Classic Labs/findings part 2

Question 1

“Apple core” lesion on barium enema x-ray

Answer 1

Colorectal cancer (usually left-sided)

Question 2

Eosinophilic cytoplasmic inclusion in liver cell

Answer 2

Mallory body (alcoholic liver disease)

Question 3

Triglyceride accumulation in liver cell vacuoles

Answer 3

Fatty liver disease (alcoholic or metabolic syndrome)

Question 4

Anti-smooth muscle antibodies (ASMAs), anti-liver/kidney microsomal-1 (anti-LKM1) antibodies

Answer 4

Autoimmune hepatitis

Question 5

“Nutmeg” appearance of liver

Answer 5

Chronic passive congestion of liver due to right heart

failure or Budd-Chiari syndrome

Question 6

Antimitochondrial antibodies (AMAs)

Answer 6

1° biliary cholangitis (female, cholestasis, portal hypertension)

Question 7

Low serum ceruloplasmin

Answer 7

Wilson disease (hepatolenticular degeneration; Kayser-
Fleischer rings due to copper accumulation)

Question 8

Migratory thrombophlebitis (leading to migrating DVTs and vasculitis)

Answer 8

Trousseau syndrome (adenocarcinoma of pancreas or lung)

Question 9

Hypersegmented neutrophils

Answer 9

Megaloblastic anemia (B12 deficiency: neurologic
symptoms; folate deficiency: no neurologic symptoms)

Question 10

Basophilic nuclear remnants in RBCs

Answer 10

Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)

Question 11

Basophilic stippling of RBCs

Answer 11

Lead poisoning or sideroblastic anemia

Question 12

Hypochromic, microcytic anemia

Answer 12

Iron deficiency anemia, lead poisoning, thalassemia (fetal hemoglobin sometimes present)

Question 13

“Hair on end” (“crew cut”) appearance on x-ray

Answer 13

β-thalassemia, sickle cell disease (marrow expansion)

Question 14

Anti-GpIIb/IIIa antibodies

Answer 14

Immune thrombocytopenia

Question 15

High level of d-dimers

Answer 15

DVT, DIC

Question 16

Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”)

Answer 16

Reed-Sternberg cells (Hodgkin lymphoma)

Question 17

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

Answer 17

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

Question 18

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

Answer 18

Multiple myeloma

Question 19

Monoclonal spike on serum protein electrophoresis

Answer 19

Multiple myeloma (usually IgG or IgA)
Waldenström macroglobulinemia (IgM)
Monoclonal gammopathy of undetermined
significance

Question 20

Stacks of RBCs

Answer 20

Rouleaux formation (high ESR, multiple myeloma)

Question 21

Azurophilic peroxidase ⊕ granular inclusions in

granulocytes and myeloblasts

Answer 21

Auer rods (APL)

Question 22

WBCs that look “smudged”

Answer 22

CLL

Question 23

“Tennis racket”-shaped cytoplasmic organelles (EM) in Langerhans cells

Answer 23

Birbeck granules (Langerhans cell histiocytosis)

Question 24

“Soap bubble” in femur or tibia on x-ray

Answer 24

Giant cell tumor of bone (generally benign)

Question 25

Raised periosteum (creating a “Codman triangle”)

Answer 25

Aggressive bone lesion (eg, osteosarcoma, Ewing

sarcoma)

Question 26

“Onion skin” periosteal reaction

Answer 26

Ewing sarcoma (malignant small blue cell tumor)

Question 27

Anti-IgG antibodies

Answer 27

Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere and swan neck deformities)

Question 28

Rhomboid crystals, ⊕ birefringent

Answer 28

Pseudogout (calcium pyrophosphate dihydrate crystals)

Question 29

Needle-shaped, ⊝ birefringent crystals

Answer 29

Gout (monosodium urate crystals)

Question 30

High uric acid levels

Answer 30

Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics