Classic Labs/Findings Flashcards
anticentromere antibodies
Scleroderma (CREST)
andidesmoglein (epithelial) antibodies
pemphigus vulgaris (blistering)
anti-glomerular basement membrane antibodies
Goodpasture syndrome (glomerulonephritis and hemoptysis)
antihistone antibodies
drug-induced SLE (hydralizine, INH, phenytoin, procainamide)
anti-IgG antibodies
rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity)
antimitochondrial antibodies
primary biliary cirrhosis (female, cholestasis, portal HTN)
antineutrophil cytoplasmic antibodies (ANCA)
microscopic polyangiitis and Churg-Strauss syndrome (MPO-ANCA/p-ANCA)
granulomatosis with polyangiitis/Wegener’s granulomatosis (PR3-ANCA/c-ANCA)
antinuclear antibodies (ANAs: 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 L sided)
azurophilic peroxidase + granular inclusions in granulocytes and myeloblasts
Auer rods (AML, especially the promyelocytic M3 type)
Bacitracin response
Sensitive: Streptococcus pyogenes (group A)
Resistant:: Streptococcus agalactiae (group B)
“Bamboo spine” on x-ray
Ankylosing spondylitis (chronic inflammatory arthritis, associated with HLA-B27)
basophilic nuclear remnants in RBCs
Howell-Jolly bodies (due to splenectomy or functional asplenia)
basophilic stippling of RBCs
lead poisoning or sideroblastic anemia
bloody tap on LP
subarachnoid hemorrhage
“boot-shaped” heart on x-ray
Tetralogy of Fallot (children)
RVH (adults)
branching gram-positive rods with sulfur granules
Actinomyces israelii
bronchiogenic apical lung tumor on imaging
Pancoast tumor
can compress sympathetic ganglion and cause Horner syndrome
“Brown” tumor of bone
hyperparathyroidism or osteitis fibrosa cystica
deposited hemosiderin from hemorrhage gives brown color
cardiomegaly with apical atrophy
Chagas disease (Trypanosoma cruzi)
cellular crescents in Bowman 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-producing Pseudomonas in lungs
Cystic fibrosis
AR mutation in CFTR gene –> fat soluble vitamin deficiency and mucus plugs
decreased AFP in amnoitic fluid/maternal serum
Down syndrome or other chromosomal abnormality
degeneration of dorsal column nerves
Tabes dorsalis (tertiary syphillis), subacute combined degeneration (dorsal columns + lateral corticospinal tracts affected)
degeneration of neurons in substantia nigra
Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)
desquamated epithelial casts in sputum
Curschmann spirals (bronchial asthma, can result in whorled mucous 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)
enlarged cells with intranuclear inclusion bodies
“Owl eye” appearance of CMV
Enlarged thryoid cells with ground-glass nuclei
“Orphan Annie” nuclei
papillary carcinoma of the thyroid
eosinophilic cytoplasmic inclusion in liver cell
Mallory body (alcoholic liver disease)
Eosinophilic cytoplasmic inclusion in nerve cell
Lewy body (Parkinson disease)
Eosinophilic globule in liver
Councilman body (toxic or viral hepatitis, often yellow fever)
Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar nerve cells
Negri bodies of rabies
extracellular amyloid deposition in gray matter of the brain
senile plaques (Alzheimer disease)
Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”)
Reed-Sternberg cells (Hodgkin lymphoma)
Glomerulus-like structure surrounding vessel in germ cells
Schiller-Duval bodies (yolk sac tumor)
“Hair on end” (crew-cut) appearance on x-ray
B-thalassemia, sickle cell anemia (marrow expansion)
hCG elevated
choriocarcinoma, hydatidiform mole, multiple pregnancy
heart nodules (granulomatous)
Aschoff bodies (rheumatic fever)
heterophile antibodies
infectious mononucleosis (EBV)
hexagonal, double-pointed, needle-like crystals in bronchial secretions
bronchial asthma
Charcot-Leyden crystals, eosinophilic granules
high level of D-dimers
DVT, PE, 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 DVTs and vasculitis
Trousseau syndrome (adenocarcinoma of the pancreas or lung)
hypersegmented neutrophils
megaloblastic anemia (B12 deficiency: neurologic sx, folate deficiency: no neurologic sx)
HTN, hypokalema, metabolic alkalosis
Conn syndrome (aldosterone producing adenoma)
hypochromic, microcytic anemia
iron deficiency anemia, lead poisoning, thalassemia (fetal Hgb sometimes present)
increased AFP 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 sputum
ferruginous bodies (asbestosis: increased risk 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 x-ray
Ulcerative colitis (loss of haustra)
linear appearance of IgG deposition on glomerular basement membrane
Goodpasture syndrome
lower serum ceruloplasmin
Wilson disease (hepatolenticular degeneration)
“lumpy bumpy” appearance of glomeruli on immunoflourescence
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 (usually IgG or IgA)
- monoclonal gammopathy of undetermined significance (MGUS consequence of aging)
- Waldenstrom (M protein = IgM) macroglobulinemia
- primary amyloidosis
mucin-filled cell with peripheral nucleus
“signet ring”
gastric carcinoma
narrowing of bowel lumen on barium x-ray
“string sign”
Crohn disease
necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
granulomatosis with polyangiitis (Wegener, PR3-ANCA/c-ANCA) Goodpasture syndrome (anti-basement membrane antibodies)
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 saphrophyticus
“nutmeg” appearance of liver
chronic passive congestion of liver due to R heart failure
“onion skin” periosteal reaction
Ewing sarcoma (malignant round cell tumor)
optochin response
sensitive: Streptococcus pneumoniae
resistant: viridans Streptococci
periosteum raised from bone, creating triangular area
Codman’s triangle on x-ray
osteosarcoma, Ewing 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 tau protein
Neurofibrillary tangles (Alzheimer disease) and Pick bodies (Pick disease)
Psammoma bodies
meningioma
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 in Leydig cells
Reinke crystals (Leydig cell tumor)
Renal epithelial casts in urine
acute toxic/viral renal injury
rhomboid crystals, positively birefringent
pseudogout (calcium pyrophosphate dihydrate crystals)
rib notching
coarctation of the aorta
ring-enhancing brain lesions in AIDS
toxoplasma gondii
primary CNS lymphoma
sheets of medium-sized lymphoid cells with scattered pale, tingible body-laden macrophages (“starry sky” histology)
Burkitt lymphoma
t(8,14) –> c-myc activation
associated with EBV
“black sky” made up of malignant cells
sliver-staining spherical aggregation of tau proteins in neurons
Pick bodies
Pick disease: progressive dementia + changes in personality
“soap bubble” in femur or tibia on xray
Giant cell tumor of bone (generally benign)
“spikes” on basement membrane, “dome-like” subepithelial deposits
membranous glomerulonephritis (may progress to nephrotic syndrome)
stacks of RBCs
Rouleaux formation (high ESR, multiple myeloma)
stippled vaginal epithelial cells
“clue cells” (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/RBCs
“thumb sign” on lateral x-ray
Epiglottitis (Haemophilus influenzae)
thyroid-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
WBCs 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)