Classic Labs/Findings 4

Question 1

“Lead pipe” appearance of colon on barium enema x-ray?

Answer 1

Ulcerative colitis (loss of haustra)

Question 2

Linear appearance of IgG deposition on glomerular BM?

Answer 2

Goodpasture’s

Question 3

Low serum ceruloplasmin?

Answer 3

Wilson’s (hepatolentricular degeneration)

Question 4

“Lumpy bumpy” appearance of glomeruli on IF?

Answer 4

Poststrep glomerulonephritis (immune complex deposition of IgG + C3b)

Question 5

Lytic (“hole punched”) bone lesions on x-ray?

Answer 5

Plasma cell myeloma

Question 6

Mammary gland (“blue domed”) cyst?

Answer 6

Fibrocystic change of the breast

Question 7

Monoclonal Ab spike?

Answer 7

Multiple myeloma (IgG or IgA), MGUS (normal consequence of aging), Waldenstrom’s (M protein = IgM), primary amyloidosis

Question 8

Mucin-filled cell with peripheral nucleus?

Answer 8

Signet ring (gastric carcinoma)

Question 9

Narrowing of bowel lumen on barium x-ray?

Answer 9

“String sign” (Crohn’s)

Question 10

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis?

Answer 10

Granulomatosis with polyangiitis (Wegener’s; c-ANCA positive) and Goodpasture’s (anti-BM Abs)

Question 11

Needle-shaped, negatively birefringent crystals?

Answer 11

Gout (monosodium urate crystals)

Question 12

Nodular hyaline deposits in glomeruli?

Answer 12

Kimmelstiel-Wilson nodules (diabetic nephropathy)

Question 13

Novobiocin response?

Answer 13

Sensitive: Staph epidermidis; resistant: Staph saprophyticus

Question 14

“Nutmeg” appearance of liver?

Answer 14

Chronic passive congestion of liver due to right heart failure

Question 15

“Onion skin” periosteal reaction?

Answer 15

Ewing’s sarcoma (malignant round-cell tumor)

Question 16

Optochin response?

Answer 16

Sensitive: Strep pneumoniae; resistant: Viridans strep

Question 17

Periosteum raised from bone, creating triangular area?

Answer 17

Codman’s triangle on x-ray (osteosarcoma, Ewing’s sarcoma, pyogenic osteomyelitis)

Question 18

Podocyte fusion or “effacement” on electron microscopy?

Answer 18

Minimal change dz (child with nephrotic syndrome)

Question 19

Polished, “ivory like” appearance of bone at cartilage erosion?

Answer 19

Eburnation (osteoarthritis resulting in bony sclerosis)

Question 20

Protein aggregates in neurons from hyperphosphorylation of protein tau?

Answer 20

Neurofibrillary tangles (Alzheimer’s) and Pick’s bodies (Pick’s dz)