Classic Labs/Findings Flashcards
Pemphigus vulgaris
Antidesmoglein (epithelial) antibodies [blistering]
Scleroderma (CREST)
Anticentromere antibodies (CREST syndrome = limited/cutaneous scleroderma; CREST = calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia)
Goodpasture’s syndrome
Anti-glomerular basement membrane antibodies (glomerulonephritis and hemoptysis)
Drug-induced SLE
Antihistone antibodies (hydralazine, isoniazid, phenytoin, procainamide; anti-HIPP-stone antibodies)
Rheumatoid arthritis
Anti-IgG antibodies (systemic inflammation, joint pannus, boutonnière deformity)
Primary biliary cirrhosis
Antimitochondrial antibodies (AMAs) [female, cholestasis, portal hypertension]
Vasculitis
Antineutrophil cytoplasmic antibodies (ANCAs) [c-ANCA: granulomatosis with polyangiitis, Wegener’s granulomatosis; p-ANCA: microscopic polyangiitis, Churg-Strauss syndrome)
SLE (systemic lupus erythematosus)
Antinuclear antibodies (ANAs: antiSmith and anti-dsDNA) [type III hypersensitivity)
Idiopathic thrombocytopenic purpura
Antiplatelet antibodies
Diffuse systemic scleroderma
Anti-topoisomerase antibodies = anti-scl70 antibodies
Celiac disease
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies (diarrhea, distension, weight loss)
Colorectal cancer
“Apple core” lesion on abdominal x-ray (usually left sided)
Auer cross
Azurophilic peroxidase-positive granular inclusions in granulocytes and myeloblasts (acute myelogenous leukemia, especially the promyelocytic [M3] type)
Bacitracin response
Sensitive: Streptococcus pyogenes (group A); resistant: Streptococcus agalactiae (group B; group B Beats Bacitracin)
Akylosing spondylitis
“Bamboo spine” on x-ray (chronic inflammatory arthritis; strong association with HLA-B27)
Howell-Jolly bodies
Basophilic nuclear remnants in RBCs (due to splenectomy or nonfunctional spleen)
Lead poisoning or sideroblastic anemia
Basophilic stippling of RBCs
Subarachnoid hemorrhage
Bloody tap on LP
Tetralogy of Fallot, RVH
“Boot-shaped” heart on x-ray
Actinomyces israelii
Branching gram-positive rods with sulfur granules
Pancoast tumor
Bronchogenic apical lung tumor on imaging (can compress sympathetic ganglion and cause Horner’s syndrome)
Hyperparathyroidism or osteitis fibrosa cystica
“Brown” tumor of bone (deposited hemosiderin from hemorrhage gives brown color)
Chagas’ disease
Cardiomegaly with apical atrophy (Trypanosoma cruzi)
Rapidly progressive crescentic glomerulonephritis
Cellular crescents in Bowman’s capsule
Endometriosis
“Chocolate cyst” of ovary (frequently involves both ovaries)
Homer-Wrightt rosettes
Circular grouping of dark tumor cells surrounding pale neurofibrils (neuroblastoma, medulloblastoma, retinoblastoma)
Cystic fibrosis
Colonies of mucoid Pseudomonas in lungs (AR mutation in CFTR resulting in fat-soluble vitamin deficiency and mucous plugs)
Down syndrome or other chromosomal abnormality
⬇️ alpha-fetoprotein in amniotic fluid/maternal serum (in Down syndrome, alpha-fetoprotein goes DOWN; vs. neural tube defects, which have ⬆️ alpha-fetoprotein)
Tabes dorsalis, subacute combined degeneration
Degeneration of dorsal column nerves (tabes dorsalis: tertiary syphilis; in subacute combined degeneration, dorsal columns and lateral corticospinal tracts affected)
Parkinson’s disease
Depigmentation of neurons in substantia nigra (basal ganglia disorder: rigidity, resting tremor, bradykinesia)
Curschmann’s spirals
Desquamated epithelium casts in sputum (bronchial asthma; can result in whorled mucous plugs)
Call-Exner bodies
Disarrayed granulosa cells in eosinophilic fluid (granulosa-theca cell tumor of the ovary)
Koilocytes
Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia (HPV; predisposes to cervical cancer)
“Owl’s eye” appearance
Enlarged cells with intranuclear inclusion bodies (CMV)
“Orphan Annie’s eyes” nuclei
Enlarged thyroid cells with ground-glass nuclei (papillary carcinoma of the thyroid)
Mallory bodies
Eosinophilic cytoplasmic inclusion in liver cell (alcoholic liver disease)
Lewy body
Eosinophilic cytoplasmic inclusion in nerve cell (Parkinson’s disease)
Councilman body
Eosinophilic globule in liver (toxic or viral hepatitis, often yellow fever)
Negri bodies
Eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells (rabies, Lyssavirus)
Senile plaques
Extracellular amyloid deposition in gray matter of brain (Alzheimer’s disease)
Reed-Sternberg cells
Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”) [Hodgkin’s lymphoma]
Schiller-Duval bodies
Glomerulus-like structure surrounding vessel in germ cells (yolk sac tumor)
“Hair on end” (crew cut) appearance on x-ray
Beta-thalassemia, sickle cell anemia (due to marrow expansion)
⬆️ hCG
Choriocarcinoma, hydatidiform mole (occurs with and without embryo)
Aschoff bodies
Heart nodules (granulomatous) [rheumatic fever]
Infectious mononucleosis
Heterophile antibodies (EBV)
Bronchial asthma
Charcot-Leyden crystals: eosinophilic granules (hexagonal, double-pointed, needle-like crystals in bronchial secretions)
High level of D-dimers
DVT, pulmonary embolism, DIC
Ghon complex
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify) [primary TB: Mycobacterium bacilli]
Interstitial pulmonary fibrosis
“Honeycomb lung” on x-ray or CT
Trousseau’s syndrome
Hypercoagulability (leading to migrating DVTs and vasculitis) [adenocarcinoma of pancreas or lung]
Megaloblastic anemia
Hypersegmented neutrophils (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms)
Conn’s syndrome
Hypertension, hypokalemia, metabolic alkalosis (primary hyperaldosteronism, specifically an aldosterone-secreting adrenal adenoma)
Hypochromic, microcytic anemia
Iron deficiency anemia, lead poisoning, thalassemia (fetal Hb sometimes present)
⬆️ alpha-fetoprotein in amniotic fluid/maternal serum
Dating error, anencephaly, spina bifida (neural tube defects) [vs. Down syndrome, which has ⬇️ alpha-fetoprotein]
Increased uric acid levels
Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics)
Cowdry type A bodies
Intranuclear eosinophilic droplet-like bodies (HSV or CMV)
Ferruginous bodies
Iron-containing nodules in alveolar septum (asbestosis: ⬆️ chance of mesothelioma, but lung cancer still more common among those exposed to asbestos)
Squamous cell carcinoma
Keratin pearls on a skin biopsy
Chèdiak-Higashi disease
Large lysosomal vesicles in phagocytes, immunodeficiency (congenital failure of phagolysosome formation)
Ulcerative colitis
“Lead pipe” appearance of colon on barium enema x-ray (loss of haustra)
Goodpasture’s syndrome
Linear appearance of IgG deposition on glomerular basement membrane
Wilson’s disease
Low serum ceruloplasmin (hepatolenticular degeneration)
Postreptococcal glomerulonephritis
“Lumpy bumpy” appearance of glomeruli on immunofluorescence (immune complex deposition of IgG and C3b)
Multiple myeloma
Lytic (“hole punched”) bone lesions on x-ray
Fibrocystic change of breast
Mammary gland (“blue domed”) cyst
Monoclonal antibody spike
- Multiple myeloma (usually IgG or IgA)
- Monoclonal gammopathy of undetermined significance (MGUS; normal consequence of aging)
- Waldenström’s (M protein = IgM) macroglobulinemia
- Primary amyloidosis
Signet ring
Mucin-filled cell with peripheral nucleus (gastric carcinoma)
“String sign”
Narrowing of bowel lumen on barium x-ray (Crohn’s disease)
Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
Granulomatous with polyangiitis (Wegener’s; c-ANCA positive) and Goodpasture’s syndrome (anti-basement membrane antibodies)
Gout
Needle-shaped, negatively birefringent crystals (monosodium urate crystals)
Kimmelstiel-Wilson nodules
Nodular hyaline deposits in glomeruli (diabetic nephropathy)
Novobiocin response
Sensitive: Staphylococcus epidermidis; resistant: Staphylococcus saprophyticus
“Nutmeg” appearance of liver
Chronic passive congestion of liver due to right heart failure
Ewing’s sarcoma
“Onion ring” periosteal reaction (malignant round cell tumor)
Optochin response
Sensitive: Streptococcus pneumoniae; resistant: Viridans streptococcus
Codman’s triangle on x-ray
Periosteum raised from bone, creating triangular area (osteosarcoma, Ewing’s sarcoma, pyogenic osteomyelitis)
Minimal change disease
Podocyte fusion or “effacement” on electron microscopy (child with nephrotic syndrome)
Eburnation
Polished, “ivory like” appearance of bone at cartilage erosion (osteoarthritis resulting in bony sclerosis)
Neurofibrillary tangles and Pick’s bodies
Protein aggregates in neurons from hyperphosphorylation of protein tau (neurofibrillary tangles: Alzheimer’s disease; Pick’s bodies: Pick’s disease)
Psamomma bodies
Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serous carcinoma of the endometrium and ovary
Gliobastoma multiforme
Pseudopalisading tumor cells on brain biopsy
Acute glomerulonephritis
RBC casts in urine
Reinke crystals
Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells (Leydig cell tumor)
Acute toxic/viral nephrosis
Renal epithelial casts in urine
Pseudogout
Rhomboid crystals, positively birefringent (calcium phosphate dihydrate crystals)
Coarctation of the aorta
Rib notching
Ring-enhancing brain lesion in AIDS
Toxoplasmosis gondii, CNS lymphoma
Burkitt’s lymphoma
Sheets of medium-sized lymphoid cells with scattered pale, tingible body-laden macrophages (“starry sky” histology) (t[8:14] c-myc activation, associated with EBV; “black sky” made up of malignant cells)
Pick bodies
Silver-staining spherical aggregation of tau proteins in neurons (Pick’s disease: progressive dementia, changes in personality)
Giant cell tumor of bone
“Soap bubble” in femur or tibia on x-ray (generally benign)
Membranous glomerulonephritis
“Spikes” on basement membrane, “dome like” subepithelial deposits (may progress to nephrotic syndrome)
Rouleaux formation
Stacks of RBCs (high ESR, multiple myeloma)
“Clue cells”
Stippled vaginal epithelial cells (Gardnerella vaginalis)
Birbeck granules
“Tennis racket” shaped cytoplasmic organelles (EM) in Langerhans cells (Langerhans cell histiocytosis or hystiocytosis x: eosinophilic granuloma)
Lines of Zahn
Thrombi made of white/red layers (arterial thrombus, layers of platelets/RBCs)
Epiglottitis
“Thumb sign” on lateral x-ray (Haemophilus influenzae)
Chronic bacterial pyelonephritis
Thyroid-like appearance of kidney
Membranoproliferative glomerulonephritis
Tram-track appearance of capillary loops of glomerular basement membranes on light microscopy
Fatty liver disease
Triglyceride accumulation in liver cell vacuoles (alcoholic or metabolic syndrome)
Chronic end-stage renal disease
“Waxy” casts with very low urine flow
Acute pyelonephritis
WBC casts in urine
CLL
WBCs that look smudged (almost always B cell)
Lupus nephropathy
“Wire loop” glomerular capillary appearance on light microscopy
Xanthochromia
Yellowish CSF (e.g., due to subarachnoid hemorrhage)
