CLASSIC LAB/FINDINGS II

Question 1

“Delta wave” on ECG, short PR interval, supraventricular

tachycardia

Answer 1

Wolff-Parkinson-White syndrome (Bundle of Kent

bypasses AV node)

Question 2

“Boot-shaped” heart on x-ray

Answer 2

Tetralogy of Fallot (due to RVH)

Question 3

Rib notching (inferior surface, on x-ray)

Answer 3

Coarctation of the aorta

Question 4

Heart nodules (granulomatous)

Answer 4

Aschoff bodies (rheumatic fever)

Question 5

Electrical alternans (alternating amplitude on ECG)

Answer 5

Cardiac tamponade

Question 6

Antineutrophil cytoplasmic antibodies (ANCAs)

Answer 6

Microscopic polyangiitis and eosinophilic granulomatosis
with polyangiitis (MPO-ANCA/p-ANCA);
granulomatosis with polyangiitis (Wegener; PR3-
ANCA/c-ANCA); primary sclerosing cholangitis (MPO-
ANCA/p-ANCA)

Question 7

Hypertension, hypokalemia, metabolic alkalosis

Answer 7

1° hyperaldosteronism (Conn syndrome)

Question 8

Enlarged thyroid cells with ground-glass nuclei with

central clearing

Answer 8

“Orphan Annie” eyes nuclei (papillary carcinoma of the

thyroid)

Question 9

Mucin-filled cell with peripheral nucleus

Answer 9

“Signet ring” (gastric carcinoma)

Question 10

Anti-transglutaminase/anti-gliadin/anti-endomysial

antibodies

Answer 10

Celiac disease (diarrhea, weight loss)

Question 11

Narrowing of bowel lumen on barium x-ray

Answer 11

“String sign” (Crohn disease)

Question 12

“Lead pipe” appearance of colon on abdominal imaging

Answer 12

Ulcerative colitis (loss of haustra)

Question 13

Thousands of polyps on colonoscopy

Answer 13

Familial adenomatous polyposis (autosomal dominant, mutation of APC gene)

Question 14

“Apple core” lesion on barium enema x-ray

Answer 14

Colorectal cancer (usually left-sided)

Question 15

Eosinophilic cytoplasmic inclusion in liver cell

Answer 15

Mallory body (alcoholic liver disease)

Question 16

Triglyceride accumulation in liver cell vacuoles

Answer 16

Fatty liver disease (alcoholic or metabolic syndrome)

Question 17

“Nutmeg” appearance of liver

Answer 17

Chronic passive congestion of liver due to right heart

failure or Budd-Chiari syndrome

Question 18

Antimitochondrial antibodies (AMAs)

Answer 18

1° biliary cholangitis (female, cholestasis, portal hypertension)

Question 19

Low serum ceruloplasmin

Answer 19

Wilson disease (hepatolenticular degeneration; Kayser-
Fleischer rings due to copper accumulation)

Question 20

Migratory thrombophlebitis (leading to migrating DVTs
and vasculitis)

Answer 20

Trousseau syndrome (adenocarcinoma of pancreas or lung)

Question 21

Basophilic nuclear remnants in RBCs

Answer 21

Howell-Jolly bodies (due to splenectomy or nonfunctional

spleen)

Question 22

Basophilic stippling of RBCs

Answer 22

Lead poisoning or sideroblastic anemia

Question 23

Hypochromic, microcytic anemia

Answer 23

Iron deficiency anemia, lead poisoning, thalassemia (fetal

hemoglobin sometimes present)

Question 24

“Hair on end” (“Crew-cut”) appearance on x-ray

Answer 24

β-thalassemia, sickle cell disease (marrow expansion)

Question 25

Hypersegmented neutrophils

Answer 25

Megaloblastic anemia (B12 deficiency: neurologic
symptoms; folate deficiency: no neurologic symptoms)

Question 26

Antiplatelet antibodies

Answer 26

Idiopathic thrombocytopenic purpura

Question 27

High level of d-dimers

Answer 27

DVT, PE, DIC

Question 28

Giant B cells with bilobed nuclei with prominent

inclusions (“owl’s eye”)

Answer 28

Reed-Sternberg cells (Hodgkin lymphoma)