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Step 1: Lab Findings
| Question | Answer |
|---|---|
| Anticentromere antibodies | Scleroderma (CREST) |
| Antidesmoglein (epithelial) antibodies | Pemphigus vulgaris (blistering) |
| Anti-GBM antibodies | Goodpasture's (glomerulonephritis and hemoptysis) |
| Anti-IgG antibodies | Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity) |
| Antihistone antibodies | Drug induced SLE (hydralazine, isoniazid, phenytoin, procainamide) |
| Antimitochondrial antibodies (AMA) | Primary biliary cirrhosis (Female, cholestasis, portal HTN) |
| Antineutrophil cytoplasmic antibodies (ANCAs) | Vasculitis (c-ANCA: wegener's; p-ANCA: microscopic polyangiitis, Churg-Strauss syndrome) |
| Antinuclear antibodies (ANAs: anti-smith, anti-dsDNA | SLE (type III hypersensitivity) |
| Antiplatelet antibodies | ITP |
| Anti-topoisomerase antibodies | Diffuse systemic scleroderma |
| "Apple core" lesion on abdominal X ray | Colorectal cancer (usually left sided) |
| Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies | Celiac disease (diarrhea, distention, weight loss) |
| Azurophilic granular needles in leukemic blasts | Auer rods, AML especially M3 type |
| Bacitracin response | Sensitive: Streptococcus pyogenes (group A); resistant: Streptococcus agalactiae (group B) |
| Bamboo spine on X Ray | Ankylosing spondylitis (HLA-B27) |
| Basophilic nuclear remnants in RBCs | Howell-Jolly bodies (splenectomy, nonfx spleen) |
| Basophilic stippling of RBCs | Lead poisoning or sideroblastic anemia |
| Bloody tap on LP | Subarachnoid hemorrhage |
| "Boot shaped" heart on X Ray | Tetralogy of Fallot, RVH |
| Branching gram + rods with sulfur granules | Actinomyces israelii |
| Bronchogenic apical lung tumor | Pancoast tumor - can compress sympathetic ganglion and cause Horner's syndrome |
| "Brown" tumor of bone | Hemorrhagic (hemosiderin) causes brown color of osteolytic cysts Due to: hyperparathyroidism, osteitis fibrosa cystica |
| Cardiomegaly with apical atrophy | Chagas disease (T. Cruzi) |
| Cellular crescents in Bowman's capsule | Rapidly progressive crescenteric glomerulonephritis |
| "Chocolate cyst" of ovary | Endometriosis (frequently involves both ovaries) |
| Circular grouping of dark tumor cells surrounding pale neurofibrils | Homer Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma) |
| Colonies of mucoid Pseudomonas in lungs | CF (AR mutation to CFTR resulting in fat-soluble vitamin deficiency and mucous plugs) |
| Decreased a-fetoprotein in amniotic fluid/maternal serum | Down syndrome or other chromosomal abnormality |
| Degeneration of dorsal column nerves | Tabes dorsalis (tertiary syphilis) |
| Depigmentatin of neurons in the substantia nigra | Parkinson's disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia) |
| Desquamated epithelium casts in sputum | Curschmann's spirals (bronchial asthma, can result in whorled mucous plugs) |
| Disarrayed granulosa cells in eosinophilic fluid | Call-Exner bodies (granulosa-theca cell tumor of the ovary) |
| Dysplastic squamous cervical cells w/nuclear enlargement and hyperchromasia | Koilocytes (HPV - predisposes to cervical cancer) |
| Enlarged cells with intranuclear inclusion bodies | "Owls 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 (Parkinsons disease) |
| Eosinophilic globule in liver | Councilman body (toxic or viral hepatitis, often yellow fever) |
| Eosinophilic inclusion bodies in cytoplasm of hippocampal nerve cells | Rabies virus |
| Giant B cells with bilobed nuclei with prominent inclusions "owls eye" | Reed Sternberg cells (Hodgkins lymphoma) |
| Extracellular amyloid deposition in gray matter in the brain | Senile plaques (Alzheimer's disease) |
| Glomerulus-like structure surrounding vessel in germ cells | Schiller-Duval bodies (yolk sac tumor) |
| "Hair-on-end" crew cut appearance on x ray | B-thalassemia, sickle cell anemia (marrow expansion) |
| hCG elevated | Choriocarcinoma, hydatidiform mole (occurs with and without embryo) |
| Heart nodules | Aschoff bodies (rheumatic fever) |
| Heterophile antibodies | Infectious mononucleosis (EBV) |
| Hexagonal, double-pointed, needle like crystals in bronchial secretions | Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules) |
| High levels of D - dimer | DVT, PE, DIC |
| Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify) | Ghon complex (primary TB, Mycobacterium bacilli) |
| "Honeycomb" lung on xray | Interstitial fibrosis |
| Hypersegmented neutrophils | Megaloblastic anemia (B12 deficiency = neurologic symptoms, folate deficiency = no neurologic symptoms) |
| Hypochromic microcytic anemia | Iron def anemia, lead poisoning, thalassemia (HbF sometimes present) |
| Increased alpha-fetoprotein in amniotic fluid | Dating error, anencephaly, spina bifida (neural tube defects) |
| Increased uric acid levels | Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics |
| Intranuclear eosinophilic droplet-like bodies | Cowdry type A bodies (HSV or CMV) |
| Iron-containing nodules in alveolar septum | Ferruginous bodies (asbestosis: increased chance of mesothelioma) |
| Large lysosomal vesicles in phagocytes, immunodeficiency | Chediak-Higashi disease (congenital failure of phagolysosome formation) |
| "Lead pipe" appearance of colon on xray | 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-streptococcal glomerulonephritis (immune complex 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 (called the M protein, usually IgG or IgA) 2. Monoclonal gammopathy of undetermined significance (MGUS- normal consequence of aging 3. Waldenstrom's (M protein = IgM) 4. Primary amyloidosis |
| Monoclonal globulin protien in blood/urine | Bence Jones proteins (multiple myeloma), Waldenstrom's macroglobulinemia (IgM) |
| Mucin-filled cell with peripheral nucleus | Signet ring (gastric carcinoma) |
| Narrowing of bowel lumen on barium graph | "String sign" Crohns disease |
| Needle-shaped, negatively bifringent crystals | Gout (monosodium urate crystals) |
| Nodular hyaline deposits in glomeruli | Kimmelstiel-Wilson nodules |
| Novobiocin response | Sensitive: staph epidermis Resistant: staph saprophyticus |
| "Nutmeg" appearance of liver | Chronic passive congestion of liver due to right heart failure |
| "Onion skin" periosteal reaction | Ewing's sarcoma (malignant round cell tumor) |
| Optochin response | Sensitive: Strep pneumoniae Resistant: Strep viridans |
| Periosteum raised from bone, creating a triangular area | Codman's triange on x-ray (osteosarcoma, Ewing sarcoma, pyogenic osteomyelitis) |
| Podocyte fusion on EM | Minimal change disaese (child w/nephrotic syndrome) |
| Polished "ivory like" appearance of bone at cartilage erosion | Eburnation (OA resulting in bony sclerosis) |
| Pseudopalasading tumor cells on brain biopsy | Glioblastoma multiforme |
| RBC casts in urine | Acute glomerulonephritis |
| Protein aggregates in neurons from hyperphosphorylation of protein tau | Neurofibrillary tangles (Alzheimers disease and CJD) |
| Renal epithelial casts in urine | Acute toxic/viral nephrosis |
| Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells | Reinke crystals (Leydig cell tumor) |
| Rhomboid crystals, positively bifringent | Pseudogout (calcium pyrophosphate dihydrate) |
| Rib notching | Coarctation of aorta |
| Ring enhancing lesions in AIDS pts | Toxoplasma gondii |
| Sheets of medium sized lymphoid cells "starry sky appearance" | Burkitts lymphoma (t8; 14) c-myc activation, associated with EBV, "black sky" made up of malignant cells |
| "Soap bubble" in femur or tibia | Giant cell tumor of the bone |
| Silver staining spherical aggregation of tau protiens in neurons | Pick bodies (Picks disease - progressive dementia, changes in personality) |
| "Spikes" on BM, "dome like" subepithelial deposits | Membranous glomerulonephritis |
| Stacks of RBCs | Rouleaux formation (high ESR, Multiple Myeloma) |
| "Tennis racket" shaped cytoplasmic organelles (EM) in Langerhans cells | Bierbeck granules, histiocytosis X |
| Strippled vaginal epithelial cells | "Clue cells" Gardnerella vaginalis |
| "Thumb" sign on lateral xray | Epiglottitis (H influenzae) |
| Thrombi made of white/red layers | Lines of Zahn (arterial thrombus, layers of platelets, RBCs) |
| Thyroid-like appearance of kidney | Chronic bacterial pyelonephritis |
| "Tram track" appearance on LM | Membranoproliferative glomerulonephritis |
| Triglyceride accumulation in liver cell vacuoles | Fatty liver disease |
| WBCs that look smudged | CLL (almost always B cell, affects elderly) |
| "Wire loop" glomerular appearance on LM | Lupus nephropathy |
| Yellow CSF | Xanthochromia (previous subarachnoid hemorrhage) |
Created by:
092309
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