Rapid Review - Classic Labs/Findings (Part 2)

Question 1

Heterophile antibodies

Answer 1

Infectious mononucleosis (EBV)

Question 2

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

Answer 2

Bronchial asthma (Charcot-Leyden crystals; eosinophilic granules)

Question 3

High level of D-dimers

Answer 3

DVT, PE, DIC

Question 4

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

Answer 4

Ghon complex (primary TB: Mycobacterium bacilli)

Question 5

“Honeycomb lung” on x-ray or CT

Answer 5

Interstitial pulmonary fibrosis

Question 6

Hypercoagulability (leading to migrating DVTs and vasculitis)

Answer 6

Trousseau syndrome (adenocarcinoma of pancreas or lung)

Question 7

Hypersegmented neutrophils

Answer 7

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

Question 8

Hypertension, hypokalemia, metabolic alkalosis

Answer 8

Conn syndrome

Question 9

Hypochromic, microcytic anemia

Answer 9

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

Question 10

Increased AFP in amniotic fluid/maternal serum

Answer 10

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

Question 11

Increased uric acid levels

Answer 11

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

Question 12

Intranuclear eosinophilic droplet-like bodies

Answer 12

Cowdry type A bodies (HSV or CMV)

Question 13

Iron-containing nodules in alveolar septum

Answer 13

Ferruginous bodies (asbestosis: increased chance of mesothelium)

Question 14

Keratin pearls on a skin biopsy

Answer 14

Squamous cell carcinoma

Question 15

Large lysosomal vesicles in phagocytes, immunodeficiency

Answer 15

Chediak-Higashi disease (congenital failure of phagolysosome formation)

Question 16

“Lead pipe” appearance of colon on barium enema x-ray

Answer 16

Ulcerative colitis (loss of haustra)

Question 17

Linear appearance of IgG deposition on glomerular basement membrane

Answer 17

Goodpasture syndrome

Question 18

Low serum ceruloplasmin

Answer 18

Wilson disease (hepatolenticular degeneration)

Question 19

“Lumpy bumpy” appearance of glomeruli on immunofluorescence

Answer 19

Poststreptococcal glomerulonephritis (immune complex deposition of IgG and C3b)

Question 20

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

Answer 20

Multiple myeloma

Question 21

Mammary gland (“blue domed”) cyst

Answer 21

Fibrocystic change of the breast

Question 22

Monoclonal antibody spike

Answer 22

(1) Multiple myeloma (usually IgG or IgA) (2) Monoclonal gammopathy of undetermined significance (MGUS consequence of aging) (3) Waldenstrom (M protein = IgM) macroglobulinemia (4) Primary amyloidosis

Question 23

Mucin-filled cell with peripheral nucleus

Answer 23

“Signet ring” (gastric carcinoma)

Question 24

Narrowing of bowel lumen on barium x-ray

Answer 24

“String sign” (Crohn disease)

Question 25

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

Answer 25

Granulomatosis with polyangitis (Wegener; PR3-ANCA/c-ANCA) and Goodpasture syndrome (anti-basement membrane antibodies)

Question 26

Needle-shaped, negatively birefringent crystals

Answer 26

Gout (monosodium urate crystals)

Question 27

Nodular hyaline deposits in glomeruli

Answer 27

Kimmelstiel-Wilson nodules (diabetic nephropathy)

Question 28

Novobiocin response

Answer 28

Sensitive: Staphylococcus epidermidis; Resistant: Staphylococcus saprophyticus

Question 29

"Nutmeg" appearance of liver

Answer 29

Chronic passive congestion of liver due to right heart failure

Question 30

"Onion skin" periosteal reaction

Answer 30

Ewing sarcoma (malignant round-cell tumor)

Question 31

Optochin response

Answer 31

Sensitive: Streptococcus pneumoniae; Resistant: viridans streptoccoci

Question 32

Periosteum raised from bone, creating triangular area

Answer 32

Codman triangle on x-ray (osteosarcoma, Ewing sarcoma, pyogenic osteomyelitis)

Question 33

Podocyte fusion or "effacement" on electron microscopy

Answer 33

Minimal change disease (child with nephrotic syndrome)

Question 34

Polished, "ivory-like" appearance of bone at cartilage erosion

Answer 34

Eburnation (osteoarthritis resulting in bony sclerosis)

Question 35

Protein aggregates in neurons from hyperphosphorylation of tau protein

Answer 35

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

Question 36

Psammoma bodies

Answer 36

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

Question 37

Pseudopalisading tumor cells on brain biopsy

Answer 37

Glioblastoma multiforme

Question 38

RBC casts in urine

Answer 38

Acute glomerulonephritis

Question 39

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

Answer 39

Reinke crystals (Leydig cell tumor)

Question 40

Renal epithelial casts in urine

Answer 40

Acute toxic/viral renal injury

Question 41

Rhomboid crystals, positively birefringent

Answer 41

Pseudogout (calcium pyrophosphate dihydrate crystals)

Question 42

Rib notching

Answer 42

Coarctation of the aorta

Question 43

Ring-enhancing brain lesion in AIDS

Answer 43

Toxoplasma gondii, CNS lymphoma

Question 44

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

Answer 44

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

Question 45

Silver-staining spherical aggregation of tau proteins in neurons

Answer 45

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

Question 46

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

Answer 46

Giant cell tumor of bone (generally benign)

Question 47

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

Answer 47

Membranous glomerulonephritis (may progress to nephrotic syndrome)

Question 48

Stacks of RBCs

Answer 48

Rouleaux formation (high ESR, multiple myeloma)

Question 49

Stippled vaginal epithelial cells

Answer 49

"Clue cells" (Gardnerella vaginalis)

Question 50

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

Answer 50

Birbeck granules (Langerhans cell histiocytosis or histocytosis X: eosinophilic granuloma)

Question 51

Thrombi made of white/red layers

Answer 51

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

Question 52

"Thumb sign" on lateral x-ray

Answer 52

Epiglottitis (Haemophilus influenzae)

Question 53

Thyroid-like appearance of kidney

Answer 53

Chronic bacterial pyelonephritis

Question 54

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

Answer 54

Membranoproliferative glomerulonephritis

Question 55

Triglyceride accumulation in liver cell vacuoles

Answer 55

Fatty liver disease (alcoholic or metabolic syndrome)

Question 56

"Waxy" casts with very low urine flow

Answer 56

Chronic end-stage renal disease

Question 57

WBC casts in urine

Answer 57

Acute pyelonephritis

Question 58

WBCs that look "smudged"

Answer 58

CLL (almost always B cell)

Question 59

"Wire loop" glomerular capillary appearance on light microscopy

Answer 59

Lupus nephropathy

Question 60

Yellowish CSF

Answer 60

Xanthochromia (e.g., due to subarachnoic hemorrhage)