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Flashcards in Classic Labs/Findings Deck (106):
1

Low AFP in amniotic fluid/maternal serum

Down syndrome or other chromosomal abnormality

2

Large granules in phagocytes, immunodeficiency

Chediak-Higashi disease (congenital failure of phagolysosome formation)

3

Recurrent infections, eczema, thrombocytopenia

Wiskott-Aldrich syndrome

4

Branching gram + rods with sulfur granules

Actinomyces israelii

5

Optochin sensitivity

Sensitive: S pneumo; resistant: viridans strep (S mutans, S sanguis)

6

Novobiocin response

Sensitive: S epi, resistant: S agalactiae (group B)

7

Strep bovis bacteremia

Colon cancer

8

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

Ghon complex (primary TB - mycobacterium bacilli)

9

Bacteria-covered vaginal epithelial cells

"Clue cells" (Gardnerella vaginalis)

10

Ring-enhancing brain lesion on CT/MRI in AIDS

Toxoplasma gondii, CNS lymphoma

11

Cardiomegaly with atypical atrophy

Chagas disease (Trypanosoma cruzi)

12

Heterophile antibodies

Infectious mononucleosis (EBV)

13

Intranuclear eosinophilic droplet-like bodies

Cowdry type A bodies (HSV or VZV)

14

Eosinophilic globule in liver

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

15

"Steeple" sign on frontal CXR

Croup (parainfluenza virus)

16

Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons

Negri bodies of rabies

17

Atypical lymphocytes

EBV

18

Enlarged cells with intranuclear inclusion bodies

"Owl eye" appearance of CMV

19

"Thumb sign" on lateral neck x-ray

Epiglottitis (H flu)

20

"Delta wave" on EKG, short PR interval, supraventricular tachycardia

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

21

"Boot-shaped" heart on x-ray

Tetralogy of Fallot (due to RVH)

22

Rib notching (inferior surface, on x-ray)

Coarctation of the aorta

23

Heart nodules (granulomatous)

Aschoff bodies (rheumatic fever)

24

Electrical alternans (alternating amplitude on EKG)

Pericardial tamponade

25

Hypertension, hypokalemia, metabolic alkalosis

Primary hyperaldosteronism (Conn syndrome)

26

Enlarged thyroid cells with ground-glass nuclei with central clearing

"Orphan Annie" eyes nuclei
in papillary carcinoma of the thyroid

27

ANCAs (antineutrophil cytoplasmic antibodies)

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)

28

Mucin-filled cell with peripheral nucleus

"Signet ring"
in gastric carcinoma

29

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

Celiac disease

30

Narrowing of bowel lumen on barium x-ray

"String sign"
Seen in Crohn's

31

"Lead pipe" appearance of colon on abdominal imaging

Loss of haustra in Ulcerative colitis

32

Thousands of polyps on colonoscopy

Familial adenomatous polyposis
Autosomal dominant, mutation of APC gene

33

"Apple core" lesion on barium enema x-ray

Colorectal cancer (usually left-sided)

34

Eosinophilic cytoplasmic inclusion in liver cell

Mallory body
Seen in alcoholic liver disease

35

Triglyceride accumulation in liver cell vacuoles

Fatty liver disease
In alcoholic or metabolic syndrome

36

"Nutmeg" appearance of liver

Chronic passive congestion of liver due to right heart failure or Budd-Chiari syndrome

37

Antimitochondrial antibodies (AMAs)

Seen in primary biliary cirrhosis (typically female, cholestasis, portal hypertension)

38

Low serum ceruloplasmin

Wilson's Disease

39

Migratory thrombophlebitis (leading to migrating DVTs and vasculitis)

Trousseau Syndrome (adenocarcinoma of pancreas or lung)

40

Basophilic nuclear remnants in RBCs

Howell-Jolly bodies
(2/2 splenectomy or nonfunctional spleen)

41

Hypochromic, microcytic anemia

Iron deficiency anemia
Lead poisoning
Thalassemia

42

Basophilic stippling of RBCs

Lead poisoning or sideroblastic anemia

43

"Hair on end" ("Crew-cut") appearance on x-ray

Beta-thalassemia
Sickle cell disease (marrow expansion)

44

Hypersegmented neutrophils

Megaloblastic anemia (b12 def, folate def)

45

Antiplatelet antibodies

Idiopathic thrombocytopenic purpura

46

High level of D-dimers

DVT, PE, DIC

47

Giant B cells with bilobed nuclei with prominent inclusions ("owl's eyes")

Reed-Sternberg cells
Characteristic of Hodgkin lymphoma

48

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

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

49

Lytic "punched-out" bone lesions on x-ray

Multiple myeloma

50

Monoclonal antibody spike

Multiple myeloma (usually IgG or IgA)
MGUS
Waldenstrom macroglobulinemia
Primary amyloidosis

51

Stacks of RBCs

Rouleaux formation (high ESR, multiple myeloma)

52

Azurophilic peroxidase + granular inclusions in granulocytes and myeloblasts

Auer rods
Seen in AML, epsecially the promyelocytic type

53

WBCs that look "smudged"

CLL (almost always B cell)

54

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

Birbeck granules
Seen in Langerhans cell histiocytosis

55

"Brown" tumor of bone

Hyperparathyroidism or osteitis fibrosis cystica (deposited hemosiderin from hemorrhage gives brown color)

56

Raised periosteum (creating a "Codman triangle")

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

57

"Soap bubble" in femur or tibia on x-ray

Giant cell tumor of bone (generally benign)

58

"Onion skin" periosteal reaction

Ewing sarcoma (malignant small blue cell tumor)

59

Anti-IgG antibodies

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

60

Rhomboid crystals, +birefringent

Pseudogout (calcium pyrophosphate dihydrate crystals)

61

Needle-shaped, - birefringent crystals

Gout (monosidum urate crystals)

62

Increased uric acid levels

Gout
Lesch-Nyhan syndrome
Tumor lysis syndrome
Loop and thiazide diuretics

63

"Bamboo spine" on x-ray

Ankylosing spondylitis (chronic inflammatory arthritis, assoc w/ HLA-B27)

64

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

SLE (type III hypersensitivity)

65

Anti-topoisomerase antibodies

Diffuse systemic scleroderma

66

Keratin pearls on a skin biopsy

Squamous cell carcinoma

67

Antihistone antibodies

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

68

Bloody or yellow tap on lumbar puncture

Subarachnoid hemorrhage

69

Yellowish CSF

Xanthochromia (eg due to subarachnoid hemorrhage)

70

Eosinophilic cytoplasmic inclusion in neuron

Lewy Body (Parkinson disease and Lewy body dementia)

71

Extracellular amyloid deposition in gray matter of brain

Senile plaques (Alzheimer disease)

72

Depigmentation of neurons in substantia nigra

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

73

Protein aggregates in neurons from hyperphosphorylation of tau protein

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

74

Silver-staining spherical aggregation of tau proteins in neurons

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

75

Pseudopalisading tumor cells on brain biopsy

GBM

76

Circular grouping of dark tumor cells surrounding pale neurofibrils

Homer-Wright rosettes (neuroblastoma, medulloblastoma)

77

"Waxy" casts with very low urine flow

Chronic end-stage renal disease

78

RBC casts in urine

Glomerulonephritis

79

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

Membranoproliferative glomerulonephritis

80

Nodular hyaline deposits in glomeruli

Kimmelstiel-Wilson nodules (diabetic nephropathy)

81

Podocyte fusion or "effacement" on electron microscopy

Minimal change disease (child with nephrotic syndrome)

82

"Spikes" on basement membrane, "dome-like" subepithelial deposits

Membranous nephropathy (nephrotic syndrome)

83

Anti-glomerular basement membrane antibodies

Goodpasture syndrome (glomerulonephritis and hemoptysis)

84

Cellular crescents in Bowman capsule

Rapidly progressive crescentic glomerulonephritis

85

"Wire loop" glomerular capillary appearance on light microscopy

Diffuse proliferative glomerulonephritis (usually seen with lupus)

86

Linear appearance of IgG deposition on glomerular and alveolar basement membranes

Goodpasture syndrome

87

"Lumpy bumpy" appearance of glomeruli on immunofluorescence

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

88

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

Granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA) and Goodpasture syndrome (anti-BM antibodies)

89

Thyroid-like appearance of kidney

Chronic pyelonephritis (usually 2/2 recurrent infections)

90

WBC casts in urine

Acute pyelonephritis

91

Renal epithelial casts in urine

Intrinsic renal failure (eg ischemia or toxic injury)

92

hCG elevated

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

93

Dysplastic squamous cervical cells with "raisinoid" nuclei and hyperchromasia

Koilocytes (HPV: predisposes to cervical cancer)

94

Psamomma bodies

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

95

Disarrayed granulosa cells arranged around collections of eosinophilic fluid

Call-Exner bodies
Seen in granulosa cell tumor of the ovary

96

"Chocolate cyst" of ovary

Endometriosis
Frequently involves both ovaries

97

Mammary gland ("blue domed") cyst

Fibrocystic change of the breast

98

Glomerulus-like structure surrounding vessel in germ cells

Schiller-Duval bodies (yolk sac tumor)

99

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

Reinke crystals (Leydig cell tumor)

100

thrombi made of white/red layers

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

101

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

Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)

102

Desquamated epithelium casts in sputum

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

103

"Honeycomb lung" on x-ray or CT

Interstitial pulmonary fibrosis

104

Colonies of mucoid Pseudomonas in lungs

Cystic fibrosis

105

Iron-containing nodules in alveolar septum

Ferruginous bodies
Seen in asbestosis, increasing chance of lung cancer

106

Bronchogenic apical lung tumor on imaging

Pancoast tumor