Classic Labs/findings part 3

Question 1

“Bamboo spine” on x-ray

Answer 1

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

Question 2

Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)

Answer 2

SLE (type III hypersensitivity)

Question 3

Antineutrophil cytoplasmic antibodies (ANCAs)

Answer 3

Microscopic polyangiitis and eosinophilic granulomatosis
with polyangiitis (MPO-ANCA/p-ANCA);
Granulomatosis with polyangiitis (PR3-ANCA/c-ANCA);
Primary sclerosing cholangitis (MPO-ANCA/p-ANCA)

Question 4

Anticentromere antibodies

Answer 4

Scleroderma (CREST syndrome)

Question 5

Anti-topoisomerase antibodies

Answer 5

Diffuse scleroderma

Question 6

Anti-desmoglein (anti-desmosome) antibodies

Answer 6

Pemphigus vulgaris (blistering)

Question 7

Keratin pearls on a skin biopsy

Answer 7

Squamous cell carcinoma

Question 8

High AFP in amniotic fluid/maternal serum

Answer 8

Dating error, anencephaly, spina bifida (open neural tube defects)

Question 9

Bloody or yellow tap on lumbar puncture

Answer 9

Xanthochromia (due to subarachnoid hemorrhage)

Question 10

Eosinophilic cytoplasmic inclusion in neuron

Answer 10

Lewy body (Parkinson disease and Lewy body dementia)

Question 11

Extracellular amyloid deposition in gray matter of brain

Answer 11

Senile plaques (Alzheimer disease)

Question 12

Depigmentation of neurons in substantia nigra

Answer 12

Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)

Question 13

Protein aggregates in neurons from hyperphosphorylation

of tau protein

Answer 13

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

Question 14

Silver-staining spherical aggregation of tau proteins in neurons

Answer 14

Pick bodies (frontotemporal dementia: progressive
dementia, changes in personality)

Question 15

Pseudopalisading pleomorphic tumor cells on brain biopsy

Answer 15

Glioblastoma multiforme

Question 16

Circular grouping of dark tumor cells surrounding pale

neurofibrils

Answer 16

Homer-Wright rosettes (neuroblastoma, medulloblastoma)

Question 17

“Waxy” casts with very low urine flow

Answer 17

Chronic end-stage renal disease

Question 18

WBC casts in urine

Answer 18

Acute pyelonephritis, transplant rejection,

tubulointerstitial inflammation

Question 19

RBC casts in urine

Answer 19

Glomerulonephritis

Question 20

“Tram-track” appearance of capillary loops of glomerular

basement membranes on light microscopy

Answer 20

Membranoproliferative glomerulonephritis

Question 21

Anti–glomerular basement membrane antibodies

Answer 21

Goodpasture syndrome (glomerulonephritis and hemoptysis)

Question 22

Cellular crescents in Bowman capsule

Answer 22

Rapidly progressive (crescentic) glomerulonephritis

Question 23

“Wire loop” glomerular capillary appearance on light microscopy

Answer 23

Diffuse proliferative glomerulonephritis (usually seen

with lupus)

Question 24

Linear appearance of IgG deposition on glomerular and

alveolar basement membranes

Answer 24

Goodpasture syndrome

Question 25

“Lumpy bumpy” appearance of glomeruli on immunofluorescence

Answer 25

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

Question 26

Necrotizing vasculitis (lungs) and necrotizing
glomerulonephritis

Answer 26

Granulomatosis with polyangiitis (PR3-ANCA/c-ANCA)
and Goodpasture syndrome (anti–basement membrane
antibodies)

Question 27

Nodular hyaline deposits in glomeruli

Answer 27

Kimmelstiel-Wilson nodules (diabetic nephropathy)

Question 28

Podocyte fusion or “effacement” on electron microscopy

Answer 28

Minimal change disease (child with nephrotic syndrome)

Question 29

“Spikes” on basement membrane, “dome-like”

subepithelial deposits

Answer 29

Membranous nephropathy (nephrotic syndrome)

Question 30

Thyroid-like appearance of kidney

Answer 30

Chronic pyelonephritis (usually due to recurrent infections)

Question 31

Granular casts in urine

Answer 31

Acute tubular necrosis (eg, ischemia or toxic injury)

Question 32

hCG elevated

Answer 32

Multiple gestations, hydatidiform moles,

choriocarcinomas, Down syndrome

Question 33

Dysplastic squamous cervical cells with “raisinoid” nuclei

and hyperchromasia

Answer 33

Koilocytes (HPV: predisposes to cervical cancer)

Question 34

Sheets of uniform “fried egg” cells, high hCG, high LDH

Answer 34

Dysgerminoma

Question 35

Disarrayed granulosa cells arranged around collections of

eosinophilic fluid

Answer 35

Call-Exner bodies (granulosa cell tumor of the ovary)

Question 36

“Chocolate cyst” of ovary

Answer 36

Endometriosis (frequently involves both ovaries)

Question 37

Mammary gland (“blue domed”) cyst

Answer 37

Fibrocystic change of the breast

Question 38

Glomerulus-like structure surrounding vessel in germ

cells

Answer 38

Schiller-Duval bodies (yolk sac tumor)

Question 39

Rectangular, crystal-like, cytoplasmic inclusions in Leydig

cells

Answer 39

Reinke crystals (Leydig cell tumor)

Question 40

Thrombi made of white/red layers

Answer 40

Lines of Zahn (arterial thrombus, layers of platelets/RBCs)

Question 41

Hexagonal, double-pointed, needle-like crystals in bronchial secretions

Answer 41

Bronchial asthma (Charcot-Leyden crystals: eosinophilic
granules)

Question 42

Desquamated epithelium casts in sputum

Answer 42

Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)

Question 43

“Honeycomb lung” on x-ray or CT

Answer 43

Idiopathic pulmonary fibrosis

Question 44

Iron-containing nodules in alveolar septum

Answer 44

Ferruginous bodies (asbestosis: increased chance of lung cancer)

Question 45

Bronchogenic apical lung tumor on imaging

Answer 45

Pancoast tumor (can compress cervical sympathetic chain and cause Horner syndrome)