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CLASSIC PRESENTATIONS
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CLINICAL PRESENTATION DIAGNOSIS/DISEASE PAGE
Gout, intellectual disability, self-mutilating behavior in a Lesch-Nyhan syndrome (HGPRT deficiency, X-linked 37
boy recessive)
Situs inversus, chronic sinusitis, bronchiectasis, infertility Kartagener syndrome (dynein arm defect affecting cilia) 49
Blue sclera Osteogenesis imperfecta (type I collagen defect) 51
Elastic skin, hypermobility of joints,  bleeding tendency Ehlers-Danlos syndrome (type V collagen defect, type III 51
collagen defect seen in vascular subtype of ED)
Arachnodactyly, lens dislocation (upward and temporal), Marfan syndrome (fibrillin defect) 52
aortic dissection, hyperflexible joints
Café-au-lait spots (unilateral), polyostotic fibrous McCune-Albright syndrome (Gs-protein activating 57
dysplasia, precocious puberty, multiple endocrine mutation)
abnormalities
Calf pseudohypertrophy Muscular dystrophy (most commonly Duchenne, due to 61
X-linked recessive frameshift mutation of dystrophin
gene)
Child uses arms to stand up from squat Duchenne muscular dystrophy (Gowers sign) 61
Slow, progressive muscle weakness in boys Becker muscular dystrophy (X-linked non-frameshift 61
deletions in dystrophin; less severe than Duchenne)
Infant with cleft lip/palate, microcephaly or Patau syndrome (trisomy 13) 63
holoprosencephaly, polydactyly, cutis aplasia
Infant with microcephaly, rocker-bottom feet, clenched Edwards syndrome (trisomy 18) 63
hands, and structural heart defect
Single palmar crease Down syndrome 63
Dilated cardiomyopathy, edema, alcoholism or Wet beriberi (thiamine [vitamin B1] deficiency) 66
malnutrition
Dermatitis, dementia, diarrhea Pellagra (niacin [vitamin B3] deficiency) 67
Swollen gums, mucosal bleeding, poor wound healing, Scurvy (vitamin C deficiency: can’t hydroxylate proline/ 69
petechiae lysine for collagen synthesis)
Chronic exercise intolerance with myalgia, fatigue, McArdle disease (skeletal muscle glycogen phosphorylase 87
painful cramps, myoglobinuria deficiency)
Infant with hypoglycemia, hepatomegaly Cori disease (debranching enzyme deficiency) or Von 87
Gierke disease (glucose-6-phosphatase deficiency, more
severe)
Myopathy (infantile hypertrophic cardiomyopathy), Pompe disease (lysosomal α-1,4-glucosidase deficiency) 87
exercise intolerance
“Cherry-red spots” on macula Tay-Sachs (ganglioside accumulation) or Niemann-Pick 88
(sphingomyelin accumulation), central retinal artery
occlusion
Hepatosplenomegaly, pancytopenia, osteoporosis, Gaucher disease (glucocerebrosidase [β-glucosidase] 88
avascular necrosis of femoral head, bone crises deficiency)
Achilles tendon xanthoma Familial hypercholesterolemia ( LDL receptor signaling) 94
Anaphylaxis following blood transfusion IgA deficiency 116
Male child, recurrent infections, no mature B cells Bruton disease (X-linked agammaglobulinemia) 116

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Recurrent cold (noninflamed) abscesses, eczema, high Hyper-IgE syndrome (Job syndrome: neutrophil 116
serum IgE,  eosinophils chemotaxis abnormality)
“Strawberry tongue” Scarlet fever 136,
Kawasaki disease 314
Abdominal pain, diarrhea, leukocytosis, recent antibiotic Clostridium difficile infection 138
use
Back pain, fever, night sweats Pott disease (vertebral TB) 140
Adrenal hemorrhage, hypotension, DIC Waterhouse-Friderichsen syndrome (meningococcemia) 142,
349
Red “currant jelly” sputum in alcoholic or diabetic Klebsiella pneumoniae pneumonia 145
patients
Large rash with bull’s-eye appearance Erythema migrans from Ixodes tick bite (Lyme disease: 146
Borrelia)
Ulcerated genital lesion Nonpainful, indurated: chancre (1° syphilis, Treponema 147,
pallidum) 184
Painful, with exudate: chancroid (Haemophilus ducreyi)
Pupil accommodates but doesn’t react Neurosyphilis (Argyll Robertson pupil) 147
Smooth, moist, painless, wart-like white lesions on Condylomata lata (2° syphilis) 147
genitals
Fever, chills, headache, myalgia following antibiotic Jarisch-Herxheimer reaction (rapid lysis of spirochetes 148
treatment for syphilis results in endotoxin-like release)
Dog or cat bite resulting in infection Pasteurella multocida (cellulitis at inoculation site) 149
Rash on palms and soles Coxsackie A, 2° syphilis, Rocky Mountain spotted fever 150
Black eschar on face of patient with diabetic ketoacidosis Mucor or Rhizopus fungal infection 153
Chorioretinitis, hydrocephalus, intracranial calcifications Congenital toxoplasmosis 156
Child with fever later develops red rash on face that Erythema infectiosum/fifth disease (“slapped cheeks” 164
spreads to body appearance, caused by parvovirus B19)
Fever, cough, conjunctivitis, coryza, diffuse rash Measles 170
Small, irregular red spots on buccal/lingual mucosa with Koplik spots (measles [rubeola] virus) 170
blue-white centers
Bounding pulses, wide pulse pressure, diastolic heart Aortic regurgitation 291
murmur, head bobbing
Systolic ejection murmur (crescendo-decrescendo) Aortic stenosis 291
Continuous “machine-like” heart murmur PDA (close with indomethacin; keep open with PGE 291
analogs)
Chest pain on exertion Angina (stable: with moderate exertion; unstable: with 304
minimal exertion or at rest)
Chest pain with ST depressions on ECG Angina (⊝ troponins) or NSTEMI (⊕ troponins) 304
Chest pain, pericardial effusion/friction rub, persistent Dressler syndrome (autoimmune-mediated post-MI 307
fever following MI fibrinous pericarditis, 2 weeks to several months after
acute episode)
Painful, raised red lesions on pads of fingers/toes Osler nodes (infective endocarditis, immune complex 311
deposition)

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Painless erythematous lesions on palms and soles Janeway lesions (infective endocarditis, septic emboli/ 311
microabscesses)
Splinter hemorrhages in fingernails Bacterial endocarditis 311
Retinal hemorrhages with pale centers Roth spots (bacterial endocarditis) 311
Distant heart sounds, distended neck veins, hypotension Beck triad of cardiac tamponade 310
Cervical lymphadenopathy, desquamating rash, coronary Kawasaki disease (mucocutaneous lymph node syndrome, 314
aneurysms, red conjunctivae and tongue, hand-foot treat with IVIG and aspirin)
changes
Palpable purpura on buttocks/legs, joint pain, abdominal Immunoglobulin A vasculitis (Henoch-Schönlein 315
pain (child), hematuria purpura, affects skin and kidneys)
Telangiectasias, recurrent epistaxis, skin discoloration, Hereditary hemorrhagic telangiectasia (Osler-Weber- 316
arteriovenous malformations, GI bleeding, hematuria Rendu syndrome)
Skin hyperpigmentation, hypotension, fatigue 1° adrenocortical insufficiency   ACTH,  α-MSH (eg, 349
Addison disease)
Cutaneous flushing, diarrhea, bronchospasm Carcinoid syndrome (right-sided cardiac valvular lesions, 352
 5-HIAA)
Cold intolerance, weight gain, brittle hair Hypothyroidism 341
Cutaneous/dermal edema due to deposition of Myxedema (caused by hypothyroidism, Graves disease 340
mucopolysaccharides in connective tissue [pretibial])
Facial muscle spasm upon tapping Chvostek sign (hypocalcemia) 344
No lactation postpartum, absent menstruation, cold Sheehan syndrome (postpartum hemorrhage leading to 339
intolerance pituitary infarction)
Deep, labored breathing/hyperventilation Diabetic ketoacidosis (Kussmaul respirations) 347
Pancreatic, pituitary, parathyroid tumors MEN 1 (autosomal dominant) 351
Thyroid tumors, pheochromocytoma, MEN 2B (autosomal dominant RET mutation) 351
ganglioneuromatosis, Marfanoid habitus
Thyroid and parathyroid tumors, pheochromocytoma MEN 2A (autosomal dominant RET mutation) 351
Jaundice, palpable distended non-tender gallbladder Courvoisier sign (distal malignant obstruction of biliary 398
tree)
Vomiting blood following gastroesophageal lacerations Mallory-Weiss syndrome (alcoholic and bulimic patients) 377
Dysphagia (esophageal webs), glossitis, iron deficiency Plummer-Vinson syndrome (may progress to esophageal 377
anemia squamous cell carcinoma)
Enlarged, hard left supraclavicular node Virchow node (abdominal metastasis) 379
Arthralgias, adenopathy, cardiac and neurological Whipple disease (Tropheryma whipplei) 381
symptoms, diarrhea
Severe RLQ pain with palpation of LLQ Rovsing sign (acute appendicitis) 383
Severe RLQ pain with deep tenderness McBurney sign (acute appendicitis) 383
Hamartomatous GI polyps, hyperpigmented macules on Peutz-Jeghers syndrome (inherited, benign polyposis can 387
mouth, feet, hands, genitalia cause bowel obstruction;  cancer risk, mainly GI)
Multiple colon polyps, osteomas/soft tissue tumors, Gardner syndrome (subtype of FAP) 387
impacted/supernumerary teeth
Abdominal pain, ascites, hepatomegaly Budd-Chiari syndrome (posthepatic venous thrombosis) 392

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Severe jaundice in neonate Crigler-Najjar syndrome (congenital unconjugated 394
hyperbilirubinemia)
Golden brown rings around peripheral cornea Wilson disease (Kayser-Fleischer rings due to copper 395
accumulation)
Fat, female, forty, fertile Cholelithiasis (gallstones) 396
Painless jaundice Cancer of the pancreatic head obstructing bile duct 398
Bluish line on gingiva Burton line (lead poisoning) 419
Short stature, café-au-lait spots, thumb/radial defects, Fanconi anemia (genetic loss of DNA crosslink repair; 421
 incidence of tumors/leukemia, aplastic anemia often progresses to AML)
Red/pink urine, fragile RBCs Paroxysmal nocturnal hemoglobinuria 422
Painful blue fingers/toes, hemolytic anemia Cold agglutinin disease (autoimmune hemolytic 423
anemia caused by Mycoplasma pneumoniae, infectious
mononucleosis, CLL)
Petechiae, mucosal bleeding, prolonged bleeding time Platelet disorders (eg, Glanzmann thrombasthenia, 427
Bernard Soulier, HUS, TTP, ITP)
Fever, night sweats, weight loss B symptoms of malignancy 429
Skin patches/plaques, Pautrier microabscesses, atypical Mycosis fungoides (cutaneous T-cell lymphoma) or 430
T cells Sézary syndrome (mycosis fungoides + malignant
T cells in blood)
WBCs that look “smudged” CLL 432
Neonate with arm paralysis following difficult birth, arm Erb-Duchenne palsy (superior trunk [C5–C6] brachial 448
in “waiter’s tip” position plexus injury)
Anterior drawer sign ⊕ Anterior cruciate ligament injury 454
Bone pain, bone enlargement, arthritis Osteitis deformans (Paget disease of bone,  osteoblastic 463
and osteoclastic activity)
Swollen, hard, painful finger joints in an elderly Osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP 466
individual, pain worse with activity [Heberden nodes])
Sudden swollen/painful big toe joint, tophi Gout/podagra (hyperuricemia) 467
Dry eyes, dry mouth, arthritis Sjögren syndrome (autoimmune destruction of exocrine 468
glands)
Urethritis, conjunctivitis, arthritis in a male Reactive arthritis associated with HLA-B27 469
“Butterfly” facial rash and Raynaud phenomenon in a Systemic lupus erythematosus 470
young female
Painful fingers/toes changing color from white to blue to Raynaud phenomenon (vasospasm in extremities) 472
red with cold or stress
Anticentromere antibodies Scleroderma (CREST) 473
Dark purple skin/mouth nodules in a patient with AIDS Kaposi sarcoma, associated with HHV-8 478
Anti-desmoglein (anti-desmosome) antibodies Pemphigus vulgaris (blistering) 480
Pruritic, purple, polygonal planar papules and plaques Lichen planus 482
(6 P’s)
 AFP in amniotic fluid/maternal serum Dating error, anencephaly, spina bifida (open neural tube 491
defects)
Ataxia, nystagmus, vertigo, dysarthria Cerebellar lesion 499

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Toe extension/fanning upon plantar scrape Babinski sign (UMN lesion) 510
Hyperphagia, hypersexuality, hyperorality Klüver-Bucy syndrome (bilateral amygdala lesion) 511
Resting tremor, athetosis, chorea Basal ganglia lesion 511
Lucid interval after traumatic brain injury Epidural hematoma (middle meningeal artery 513
rupture)
“Worst headache of my life” Subarachnoid hemorrhage 513
Resting tremor, rigidity, akinesia, postural instability, Parkinson disease (loss of dopaminergic neurons in 520
shuffling gait substantia nigra pars compacta)
Chorea, dementia, caudate degeneration Huntington disease (autosomal dominant CAG repeat 520
expansion)
Nystagmus, intention tremor, scanning speech, bilateral Multiple sclerosis 523
internuclear ophthalmoplegia
Rapidly progressive limb weakness that ascends following Guillain-Barré syndrome (acute inflammatory 524
GI/upper respiratory infection demyelinating polyradiculopathy subtype)
Café-au-lait spots, Lisch nodules (iris hamartoma), Neurofibromatosis type I 525
cutaneous neurofibromas, pheochromocytomas, optic
gliomas
Vascular birthmark (port-wine stain) of the face Nevus flammeus (benign, but associated with Sturge- 525
Weber syndrome)
Renal cell carcinoma (bilateral), hemangioblastomas, von Hippel-Lindau disease (dominant tumor suppressor 525
angiomatosis, pheochromocytoma gene mutation)
Bilateral vestibular schwannomas Neurofibromatosis type 2 525
Hyperreflexia, hypertonia, Babinski sign present UMN damage 529
Hyporeflexia, hypotonia, atrophy, fasciculations LMN damage 529
Spastic weakness, sensory loss, bowel/bladder dysfunction Spinal cord lesion 530
Unilateral facial drooping involving forehead LMN facial nerve (CN VII) palsy; UMN lesions spare the 532
forehead
Episodic vertigo, tinnitus, hearing loss Ménière disease 534
Ptosis, miosis, anhidrosis Horner syndrome (sympathetic chain lesion) 540
Conjugate horizontal gaze palsy, horizontal diplopia Internuclear ophthalmoplegia (damage to MLF; may be 543
unilateral or bilateral)
Polyuria, renal tubular acidosis type II, growth failure, Fanconi syndrome (multiple combined dysfunction of the 586
electrolyte imbalances, hypophosphatemic rickets proximal convoluted tubule)
Athlete with polycythemia 2° to erythropoietin injection 589
Periorbital and/or peripheral edema, proteinuria (> 3.5g/ Nephrotic syndrome 597
day), hypoalbuminemia, hypercholesterolemia
Hereditary nephritis, sensorineural hearing loss, Alport syndrome (mutation in collagen IV) 596
retinopathy, lens dislocation
Streak ovaries, congenital heart disease, horseshoe kidney, Turner syndrome (45,XO) 638
cystic hygroma at birth, short stature, webbed neck,
lymphedema
Red, itchy, swollen rash of nipple/areola Paget disease of the breast (sign of underlying neoplasm) 650

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Fibrous plaques in tunica albuginea of penis with Peyronie disease (connective tissue disorder) 651
abnormal curvature
Hypoxemia, polycythemia, hypercapnia Chronic bronchitis (hyperplasia of mucous cells, “blue 674
bloater”)
Pink complexion, dyspnea, hyperventilation Emphysema (“pink puffer,” centriacinar [smoking] or 674
panacinar [α1-antitrypsin deficiency])
Bilateral hilar adenopathy, uveitis Sarcoidosis (noncaseating granulomas) 676

CLASSIC LABS/FINDINGS
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LAB/DIAGNOSTIC FINDING DIAGNOSIS/DISEASE PAGE
 AFP in amniotic fluid/maternal serum Down syndrome, Edwards syndrome 63
Large granules in phagocytes, immunodeficiency Chédiak-Higashi disease (congenital failure of 117
phagolysosome formation)
Recurrent infections, eczema, thrombocytopenia Wiskott-Aldrich syndrome 117
Optochin sensitivity Sensitive: S pneumoniae; resistant: viridans streptococci 134
(S mutans, S sanguis)
Novobiocin response Sensitive: S epidermidis; resistant: S saprophyticus 134
Bacitracin response Sensitive: S pyogenes (group A); resistant: S agalactiae 134
(group B)
Streptococcus bovis bacteremia Colon cancer 137
Branching gram ⊕ rods with sulfur granules Actinomyces israelii 139
Hilar lymphadenopathy, peripheral granulomatous lesion Ghon complex (1° TB: Mycobacterium bacilli) 140
in middle or lower lung lobes (can calcify)
“Thumb sign” on lateral neck x-ray Epiglottitis (Haemophilus influenzae) 142
Bacteria-covered vaginal epithelial cells “Clue cells” (Gardnerella vaginalis) 148
Cardiomegaly with apical atrophy Chagas disease (Trypanosoma cruzi) 158
Atypical lymphocytes EBV 165
Enlarged cells with intranuclear inclusion bodies “Owl eye” appearance of CMV 165
Heterophile antibodies Infectious mononucleosis (EBV) 165
Intranuclear eosinophilic droplet-like bodies Cowdry type A bodies (HSV or VZV) 166
Eosinophilic globule in liver Councilman body (viral hepatitis, yellow fever), represents 168
hepatocyte undergoing apoptosis
“Steeple” sign on frontal CXR Croup (parainfluenza virus) 170
Eosinophilic inclusion bodies in cytoplasm of Negri bodies of rabies 171
hippocampal and cerebellar neurons
Ring-enhancing brain lesion on CT/MRI in AIDS Toxoplasma gondii, CNS lymphoma 177
Psammoma bodies Meningiomas, papillary thyroid carcinoma, 211
mesothelioma, papillary serous carcinoma of the
endometrium and ovary

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“Delta wave” on ECG, short PR interval, supraventricular Wolff-Parkinson-White syndrome (Bundle of Kent 294
tachycardia bypasses AV node)
“Boot-shaped” heart on x-ray Tetralogy of Fallot (due to RVH) 298
Rib notching (inferior surface, on x-ray) Coarctation of the aorta 299
Heart nodules (granulomatous) Aschoff bodies (rheumatic fever) 312
Electrical alternans (alternating amplitude on ECG) Cardiac tamponade 310
Antineutrophil cytoplasmic antibodies (ANCAs) Microscopic polyangiitis and eosinophilic granulomatosis 315
with polyangiitis (MPO-ANCA/p-ANCA);
granulomatosis with polyangiitis (Wegener; PR3-
ANCA/c-ANCA); primary sclerosing cholangitis (MPO-
ANCA/p-ANCA)
Hypertension, hypokalemia, metabolic alkalosis 1° hyperaldosteronism (Conn syndrome) 349
Enlarged thyroid cells with ground-glass nuclei with “Orphan Annie” eyes nuclei (papillary carcinoma of the 343
central clearing thyroid)
Mucin-filled cell with peripheral nucleus “Signet ring” (gastric carcinoma) 379
Anti-transglutaminase/anti-gliadin/anti-endomysial Celiac disease (diarrhea, weight loss) 381
antibodies
Narrowing of bowel lumen on barium x-ray “String sign” (Crohn disease) 382
“Lead pipe” appearance of colon on abdominal imaging Ulcerative colitis (loss of haustra) 382
Thousands of polyps on colonoscopy Familial adenomatous polyposis (autosomal dominant, 387
mutation of APC gene)
“Apple core” lesion on barium enema x-ray Colorectal cancer (usually left-sided) 388
Eosinophilic cytoplasmic inclusion in liver cell Mallory body (alcoholic liver disease) 391
Triglyceride accumulation in liver cell vacuoles Fatty liver disease (alcoholic or metabolic syndrome) 391
“Nutmeg” appearance of liver Chronic passive congestion of liver due to right heart 392
failure or Budd-Chiari syndrome
Antimitochondrial antibodies (AMAs) 1° biliary cholangitis (female, cholestasis, portal 395
hypertension)
Low serum ceruloplasmin Wilson disease (hepatolenticular degeneration; Kayser- 395
Fleischer rings due to copper accumulation)
Migratory thrombophlebitis (leading to migrating DVTs Trousseau syndrome (adenocarcinoma of pancreas or 398
and vasculitis) lung)
Basophilic nuclear remnants in RBCs Howell-Jolly bodies (due to splenectomy or nonfunctional 416
spleen)
Basophilic stippling of RBCs Lead poisoning or sideroblastic anemia 416
Hypochromic, microcytic anemia Iron deficiency anemia, lead poisoning, thalassemia (fetal 418,
hemoglobin sometimes present) 419
“Hair on end” (“Crew-cut”) appearance on x-ray β-thalassemia, sickle cell disease (marrow expansion) 422
Hypersegmented neutrophils Megaloblastic anemia (B12 deficiency: neurologic 420
symptoms; folate deficiency: no neurologic symptoms)
Antiplatelet antibodies Idiopathic thrombocytopenic purpura 427
High level of d-dimers DVT, PE, DIC 428
Giant B cells with bilobed nuclei with prominent Reed-Sternberg cells (Hodgkin lymphoma) 429
inclusions (“owl’s eye”)

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Sheets of medium-sized lymphoid cells with scattered Burkitt lymphoma (t[8:14] c-myc activation, associated 430
pale, tingible body–laden macrophages (“starry sky” with EBV; “starry sky” made up of malignant cells)
histology)
Lytic (“punched-out”) bone lesions on x-ray Multiple myeloma 431
Monoclonal antibody spike ƒƒ Multiple myeloma (usually IgG or IgA) 431
ƒƒ Monoclonal gammopathy of undetermined
significance (MGUS consequence of aging)
ƒƒ Waldenström (M protein = IgM) macroglobulinemia
ƒƒ Primary amyloidosis
Stacks of RBCs Rouleaux formation (high ESR, multiple myeloma) 423
Azurophilic peroxidase ⊕ granular inclusions in Auer rods (AML, especially the promyelocytic [M3] type) 432
granulocytes and myeloblasts
WBCs that look “smudged” CLL (almost always B cell) 432
“Tennis racket”-shaped cytoplasmic organelles (EM) in Birbeck granules (Langerhans cell histiocytosis) 434
Langerhans cells
“Brown” tumor of bone Hyperparathyroidism or osteitis fibrosa cystica (deposited 464
hemosiderin from hemorrhage gives brown color)
“Soap bubble” in femur or tibia on x-ray Giant cell tumor of bone (generally benign) 464
Raised periosteum (creating a “Codman triangle”) Aggressive bone lesion (eg, osteosarcoma, Ewing 465
sarcoma, osteomyelitis)
“Onion skin” periosteal reaction Ewing sarcoma (malignant small blue cell tumor) 465
Anti-IgG antibodies Rheumatoid arthritis (systemic inflammation, joint 466
pannus, boutonniere and swan neck deformities)
Rhomboid crystals, ⊕ birefringent Pseudogout (calcium pyrophosphate dihydrate crystals) 467
Needle-shaped, ⊝ birefringent crystals Gout (monosodium urate crystals) 467
 uric acid levels Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, 467
loop and thiazide diuretics
“Bamboo spine” on x-ray Ankylosing spondylitis (chronic inflammatory arthritis: 469
HLA-B27)
Antinuclear antibodies (ANAs: anti-Smith and anti- SLE (type III hypersensitivity) 470
dsDNA)
Anti-histone antibodies Drug-induced SLE (eg, hydralazine, isoniazid, 250
phenytoin, procainamide)
Anti-topoisomerase antibodies Diffuse scleroderma 473
Keratin pearls on a skin biopsy Squamous cell carcinoma 484
Bloody or yellow tap on lumbar puncture Xanthochromia (due to subarachnoid hemorrhage) 513
Eosinophilic cytoplasmic inclusion in neuron Lewy body (Parkinson disease and Lewy body dementia) 520
Extracellular amyloid deposition in gray matter of brain Senile plaques (Alzheimer disease) 520
Depigmentation of neurons in substantia nigra Parkinson disease (basal ganglia disorder: rigidity, resting 520
tremor, bradykinesia)
Protein aggregates in neurons from hyperphosphorylation Neurofibrillary tangles (Alzheimer disease) and Pick 520
of tau protein bodies (Pick disease)
Silver-staining spherical aggregation of tau proteins in Pick bodies (Pick disease: progressive dementia, changes 520
neurons in personality)

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Pseudopalisading tumor cells on brain biopsy Glioblastoma multiforme 526
Circular grouping of dark tumor cells surrounding pale Homer-Wright rosettes (neuroblastoma, medulloblastoma) 528
neurofibrils
“Waxy” casts with very low urine flow Chronic end-stage renal disease 594
Nodular hyaline deposits in glomeruli Kimmelstiel-Wilson nodules (diabetic nephropathy) 597
Podocyte fusion or “effacement” on electron microscopy Minimal change disease (child with nephrotic syndrome) 597
“Spikes” on basement membrane, “dome-like” Membranous nephropathy (nephrotic syndrome) 597
subepithelial deposits
RBC casts in urine Glomerulonephritis 594
“Tram-track” appearance of capillary loops of glomerular Membranoproliferative glomerulonephritis 596
basement membranes on light microscopy
Anti–glomerular basement membrane antibodies Goodpasture syndrome (glomerulonephritis and 596
hemoptysis)
Cellular crescents in Bowman capsule Rapidly progressive (crescentic) glomerulonephritis 596
“Wire loop” glomerular capillary appearance on light Diffuse proliferative glomerulonephritis (usually seen 596
microscopy with lupus)
Linear appearance of IgG deposition on glomerular and Goodpasture syndrome 596
alveolar basement membranes
“Lumpy bumpy” appearance of glomeruli on Poststreptococcal glomerulonephritis (due to deposition 596
immunofluorescence of IgG, IgM, and C3)
Necrotizing vasculitis (lungs) and necrotizing Granulomatosis with polyangiitis (Wegener; PR3-ANCA/ 596
glomerulonephritis c-ANCA) and Goodpasture syndrome (anti–basement
membrane antibodies)
Thyroid-like appearance of kidney Chronic pyelonephritis (usually due to recurrent 600
infections)
WBC casts in urine Acute pyelonephritis 600
Renal epithelial casts in urine Intrinsic renal failure (eg, ischemia or toxic injury) 601
hCG elevated Choriocarcinoma, hydatidiform mole (occurs with and 633
without embryo, and multiple pregnancy)
Dysplastic squamous cervical cells with “raisinoid” nuclei Koilocytes (HPV: predisposes to cervical cancer) 645
and hyperchromasia
Disarrayed granulosa cells arranged around collections of Call-Exner bodies (granulosa cell tumor of the ovary) 647
eosinophilic fluid
“Chocolate cyst” of ovary Endometriosis (frequently involves both ovaries) 648
Mammary gland (“blue domed”) cyst Fibrocystic change of the breast 649
Glomerulus-like structure surrounding vessel in germ Schiller-Duval bodies (yolk sac tumor) 647
cells
Rectangular, crystal-like, cytoplasmic inclusions in Leydig Reinke crystals (Leydig cell tumor) 653
cells
Thrombi made of white/red layers Lines of Zahn (arterial thrombus, layers of platelets/ 672
RBCs)
Hexagonal, double-pointed, needle-like crystals in Bronchial asthma (Charcot-Leyden crystals: eosinophilic 674
bronchial secretions granules)

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