Lessons 1 Flashcards by Shahnaz Fareed

Gout, intellectual disability, self-mutilating behavior in a boy

Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)

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Situs inversus, chronic sinusitis, bronchiectasis, infertility

Kartagener syndrome (dynein arm defect affecting cilia)

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Blue sclera

Osteogenesis imperfecta (type I collagen defect)

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Elastic skin, hypermobility of joints,bleeding tendency

Ehlers-Danlos syndrome (type V collagen defect, type III collagen defect seen in vascular subtype of ED)

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Arachnodactyly, lens dislocation (upward and temporal), aortic dissection, hyperflexible joints

Marfan syndrome (fibrillin defect)

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Café-au-lait spots (unilateral), polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities

McCune-Albright syndrome (Gs-protein activating mutation)

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Calf pseudohypertrophy

Muscular dystrophy (most commonly Duchenne, due to X-linked recessive frameshift mutation of dystrophin gene)

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Child uses arms to stand up from squat

Duchenne muscular dystrophy (Gowers sign)

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Slow, progressive muscle weakness in boys

Becker muscular dystrophy (X-linked non-frameshift deletions in dystrophin; less severe than Duchenne)

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Infant with cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia

Patau syndrome (trisomy 13)

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Infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect

Edwards syndrome (trisomy 18)

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Single palmar crease

Down syndrome

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Dilated cardiomyopathy, edema, alcoholism or malnutrition

Wet beriberi (thiamine [vitamin B1] deficiency)

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Dermatitis, dementia, diarrhea

Pellagra (niacin [vitamin B3] deficiency)

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Swollen gums, mucosal bleeding, poor wound healing, petechiae

Scurvy (vitamin C deficiency: can’t hydroxylate proline/ lysine for collagen synthesis)

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Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria

McArdle disease (skeletal muscle glycogen phosphorylase deficiency)

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Infant with hypoglycemia, hepatomegaly

Cori disease (debranching enzyme deficiency) or Von Gierke disease (glucose-6-phosphatase deficiency, more severe)

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Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

Pompe disease (lysosomal α-1,4-glucosidase deficiency)

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Cherry-red spots” on macula

Tay-Sachs (ganglioside accumulation) or Niemann-Pick (sphingomyelin accumulation), central retinal artery occlusion

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Hepatosplenomegaly, pancytopenia, osteoporosis, avascular necrosis of femoral head, bone crises

Gaucher disease (glucocerebrosidase [β-glucosidase] deficiency)

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Achilles tendon xanthoma

Familial hypercholesterolemia (LDL receptor signaling

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Anaphylaxis following blood transfusion

IgA deficiency

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Male child, recurrent infections, no mature B cells

Bruton disease (X-linked agammaglobulinemia)

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Recurrent cold (noninflamed) abscesses, eczema, high

Hyper-IgE syndrome (Job syndrome: neutrophil serum IgE,eosinophils chemotaxis abnormality)

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Strawberry tongue”

Scarlet fever Kawasaki disease

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Abdominal pain, diarrhea, leukocytosis, recent antibiotic

Clostridium difficile infection

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Back pain, fever, night sweats

Pott disease (vertebral TB)

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Adrenal hemorrhage, hypotension, DIC

Waterhouse-Friderichsen syndrome (meningococcemia)

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Red “currant jelly” sputum in alcoholic or diabetic

Klebsiella pneumoniae pneumonia

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Large rash with bull’s-eye appearance

Erythema migrans from Ixodes tick bite (Lyme disease: Borrelia)

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Ulcerated genital lesion

Nonpainful, indurated: chancre (1° syphilis, Treponema , pallidum)
Painful, with exudate: chancroid (Haemophilus ducreyi)

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Pupil accommodates but doesn’t react

Neurosyphilis (Argyll Robertson pupil)

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Smooth, moist, painless, wart-like white lesions on

Condylomata lata (2° syphilis) genitals

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Fever, chills, headache, myalgia following antibiotic

Jarisch-Herxheimer reaction (rapid lysis of spirochetes treatment for syphilis results in endotoxin-like release)

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Dog or cat bite resulting in infection

Pasteurella multocida (cellulitis at inoculation site)

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Rash on palms and soles

Coxsackie A, 2° syphilis, Rocky Mountain spotted fever

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Black eschar on face of patient with diabetic ketoacidosis

Mucor or Rhizopus fungal infection

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Chorioretinitis, hydrocephalus, intracranial calcifications

Congenital toxoplasmosis

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Child with fever later develops red rash on face that

Erythema infectiosum/fifth disease (“slapped cheeks” spreads to body appearance, caused by parvovirus B19)

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Fever, cough, conjunctivitis, coryza, diffuse rash

Measles

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Small, irregular red spots on buccal/lingual mucosa with

Koplik spots (measles [rubeola] virus) blue-white centers

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Bounding pulses, wide pulse pressure, diastolic heart murmur, head bobbing

Aortic regurgitation

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Systolic ejection murmur (crescendo-decrescendo)

Aortic stenosis

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Continuous “machine-like” heart murmur

PDA (close with indomethacin; keep open with PGE analogs)

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Chest pain on exertion

Angina (stable: with moderate exertion; unstable: with minimal exertion or at rest)

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Chest pain with ST depressions on ECG

Angina (⊝ troponins) or NSTEMI (⊕ troponins)

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Chest pain, pericardial effusion/friction rub, persistent fever following MI

Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 2 weeks to several months after
acute episode)

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Painful, raised red lesions on pads of fingers/toes

Osler nodes (infective endocarditis, immune complex deposition)

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Painless erythematous lesions on palms and soles

Janeway lesions (infective endocarditis, septic emboli/ microabscesses)

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Splinter hemorrhages in fingernails

Bacterial endocarditis

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Retinal hemorrhages with pale centers

Roth spots (bacterial endocarditis)

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Distant heart sounds, distended neck veins, hypotension

Beck triad of cardiac tamponade

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Cervical lymphadenopathy, desquamating rash, coronary aneurysms, red conjunctivae and tongue, hand-foot
changes

Kawasaki disease (mucocutaneous lymph node syndrome, treat with IVIG and aspirin)

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Palpable purpura on buttocks/legs, joint pain, abdominal

Immunoglobulin A vasculitis (Henoch-Schönlein pain (child), hematuria purpura, affects skin and kidneys)

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Telangiectasias, recurrent epistaxis, skin discoloration, Weber- arteriovenous malformations, GI bleeding, hematuria

Hereditary hemorrhagic telangiectasia (Osler-Rendu syndrome)

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Skin hyperpigmentation, hypotension, fatigue 1°

adrenocortical insufficiencyACTH,α-MSH (eg, Addison disease

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Cutaneous flushing, diarrhea, bronchospasm

Carcinoid syndrome (right-sided cardiac valvular lesions, 5-HIAA)

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Cold intolerance, weight gain, brittle hair

Hypothyroidism

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Cutaneous/dermal edema due to deposition of mucopolysaccharides in connective tissue [pretibial])

Myxedema (caused by hypothyroidism, Graves disease

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Facial muscle spasm upon tapping

Chvostek sign (hypocalcemia)

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No lactation postpartum, absent menstruation, cold intolerance

Sheehan syndrome (postpartum hemorrhage leading to pituitary infarction)

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Deep, labored breathing/hyperventilation

Diabetic ketoacidosis (Kussmaul respirations)

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Pancreatic, pituitary, parathyroid tumors

MEN 1 (autosomal dominant)

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Thyroid tumors, pheochromocytoma, ganglioneuromatosis, Marfanoid habitus

MEN 2B (autosomal dominant RET mutation)

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Thyroid and parathyroid tumors, pheochromocytoma

MEN 2A (autosomal dominant RET mutation)

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Jaundice, palpable distended non-tender gallbladder

Courvoisier sign (distal malignant obstruction of biliary tree)

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Vomiting blood following gastroesophageal lacerations

Mallory-Weiss syndrome (alcoholic and bulimic patients)

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Dysphagia (esophageal webs), glossitis, iron deficiency anemia

Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)

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Enlarged, hard left supraclavicular node

Virchow node (abdominal metastasis)

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Arthralgias, adenopathy, cardiac and neurological symptoms, diarrhea

Whipple disease (Tropheryma whipplei)

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Severe RLQ pain with palpation of LLQ

Rovsing sign (acute appendicitis)

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Severe RLQ pain with deep tenderness

McBurney sign (acute appendicitis)

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Hamartomatous GI polyps, hyperpigmented macules on(inherited, benign polyposis mouth, feet, hands, genitalia

Peutz-Jeghers syndrome can cause bowel obstruction;cancer risk, mainly GI)

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Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth

Gardner syndrome (subtype of FAP)

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Abdominal pain, ascites, hepatomegaly

Budd-Chiari syndrome (posthepatic venous thrombosis)

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Severe jaundice in neonate

Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia)

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Golden brown rings around peripheral cornea

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

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Fat, female, forty, fertile

Cholelithiasis (gallstones)

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Painless jaundice

Cancer of the pancreatic head obstructing bile duct

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Bluish line on gingiva

Burton line (lead poisoning)

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Short stature, café-au-lait spots, thumb/radial defects, incidence of tumors/leukemia, aplastic anemia

Fanconi anemia (genetic loss of DNA crosslink repair; often progresses to AML)

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Red/pink urine, fragile RBCs

Paroxysmal nocturnal hemoglobinuria

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Painful blue fingers/toes, hemolytic anemia

Cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious
mononucleosis, CLL)

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Petechiae, mucosal bleeding, prolonged bleeding time

Platelet disorders (eg, Glanzmann thrombasthenia, Bernard Soulier, HUS, TTP, ITP)

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Fever, night sweats, weight loss

B symptoms of malignancy

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Skin patches/plaques, Pautrier microabscesses, atypical T cells

Mycosis fungoides (cutaneous T-cell lymphoma) or Sézary syndrome (mycosis fungoides + malignant
T cells in blood)

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WBCs that look “smudged”

CLL

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Neonate with arm paralysis following difficult birth, arm in “waiter’s tip” position

Erb-Duchenne palsy (superior trunk [C5–C6] brachial plexus injury)

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Anterior drawer sign ⊕

Anterior cruciate ligament injury

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Bone pain, bone enlargement, arthritis

Osteitis deformans (Paget disease of bone,osteoblastic and osteoclastic activity)

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Swollen, hard, painful finger joints in an elderly individual, pain worse with activity

Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP Heberden nodes])

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Sudden swollen/painful big toe joint

Gout/podagra (hyperuricemia)

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Dry eyes, dry mouth, arthritis

Sjögren syndrome (autoimmune destruction of exocrine glands)

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Urethritis, conjunctivitis, arthritis in a male

Reactive arthritis associated with HLA-B27

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Butterfly” facial rash and Raynaud phenomenon in a young female

Systemic lupus erythematosus

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Painful fingers/toes changing color from white to blue to) red with cold or stress

Raynaud phenomenon (vasospasm in extremities

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Anticentromere antibodies

Scleroderma (CREST)

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Dark purple skin/mouth nodules in a patient with AIDS

Kaposi sarcoma, associated with HHV-8

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Anti-desmoglein (anti-desmosome) antibodies

Pemphigus vulgaris (blistering)

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Pruritic, purple, polygonal planar papules and plaques (6 P’s)

Lichen planus

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elevated AFP in amniotic fluid/maternal serum

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

Ataxia, nystagmus, vertigo, dysarthria

Cerebellar lesion

Toe extension/fanning upon plantar scrape

Babinski sign (UMN lesion)

Hyperphagia, hypersexuality, hyperorality

Klüver-Bucy syndrome (bilateral amygdala lesion)

Resting tremor, athetosis, chorea

Basal ganglia lesion

Lucid interval after traumatic brain injury

Epidural hematoma (middle meningeal artery rupture)

Worst headache of my life”

Subarachnoid hemorrhage

Resting tremor, rigidity, akinesia, postural instability,(shuffling gait

Parkinson disease loss of dopaminergic neurons in substantia nigra pars compacta)

Chorea, dementia, caudate degeneration

Huntington disease (autosomal dominant CAG repeat expansion)

Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia

Multiple sclerosis

Rapidly progressive limb weakness that ascends following GI/upper respiratory infection

Guillain-Barré syndrome (acute inflammatory demyelinating polyradiculopathy subtype)

Café-au-lait spots, Lisch nodules (iris hamartoma), cutaneous neurofibromas, pheochromocytomas, optic
gliomas

Neurofibromatosis type I

Vascular birthmark (port-wine stain) of the face

Nevus flammeus (benign, but associated with Sturge- Weber syndrome)

Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma

von Hippel-Lindau disease (dominant tumor suppressor gene mutation)

Bilateral vestibular schwannomas

Neurofibromatosis type 2

Hyperreflexia, hypertonia, Babinski sign present

UMN damage

Hyporeflexia, hypotonia, atrophy, fasciculations

LMN damage

Spastic weakness, sensory loss, bowel/bladder dysfunction

Spinal cord lesion

Unilateral facial drooping involving forehead

LMN facial nerve (CN VII) palsy; UMN lesions spare the forehead

Episodic vertigo, tinnitus, hearing loss

Ménière disease

Ptosis, miosis, anhidrosis

Horner syndrome (sympathetic chain lesion)

Conjugate horizontal gaze palsy, horizontal diplopia

Internuclear ophthalmoplegia (damage to MLF; may be unilateral or bilateral)

Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets

Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule)l

Athlete with polycythemia

2° to erythropoietin injection

Periorbital and/or peripheral edema, proteinuria (> 3.5g/ day), hypoalbuminemia, hypercholesterolemia

Nephrotic syndrome

Hereditary nephritis, sensorineural hearing loss, retinopathy, lens dislocation

Alport syndrome (mutation in collagen IV)

Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck,
lymphedema

Turner syndrome (45,XO)

Red, itchy, swollen rash of nipple/areola sign of underlying neoplasm)

Paget disease of the breast

Fibrous plaques in tunica albuginea of penis with abnormal curvature

Peyronie disease (connective tissue disorder)

Hypoxemia, polycythemia, hypercapnia

Chronic bronchitis (hyperplasia of mucous cells, “blue bloater”)

Pink complexion, dyspnea, hyperventilation

Emphysema (“pink puffer,” centriacinar [smoking] or panacinar [α1-antitrypsin deficiency])

Bilateral hilar adenopathy, uveitis

Sarcoidosis (noncaseating granulomas)

Low AFP in amniotic fluid/maternal serum

Down syndrome, Edwards syndrome

Large granules in phagocytes, immunodeficiency

Chédiak-Higashi disease (congenital failure of phagolysosome formation)

Recurrent infections, eczema, thrombocytopenia

Wiskott-Aldrich syndrome

Optochin sensitivity

Sensitive: S pneumoniae; resistant: viridans streptococci (S mutans, S sanguis)

Novobiocin response

Sensitive: S epidermidis; resistant: S saprophyticus

Bacitracin response

Sensitive: S pyogenes (group A); resistant: S agalactiae (group B)

Streptococcus bovis bacteremia

Colon cancer

Branching gram ⊕ rods with sulfur granules

Actinomyces israelii

Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)

Ghon complex (1° TB: Mycobacterium bacilli)

Thumb sign” on lateral neck x-ray

Epiglottitis (Haemophilus influenzae)

Bacteria-covered vaginal epithelial cells
“

Clue cells” (Gardnerella vaginalis)

Cardiomegaly with apical atrophy

Chagas disease (Trypanosoma cruzi)

Atypical lymphocytes

EBV

Enlarged cells with intranuclear inclusion bodies

“Owl eye” appearance of CMV

Heterophile antibodies

Infectious mononucleosis (EBV

Intranuclear eosinophilic droplet-like bodies

Cowdry type A bodies (HSV or VZV)

Eosinophilic globule in liver

Councilman body (viral hepatitis, yellow fever), represents hepatocyte undergoing apoptosis

Steeple” sign on frontal CXR

Croup (parainfluenza virus)

Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons

Negri bodies of rabies

Ring-enhancing brain lesion on CT/MRI in AIDS

Toxoplasma gondii, CNS lymphoma

Psammoma bodies

Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serous carcinoma of the endometrium and ovary

Delta wave” on ECG, short PR interval, supraventricular tachycardia

Wolff-Parkinson-White syndrome (Bundle of Kent bypasses AV node)

Boot-shaped” heart on x-ray

Tetralogy of Fallot (due to RVH)

Rib notching (inferior surface, on x-ray)

Coarctation of the aorta

Heart nodules (granulomatous)

Aschoff bodies (rheumatic fever)

Electrical alternans (alternating amplitude on ECG)

Cardiac tamponade

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)

Hypertension, hypokalemia, metabolic alkalosis

1° hyperaldosteronism (Conn syndrome)

Enlarged thyroid cells with ground-glass nuclei with “central clearing

Orphan Annie” eyes nuclei (papillary carcinoma of the thyroid)

Mucin-filled cell with peripheral nucleus “

Signet ring” (gastric carcinoma)

Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies

Celiac disease (diarrhea, weight loss) 381

Narrowing of bowel lumen on barium x-ray “

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 (autosomal dominant, mutation of APC gene)

Apple core” lesion on barium enema x-ray

Colorectal cancer (usually left-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)

1° biliary cholangitis (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)

Basophilic stippling of RBCs

Lead poisoning or sideroblastic anemia

Hypochromic, microcytic anemia

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

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

β-thalassemia, sickle cell disease (marrow expansion)

Hypersegmented neutrophils

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

Antiplatelet antibodies

Idiopathic thrombocytopenic purpura

High level of d-dimers

DVT, PE, DIC 428

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

Reed-Sternberg cells (Hodgkin lymphoma

Sheets of medium-sized lymphoid cells with scattered tingible body–laden macrophages histology)

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

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

Multiple myeloma

Monoclonal antibody spike

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

Stacks of RBCs

Rouleaux formation (high ESR, multiple myeloma)

Azurophilic peroxidase ⊕ granular inclusions in (granulocytes and myeloblasts

Auer rods AML, especially the promyelocytic [M3] type)

WBCs that look “smudged”

CLL (almost always B cell)

Tennis racket”-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)

Soap bubble” in femur or tibia on x-ray

Giant cell tumor of bone (generally benign)

Raised periosteum (creating a “Codman triangle”)

Aggressive bone lesion (eg, osteosarcoma, Ewing sarcoma, osteomyelitis)

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, ⊕ birefringent

Pseudogout (calcium pyrophosphate dihydrate crystals)

Needle-shaped, ⊝ birefringent crystals

Gout (monosodium urate crystals)

High uric acid levels

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

Bamboo spine” on x-ray

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

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

SLE (type III hypersensitivity

Anti-histone antibodies

Drug-induced SLE (eg, hydralazine, isoniazid, phenytoin, procainamide)

Anti-topoisomerase antibodies

Diffuse scleroderma

Keratin pearls on a skin biopsy

Squamous cell carcinoma

Bloody or yellow tap on lumbar puncture)

Xanthochromia (due to subarachnoid hemorrhage

Eosinophilic cytoplasmic inclusion in neuron

Lewy body (Parkinson disease and Lewy body dementia)

Extracellular amyloid deposition in gray matter of brain

Senile plaques (Alzheimer disease)

Depigmentation of neurons in substantia nigra

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

Protein aggregates in neurons from hyperphosphorylation tau protein

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

Silver-staining spherical aggregation of tau proteins in neurons bodies

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

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)

RBC casts in urine

Glomerulonephritis

Tram-track” appearance of capillary loops of glomerular basement membranes on light microscopy

Membranoproliferative glomerulonephritis

Anti–glomerular basement membrane antibodies

Goodpasture syndrome (glomerulonephritis and hemoptysis)

Cellular crescents in Bowman capsule

Rapidly progressive (crescentic) glomerulonephritis

Wire loop” glomerular capillary appearance on light microscopy

Diffuse proliferative glomerulonephritis usually seen with lupus

Linear appearance of IgG deposition 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)l

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

Choriocarcinoma, hydatidiform mole (occurs with and without embryo, and multiple pregnancy)

Dysplastic squamous cervical cells with “raisinoid” nuclei and hyperchromasia

Koilocytes (HPV: predisposes to cervical cancer)

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) cells

Leydig 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 x-ray or CT

Idiopathic pulmonary fibrosis

Colonies of mucoid Pseudomonas in lungs

Cystic fibrosis (autosomal recessive mutation in CFTR genefat-soluble vitamin deficiency and mucous plugs)

Iron-containing nodules in alveolar septum

Ferruginous bodies (asbestosis:chance of lung cancer increased)

Bronchogenic apical lung tumor on imaging

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

Ethylene glycol/methanol intoxication

Fomepizole (alcohol dehydrogenase inhibitor)

Chronic hepatitis B or C

IFN-α (HBV and HCV); ribavirin, simeprevir, sofosbuvir (HCV)

Streptococcus bovis

Penicillin prophylaxis; evaluation for colon cancer if linked to endocarditis

Clostridium botulinum

Antitoxin

Clostridium tetani

Antitoxin

Haemophilus influenzae (B)

Amoxicillin ± clavulanate (mucosal infections), ceftriaxone (meningitis), rifampin (prophylaxis)

Neisseria gonorrhoeae

Ceftriaxone (add doxycycline to cover likely concurrent C trachomatis)

Neisseria meningitidis

Penicillin/ceftriaxone, rifampin (prophylaxis)

Legionella pneumophila

Macrolides (eg, azithromycin)

Pseudomonas aeruginosa

Piperacillin/tazobactam, aminoglycosides, carbapenems

Treponema pallidum

Penicillin G

Chlamydia trachomatis

Doxycycline (+ ceftriaxone for gonorrhea coinfection), oral erythromycin to treat chlamydial conjunctivitis in infants

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