Classic Labs/Findings Flashcards
Anti-desmoglein (epithelial) Ab’s
Pemphigus vulgaris (blistering)
Anti-glomerular basement membrane anti-bodies
Goodpasture’s syndrome
glomerulonephritis and hemoptysis
Antihistone anti-bodies
Drug-induced SLE
hydralazine, isoniazid, phenytoin, procainamide
Anti-IgG antibodies
Rheumatoid arthritis
systemic inflammation, join pannus, boutonnière deformity
Anti-mitochondrial antibodies (AMAs)
Primary biliary cirrhosis
female, cholestasis, portal hypertension
Anti-neutrophilic cytoplasmic anti-bodies (ANCAs)
Vasculitis
(c-ANCA: Granulomatosis with pharyngitis [Wagner’s])
(p-ANCA: microscopic Pharyngitis, Churg–Strauss syndrome)
Anti-nuclear antibodies
AMAs: anti-Smith and anti-dsDNA
SLE (Type III hypersensitivity)
Antiplatelet antibodies
Idiopathic thrombocytopenic Purpera (ITP)
Anti-topoisomerase anti-bodies
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)
Azurpphilic peroxidase-positive granular inclusions in granulocytes and myeloblasts
Auer rods
acute myelogenous leukemia, 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: HLA-B27
Basophilic nuclear remnants in RBCs
Howell-Jolly bodies
due to splenectomy or nonfunctional spleen
Basophilic stippling of RBCs
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
Actinomycetes israelii
Bronchogenic apical lung tumor on imaging
Pancoast tumor
can compress sympathetic ganglion and cause Horner’s 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’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 and lungs
Cystic fibrosis
autosomal-recessive mutation in CFTR resulting in fat-soluble vitamin deficiency and mucous plugs
Decreased alpha-fetoprotein in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormalities
Degeneration of dorsal column nerves
~Tabes dorsalis (tertiary syphilis)
~subacute combined degeneration (dorsal columns and lateral corticospinal tract affected)
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
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 inclusion in liver cells
Mallory bodies
alcoholic liver disease
Eosinophilic cytoplasmic inclusions 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
Negri bodies of rabies
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
Bronchial asthma
Charcot-Leyden crystals: eosinophilic granules
High level of D-dimers
~DVT
~pulmonary embolism
~DIC
~Hailar 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’s syndrome
adenocarcinoma of pancreas or lung
Hypersegmented neutrophils
Megaloblastic anemia
(B12 deficiency: neurologic symptoms)
(folate deficiency: no neurologic symptoms)
1) Hypertension
2) hypokalemia
3) 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
~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
Keratin pearls on a skin biopsy
Squamous cell carcinoma
Large lysosomal vesicles in phagocytes, immunodeficiency
Chédiak-Hagashi 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 (hepatolenticular degeneration)
“Lumpy bumpy” appearance of glomeruli on immunoflorescence
Poststreptococcal glomerulonephritis
immune complex deposition of IgG and C3b
Lytic (“hole punched”) bone lesions on x-ray
Multiple myeloma
Mammary gland (“blue dome”) cyst
Fibrocystic change of the breast
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
Mucin-filled cells with peripheral nucleus
Singlet 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) and Goodpasture’s 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 saprophyticus
“Nutmeg” appearance of 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: Streptococcus pneumoniae
Resistant: Viridans streptococcus
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 disease) 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 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 crystals
Rib notching
Coarctation of the aorta
Ring-enhancing brain lesion 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: progressive dementia, changes in personality
“Soap bubble” in femur or tibia an 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 RBCs
Rouleaux formation
high ESR, multiple myeloma
Stippled vaginal epithelial cells
“Clue cells” (Gardnerella vaginalis)
“Tennis racket” shape cytoplasmic organelles (EM) in Langerhans cells
Birbeck granules
Langerhans cells 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
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
Anticentromere antibodies
Scleroderma (CREST)