Classic Labs/Findings III

Question 1

Low serum ceruloplasmin

Answer 1

Wilson disease (hepatolenticular degenration)

Question 2

“Lumpy bumpy” appearance of glomeruli on immunofluorescence

Answer 2

Poststreptococcal glomerulonephritis (due to deposition of IgG, IgM, and C3)

Question 3

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

Answer 3

Multiple myeloma

Question 4

Mammary gland (“blue domed”) cyst

Answer 4

Fibrocystic change of the breast

Question 5

Monoclonal antibody spike

Answer 5

Multiple myeloma (usually IgG or IgA)
Monoclonal gammopathy of undetermined significance (consequence of aging)
Waldenstrom (M protein = IgM) macroglobulinemia
Primary amyloidosis

Question 6

Mucin-filled cell with peripheral nucleus

Answer 6

“Signet ring” (gastric carcinoma)

Question 7

Narrowing of bowel lumen on barium X-ray

Answer 7

“String sign” (Crohn’s disease)

Question 8

Nodular hyaline deposits in glomeruli

Answer 8

Kimmelsteil-Wilson nodules (diabetic nephropathy)

Question 9

Necrotizing vasculitis (lungs) and necrotising glomerulonephritis

Answer 9

Granulomatous with polyangiitis (Wegener, Pr3-ANCA and c-ANCA)
Goodpasture syndrome (anti-basement membrane antibodies)

Question 10

Needle-shaped, negatively birefringent crystals

Answer 10

Gout (monosodium urate crystals)

Question 11

Novobiocin response

Answer 11

Sensitive: Staph epidermidis
Resistant: Staph saprophyticus

Question 12

Nutmeg appearance of liver

Answer 12

Chronic passive congestion of liver due to right heart failure or Budd Chiari syndrome

Question 13

Optochin response

Answer 13

Sensitive: Strep pneumoniae
Resistant: Strep viridans (mutans, sanguis)

Question 14

Onion skin periosteal reaction

Answer 14

Ewing sarcoma (malignant small blue cell tumor)

Question 15

Periosteum raised from bone, creating triangular area

Answer 15

Codman triangle on x-ray, Ewing sarcoma, pyogenic osteomyelitis

Question 16

Podocyte fusion or effacement on electron microscopy

Answer 16

Minimal change disease (child with nephrotic syndrome)

Question 17

Polished, ivory-like appearance of bone at cartilage erosion

Answer 17

Eburnation (osteoarthritis resulting in bony sclerosis)

Question 18

Protein aggregates in neurons from hyperphosphrylation of tau protein

Answer 18

Neurofibrillary tangles (Alzheimer disease) and Pick bodies (Pick disease)

Question 19

Psammomma bodies

Answer 19

Meningiomas
Papillary thyroid carcinoma
Mesothelioma
Papillary serous carcinoma of endometrium and ovary

Question 20

Pseudopalisading tumor cells on brain biopsy

Answer 20

Glioblastoma multiforme

Question 21

RBC casts in urine

Answer 21

Glomerulonephritis

Question 22

Rectangular crystal-like, cytoplasmic inclusions in Leydig Cells

Answer 22

Reinke crystals (Leydig cell tumor)

Question 23

Recurrent infections, eczema, thrombocytopenia

Answer 23

Wiskott-Aldrich syndrome

Question 24

Renal epithelial casts in urine

Answer 24

Intrinsic renal failure (e.g., ischemia or toxic injury)

Question 25

Rhomboid crystals, positively birefringent

Answer 25

Pseudogout (calcium pyrophosphate dihydrate crystals)

Question 26

Rib notching

Answer 26

Coarctation of the aorta

Question 27

Ring-enhancing brain lesions in AIDS

Answer 27

Toxoplasma gondii, CNS lymphoma

Question 28

Sheets of medium-sized lymphoid cells with scattered pale, tingible body-laden macrophages (“starry sky” histology)

Answer 28

Burkitt lymphoma (t[8,14] c-myc activation associated with EBV; “starry sky” made up of malignant cells)

Question 29

Silver-staining spherical aggregation of tau proteins in neurons

Answer 29

Pick bodies (Pick disease: progressive dementia, changes in personality