in granulocytes and myeloblasts
Auer rods (AML)
Bacitracin response
Sensitive = S. pyogenes
Resistant = S. agalactiae
“Bamboo spine” on x-ray
Ankylosing spondylitis
-Chronic inflammatory arthritis assoc. w/ HLA-B27
Basophilic nuclear remnants in RBCs
Howell-Jolly bodies
-due to splenectomy or nonfunctional spleen
Bloody or yellow tap on lumbar puncture
Subarachnoid hemorrhage
Basophilic stippling of RBCs
Lead poisoning
or
Sideroblastic anemia
“Boot-shaped” heart on x-ray
TOF
-due to RVH
Branching Gram + rods w/ sulfur granules
Actinomyces israelii
Bronchogenic apical lung tumor on imaging
Pancoast tumor
-Can compress cervical sympathetic chain and cause Horner Syndrome ; can also compress recurrent laryngeal nerve
“Brown” tumor of bone
Hyperparathyroidism or osteitis fibrosa cystica
-Deposited hemosiderin from hemorrhage gives brown color)
Cardiomegaly w/ apical atrophy
Chagas disease
Cellular crescents in Bowman’s capsule
Rapidly progressive crescentic glomerulonephritis
“Chocolate cyst” of the ovary
Endometriosis
-frequently involves both ovaries
Circular grouping of dark tumor cells surrounding pale neurofibrils
Homer-Wright rosettes
-Neuroblastoma, medulloblastoma
Colonies of mucoid Pseudomonas in the lungs
CF
-AR mutation in CFTR gene =» fat-soluble vitamin deficiency and mucous plugs)
Decreased AFP in amniotic fluid
Down Syndrome
or other chromosomal abnormalities
Degeneration of dorsal column fibers
Tabes dorsalis (tertiary syphilis)
Subacute combined degeneration
-affects dorsal columns, lateral corticospinal tracty, and spinocerebellar tracts
“Delta wave” on EKG, short PR interval, supraventricular tachycardia
Wolf-Parkinson-White syndrome
-(bundle of KENT bypasses the AV node)
Degeneration of neurons in the SN
Parkinson’s disease
-basal ganglia disorder; rigidity, resting tremor, bradykinesia
Desquamated epithelium casts in sputum
Curschmann spirals
-Bronchial asthma; can result in whorled mucous plugs
Disarrayed granulosa cells arranged around collections of eosinophilic fluid
Call-Exner bodies
granulosa cell tumor of the ovary
Dysplastic squamous cervical cells w/ “rasanoid” nuclei and hyperchromasia
Koilocytes
HPV; predisposes a pt. to cervical cancer
pgRNA
pregenomic RNA; serves 2 fnxns
- template for HBV genome replication
- encodes viral polymerase and HBcAg
* Has a 5’ epsilon region where genome replication begins at
Roles of 5’ epsilon region
Pol binding site
Template for DNA oligo synthesis
Encapsidation signal in assoc. w/ HBcAg
Cellular responses to HBV
Noncytolytic clearance: mediated by viral-specific CTL cytokines like IFNa/b, TNF-a, and IFN-y; occurs after peak of viral replication
Inflammatory mediated liver damage: High levels of CD8 and CD4 specific T-cells followed by nonspecific T-cells, NK cells, and PMNs
HCV infxn pathway
Interaction w/ HCV E1,E2 heterodimer w/ surface proteins such as CD-81 and SR-B1 which will form complex
SR-B1= Scavenger-receptor class B1 protein
Target organ in CO poisoning
Globus pallidus in the cerebellum
-CO binds to Fe2+-Hb stronger than O2 and also decreases the release of bound O2 to tissues
CN- poisoning
Binds to Fe3+ of mitochondrial cytochrome oxidase decreasing the fnxn of the electron transport chain
Sx: N/V, stupor, coma, convulsions, hyperventilation, heart increases then decreases, death from respiratory failure
-Survivors suffer from severe brain damage
Tx: 1. Nitrite (Converts HbFe2+ to HbFe3+ which combines w/ CN- pulling it out of the tissues
2. Thiosulfate (transfers S2- group making SCN-, a much less toxic metabolite) 3. Methylene blue (gets rid of methemeglobin) probs not on test
SLUD (Organophosphate poisoning)
Salivation
Lacrimation
Urination
Defecation
-Also miosis, respiratory wheezing, and (nicotinic) muscle twitch and tachycardia
Tx: Atropine (muscarinic antagonist) or pralidoxime (AchE regenerator)
Carbaryl works the same way but AchE is reactivated in water (only give atoprine)**
Paraquat poisoning
Produces free radicals that lead to lipid peroxidation
Clinical: Causes SOB, pulmonary edema, pulmonary fibrosis (if chronic), Ulceration of mucous membranes, cataract formation (chronic)
Tx: Gastric lavage; hemodialysis
Diagnosis: Sodium dithionite in 2N NaOH to form a blue color confirming its presence (performed on urine)
Anticentromere bodies
Scleroderma (CREST)
Electrical alternans
Pericardial tamponade
Enlarged cells w/ intranuclear inclusion bodies
“Owl eye” appearance of CMV
Eosinophilic cytoplasmic inclusion in liver cell
Mallory body
alcoholic liver disease
Eosinophilic cytoplasmic inclusion in nerve cell
Lewy Body
Parkinson disease
Eosinophilic globule in the liver
Councilman body (viral hepatitis, yellow fever)
-represents hepatocyte undergoing apoptosis
Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons
Negri bodies
-Rabies
Extracellular amyloid deposition in gray matter of brain
Senile plaques
-Alzheimer’s disease
Gian B cells w/ bilobed nuclei w/ prominent inclusions (Owl’s eye)
Hodgkin’s lymphoma
Glomerulus-like structure surrounding vessel in germ cells
Schiller-Duval bodies
-Endodermal sinus tumor/Yolk-sac tumor
“Hair on end” (Crew-cut) appearance on x-ray
B-thalassemia, SCD
-represents extramedullary hematopoesis
hCG elevated
Choriocarcinoma, hydatiform mole
-Occurs w/ and w/o embryo, and multiple pregnancy
Heart nodules (granulomatous)
Aschoff bodies
-indicates RF
Heterophile antibodies
EBV (mono)
Hexagonal, double-pointed, needle-like crystals in bronchial secretions
Bronchial asthma (Charcot-Leiden crystals)
Elevated D-dimer
DVT, PE, DIC
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)
Ghon complex
-Primary TB
“Honeycomb lung”
Interstitial pulmonary fibrosis
Hypercoaguability (leading to migrating DVTs and vasculitis)
Trousseau syndrome
-adenocarcinoma of the pancreas or lung
Hypersegmented PMNs
Megaloblastic anemia
B12 de =» Neurological sx.
Folate def. =» No neurological sx.
HTN, hypokalemia, metabolic alkalosis
Conn Syndrome
-Primary hyperaldosteronism
Hypochromic, microcytic anemia
IDE, Pb2+ poisoning, thalassemia
Increased AFP in amniotic fluid
Anencephaly, spina bifida
-Neural tube defects
Hyperuricemia
Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies
Cowdry Type A bodies
HSV or VZV
Iron-containing nodules in alveolar septum
Ferruginous bodies
-Asbestosis; increased chance of bronchogenic carcinoma or mesothelioma
Keratin pearls
SCC
Large granules in phagocytes, immunodeficiency
Chediak-Higashi disease
-Congenital failure of phagolysosome formation
“Lead pipe” appearance of colon on abdominal imaging
Ulcerative colitis; occurs due to loss of haustra
Linear appearance of IgG deposition on glomerular and alveolar BMs
Goodpasture Syndrome
Decreased ceruloplasmin
Wilson’s disease
-Hepatolenticular degeneration
“Lumpy bumpy” appearance of glomeruli on IF
PSGN
-due to deposition of IgG, IgM, and C3
Lytic (“punched out”) bone lesions on x-ray
MM
Mammary gland (“Blue domed”) cyst
Fibrocystic change of the breast
Monoclonal antibody spike
MM (usually IgG or IgA)
Monoclonal gammopathy of undetermined significance
Waldenstroms Macroglobulinemia (IgM)
Primary amyloidosis
Mucin-filled cell w/ peripheral nucleus
Signet ring
-Gastric carcinoma
Narrowing of bowel of lumen on barium x-ray
String sign
-Crohn’s disease
Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
Granulomatosis w/ polyangiitis (PR3-ANCA, c-ANCA pos)
Goodpasture syndrome (anti-basement membrane abs)
Needle-shaped, negatively birefringent crystals
Gout
-Monsodium urate crystals
Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules
-Diabetic nephropathy
Novobiocin response
Sensitive = S. epidermidis
Resistant = S. saprophyticus
“Nutmeg” appearance of liver
RHF
or
Budd-Chiari syndrome
“Onion skin” periosteal reaction
Ewing sarcoma
-malignant small blue cell tumor
Optochin response
Sensitive= S. pneumoniae
Resistant= Strep viridans
Periosteum raised from bone, creating triangular area
Codman’s triangle (Osteosarcoma)
Ewing sarcoma
Pyogenic osteomyelitis
Podocyte fusion or “effacement” on electron microscopy
MCD (MCC of childhood nephrotic syndrome)
Polished, ivory-like appearance of bone at cartilage erosion
Eburnation
-Osteoarthritis resulting in bony sclerosis)
Protein aggregates in neurons from hyperphosphorylation of tau protein
NFTs (Alzheimers)
Pick bodies (Pick’s disease)
Psammoma bodies
Meningiomas
Papillary thyroid carcinoma
Mesothelioma
Papillary serous carcinoma of the endometrium and ovary
Pseudopalisading tumor cells on brain biopsy
Glioblastoma multiforme
RBC casts in the urine
Glomerulonephritis
Rectangular, crystal-like cytoplasmic inclusions of Leydig Cells
Reinke crystals
-Leydig cell tumor
Recurrent infxns, eczema, thrombocytopenia
Wiskott-Aldrich syndrome
Renal epithelial casts in urine
Intrinsic renal failure
-could be due to ischemia or toxic injury
Rhomboid crystals, positively birefringent
Pseudogout
-calcium pyrophosphate crystals
Rib notching
Aortic coarction
Ring-enhancing brain lesion in AIDS
Toxplasa gondii
CNS lymphoma
Sheets of medium-size lymphoid cells w/ scattered pale tingible body-laden macrophages (“starry sky” histology)
Burkitt’s lymphoma (t[8;14])
-c-myc activation assoc. w/ EBV
Silver-staining spherical aggregation of tau protein in neurons
Pick bodies
-Pick disease: progressive dementia, changes in personality
“Soap bubble” in femur or tibia on x-ray
Giant cell tumor of the bone
“Spikes” on BM, “done-like” subepithelial deposits
Membranous nephropathy
Stacks of RBCs
Rouleux
-high ESR, MM
“Steeple” sign on CXR
Croup
-parainfluenza virus
Stippled vaginal epithelial cells
“Clue cells”
-Gardnerella vaginalis
Streptococcus bovus bacteremia
Colon cancer
“Tennis racket” shaped cytoplasmic organelles (EM) in Langerhans cells
Birbeck granules
-Langheran’s cell histiocytosis
Thousands of polyps on colonoscopy
FAP (AD mutation of APC gene)
Thrombi made of white/red layers
Lines off Zahn
-arterial thrombus, layers of platelets/rbcs respectively
“Thumb sign” on lateral neck x-ray
Epiglottitis
-H. influenzae, could be a medical emergency
Thyroid-like appearance of the kidney
Chronic pyelonephritis
-usually due to recurrent infxns
“Tram track” appearance of capillary loops on glomerular BM on light microscopy
Membranoproliferative glomerulonephritis
TGL accumulation in liver cell vacuoles
Fatty liver disease
-alcoholic or metabolic syndrome
“Waxy” casts w/ very low urine flow
Chronic end-stage renal disease
WBC casts in urine
Acute pyelonephritis
WBCs that look “smudged”
CLL
-are always B-cells
“Wire loop” glomerular capillary appearance on light microscopy
Diffuse proliferative glomerulonephritis
-usually seen w/ SLE
Yellowish CSF
Xanthochromia
-due to SAH
Anti-ribonucleoprotein antibodies
Sjogren’s Syndrome
anti-SSA/Ro or anti-SSB/La
Anti-DNA topoisomerase I
Diffuse systemic sclerosis abs
Anti-u1 ribonucleoprotein abs
MCTD
-Mixed features of SLE, systemic sclerosis, and polymyositis
PDGFB mutation
Associated w/ astrocytomas
KIT mutations
Assoc. w/ gastrointestinal stromal tumors
-Due to a point mutation in this stem cell growth factor receptor
RAS mutations
Occurs in mutations due to GTPase activating protein which normally breaks down GTP =» GDP
-Withouth “GAP”, uncontrolled activation of Ras occurs
=»Multitude of lymphomas, melanoma, carcinomas
N-MYC mutations
Amplified transcription factor that can cause Neuroblastomas
L-MYC mutations
Amplification of the transcription factor that can result in Lung cancer
Li-fraumeni syndrome
Mutation in p53 leads to decreased BAX and increased Bcl-2 stability
-Develop multiple types of cancers; requires 2 hits
Retinoblastoma
Mutation allows constant release of E2F which constitutively activates the S-phase of the cell cycle
- Familial causes bilateral retinoblastoma AND OSTEOSARCOMA
- Requires two hits
GFAP stain
Stains neuroglia
Chromogranin stain
Stains neuroendocrine cells
-Possible to see in Small cell carinoma of the lung, carcinoid tumors, an and medulloblastoma
S-100 stain
Stains melanoma, schwannoma, and Langerhan’s cell histiocyosis
*These are neural crest derivatives
Enlarged Platelets
Bernard-Soulier syndrome; GpIb deficiency =» deficient platelet adhesion
“Big Suckers”
Anti-mitochondrial abs
Primary biliary cirrhosis
Thymoma
Tumor of thymic epitheliocytes
-Appear as multiple clear cells inside the thymus
Site where lymphs leave the blood stream and enter lymph nodes
Post-capillary venules
FTA antibodies
Confirmatory test for syphilis
Enfurvitide
Inhibits envelope protein gp41 from binding to CD4 cells
Age related Macular degeneration (dry type)
Chronic oxidative damage leads to subretinal inflammation w/ drusen deposits
-Leading cause of blindness in industrialized countries; assoc. With smoking
Age related macular degeneration (wet type)
Progressive ECM deposition leads to chronic hypoxia and increased angiogenesis
-Gray-green subretinal discoloration w/ small hemorrhages
COX-2
Only expressed at sites of inflammation; inhibited by Celecoxib
Carcinoid 1/3 rule
1/3 are multiple tumors
-necessary for systemic sx. due to hepatic inactivation
1/3 are in the small bowel
1/3 metastasize
1/3 have a second malignancy
Alveolar ventilation equation
Va= (Vt-Vd) x RR
Dead Space Equation
Vd= Vt x (PaCO2-PeCO2)/PaCO2
Decreased lung compliance examples
Pulmonary fibrosis, pneumonia, edema
Methemoglobinemia tx
Methylene blue
O2 delivery equation
O2 content X CO
O2 content= (1.34 x % saturation) + dissolved O2
-( typically ~20)
Causes of increased A-a gradient
Pulmonary fibrosis, COPD (diffusion mismatches)
V/Q mismatch
Shunting
Pneumonia
Changes in response to high altitude
Increased EPO, ventilation, 2,3-BPG, cellular mitochondria, renal HCO3 excretion, and pulmonary HTN (RVH eventually)
N-acetylcysteine
Mucolytic that loosens mucous plugs in CF pts by disrupting disulfide bonds
-Also used for acetaminophen OD obviously
