Classic Labs/Findings Flashcards
Anticentromere antibodies
Scleroderma (CREST)
Antidesmoglein (epithelial) antibodies
Pemphigus vulgaris (blistering)
Antiglomerular basement membrane antibodies
Goodpasture’s syndrome (glomerulonephritis and hemoptysis)
Antihistone antibodies
Drug induced SLE (hydralazine, isoniazid, phentynoin, procainamide)
Anti-IgG antibodies
Rheumatoid arthritis– systemic inflammation, joint pannus, boutonniere deformity
Antimitochondrial antibodies
Primary biliary cirrhosis– female, cholestasis, portal hypertension
Antineutrophil cytoplasmic antibodies (ANCA’s)
c-ANCA- Wegener’s granulomatosis with polyangiitis; p-ANCA- microscopic polyangiitis, Churg-Strauss syndrome
ANA: anti-Smith and anti-dsDNA
SLE (type III hypersensitivity)
Antiplatelet antibodies
Idiopathic thrombocytopenic purpura
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 peroxidase-positive granular inclusions in granulocytes and myeloblasts
Auer rods- acute myelogenous leukemia, especially the promyelocytic (M3) type
Bacitracin response
Sensitive: group A strep aka Strep pyogenes; Resistant: group B strep aka Strep agalactiae
Bamboo spine on x-ray
Ankylosing spondylitis (chronic inflammatory arthritis– HLA B27)
Basophilic nuclear remnants in RBC’s
Howell-Jolly bodies- due to splenectomy or non-functional spleen
Basophilic stippling of RBC’s
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 on imaging
Pancoast tumor- can compress sympathetic ganglion and cause Horner’s syndrome
Brown tumor of bone
Hyperparathyroidism of osteitis fibrosa cystica; deposited hemosiderin from hemorrhage gives brown color
Cardiomegaly and apical atrophy
Chagas’ disease (Trypanosoma cruzi)
Cellular crescents in Bowman’s capsule
Rapidly progressive crescenteric glomerulonephritis
Chocolate cyst of ovary
Endometriosis (frequently bilateral)
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 in CFTR resulting in fat-soluble vitamin deficiency and mucus plugs
Decreased alpha-fetoprotein in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormality
Degeneration of dorsal column nerves
Tabes dorsalis (tertiary syphilis), subacute combined degeneration (dorsal columns and lateral corticospinal tracts affected)
Depigmentation of neurons in substantia nigra
Parkinson’s disease– basal ganglia disorder characterized by rigidity, resting tremor, bradykinesia
Desquamated epithelium casts in sputum
Curschmann’s spirals- bronchial asthma; can result in whorled mucus plugs
Disarrayed granulosa cells in eosinophilic fluid
Call-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’s eyes nuclei- papillary carcinoma of the thyroid
Eosinophilic cytoplasmic inclusions in liver cell
Mallory bodies (alcoholic liver disease)
Eosinophilic cytoplasmic inclusion in nerve cell
Lewy body (Parkinson’s disease)
Eosinophilic globule in the liver
Councilman body (toxic or viral hepatitis, often yellow fever)
Eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells
Negri bodies of rabies (Lyssavirus)
Extracellular amyloid deposition in gray matter of brain
Senile plaques of Alzheimers disease
Giant B cells with bilobed nuclei with prominent inclusions (owl’s eye)
Reed-Sternberg cells of 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 mono (EBV)
Hexagonal, double-pointed, needle-like crystals in bronchial secretions
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 or CT
Interstitial pulmonary fibrosis
Hypercoagulability leading to migrating DVT’s and vasculitis
Trousseau’s syndrome (adenocarcinoma of pancreas or lung)
Hypersegmented neutrophils
Megaloblastic anemia- B12 deficiency characterized by neurologic symptoms; folate deficiency does not have neuro symptoms
Hypertension, hypokalemia, metabolic alkalosis
Conn’s syndrome
Hypochromic, microcytic anemia
Iron deficiency anemia, lead poisoning, thalassemia (fetal hemoglobin sometimes present)
Increased alpha-fetoprotein in amniotic fluid/maternal serum
Dating error, anencephaly, neural tube defects
Increased uric acid levels
Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies
Cowdry A bodies (HSV or CMV)
Iron containing nodules in alveolar sputum
Ferruginous bodies: asbestosis leads to increased chance of mesothelioma
Keratin pearls on skin biopsy
Squamous cell carcinoma
Large lysosomal vesicles in phagocytes, immunodeficiency
Chediak-Higashi disease (congenital failure of phagolysosome formation)
Lead pipe appearance of colon on barium enema x-ray
Ulcerative colitis (loss of haustra)
Linear appearance of IgG deposition on glomerular basement membrane
Goodpasture’s syndrome
Low serum ceruloplasmin
Wilson’s disease
Lumpy bumpy appearance of glomeruli on immunofluorescence
Postreptococcal 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 (usually IgG or IgA); MGUS (normal consequence of aging); Waldenstrom’s macroglobulinemia (M protein= IgM); Primary amyloidosis
Mucin filled with peripheral nucleus
Signet ring (gastric carcinoma)
Narrowing of bowel lumen on barium x-ray
String sign (Crohn’s disease)
Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
Granulomatosis with polyangiitis (Wegener’s c-ANCA positive) & Goodpasture’s syndrome (anti-basement membrane antibodies)
Needle shaped negatively birefringent crystals
Gout (MSU crystals)
Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson disease (diabetic nephropathy)
Novobiocin response
Sensitive: Staph epidermidis; Resistant: Staph saprophyticus
Nutmeg appearance of the liver
Chronic passive congestion of liver due to right heart failure
Onion skin periosteal reaction
Ewing’s sarcoma (malignant round cell tumor)
Optochin response
Sensitive: Strep pneumo; Resistant: Viridans strep
Periosteum raised from bone, creating triangular area
Codman’s triangle on x-ray– osteosarcoma, Ewing’s sarcoma, pyogenic osteomyelitis
Podocyte fusion or “effacement” on electron microscopy
Minimal change disease (child with nephrotic syndrome)
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) and Pick’s 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 urine
Acute glomerulonephritis
Rectangular, crystal-like, cytoplasmic inclusions of Leydig cells
Reinke crystals (Leydig cell tumors)
Renal epithelial casts in urine
Acute toxic/viral nephrosis
Rhomboid crystals, positively birefringent
Pseudogout (calcium pyrophosphate dihydrate crystals)
Rib notching
Coarctation of the aorta
Ring enhancing lesions in AIDS
Toxoplasma gondii, CNS lymphoma
Sheets of medium-sized lymphoid cells with scattered pale, tingible body-laden macrophages (‘starry sky’ 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
Pick bodies– Pick’s disease characterized by progressive dementia, changes in personality
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 RBC’s
Rouleaux formation- high ESR, multiple myeloma
Stippled vaginal epithelial cells
Clue cells of Gardnerella vaginalis
Tennis racket shaped cytoplasmic organelles (EM) in Langerhans cells
Birbeck granules- Langerhans cell histiocytosis or histiocytosis X; eosinophilic granuloma
Thrombi made of white/red layers
Lines of Zahn– arterial thrombus, layers of platelets/RBC’s
Thumb sign on lateral x-ray
Epiglottitis (Haemophilus influenzae)
Thryoid like appearance of kidney
Chronic bacterial pyelonephritis
Tram track appearance of capillary loops of glomerular basement membranes on light microscopy
Membranoproliferative glomerulonephritis
Triglyceride accumulation in liver cell vacuoles
Fatty liver disease (alcoholic or metabolic syndrome)
Waxy casts with very low urine flow
Chronic end-stage renal disease
WBC casts in urine
Acute pyelonephritis
WBC’s that look “smudged”
CLL (almost always B cell)
Wire loop glomerular capillary appearance on light microscopy
Lupus nephropathy
Yellowish CSF
Xanthochromia (e.g. due to subarachnoid hemorrhage)
Acanthocyte (spur cell)
Liver disease, abetalipoproteinemia (states of cholesterol dysregulation)
“Acantho” = spiny
Spherocytes
Hereditary spherocytosis, Autoimmune Hemolysis
Teardrop cell
Bone Marrow infiltration (e.g. myelofibrosis)
Target cell
HbC disease, Asplenia, Liver disease, Thalassemia