RR - Classic Labs/Findings - complete

p. 726-730

colonies of Pseudomonas in lungs; increased Cl- on sweat test, increased immunoreactive trypsinogen

cystic fibrosis (AR mutation in CFTR gene —> fat-soluble vitamin deficiency and mucous plugs)

decreased AFP on second trimester screening

down syndrome, edwards syndrome

increased B-hCG, decreased PAPP-A on first trimester screening

down syndrome

increased serum homocysteine, increased methylmalonic acid (MMA), decreased folate

vitamin B12 deficiency

anti-histone antibodies

drug-induced lupus

decreased T cells, decreased PTH, decreased Ca2+, absent thymic shadow on CXR

thymic aplasia (22q11 microdeletion: DiGeorge syndrome, velocardiofacial syndrome)

recurrent infections, eczema, thrombocytopenia

wiskott-aldrich syndrome (WAS gene mutation)

large granules in phagocytes, immunodeficiency

chédiak-higashi disease (LYST gene mutation: congenital failure of phagolysosome formation)

optochin sensitivity

sensitive: s. pneumoniae, resistant: viridans streptococci (s. mutans, s. sanguis, s. mitis)

novobiocin response

sensitive: s. epidermidis, resistant: s. saprophyticus

bacitracin response

sensitive: s. pyogenes (group A); resistant: s. agalactiae (group B)

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 (h. influenzae)

bacteria covered in vaginal epithelial cells, (+) whiff test

“clue cells” = gardnerella vaginalis

ring-enhancing brain lesion on CT/MRI in AIDS

toxoplasma gondii (multiple), CNS lymphoma (may be solitary)

dilated cardiomyopathy with atypical atrophy, megacolon, megaesophagus

chagas disease (t. cruzi)

atypical lymphocytes, heterophile antibodies

infectious mononucleosis (EBV infection)

narrowing of upper trachea subglottis (steeple sign) on xray

croup (parainfluenza virus)

eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons

negri bodies of rabies

concentrically laminated calcified spherules (psammoma bodies)

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

“boot shaped” heart on xray

ToF (due to RVH)

rib notching (inferior surface, on xray)

coarctation of the aorta

“delta wave” on ECG, short PR interval, supraventricular tachycardia

wolff-parkinson-white syndrome (bundle of Kent bypasses AV node)

electrical alterans (alternating amplitude on ECG)

cardiac tamponade

granuloma with giant cells after pharyngeal infection

aschoff bodies (rheumatic fever)

empty-appearing nuclei with central clearing of thyroid cells

“orphan Annie” eyes nuclei (papillary carcinoma of the thyroid)

“brown” tumor of bone

hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color)

hypertension, hypokalemia, metabolic alkalosis, increased aldosterone and renin

1° hyperaldosteronism (eg Conn syndrome)

mucin-filled cell with peripheral nucleus

“signet ring” cells (diffuse gastric carcinoma)

anti-transglutaminase/anti-deaminated gliadin/anti-endomysial antibodies

celiac disease (diarrhea, weight loss)

narrowing of bowel lumen of barium xray

“string sign” of chrons disease

“lead pipe” appearance of colon on abdominal imaging

ulcerative colitis (loss of haustra)

thousands of polyps on colonoscopy after puberty

familial adenomatous polyposis (AD, mutation of APC gene)

“apple core” lesion on barium enema xray

colorectal cancer (usually left-sided)

“nutmeg” appearance of liver

chronic passive congestion of liver due to right heart failure (budd-chiari syndrome)

eosinophilic cytoplasmic inculsion of damaged keratin within hepatocyte

mallory body (alcoholic hepatitis)

triglyceride accumulation in liver cell vacuoles

fatty liver disease (alcoholic or metabolic syndrome)

anti-smooth muscle antibodies (ASMAs), anti-liver/kidney microsomal-1 (anti-LKM1) antibodies

autoimmune hepatitis

antimitochondrial antibodies (AMAs)

1° biliary cholangitis (female, cholestasis, portal hypertension)

low serum veruloplasmin

wilson disease

migratory thrombophlebitis (leading to migrating DVTs and vasculitis)

trousseau syndrome (adenocarcinoma of pancreas)

hypersegmented neutrophils

megaloblastic anemia (vitamin B 12 deficiency: neurologic symptoms; folate: no neuro symptoms)

basophilic nuclear remnants in RBCs

howell-jolly bodies (due to splenectomy or nonfunctional spleen)

basophilic stippling of RBCs

sideroblastic anemias, thalassemias

hypochromic, microcytic anemia

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

“hair on end” crew cut appearance on xray

B thalassemia, sickle cell anemia (marrow expansion)

anti-GpIIb/IIIa antibodies

immune thrombocytopenia

high level of fibrin degradation products (D-dimers)

DVT, DIC

giant B cells with bilobed nucleus with prominent inclusions (“owls eye”)

reed sternberg cells (hodgkin lymphoma)

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)

lytic (“punched out”) bone lesions on xray

multiple myeloma

monoclonal spike on spectrum protein electrophoresis

multiple myeloma (usually IgG or IgA)

waldenstöm macroglobulinemia (IgM)

MGUS

stacks of RBCs

rouleaux formation (high ESR, multiple myeloma)

myeloperoxidase (+) cytoplasmic inclusions in myeloblasts, with increased circulating myeloblasts

auer rods (APL)

WBCs that look “smudged”

CLL

“tennis racket” shaped cytoplasmic organelles (EM) in Langerhans cells

birbeck granules (langerhans cell histiocytosis)

“soap bubble” in femur or tibia on xray

giant cell tumor of bone (generally benign)

raised periosteum (creating a “codman triangle”)

aggressive bone lesion (eg osteosarcoma, ewing sarcoma)

“onion skin” periostial reaction

ewing sarcoma (malignant small blue cell tumor)

IgM antibody that targets IgG Fc region, anti-cyclic citullinated peptide antibodies

rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere and swan neck deformities)

needle-shaped, (-) birefringent crystals

gout (monosodium urate crystals)

increased uric acid levels

gout, lesch-nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics

rhomboid crystals, (+) birefringent

pseudogout (calcium pyrophosphate dihydrate crystals)

“bamboo spine” on xray

ankylosis spondylitis (chronic inflammatory arthritis: HLA B27)

antinuclear antibodies (ANAs: antismith, antidsDNA)

SLE (type III hypersensitivity)

antineutrophil cytoplasmic antibodies (ANCAs)

microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, and primary sclerosing cholangitis, (MPO-ANCA/p-ANCA); granulomatosis with polyangiitis (PR3-ANCA/c-ANCA)

anticentromere antibodies

limited scleroderma (CREST syndrome)

anti-scl-70 (anti-DNA topoisomerase I) and anti-RNA polymerase III antibodies

diffuse scleroderma

anti-desmoglein (anti-desmosome) antibodies

pemphigus vulgaris

antihemodesmosome antibodies

bullous pemphigoid

keratin pearls on skin biopsy

squamous cell carcinoma

increased AFP in maternal serum

dating error, open neural tube defects

bloody or yellow CSF on lumbar puncture

xanthochromia (due to subarachnoid hemorrage)

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)

loss of dopaminergic (pigmented) neurons in substantia nigra

parkinson disease

protein aggregates in neurons from hyperphosphorylation of tau protein

neurofibrillary tangles (alzheimer disease) and Pick bodies (frontotemporal dementia)

pseudopalisading pleomorphic tumor cells on brain biopsy

glioblastoma

small blue cells surrounding central area of neutrophil

Homer-Wright rosettes (neuroblastoma, medulloblastoma)

RBC casts in urine

glomerulonephritis, hypertensive emergency

WBC casts in urine

acute pyelonephritis, transplant rejection, tubulointerstitial inflammation

granular, “muddy brown” casts in urine

acute tubular necrosis (eg ischemia or toxic injury)

“waxy” casts with very low urine flow

end-stage renal diasese/chronic kidney disease

“lumpy bumpy” appearance of glomeruli on immunofluorescence

infection-related glomerulonephritis (due to deposition of IgG, IgM, and C3)

anti-glomerular basement membrane antibodies

goofpasture syndrome (hematuria and hemoptysis)

linear appearance of IgG deposition on glomerular and alveolar basement membranes

goodpasture syndrome

necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

granulomatosis with polyangiitis (PR3-ANCA/c-ANCA) and goodpasture syndrome (anti-basement membrane antibodies)

cellular crescents in Bowman’s space on light microscopy

rapidly progressive (crescentic) glomerulonephritis

“wire loop” glomerular capillary appearance on light microscopy

diffuse proliferative glomerulonephritis (usually seen with lupus)

“tram track” appearance of capillary loops of glomerular basement membranes on light microscopy

membranoproliferative glomerulonephritis

“spikes” on basement membrane, “domelike” subepithelial deposits

membranous neohropathy (nephrotic syndrome)

effacement of podocyte foot processes on electron microscopy

minimal change disease (child with nephrotic syndrome)

eosinophilic nodular hyaline deposits in glomeruli

kimmelstiel-wilson nodules (diabetic glomerulonephropathy)

thyroidlike appearance of kidney

chronic pyelonephritis

hCG elevated

multifetal gestation, hydatidiform moles, choriocarcinomas, down syndrome

dysplastic squamous cervical cells with “raisinoid” nuclei and perinuclear halo

koilocytes (HPV infection: predisposes to cervical cancer)

sheets of uniform “fried egg” cells, increased hCG, increased LDH

dysgerminoma

schiller-duval bodies (resemble glomeruli), increased AFP

yolk sac tumor

disarrayed granulosa cells arranged around collections of eosinophilic fluid

call-exner bodies (granulosa cell tumor of the ovary)