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U01.17.002 Classic Labs & associated findings review
| LAB DIAGNOSIS/FINDINGS | DIAGNOSIS/DISEASE |
|---|---|
| A | |
| AFP in amniotic fluid/maternal serum | Dating error, anencephaly, spina bifida (open neural tube defects) |
| Anti centromere antibodies | Scleroderma (CREST) |
| Anti-desmoglein (anti-desmosome) antibodies | Pemphigus Vulgaris (blistering) |
| Anti–glomerular basement membrane antibodies | Goodpasture syndrome (glomerulonephritis and hemoptysis) |
| Antihistone antibodies | Drug-induced SLE (eg, hydralazine, isoniazid, phenytoin, procainamide) |
| Anti-IgG antibodies | Rheumatoid arthritis (systemic inflammation, joint pannus, boutonnière deformity) |
| Antimitochondrial antibodies (AMAs) | 1° biliary cirrhosis (female, cholestasis, portal hypertension) |
| Antineutrophil cytoplasmic antibodies (ANCAs) | 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 |
| Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA) | SLE (type III hypersensitivity) |
| Antiplatelet antibodies | Idiopathic thrombocytopenic purpura |
| Anti-topoisomerase antibodies | Diffuse systemic scleroderma |
| Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies | Celiac disease (diarrhea, weight loss) |
| “Apple core” lesion on barium enema x-ray | Colorectal cancer (usually left-sided) |
| Atypical lymphocytes | EBV |
| Azurophilic peroxidase ⊕ granular inclusions in granulocytes and myeloblasts | Auer rods (AML, especially the promyelocytic [M3] type) 410 |
| B | |
| Bacitracin response | Sensitive: S pyogenes (group A); resistant: S agalactiae (group B) |
| “Bamboo spine” on x-ray | Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27) |
| Basophilic nuclear remnants in RBCs | Howell-Jolly bodies (due to splenectomy or nonfunctional spleen) |
| Basophilic stippling of RBCs | Lead poisoning or sideroblastic anemia |
| Bloody or yellow tap on lumbar puncture | Subarachnoid hemorrhage |
| “Boot-shaped” heart on x-ray | Tetralogy of Fallot (due to RVH) |
| Branching gram ⊕ rods with sulfur granules | Actinomyces israelii |
| “Brown” tumor of bone | Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color) |
| C | |
| Cardiomegaly with apical atrophy | Chagas disease (Trypanosoma cruzi) |
| Cellular crescents in Bowman capsule | Rapidly progressive crescentic glomerulonephritis |
| “Chocolate cyst” of the ovary | Endometriosis (frequently involves both ovaries) |
| Circular grouping of dark tumor cells surrounding pale neurofibrils | Homer-Wright rosettes (neuroblastoma, medulloblastoma) |
| Colonies of mucoid Pseudomonas in lungs | Cystic fibrosis (autosomal recessive mutation in CFTR gene ? fat-soluble vitamin deficiency and mucous plugs) |
| D | |
| Decreased AFP in amniotic fluid/maternal serum. | Down syndrome or other chromosomal abnormalities |
| Degeneration of dorsal column fibers | Tabes dorsalis (3° syphilis), subacute combined degeneration (dorsal columns, lateral corticospinal, spinocerebellar tracts affected) |
| “Delta wave” on EKG, short PR interval, supraventricular tachycardia | Wolff-Parkinson-White syndrome (Bundle of Kent bypasses AV node) |
| Depigmentation of neurons in substantia nigra | Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia) |
| Desquamated epithelium casts in sputum | Curschmann spirals (bronchial asthma; can result in whorled mucous plugs) |
| Disarrayed granulosa cells arranged around collections of eosinophilic fluid | Call-Exner bodies (granulosa cell tumor of the ovary) |
| Dysplastic squamous cervical cells with “raisinoid” nuclei and hyperchromasia | Koilocytes (HPV: predisposes to cervical cancer) |
| E | |
| Electrical alternans (alternating amplitude on EKG) | Pericardial tamponade |
| Enlarged cells with intranuclear inclusion bodies | “Owl eye” appearance of CMV |
| Enlarged thyroid cells with ground-glass nuclei with central clearing | “Orphan Annie” eyes nuclei (papillary carcinoma of the thyroid) |
| Eosinophilic cytoplasmic inclusion in liver cell | Mallory body (alcoholic liver disease) |
| Eosinophilic cytoplasmic inclusion in neuron | Lewy body (Parkinson disease and Lewy body dementia) |
| Eosinophilic globule in liver | Councilman body (viral hepatitis, yellow fever), represents hepatocyte undergoing apoptosis |
| Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons | Negri bodies of rabies |
| Extracellular amyloid deposition in gray matter of brain | Senile plaques (Alzheimer disease) |
| G | |
| Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”) | Reed-Sternberg cells (Hodgkin lymphoma) |
| Glomerulus-like structure surrounding vessel in germ cells | Schiller-Duval bodies (yolk sac tumor) |
| H | |
| “Hair on end” (“Crew-cut”) appearance on x-ray | β-thalassemia, sickle cell disease (marrow expansion) |
| hCG elevated | Choriocarcinoma, hydatidiform mole (occurs with and without embryo, and multiple pregnancy) |
| Heart nodules (granulomatous) | 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 level of d-dimers | DVT, PE, DIC |
| Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify) | Ghon complex (1° TB: Mycobacterium bacilli) |
| Honeycomb lung” on x-ray or CT | Interstitial pulmonary fibrosis |
| Hypercoagulability (leading to migrating DVTs and vasculitis) | Trousseau syndrome (adenocarcinoma of pancreas or lung) |
| Hypersegmented neutrophils | Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms) |
| Hypertension, hypokalemia, metabolic alkalosis | 1° hyperaldosteronism (Conn syndrome) |
| Hypochromic, microcytic anemia | Iron deficiency anemia, lead poisoning, thalassemia (fetal hemoglobin sometimes present) |
| I | |
| Intranuclear eosinophilic droplet-like bodies | Cowdry type A bodies (HSV or VZV) |
| Iron-containing nodules in alveolar septum | Ferruginous bodies (asbestosis: ? chance of lung cancer) |
| K | |
| Keratin pearls on a skin biopsy | Squamous cell carcinoma |
| L | |
| Large granules in phagocytes, immunodeficiency | Chédiak-Higashi disease (congenital failure of phagolysosome formation) |
| Lead pipe” appearance of colon on abdominal imaging | Ulcerative colitis (loss of haustra) |
| Linear appearance of IgG deposition on glomerular and alveolar basement membranes | Goodpasture syndrome |
| Low serum ceruloplasmin | Wilson disease (hepatolenticular degeneration) |
| “Lumpy bumpy” appearance of glomeruli on immunofluorescence | Poststreptococcal glomerulonephritis (due to deposition of IgG, IgM, and C3) |
| Lytic (“punched-out”) bone lesions on x-ray | Multiple myeloma |
| M | |
| Mammary gland (“blue domed”) cyst | Fibrocystic change of the breast |
| Monoclonal antibody spike | ? Multiple myeloma (usually IgG or IgA) ? Monoclonal gammopathy of undetermined significance (MGUS consequence of aging) ? Waldenström (M protein = IgM) macroglobulinemia ? Primary amyloidosis |
| Mucin-filled cell with a peripheral nucleus | “Signet ring” (gastric carcinoma) |
| Narrowing of bowel lumen on barium x-ray | “String sign” (Crohn disease) |
| Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis | Granulomatosis with polyangiitis (Wegener; PR3-ANCA/ c-ANCA) and Goodpasture syndrome (anti–basement membrane antibodies) |
| Needle-shaped, ⊝ birefringent crystals | Gout (monosodium urate crystals) |
| Nodular hyaline deposits in glomeruli | Kimmelstiel-Wilson nodules (diabetic nephropathy) |
| Novobiocin response | Sensitive: S epidermidis; resistant: S saprophyticus |
| “Nutmeg” appearance of liver | Chronic passive congestion of liver due to right heart failure or Budd-Chiari syndrome |
| “Onion skin” periosteal reaction | Ewing sarcoma (malignant small blue cell tumor) |
| Optochin sensitivity | Sensitive: S pneumoniae; resistant: viridans streptococci (S mutans, S sanguis) |
| P | |
| Podocyte fusion or “effacement” on electron microscopy | Minimal change disease (child with nephrotic syndrome) |
| Protein aggregates in neurons from hyperphosphorylation of tau protein | Neurofibrillary tangles (Alzheimer disease) and Pick bodies (Pick disease) |
| Psammoma bodies | Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serous carcinoma of the endometrium and ovary |
| Pseudopalisading tumor cells on brain biopsy | Glioblastoma multiforme |
| Raised periosteum (creating a “Codman triangle”) | Aggressive bone lesion (eg, osteosarcoma, Ewing sarcoma, osteomyelitis) |
| RBC casts in the urine | Glomerulonephritis |
| Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells | Reinke crystals (Leydig cell tumor) |
| Recurrent infections, eczema, thrombocytopenia | Wiskott-Aldrich syndrome |
| Renal epithelial casts in the urine | Intrinsic renal failure (eg, ischemia or toxic injury) |
| Rhomboid crystals, ⊕ birefringent | Pseudogout (calcium pyrophosphate dihydrate crystals) |
| Rib notching (inferior surface, on x-ray) | Coarctation of the aorta |
| Ring-enhancing brain lesion on CT/MRI in AIDS | Toxoplasma gondii, CNS lymphoma |
| S | |
| 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) |
| Silver-staining spherical aggregation of tau proteins in | Pick bodies (Pick disease: progressive dementia, changes in personality) |
| “Soap bubble” in femur or tibia o“Soap bubble” in femur or tibia on x-ray x-ray | Giant cell tumor of bone (generally benign) |
| “Spikes” on the basement membrane, “dome-like” subepithelial deposits | Membranous nephropathy (nephrotic syndrome) |
| “Spikes” on the basement membrane, “dome-like” subepithelial deposits | Membranous nephropathy (nephrotic syndrome) |
| Stacks of RBCs | Rouleaux formation (high ESR, multiple myeloma) |
| “Steeple” sign on frontal CXR | Croup (parainfluenza virus) |
| Bacteria-covered vaginal epithelial cells | “Clue cells” (Gardnerella vaginalis) |
| Streptococcus Bovis bacteremia | Colon cancer |
| T | |
| “Tennis racket”-shaped cytoplasmic organelles (EM) in Langerhans cells | Birbeck granules (Langerhans cell histiocytosis) |
| Thousands of polyps on colonoscopy | Familial adenomatous polyposis (autosomal dominant, mutation of APC gene) |
| Thrombi made of white/red layers | Lines of Zahn (arterial thrombus, layers of platelets/ RBCs) |
| “Thumb sign” on lateral neck x-ray | Epiglottitis (Haemophilus influenzae) |
| The thyroid-like appearance of kidney | Chronic pyelonephritis (usually due to recurrent infections) |
| “Tram-track” appearance of capillary loops of glomerular basement membranes on light microscopy | Membranoproliferative glomerulonephritis |
| Triglyceride accumulation in liver cell vacuoles | Fatty liver disease (alcoholic or metabolic syndrome) |
| U | |
| Uric acid levels increased | Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics |
| W | |
| “Waxy” casts with very low urine flow | Chronic end-stage renal disease |
| WBC casts in the urine | Acute pyelonephritis |
| WBCs that look “smudged” | CLL (almost always B cell) |
| “Wire loop” glomerular capillary appearance on light microscopy | Diffuse proliferative glomerulonephritis (usually seen with lupus) |
| Y | |
| Yellowish CSF | Xanthochromia (eg, due to subarachnoid hemorrhage) |