Rapid Review: Classic Labs/Findings Flashcards
Anti-centromere antibodies
Scleroderma (CREST)
Antidesmoglein (epithelial) antibodies
Pemphigus vulgaris (blistering)
- Antibodies against desmosomes (macula adherens, contains cadherins)
- Flaccid blisters involving oral mucosa
- Separation of epidermis with manual traaction
Anti-glomerular basement membrane antibodies
Goodpasture’s syndomre (glomerulonephritis and hemoptysis)
Antihistone antbodies
Drug-induced SLE
- Hydralazine, INH, procainamide, penytoin
Anti-IgG antibodies
Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere’s deformity)
Antimitochrondrial antibodies (AMAs)
Primary billiary cirrhosis (female, cholestasis, portal HTN)
Antineutrophil cytoplasmic antibodies (ANCAs)
Vasculitis
- c-ANCA: Wegener’s
- p-ANCA: microscopic polyangitis, Churg-Strauss syndrome
Antinuclear antibodies (ANAs: anti-dsDNA and anti-Smith)
SLE (type III hypersensitivity)
- all ANAs: sensitive, but not specific for SLE
- anti-dsDNA: very specific, poor prognosis
- anti-Smith: very specific, less sensitive, not prognostic
Antiplatelet antibodies
Idiopathic thrombocytopenic purpura (ITP)
Anti-topoisomerase antibodies
Diffuse systemic sclerosis
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Celiac disease (diarrhea, distension, weight loss)
“Apple core” lesions on KUB
CRC (usually L-sided)
Azurophilic granular needles in leukemic blasts
Auer rods
- AML, esp M3 (promyelocytic type)
Bacitracin response
Sensitive: GAS (Strep pyogenes)
Resistant: GBS (Strep agalactiae)
“Bamboo spine” on X-ray
Ankylosing spondylitis (chronic inflammatory arthritis: HLA B-27)
Basophilic nuclear remnants in RBCs
Howell-Jolly bodies
- 2/2 splenectomy or nonfunctional spleen
Basophilic stippling of RBCs
Sideroblastic anemia
- Toxins: lead, copper, or zinc poisoning
- Drug-induced: ethanol (*MC), isoniazid, chloramphenicol, cycloserine, Linezolid, oral contraceptives
- Nutritional: pyridoxine (Vitamin B6) or copper deficiency
- Diseases: Rheumatoid arthritis or multiple myeloma
- Genetic: ALA synthase deficiency
Bloody tap on LP
Subarachnoid hemorrhage
“Boot-shaped” heart on X-ray
Tetralogy of Fallot, RVH
Branching, gram-pos rods with sulfur granules
Actinomyces israelii
- Anaerobe, not acid fast
- Oral/facial abcesses, normal oral flora
- Tx with PCN
Bronchogenic apical lung cancer
Pancoast tumor (can compress sympathetic ganglion and cause Horner’s syndrome)
“Brown” tumor of bone
Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to:
1) HyperPTH
2) Osteitis fibrosa cystica
Cardiomegaly with apical atrophy
Chaga’s disease (Typanosoma cruzi, a flagellate protozoan)
- “Kissing bug:” Rhodnius prolixus/Reduviid bug, painless bit (vs. painful Tsetse fly bite of Trypansoma brucei, African sleeping sickness)
- Romana’s sign: swelling of eyelid
Cellular crescents in Bowman’s capsule
Rapidly progressive crescentic glomerulonephritis
1) Goodpastures
2) Wegener’s
3) MPA
“Chocolate cyst” of ovary
Endometriosis (frequently involves both ovaries)
Circular grouping of dark tumor cells surrounding pale neurofibrils
Homer-Wright (pseudo)rosettes (differentiated tumor cells surround neuropil - not a true rosette b/c contains fibrillary material vs. empty lumen of Flexner–Wintersteiner rosette in retinoblastoma)
1) Neuroblastoma
2) Medulloblastoma
3) Retinoblastoma
Colonies of mucoid Pseudomonas in lungs
Cystic fibrosis (AR mutation to CFR resulting in fat-soluble vitamin deficiency and mucous plugs)
Decreased alpha-fetoprotein in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormality
Degeneration of dorsal column nerves
Tabes dorsalis (tertiary syphillis)
If involves spinocerebllar tract: Vit B12, Vit E, or Friedreich’s ataxia
Depigmentation of neurons in substania nigra
Parkinson’s disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)
Desquamated epithelium casts in sputum
call (bronchial asthma)
- Can result in whorled mucous plugs
Disarrayed granulosa cells in eosinophilic fluid
Call-Exner bodies
- Granulosa-theca cell tumor of ovary
Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia
Koilocytes (HPV)
- Predisposes to cervical cancer
Enlarged cells with intranuclear inclusion bodies
“Owl’s eye” appearance of CMV
Enlarged thyroid cells with ground-glass nuclei
“Orphan Annie” eye nuclei (papillary carcinoma of the thyroid)
Eosinophilic cytoplasmic inclusion in liver cell
Mallory bodies (Alcoholic liver disease)
Eosinophilic cytoplasmic inclusion in nerve cell
Lewy body (Parkinson’s disease)
Eosinophilic globule in liver
Councilman body (toxic or viral hepatitis) - Often yellow fever
Eosinophilic cytoplasmic inclusion bodies in hippocampal nerve cells
Rabies virus
- Lyssavirus genus in family of Rhabdovirus
- (-)ssRNA, helical capsid
Extracellular amyloid deposition in gray matter of brain
Senile plaques (Alzheimer's disease) - Beta amyloid from amyloid precursor protein
Not be be confused with senile cardiac amyloid (transthyretin amyloid in AF - Amyloid associated with familial amyloid neuropathies [AF]. Amyloid deposition of a mutant form of transthyretin, a normal serum protein that transports thyroxin and retinol [vitamin A], occurs in peripheral nerves in familial amyloid polyneuropathy, an AD disorder occurring in different parts of the world.)
Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”)
Reed-Sternberg cells (Hodgkin’s lymphoma)
Glomerulus-like structure surrounding vessel in germ cells
Schiller-Duval bodies (yolk-sac tumor)
“Hair-on-end” (crew-cut appearance on x-ray)
Marrow expansion in response to anemia
1) Beta-thalassemia
2) Sickle cell anemia
Finding seen in the diploic space on skull radiographs and has the appearance of long, thin vertical striations that look like hair standing on end.
The skull alterations are due to overactivity of the red marrow in response to anemia. This marrow hyperplasia widens the diploic space and thins the outer table. There is trabecular destruction with thickening of the residual trabeculae.
hCG elevated
Choriocarcinoma, hydatidiform mole (occurs with and without embryo)
Heart nodules (granulomatous)
Aschoff bodies (rhematic fever)
Heterophile antibodies
Infectious monocucleosis (EBV)
Hexagonal, double-pointed, needle-like crystals in bronchial secretions
Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)
High levels of D-dimers
DVT, pulmonary embolism, DIC
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)
Ghon complex (Primary TB, Mycobacterium bacilli)
“Honeycomb lung” on X-ray
Interstitial fibrosis
Hypersegmented neutrophils
Megaloblastic anemia
1) B12 deficiency: +neuro sx
2) Folate deficiency: -neuro sx
Hypochromic, microcytic anemia
Iron deficiency anemia, Pb poisoning, thalassemia (HbF sometimes present)
Increased alpha-fetoprotein in amniotic fluid/maternal serum
1) Dating error
2) Anencephaly
3) Spina bifida
4) Other NT defects
Increased uric acid levels
1) Gout
2) Lesch-Nyhan snydrome (HGPRT)
3) Tumor lysis syndrome
4) Loop and thiazide diuretics: decrease urate excretion by increasing net urate reabsorption; this can occur either by 1) enhanced reabsorption or 2) reduced secretion
The proximal tubule is the major site of urate handling; both secretion and reabsorption occur in this segment, with the net effect being reabsorption of most of the filtered urate.
Intranuclear eosinophilic droplet-like bodies
Cowdry type A bodies (HSV or CMV)
Iron-containing nodules in alveolar septum
Ferruginous bodies (asbestosis) - Increased risk of mesothelioma
Large lysosomal vesicles in phagocytes, inmmunodeficiency
Chediak-Higashi disease
- Congenital failure of phagolysosome formation
“Lead pipe” appearance of colon on x-ray
Ulcerative colitis (loss of haustra)
Linear appearance of glomeruli on immunofluorescence
Goodpasture’s syndrome
Low serum ceruloplasmin
Wilson’s disease
- Hepatolenticular degeneration
“Lumpy-bumpy” appearance of glomeruli on immunofluorescence
Post-strep glomerulonephritis
- IC deposition of IgG and C3b
Lytic (“hole-punched”) bone lesions on x-ray
Multiple myeloma
Mammary gland (“blue domed”) cyst
Fibrocystic change of the breast
Monoclonal antibody spike
1) Multiple myeloma: M protein–usually IgG or IgA, CRAB, hyperviscosity syndrome
2) Monoclonal gammopathy of undetermined significance (MGUS): normal consequence of aging, monoclonal plasma cell expansion w/o MM sx
3) Waldenstrom’s (M protein = IgM) macroglobulinemia: no lytic bone lesions, hyperviscosity syndrome
4) Primary amyloidosis
Monoclonal globulin protein in blood/urine
1) Bence Jones proteins: multiple myeloma, kappa or lambda Ig light chains in urine
2) Waldenstrom’s macroglobulinemia: IgM, indolent B cell lymphoma
Mucin-filled cell with peripheral nucleus
Signet ring (gastric carcinoma)
Narrowing of bowel lumen on barium radiograph
“String sign” (Crohn’s disease)
Needle-shaped, negatively birefringent crystals
Gout (monosodium urate crystals)
Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules (diabetic neuropathy)
Novobiocin response
Sensitive: Staph epidermis
Resistant: Staph saprophyticus
“Nutmeg” appearance of liver
Chronic passive congestion of liver due to RHF
“Onion skin” periosteal reaction
Ewing’s sarcoma (malignant round-cell tumor)
- t(11;22): fuses the EWS gene of chromosome 22 to the FLI1 gene (TF/protooncogene) of chromosome 11
Optochin response
Sensitive: Strep viridans
Resistant: Strep pneumo
Periosteum raised from bone, creating triangular area
Codman’s triangle
1) Osteosarcoma
2) Ewing’s sarcoma
3) Pyogenic osteomyelitis
Podocyte fusion on EM
Minimal change disease (child with nephrotic syndrome)
Polished, “ivory-like” appearance of bone at cartilage erosin
Eburnation (osteoarthritis resulting in bony sclerosis)
Protein aggregates in neurons from hyperphosphorylation of protein tau
1) Neurofibrillary tangles: Alzheimer’s disease and CJD
2) Pick’s bodies: Pick’s disease
Pseudopalisading tumor cells on brain biopsy
Gliobastoma multiforme
RBC casts in urine
Acute glomerulonephritis
Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells
Reinke crystals (Leydig cell tumor)
Renal epithelial casts in urine
Acute toxic/viral nephrosis
Rhomboid crystals, positively birefringent
Pseudogout (Ca pyrophosphate dihydrate)
Rib notching
Coarctation of the aorta
Ring-enhancing brain lesions in AIDS
Toxoplasma gondii
Sheets of medium-sized lymphoid cells (“starry sky” appearance on histology)
Bukitt’s lymphoma
- t(8;14): c-myc activation (transcription factor)
- EBV associated
- “black sky” made up of malignant cells
Silver-staining spherical aggregation of tau proteins in neurons
Pick bodies (Pick's disease) - progressive dementia, changes in personality
“Soap bubble” or “double bubble” in femur or tibia on x-ray
Giant cell tumor of bone
- 20-40 yrs
- Epiphyseal end of long bones (vs. osteochondroma in metaphysis)
- Spindle shaped cells with multinucleated giant cells
Stacks of RBCs
Rouleaux formation (high ESR, multiple myeloma)
- CRAB: hyperCa, Renal insufficiency, Anemia, Bone punched-out lytic lesions/Back pain
- Primary amyloidosis (AL)
- M spike on SPEP
- incr susceptibility to infection
“Spikes” on basement membrane, “dome-like” subepithelial deposits
Membranous glomerulonephritis
- May progress to nephrotic syndrome
- Causes: idiopathic (85%), autoimmune conditions (SLE), infections (syphilis, malaria, HBV), drugs (captopril, NSAIDs, penicillamine, probenecid), inorganic salts (Ag, Hg), tumors (lung, colon)
By contrast, membranoproliferative glomerulonephritis has a similar name, but is considered a separate condition. MPGN involves the basement membrane AND mesangium, while membranous glomerulonephritis involves the basement membrane but NOT the mesangium
Stippled vaginal epithelial cells
“Clue cells” (Gardnerella vaginalis)
- Gram-variable facultative anaerobic
- Tx: metronidazole or clindamycin
“Tennis-racket” shaped cytoplasmic organelles (EM) in Langerhan’s cells
Birbeck granules (histiocytosis X)
- Abnormal proliferation of histiocytes
- Eosinophilic granuloma
Thrombi made of white/red layers
Lines of Zahn (arterial thrombus)
- Layers of platelets (pale) and RBCs (dark)
- Implies thrombosis at a site of rapid blood flow that happened before death. In veins or smaller arteries, where flow is not as constant, they are less apparent.
“Thumb sign” on lateral x-ray
Epiglottitis (H. flu)
Thyroid-like appearance of kidney
Chronic bacterial pyelonephritis
- Tubules contain eosinophilic casts
- Vesicoureteral reflux
“Tram-track” appearance on LM
Membranoproliferative glomerulonephritis (Type I)
- GBM splitting caused by mesagnial ingrowth
- HCV (cryoglobulinemia!), HBV
vs. Type II: “dense deposits,” C3 nephritic factor
Triglyceride accumulation in liver cell vacuoles
Fatty liver disease (alcoholic metabolic syndrome)
WBCs that look “smudged”
CLL (almost always B cell, affects elderly)
- > 60 yrs
- Warm AIHA
- Smudge cells = fragile leukemic cells
- Hypogammaglobulinemia: virgin B cells that cannot differentiate, incr infections!
- MC cause of generalized nontender lymphadenopathy in elderly
Same as SLL except with incr peripheral blood lymphocytosis
“Wire loop” glomerular appearance on LM
Lupus nephropathy
Yellow CSF
Xanthochromia (previous SAH)
- RBCs enter CSF during the bleeding. The cells are eventually destroyed by the body, releasing their oxygen-carrying molecule heme, which is degraded by enzymes into the yellow-green pigment bilirubin.
