Classic Labs and Findings Flashcards
Anticentromere antibodies
Scleroderma (CREST)
Antidesmoglein (epithelial) antibodies
Pemphigus vulgaris (blistering)
Anti-glomerular basement membrane antibodies
Goodpasture’s syndrome (glomerulonephritis and hemoptysis)
Antihistone antibodies
Drug-induced SLE (hydralazine, isoniazid, phenytoin, procainamide)
Anti-IgG antibodies
Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity)
Antimitochondrial antibodies (AMAs)
Primary biliary cirrhosis (female, cholestasis, portal hypertension)
Antineutrophil cytoplasmic antibodies (ANCAs)
Vasculitis:
c-ANCA: Wegener’s (WeCener’s);
p-ANCA: microscopic polyangiitis, Churg-Strauss syndrome
Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)
SLE (type III hypersensitivity)
Antiplatelet antibodies
Idiopathic thrombocytopenic purpura (ITP)
Anti-topoisomerase antibodies
Diffuse systemic scleroderma
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Celiac disease (diarrhea, distention, weight loss)
Apple core lesion on abdominal x-ray
Colorectal cancer (usually left-sided)
Azurophilic granular needles in leukemic blasts
Auer rods (acute myelogenous leukemia, especially the promyelocytic [M3] type)
Bacitracin response
Sensitive: Streptococcus pyogenes (group A);
Resistant: Streptococcus agalactiae (group B);
“BBRAS”
Bamboo spine on x-ray
Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)
Basophilic nuclear remnants in RBCs
Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)
Basophilic stippling of RBCs IMAGE
Lead poisoning or sideroblastic anemia
Bloody tap on LP
Subarachnoid hemorrhage
Boot-shaped heart on x-ray
Tetralogy of Fallot, RVH
Branching gram-positive rods with sulfur granules
Actinomyces israelii
Bronchogenic apical lung tumor
Pancoast tumor (can compress sympathetic ganglion and cause Horner’s syndrome)
Brown tumor of bone
Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to: 1. Hyperparathyroidism 2. Osteitis fibrosa cystica
Cardiomegaly with apical atrophy
Chagas’ disease (Trypanosoma cruzi)
Cellular crescents in Bowman’s capsule
Rapidly progressive crescentic glomerulonephritis
Chocolate cyst of ovary
Endometriosis (frequently involves both ovaries)
Circular grouping of dark tumor cells surrounding pale neurofibrils
Homer Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma)
Colonies of mucoid Pseudomonas in lungs
Cystic fibrosis (AR mutation to CFTR resulting in fat-soluble vitamin deficiency and mucous plugs)
Decreased alpha-fetoprotein in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormality
Degeneration of dorsal column nerves
Tabes dorsalis (Tertiary syphilis)
Depigmentation of neurons in substantia nigra
Parkinson’s disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)
Desquamated epithelium casts in sputum
Curschmann’s spirals (bronchial asthma; can result in whorled mucous plugs)
Disarrayed granulosa cells in eosinophilic fluid
Cali-Exner bodies (granulosa-theca cell tumor of the ovary)
Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia
Koilocytes (HPV: predisposes to cervical cancer)
Enlarged cells with intranuclear inclusion bodies
Owl’s-eye appearance of CMV
Enlarged thyroid cells with ground-glass nuclei
Orphan Annie eye nuclei (papillary carcinoma ofthe thyroid)
Eosinophilic cytoplasmic inclusion in liver cell
Mallory bodies (alcoholic liver disease)
Eosinophilic cytoplasmic inclusion in nerve cell
Lewy body (Parkinson’s disease)
Eosinophilic globule in liver
Councilman body (toxic or viral hepatitis, often yellow fever)
Eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells
Rabies virus (Lyssavirus)
Extracellular amyloid deposition in gray matter of brain
Senile plaques (Alzheimer’s disease)
Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”)
Reed-Sternberg cells (Hodgkin’s lymphoma)
Glomerulus-like structure surrounding vessel in germ cells
Schiller-Duval bodies (yolk sac tumor)
Hair-on-end (crew-cut) appearance on x-ray
Beta-thalassemia, sickle cell anemia (marrow expansion)
hCG elevated
Choriocarcinoma, hydatidiform mole (occurs with and without embryo)
Heart nodules (granulomatous)
Aschoff bodies (Rheumatic fever)
Heterophile antibodies
Infectious mononucleosis (EBV)
Hexagonal, double-pointed, needle-like crystals in bronchial secretions IMAGE
Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)
High level of D-dimers
DVT, pulmonary embolism, DIC
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)
Ghon complex (Primary TB :Mycobacterium bacilli)
Honeycomb lung on x-ray
Interstitial fibrosis
Hypersegmented neutrophils
Megaloblastic anemia: B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms “No forgetting with folate deficiency.”
Hypochromic, microcytic anemia
Iron deficiency anemia, lead poisoning, thalassemia (HbF sometimes present)
Increased alpha-fetoprotein in amniotic fluid/maternal serum
Dating error, anencephaly, spina bifida (neural tube defects)
Increased uric acid levels
Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies
Cowdry type A bodies (HSV or CMV)
Iron-containing nodules in alveolar septum
Ferruginous bodies (asbestosis: increased chance of mesothelioma)
Large lysosomal vesicles in phagocytes, immunodeficiency
Chediak-Higashi disease (congenital failure of phagolysosome formation)
Lead pipe appearance of colon on x-ray
Ulcerative colitis (loss of haustra)
Linear appearance of glomeruli on immunofluorescence
Goodpasture’s syndrome
Low serum ceruloplasmin
Wilson’s disease (hepatolenticular degeneration)
Lumpy-bumpy appearance of glomeruli on immunofluorescence
Poststreptococcal glomerulonephritis (immune complex deposition of IgG and C3b)
Lytic (“hole-punched”) bone lesions on x-ray
Multiple myeloma
Mammary gland (“blue-domed”) cyst
Fibrocystic change of the breast
Monoclonal antibody spike
- Multiple myeloma (called the M protein; usually IgG or IgA) 2. Monoclonal gammopathy of undetermined significance (MGUS; normal consequence of aging) 3. Waldenstrom’s (M protein = IgM) macroglobulinemia 4. Primary amyloidosis
Monoclonal globulin protein in blood/urine
Bence Jones proteins (multiple myeloma [kappa or lambda Ig light chains in urine]), Waldenstrom’s macroglobulinemia (lgM)
Mucin-filled cell with peripheral nucleus
Signet ring (gastric carcinoma)
Narrowing of bowel lumen on barium radiograph
String sign (Crohn’s disease)
Needle-shaped, negatively birefringent crystals
Gout (monosodium urate crystals)
Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules (diabetic nephropathy)
Novobiocin response
Sensitive: Staphylococcus epidermidis; Resistant: Staphylococcus saprophyticus
Nutmeg appearance of liver
Chronic passive congestion of liver clue to right heart failure (The image in the UL corner is a nutmeg.)
Onion-skin periosteal reaction (white arrows)
Ewing’s sarcoma (malignant round-cell tumor); Ewing sarcoma of femur. Frontal radiograph and lateral radiographs of the femur demonstrate mottled, osteolytic lesion (blue circle) with poorly marginated edges in the diaphysis of the bone. There is sunburst periosteal reaction (red circle) and lamellated periosteal reaction (white arrows).
Optochin response
Sensitive: Streptococcus pneumoniae; Resistant: Viridans streptococcus “OVeRPaSs”
Periosteum raised from bone, creating triangular area
Codman’s triangle on x-ray (osteosarcoma, Ewing’s sarcoma, pyogenic osteomyelitis)
Podocyte fusion on EM
Minimal change disease/Nil disease (child with nephrotic syndrome) This is minimal change disease (MCD) which is characterized by effacement of the epithelial cell (podocyte) foot processes and loss of the normal charge barrier such that albumin selectively leaks out and proteinuria ensues. By light microscopy, the glomerulus is normal with MCD. In this electron micrograph, the capillary loop in the lower half contains two electron dense RBC’s. Fenestrated endothelium is present, and the basement membrane is normal. However, overlying epithelial cell foot processes are effaced (giving the appearance of fusion) and run together.
Polished, “ivory-like” appearance of bone at cartilage erosion
Eburnation (osteoarthritis resulting in bony sclerosis)
Protein aggregates in neurons from hyperphosphorylation of protein tau
Neurofibrillary tangles (Alzheimer’s disease and CJD)
Pseudopalisading tumor cells on brain biopsy
Glioblastoma multiforme; This glioblastoma multiforme (GBM) demonstrates marked cellularity with marked hyperchromatism and pleomorphism. Note the prominent vascularity as well as the area of necrosis at the left with neoplastic cells palisading around it.
RBC casts in urine
Acute glomerulonephritis
Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells
Reinke crystals (Leydig cell tumor)
Renal epithelial casts in urine
Acute toxic/viral nephrosis
Rhomboid crystals, positively birefringent
Pseudogout (calcium pyrophosphate dihydrate)
Rib notching
Coarctation of the aorta
Ring-enhancing brain lesion in AIDS
Toxoplasma gondii
Sheets of medium-sized lymphoid cells (“starry sky” appearance on histology)
Burkitt’s lymphoma (t[8:14) c-myc activation, associated with EBV; “black sky” made up of malignant cells)
Silver-staining spherical aggregation of tau proteins in neurons
Neurofibrillary tangles (Alzheimer’s disease) and Pick’s bodies (Pick’s disease).
Soap bubble in femur or tibia on x-ray
Giant cell tumor of bone (generally benign)
Spikes on basement membrane, “dome-like” subepithelial deposits
Membranous glomerulonephritis (may progress to nephrotic syndrome)
Stacks of red blood cells
Rouleaux formation (high ESR, multiple myeloma)
Stippled vaginal epithelial cells
Clue cells (Gardnerella vaginalis); “I don’t have a clue why I smell fish in the vagina garden.” - First Aid
Tennis-racket-shaped cytoplasmic organelles (EM) in Langerhans cells
Birbeck granules (histiocytosis X: eosinophilic granuloma)
Thrombi made of white/red layers
Lines of Zahn (arterial thrombus, layers of platelets/RBCs)
Thumb sign” on lateral x-ray
Epiglottitis (Haemophilus influenzae)
Thyroid-like appearance of kidney
Chronic bacterial pyelonephritis
Tram-track appearance on LM
Membranoproliferative glomerulonephritis
Triglyceride accumulation in liver cell vacuoles
Fatty liver disease (alcoholic or metabolic syndrome)
WBCs that look “smudged”
CLL (almost always B cell; affects the elderly)
Wire loop glomerular appearance on LM
Lupus nephropathy “Wire loop-us.”
Yellow CSF
Xanthochromia (previous subarachnoid hemorrhage)
