First Aid Classic Labs and Findings Flashcards
decreased AFP in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormalities
large granules in phagocytes, immunodeficiency
Chediak-Higashi disease (congenital failure of phagolysosome formation)
recurrent infections, eczema, thrombocytopenia
Wiskott-Aldrich syndrome
hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)
ghon complex (primary TB)
bacteria-covered vaginal epithelial cells
“clue cells” (gardnerella vaginalis)
cardiomegaly with apical atrophy
Chagas disease (trypanosome cruzi)
intranuclear eosinophilic droplet-like bodies
Cowdry type A (HSV or VZV)
eosinophilic globule in liver
Councilman body (viral hepatitis, yellow fever), represents hepatocyte undergoing apoptosis
eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons
Negri bodies of rabies
atypical lymphocytes
EBV
enlarged cells with intranuclear inclusion bodies
“owl eyes” appearance of CMV
“delta wave” on ECG, short PR interval, supra ventricular tachycardia
Wolf-Parkinson-White syndrome (Bundle of Kent bypasses AV node)
“boot shaped” heart on XR
tetralogy of Fallot (due to RVH)
rib notching (inferior surface on XR)
coarctication of the aorta
heart nodules (granulomatous)
Aschoff bodies (rheumatic fever)
electrical alternans (alternating amplitud on ECG)
pericardial tamponade
hypertension, hypokalemia, metabolic acidosis
primary hyperaldosteronism (Conn syndrome)
enlarged thyroid cells with ground-glass nuclei with central clearing
“Orphan Annie” eyes nuclei (papillary carcinoma of the thyroid
antineutrophil cytoplasmic antibodies (ANCAs)
- Microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis
- MPO-ANCA/p-ANCA
- granulomatosis with polyangiitis (Wegener)
- PR3-ANCA/c-ANCA
- primary sclerosing cholangitis
- MPO-ANCA/p-ANCA
mucin-filled cell with peripheral nucleus
“signet ring” (gastric carcinoma)
anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
celiac disease (diarrhea, weight loss)
narrowing of bowel lumen on barium XR
“string sign” (Crohn disease)
“lead pipe” appearance of colon on abdominal imaging
ulcerative colitis (loss of haustra)
thousands of polyps on colonoscopy
Familial adenomatous polyposis (AD, mutation of APC gene)
“apple core” lesion on barium enema XR
colorectal cancer (usually L sided)
eosinophilic cytoplasmic inclusion in liver cell
Mallory body (alcoholic liver disease)
triglyceride accumulation in liver cell vacuoles
fatty liver disease (alcoholic or metabolic syndrome)
“nutmeg” appearance of liver
Chronic passive congestion of liver due to right heart failure or Budd-Chiari syndrome
Antimitochondrial antibodies (AMAs)
Primary biliary cirrhosis (female, cholestasis, portal hypertension)
low serum ceruloplasmin
Wilson disease
hepatolenticular degeneration; Kayser-Fleischer rings due to copper accumulation
migratory thrombophlebitis (leading to migrating DVTs and vasculitis)
Trousseau syndrome
adenocarcinoma of pancreas or lung
basophilic nuclear remnants in RBCs
Howell-Jolly bodies
due to splenectomy or nonfunctional spleen
hypochromic, microcytic anemia
Fe deficiency anemia, lead poisoning, thalassemia (fetal hemoglobin sometimes present)
basophilic stippling of RBCs
lead poisoning or sideroblastic anemia
“hair on end” (“crew cut”) appearance on XR
Beta-thalassemia, sickle cell disease (marrow expansion)
hypersegmented neutrophils
megaloblastic anemia
- B12 deficiency
- neurologic symptoms
- folate deficiency
- no neuro ssx
antiplatelet antibodies
idiopathic thrombocytopenic purpura
Giant B cells with bilobed nuclei with prominent inclusions (“owl eyes”)
Reed-Sternberg cells
Hodgkins lymphoma
Sheets of medium-sized lymphoid cells with scattered pale, tingible body-laden macrophages
- Burkitt lymphoma
- t(8:14)
- c-myc activation
- a/w EBV
- “starry sky” histology made of malignant cells
lytic “punched out” bone lesions on XR
multiple myeloma
monoclonal antibody spike
ddx?
- multiple myeloma (usually IgG or IgA)
- monoclonal gammopathy of undetermined significance (MGUS consequence of aging)
- Waldenstrom (M protein = IgM) macroglobulinemia
- Primary amyloidosis
stacks of RBCs
Rouleaux formation (high ESR, multiple myeloma)
azurophilic peroxidase positive granular inclusions in granulocytes and myeloblasts
auer rods (AML, especially the promyelocytic M3 type)
WBCs that look ‘smudged’
CLL (almost always B cell)
“tennis-raquet”-shaped cytoplasmic organelles (EM) in Langerhans cells
Birbeck granules (Langerhans cell histiocytosis)
“Brown” tumor of bone
hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color)
raised periosteum (creating a ‘Codman triangle’)
aggressive bone lesion (osteosarcoma, Ewing sarcoma, osteomyelitis)
“soap bubble” in femur or tibia on XR
giant cell tumor of bone (generally benign)
“onion skin” periosteal reaction
Ewing sarcoma (malignant small blue cell tumor)
Anti-IgG antibodies
Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere and swan neck deformities)
Rhomboid crystals, positive birefringent
pseudogout (calcium pyrophosphate dihydrate crystals)
needle shaped, negative birefringent crystals
gout (monosodium urate crystals)
increased uric acid levels ddx
- gout
- Lesch-Nyhan syndrome
- tumor lysis syndrome
- loop and thiazide diuretics
“bamboo spine” on XR
ankylosing spondylosis (chronic inflammatory arthritis; HLA:B27)
antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)
SLE (type III hypersensitivity)
anti-topoisomerase antibodies
diffuse systemic scleroderma
antihistone antibodies
drug-induced SLE (eg, hydralazine, isoniazid, phenytoin, procainamide)
bloody or yellow tap on LP
subarachnoid hemorrhage
yellowish CSF
xanthochromia (eg, due to subarachnoid hemorrhage)
eosinophilic cytoplasmic inclusion in neuron
Lewy body (PD and lewy body dementia)
extracellular amyloid deposition in gray matter of brain
senile plaques (AD)
protein aggregates in neurons from hyperphosphorylation of tau protein
neurofibrillary tangles (AD) and Pick bodies (Pick disease)
silver-staining spherical aggregation of tau proteins in neurons
Pick bodies (Pick disease: progressive dementia, changes in personality)
pseudopalisading tumor cells on brain biopsy
glioblastoma multiforme
circular grouping of dark tumor cells surrounding pale neurofibrils
Homer-Wright rosettes (neuroblastoma, medulloblastoma)
“waxy” casts with very low urine flow
chronic end stage renal disease
RBC casts in urine
glomerulonephritis
“tram track” appearance of capillary loops of glomerular basement membranes on light microscopy
membranoproliferative glomerulonephritis
nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules (diabetic nephropathy)
podocyte fusion or “effacement” on electron microscopy
minimal change disease (child with nephrotic syndrome)
“spikes” on basement membrane, “dome-like” subepithelial deposits
membranous nephropathy (nephrotic syndrome)
anti-glomerular basement membrane antibodies
Goodpasture syndrome (glomerulonephritis and hemoptysis)
cellular crescents in Bowman capsule
rapidly progressive crescenteric glomerulonephritis
“wire loop” glomerular capillary appearance on light microscopy
diffuse proliferative glomerulonephritis (usually seen with lupus)
linear appearance of IgG depositon on glomerular and alveolar basement membranes
Goodpasture syndrome
“lumpy bumpy” appearance of glomeruli on immunofluorescence
poststreptococcal glomerulonephritis (due to deposition of IgG, IgM, and C3)
necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA)
and
Goodpasture syndrome (anti-basement membrane antibodies)
thyroid-like appearance of kidney
chronic pyelonephritis (usually due to recurrent infections)
WBC casts in urine
acute pyelonephritis
renal epithelial casts in urine
intrinsic renal failure (eg, ischemia or toxic injury)
hCG elevated ddx
choriocarcinoma
hydatiform mole (occurs with and without embryo, and multiple pregnancy)
dysplastic squamous cervical cells with “raisinoid” nuclei and hyperchromasia
koilocytes (HPV: predisposes to cervical cancer)
psammoma bodies ddx
- meningiomas
- papillary thyroid carcinoma
- mesothelioma
- papillary serous carcinoma of the endometrium and ovary
disarrayed granulosa cells arranged around collections of eosinophilic fluid
Call-Exner bodies (granulosa cell tumor of the ovary)
“chocolate cyst” of ovary
endometriosis (frequently involves both ovaries)
mammary gland (“blue domed”) cyst
fibrocystic change of the breast
glomerulus-like structure surrounding vessel in germ cells
Schiller-Duval bodies (yolk sac tumor)
rectangular, crystal-like, cytoplasmic inclusions in Leydig cells
Reinke crystals (Leydig cell tumor)
thrombi made of white/red layers
Lines of Zahn (arterial thrombus, layers of platelets/RBCs)
hexagonal, double-pointed, needle-like crystals in bronchial secretions
bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)
desquamated epithelium casts in sputum
Curschmann spirals (bronchial asthma, can result in whorled mucous plugs)
“honeycomb lung” on XR or CT
interstitial pulmonary fibrosis
colonies of mucoid Pseudomonas in lungs
cystic fibrosis - autosomal recessive mutation of CFTR gene (fat soluble vitamin deficiency and mucous plugs)
iron-containing nodules in alveolar septum
ferruginous bodies (asbestosis: increase chance of lung cancer)
bronchogenic apical lung tumor on imaging
pancoast tumor (can compress cervical sympathetic chain and cause Horner syndrome)
