Classic Labs/Findings Flashcards
Anticentromere antibodies
Scleroderma (CREST)
Anti-desmoglein (epithelial) antibodies
Pemphigus vulgaris (blistering
Anti-glomerular basement membrane antibodies
Goodpasture syndrome (glomerulonephritis and hemoptysis)
Antihistone antibodies
Drug-induced SLE (e.g. 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) (3)
Microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome (MPO-ANCA/p-ANCA)
Granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA)
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, weight loss)
“Apple core” lesion on barium enema x-ray
Colorectal cancer (usually L sided)
Atypical lymphocytes
EBV
Azurophilic peroxidase + granular inclusions in granulocytes and myeloblasts
Auer rods (AML, especially promyelocytic M3 type)
Bacitracin response (2)
Sensitive: S. pyogenes (GAS)
Resistant: S. agalactiae (GBS)
“Bamboo spine” on x ray
Ankylosing spondyliitis (chronic inflammatory arthritis, HLA B27)
Basophilic nuclear remnants in RBCs
Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)
Bloody or yellow tap on LP
Subarachnoid hemorrhage
“Boot-shaped” heart on XR
Tetralogy of Fallot (due to RVH)
Branching gram positive rods with sulfur granules
Actinomyces israelii
Bronchogenic apical lung tumor on imaging
Pancoast tumor (can compress cervical sympathetic chain and cause Horner syndrome)
“Brown” tumor of bone
Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorhage 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)
Colonies of mucoid Pseudomonas in lungs
Cystic fibrosis (AR mut in CFTR gene yields fat soluble vitamin deficiency and mucous plugs)
Decreased AFP in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormalities
Degeneration of dorsal column fibers (2)
Tabes dorsalis (tertiary syphilis), subacute combined degeneration (dorsal columns, lateral corticospinal, spinocerebellar tracts affected)
“Delta wave” on EKG, short PR interval, supraventricular tachycardia
Wolf-Parkinson-White syndrom e(Bundle of Kent bypasses AV node)
Depigmentation of neurons in substantia nigra
Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)
Desquamated epithelium casts in sputum
Curschmann spiral (bronchial asthma, can result in worled mucous plugs)
Disarrayed granulosa cells arragned around collections of eosinophilic fluid
Call-Exner bodies (granulosa cell tumor of the ovary)
Dysplastic squamos cervical cells with “raisinoid” nuclei and hyperchromasia
Koilocytes (HPV: predisposes to cervical cancer)
Electrical alternans (alternating amplitude on EKG)
Pericardial tamponade
Enlarged cells with intranuclear inclusion bodies
“Owl eye” appearance of CMV
Enlarged thyroid cells with ground glass nuclei with central clearing
“Orphan Annie” eyes 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 (viral hepatitis, yellow fever), represents hepatocyte undergoing apoptosis
Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons
Negri bodies of rabies
Extracellular amyloid deposition in gray matter of 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 (2)
Beta thallassemia, sickle cell disease (marrow expansion)
hCG elevated (2)
Choriocarcinoma, hydatidiform mole (occurs w/ and w/out embryo, and multiple pregnancy)
Heart nodules (granulomatous)
Aschoff bodies (rheumatic fever)
Heterophile antibodies
Infectious mononucleosis (EBV)
Hexagonal, double pointed, needlie like crystals in bronchial secretions
Bronchail asthma (Charcot-Leyden crystals: eosinophilic granules)
High level of D-Dimers (3)
DVT, PE, DIC
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)
Ghon complex (primary TB)
“Honeycomb lung” on XR or CT
Interstitial pulmonary fibrosis
Hypercoagulability (leading to migrating DVTs and vasculitis)
Trousseau syndrome (adenocarcinoma of pancreas or lung)
Hypersegmented neutrophils (2)
Megaloblastic anemia (B12 def: neuro symtpoms, folate def: no neuro symptoms)
Hypertension, hypokalemia, metabolic alkalosis
Conn syndrome (primary hyperaldosteronism)
Hypochromic, microcytic anemia (3)
Iron deficiency anemia
Lead poisoning
Thalassemia (fetal hemoglobin sometimes present)
Increased AFP in amniotic fluid/maternal serum (3)
Dating error, anencephaly, spina bifida (NTD)
Increased uric acid levels (4)
Gout
Lesch-Nyhan syndrome
Tumor lysis syndrome
Loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies
Cowdry type A bodies (HSV or VZV)
Iron-containing nodules in aveolar septum
Ferruginous bodies (asbestosis: increased chance of mesothelioma)
Keratin pearls on a skin biopsy
Squamos cell carcinoma
Large granules in phagocytes, immunodeficiency
Chediak-Higashi disease (congenital failure of phagolysosome formation)
“Lead pipe” appearance of colon on abdominal imaging
Ulcerative colitis (loss of haustra)
Linear appearance of IgG deposition on glomerular and alveolar basement membranes
Goodpasture syndrome
Low ceruloplasmin
Wilson disease (hepatolenticular degeneration)
“Lumpy bumpy” appearance of glomeruli on immunofluorescence
Poststreptococcal glomerulonephritis (due to deposition of IgG, IgM, and C3)
Lytic (“punched out”) bone lesions on x ray
Multiple myeloma
Mammary gland (“Blue domed”) cyst
Fibrocystic change of the breast
Monoclonal antibody spike (4)
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” (gastic carcinoma)
Narrowing of bowel lumen on barium x ray
“String sign” (Crohn disease)
Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis (2)
Granulomatosis with polyangiitis (Wegener, PR3-ANCA/c-ANCA) and Goodpasture syndrome (anti-BM antibodies)
Needle-shaped, negatively birefringent crystals (yellow when aligned parallel, blue when across)
Gout (monosodium urate crystals)
Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules (diabetic nephropathy)
Novobiocin response (2)
Sensitive: S. epidermidis
Resistant: S. saprophyticus
“Nutmeg” appearance of liver (2)
Chronic passive congestion of liver due to RH failure or Budd-Chiari syndrome
“Onion skin” periosteal reaction
Ewing sarcoma (malignant small blue cell tumor)
Optochin response (2/3)
Sensitive: S. pneumoniae
Resistant: viridans streptococci (S. mutans, S. sanguis)
Periosteum raised from bone, creating triangular area (2)
Codman triangle on x ray, 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 agggregates in neurons from hyperphosphorylation of tau protein
Neurofibrillary tangles (Alzheimer disease) and Pick bodies (Pick disease)
Psamomma bodies (4)
Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serious carcinoma of the endometrium and ovary
Pseudopalisading tumor cells on brain biopsy
Glioblastoma multiforme
RBC casts in urine
Glomerulonephritis
Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells
Reinke crystals (Leydig cell tumor)
Recurrent infections, eczema, thrombocytopenia
Wiskott-Aldrich syndrome
Renal epithelial casts in urine
Intrinsic renal failure (like ischemia or toxic injury)
Rhomboid crystals, positively birefringent (blue in parallel, yellow across)
Pseudogout (calcium pyrophosphate dihydrate crystals)
Rib notching
Coarctation of the aorta
Ring-enhancing brain lesion in AIDS (2)
Toxoplasma gondii, 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 activations, associated with EBV. Starry sky made up of malignant cells)
Silver-staining spherical aggregation of tau proteins in neurons
Pick bodies (Pick disease: 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 nephropathy (nephrotic syndrome)
Stacks of RBCs
Rouleaux formation (high ESR, multiple myeloma)
“Steeple” sign on CXR
Croup (parainfluenza virus)
Stippled vaginal epithelial cells
“Clue cells” (Gardnerella vaginalis)
Streptococcus bovis bacteremia
Colon cancer
“Tennis racket” shaped cytoplasmic organelles (EM) in Langerhans cells
Birbeck granules (Langerhans cell histiocytosis)
Thousands of polyps on colonoscopy
FAP (AD mutation of APC gene)
Thrombi made of white/red layers
Lines of Zahn (arterial thrombus, layers of platelets/RBCs)
“Thumb sign” on lateral neck x ray
Epiglottis (H. influenzae)
Thyroid-like appearance of kidney
Chronic pyelonephritis (usually due to recurrent infections)
“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
Diffuse proliferative glomerulonephritis (usually seen with lupus)
Yellowish CSF
Xanthochromia (e.g. due to subarachnoid hemorrhage)