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Q. Riordian, M.B. B.CH., M.B.B.Ch., Ph.D.

Co-Director, Touro College of Osteopathic Medicine

It is regularly a familial dysfunction that options giant dna advanced pain treatment center greensburg pa toradol 10 mg cheap line, erythematous pain treatment for lyme disease 10 mg toradol generic free shipping, scaly plaques safe pain medication for small dogs toradol 10 mg discount fast delivery, generally on the dorsal extensor cutaneous surfaces of the body knee pain treatment running toradol 10 mg low price. None of the other choices describe increased numbers of regular squamous epithelial cells in the dermis. Keywords: Psoriasis, hyperplasia 10 the answer is B: Accumulation of irregular cells. These abnormal macrophages have a foamy cytoplasm and an eccentrically located nucleus. The underlying abnormality in Gaucher disease is a deficiency in glucocerebrosidase, a lysosomal acid glucosidase. Keywords: Gaucher illness, macrophage, lysosomal storage disease eleven the answer is B: There is a neoplastic proliferation of keratinocytes. Malignant cells have penetrated the epidermal�dermal junction and are infiltrating the dermis. The spheroidal, eosinophilic our bodies observed in this specimen are referred to as "keratin pearls. Keratin pearls are a helpful marker for squamous cell carcinomas arising in many different location, together with the esophagus, cervix, pores and skin, and lung. Keywords: Squamous cell carcinoma of the pores and skin, keratinocyte 12 the reply is A: Accumulation of cells and lipid materials within the arterial wall. These paired images distinction a traditional muscular artery (image on left) with a diseased coronary artery (image on right) from a patient with advanced atherosclerosis and ischemic heart disease. Atherosclerosis is a chronic illness of large and medium-sized elastic and muscular arteries that ends in the progressive accumulation within the intima of inflammatory cells, hyperplastic smooth muscle cells, lipids, and connective Introduction to Histopathology tissue. The ensuing attribute lesion, the fibrofatty plaque (atheroma), accommodates pools of extracellular lipid, and quite a few lipid-laden macrophages (foam cells). Cystic medial necrosis and dissecting aneurysms are sometimes diseases of the aorta (choices C and D). Keywords: Atherosclerosis, myocardial infarction 13 the answer is A: Disruption of elastic fibers. These paired photographs contrast regular elastic media (image on left) with disrupted elastic fibers (image on right) in the aorta of an aged patient with a history of systemic hypertension. Keywords: Cystic medial necrosis, hypertension 14 the answer is D: Occlusion of the lumen by a thrombus. This post-mortem specimen reveals a coronary artery with severe atherosclerosis and a recent thrombus lodged in the narrowed lumen. They are composed of insoluble fibrin, various clotting components, platelets, and other formed blood parts. A thrombus fashioned on an atherosclerotic plaque can abruptly occlude the lumen of medium-sized muscular arteries inflicting ischemic necrosis and acute myocardial infarction. None of the opposite selections describe the histopathology of atherosclerosis and thrombosis. Keywords: Myocardial infarction, atherosclerosis, thrombosis 15 the reply is B: the air spaces are filled with inflammatory cells. The alveolar air areas in this post-mortem specimen are full of acute inflammatory cells (primarily neutrophils), eosinophilic fibrin stands, and necrotic particles. This process is termed phagocytosis, and the effector cells are generally identified as phagocytes. Despite the impression of antibiotic therapy, pneumonia caused by Streptococcus pneumoniae (pneumococcus) stays a major problem. The most typical outcome of bacterial pneumonia is complete resolution, notably with acceptable antibiotic therapy. Choice A (air areas crammed with fluid) 331 is partially right, because activated endothelial cells within the lung become leaky, inflicting an exudate to accumulate within intra-alveolar air spaces. None of the other selections describe histopathologic features of acute bacterial pneumonia. Keywords: Pneumonia, irritation sixteen the reply is E: There is thickening of the arteriole wall. This renal biopsy exhibits arterioles which are markedly thickened by the deposition of basement membrane materials and by the buildup of plasma proteins. The glassy, pink-stained materials within the wall of those injured vessels is termed "hyaline," and the disease process is referred to as "hyaline arteriolosclerosis. Arterioles exhibit concentric hyaline thickening of the wall, typically with the lack of clean muscle cells. None of the opposite decisions describe histopathologic features of hyaline arteriosclerosis. Keywords: Benign nephrosclerosis, arteriosclerosis 17 the answer is A: the air spaces are crammed with fluid. Increased hydrostatic pressure related to failure of the left ventricle causes fluid (transudate) to transfer from pulmonary capillaries into interstitial tissue and intra-alveolar air areas of the lung. Patients in left-sided congestive coronary heart failure complain of shortness of breath (dyspnea) on exertion and when recumbent (orthopnea). They could also be awakened from sleep by sudden episodes of shortness of breath (paroxysmal nocturnal dyspnea). Patients with pulmonary edema have crackling breath sounds (rales) attributable to growth of the fluid-filled alveoli. Keywords: Pulmonary edema, congestive coronary heart failure 18 the answer is B: Destruction of the vessel wall by inflammatory cells. Fibrinoid necrosis is an alteration of injured blood vessels, during which the insudation and accumulation of plasma proteins causes the wall to stain intensely with eosin. These clinicopathologic findings are in maintaining with a diagnosis of polyarteritis nodosa-an acute necrotizing vasculitis that affects medium-sized and smaller muscular arteries. The commonest pathologic feature of polyarteritis nodosa is fibrinoid necrosis, during which the medial muscle and adjacent tissue are fused into an eosinophilic mass that stains for fibrin. None of the opposite decisions describe histopathologic options of a necrotizing arteritis. Keywords: Polyarteritis nodosa, arteritis 19 the answer is C: Foamy exudate throughout the air areas. The interstitium can also be thickened and accommodates a chronic inflammatory cell infiltrate. A bronchoalveolar lavage obtained from this affected person would present clusters of Pneumocystis organisms and set up a analysis of Pneumocystis pneumonia. The classic lesions of Pneumocystis pneumonia are a foamy intra-alveolar exudate and an interstitial infiltrate of plasma cells and lymphocytes. None of the opposite decisions describe the frequent histopathologic options of Pneumocystis pneumonia. Keywords: Pneumocystis pneumonia, Pneumocystis jiroveci 20 the answer is B: Deposition of collagen within the myocardium. Infarcts are geographic areas of necrosis attributable to lack of arterial blood flow (ischemia). Soon after the guts attack, neutrophils, macrophages, fibroblasts, and capillary endothelial cells infiltrate the injured coronary heart muscle. Glycogen accumulation (choice A) is seen in patients with certain inborn errors of metabolism. Enlargement of cardiac myocytes (choice C) is a trademark of hypertensive coronary heart disease. Inflammatory infiltrates (choice D) are hallmarks of infections and ischemic necrosis. Keywords: Myocardial infarct, fibrosis 21 the reply is C: the air areas are overly distended. Emphysema is a persistent lung illness, characterised by enlargement of the air spaces distal to terminal bronchioles, with destruction of their partitions, however with out fibrosis. None of the other selections describe histopathologic options of pulmonary emphysema. These pathologic findings are seen in patients with hypertrophic cardiomyopathy, a situation by which cardiac hypertrophy is out of proportion to the hemodynamic load positioned on the center. This disorder is an autosomal dominant trait in about half of the patients, involving mutations in genes that encode cardiac muscle contractile proteins. The wall of the left ventricle is usually thickened (hypertrophic) and its cavity is small. The most notable histologic attribute of this dysfunction is myofiber disarray, which is most intensive in the interventricular septum.

This accelerated release of pink cells from the bone marrow is manifested in the blood by an increased reticulocyte rely (normal reference vary = 0 pain treatment center tn toradol 10 mg otc. Reticulocytes are anucleate pink cells that symbolize the last stage of differentiation before the mature erythrocyte pain management after shingles buy 10 mg toradol with visa. The nucleus is extruded from orthochromatic erythroblasts the pain treatment and wellness center toradol 10 mg buy fast delivery, leaving mitochondria and polyribosomes within the reticulocyte pain treatment in osteoporosis toradol 10 mg discount with amex. After release from the bone marrow, reticulocytes lose their capability for aerobic metabolism and hemoglobin synthesis, and turn into a mature erythrocyte after 1 to 2 days. This leukemoid response (choice A) is typically difficult to differentiate from leukemia. Lymphocytosis (choice B) refers to increased numbers of B or T lymphocytes within the peripheral blood. None of the opposite hematologic findings are anticipated in a patient with hemolytic anemia. In transient, aplastic anemia is a disorder of pluripotential stem cells that leads to bone marrow failure. The disorder features hypocellular bone marrow and pancytopenia (decreased circulating levels of all fashioned components in the blood). Cytotoxic Blood and Hematopoiesis chemotherapy is known to trigger a transient aplastic anemia. Leukocytosis (choice A), lymphocytosis (choice C), and neutrophilia (choice D) are all characterized by a rise within the number of circulating white blood cells. Hematopoiesis also happens in blood islands within mesoderm of the extraembryonic yolk sac. Hematopoiesis switches from the yolk sac to the fetal liver around the 3rd month of embryogenesis, and switches to bone marrow after the second trimester of gestation. From delivery till 4 years of age, all bone cavities are densely full of hematopoietic tissue. After that time, the dimensions of the bone cavities outgrows the volume required for hematopoiesis, and in adults, fat cells are intermixed within the out there house. None of the other organs provide a hospitable surroundings (niche) for hematopoiesis during fetal development. Keywords: Hematopoiesis, hematopoietic stem cells 15 the answer is D: Neutrophils. It is characterised by the motion of (1) fluid and (2) leukocytes from blood into the injured tissue. These phagocytes exit the blood to clear particles and start the process of wound healing. Lobar pneumonia refers to consolidation of a complete lobe, whereas bronchopneumonia signifies scattered strong foci in the same or a quantity of lobes. Lymphocytes (choice B) and plasma cells (choice E) are mediators of chronic inflammation; they provide antigen-specific immunity to infectious diseases. Tissue macrophages (choice C) are continual inflammatory cells derived from circulating blood monocytes; they secrete quite a few cytokines to regulate wound therapeutic. Keywords: Bacterial pneumonia, Streptococcus pneumonia 16 the answer is C: Purulent exudate. Lung abscess is a localized accumulation of pus accompanied by the destruction of pulmonary parenchyma. The most typical reason for pulmonary abscess is aspiration, often within the setting of depressed consciousness. Purulent exudates and effusions are associated with pathologic conditions corresponding to bacterial infections, during which the predominant cell type is the segmented neutrophil (polymorphonuclear leukocyte). Keywords: Pulmonary abscess, exudates, purulent 17 the reply is C: Margination of segmented neutrophils. An essential function of inflammation is the buildup of leukocytes inside injured tissue. During acute inflammation, segmented neutrophils recognize vascular endothelial cells bearing acceptable receptors. This process of cell recognition and cell adhesion is termed neutrophil margination. After rolling to a cease, activated neutrophils flatten and migrate through the endothelial wall to enter the encircling connective tissue (diapedesis). None of the opposite selections describe the conduct of intravascular segmented neutrophils. Selectins are sugar-binding glycoproteins that mediate the preliminary adhesion of leukocytes to endothelial cells at websites of irritation. E-selectins are found on endothelial cells; P selectins are discovered on platelets; and L-selectins are found on leukocytes. Upon activation, E-selectins are redistributed alongside the luminal surface of the endothelial cells, the place they mediate the initial adhesion (tethering) and rolling of leukocytes. After leukocytes come to a stop, integrins (choice C) mediate transendothelial cell migration and subsequent chemotaxis to sites of harm. Na�ve lymphocytes encounter antigen-presenting cells (macrophages and dendritic cells) within the secondary lymphoid organs. None of the other leukocytes show the distinctive nuclear and cytoplasmic features of activated lymphocytes. Keywords: Infectious mononucleosis, lymphocytes 20 the reply is C: Lymphocytosis. In contrast to bacterial infections, viral infections (including infectious mononucleosis) are characterized by lymphocytosis, an absolute improve within the variety of circulating lymphocytes. The principal causes of absolute peripheral blood lymphocytosis are (1) acute infections (infectious mononucleosis, whooping cough), (2) persistent bacterial infections (tuberculosis, brucellosis), and (3) lymphoproliferative ailments. Parasitic infestations and sure allergic reactions cause eosinophilia (choice A), a rise within the variety of circulating eosinophils. Neutrophilia (choice E) represents a rise within the variety of circulating neutrophils. Keywords: Infectious mononucleosis, lymphocytosis 21 the reply is D: Macrophages. The mobile elements of continual inflammation are lymphocytes, antibody-producing plasma cells, and macrophages. Macrophages are a principal supply of growth factors and are acknowledged for their phagocytic features. During therapeutic of the lung, macrophages enter the alveolar air areas to remove inflammatory debris. Keywords: Bacterial pneumonia, Streptococcal pneumoniae 22 the reply is C: Cytokine secretion. The peripheral blood smear shows a small lymphocyte with a dark spherical nucleus and scant blue cytoplasm. Together, B and T lymphocytes represent about 30% of whole peripheral blood leukocytes. B cells secrete immunoglobulins (antibodies), whereas T cells either lyse target cells or secrete cytokines. None of the other immunological responses describe the principal function of lymphocytes. The peripheral blood smear reveals a mature eosinophil, with a trilobed nucleus and quite a few pink (eosinophilic) cytoplasmic granules. Eosinophils are granulocytes which might be derived from a standard myeloid progenitor cell in the bone marrow. They are significantly evident during allergic-type reactions and parasitic infestations. For instance, infections with Trichinella are accompanied by eosinophilia, and skeletal muscle is usually infiltrated by eosinophils. The larvae can invade almost any tissue however survive only in skeletal muscle in an encapsulated type. Keywords: Trichinosis, granulocytes, eosinophils 24 the reply is A: Degradation of pathogens. The significance of oxygen-dependent mechanisms within the bacterial killing by phagocytic cells is exemplified in chronic granulomatous disease of childhood. Keywords: Chronic granulomatous disease, phagocytosis 25 the reply is B: Leukopenia. Leukopenia may be attributable to typhoid fever and sure viral and rickettsial infections.

None of the other biological processes are involved in the maturation of secondary (antral) follicles pain management utica mi generic toradol 10 mg with amex. As the secondary follicle enlarges pain treatment elderly cheap 10 mg toradol overnight delivery, granulosa cells near the oocyte form a hillock referred to as the cumulus oophorus key pain management treatment center toradol 10 mg order online. These cells ship microvilli via openings in the zona pellucida to set up hole junction communication with the oocyte pain treatment center bismarck toradol 10 mg on-line. The corona radiata stays hooked up to the oocyte after ovulation and should not disperse till fertilization. The eosinophilic particles within the antrum of this secondary follicle represents proteins within the liquor folliculi that precipitated throughout tissue fixation. In this section, the zona pellucida seems as a skinny, eosinophilic ring between the oocyte and the corona radiata. These glycoproteins form a clear fibrous matrix that envelops the oocyte and early cleavage-stage embryo. The zona pellucida is degraded prior to implantation by proteolytic enzymes that are secreted by the blastocyst. The zona pellucida that surrounds the oocyte provides a multivalent array of receptors for sperm adhesion and activation of the sperm acrosome reaction. Theca externa cells (zone 4) include fibroblasts and clean muscle cells (fibromuscular connective tissue). Primary oocytes full the primary meiotic cell division a couple of hours earlier than ovulation. One set of chromosomes is retained by the secondary oocyte, whereas the opposite set is discarded, along with a small amount of cytoplasm, as the primary polar physique. This large vesicle varieties in the perivitelline space, between the germ cell plasma membrane and the zona pellucida. Granulosa cells synthesize aromatase, an intracellular enzyme that converts androstenedione into estradiol. Granulosa lutein and theca lutein cells (choices B and E) synthesize estrogen and progesterone in the course of the secretory phase of the menstrual cycle, after formation of the corpus luteum. Keywords: Ovaries, granulosa cells Female Reproductive System and Breast 17 the answer is D: Secondary oocyte. The resulting secondary oocyte is characterised by the presence of a single (first) polar physique. During ovulation, the secondary oocyte is launched from the surface of the ovary and enters the ampulla of the uterine tube. Zygote (choice E) describes the postfertilization embryo, previous to the primary cleavage division. Keywords: Ovaries, secondary oocytes, ovulation 18 the answer is A: Fertilization. The biochemical mechanisms that regulate this complicated course of are poorly understood. None of the other mobile or physiological processes regulate the second meiotic division. Keywords: Fertilization, meiosis 19 the reply is B: Formation of the second polar physique. Fertilization is a posh developmental course of that brings collectively haploid gametes, restores a diploid genome, and sets in movement early development. Binding of sperm to the zona pellucida triggers the sperm acrosome response (choice D). The acrosome reaction liberates hydrolytic enzymes that disperse the corona radiata (choice A) and create openings within the zona pellucida that facilitate the entry of hypermotile sperm into the perivitelline space. Movements of female and male pronuclei (choice C) can be difficult to monitor by mild microscopy. On the other hand, the formation of a second polar body could be monitored easily using an inverted part microscope. Formation of the second polar physique offers unambiguous evidence of fertilization. It signifies completion of the second meiotic division and heralds the initiation of early growth. The postfusion oocyte undergoes a speedy sequence of adjustments that block the entry of multiple spermatozoan. Three postfusion blocks to polyspermy have been described: (1) membrane depolarization (fast block), (2) Ca2+��mediated cortical granule launch (cortical reaction), and (3) enzymemediated modification of the zona pellucida (zona reaction). Exocytosis of cortical granules liberates proteases that degrade sperm receptors on the oocyte plasma membrane and on the zona pellucida. Mitochondrial membrane permeability transition (choice E) regulates programmed cell death. Atretic follicles endure degenerative adjustments related to programmed cell dying (apoptosis). Macrophages enter atretic follicles to remove mobile particles, and fibroblasts produce collagen scar tissue that will resorb over time. The circle shown on this picture reveals a small cystic cavity surrounded by pink collagen scar tissue. This part additionally exhibits stratification of the theca folliculi that surrounds a secondary (antral) follicle. This image reveals the remains of an atretic follicle that has been invaded by stromal connective tissue. Most of the cellular particles have been eliminated by macrophages; however, the glycoproteins that comprise the zona pellucida are proof against degradation. The remnant of a zona pellucida is seen in this picture as an eosinophilic loop that resembles a folded rubber band. This fibrous construction is positioned in a cystic space that was occupied by the primary oocyte. Recent studies point out that follicular atresia is triggered by down-regulation of an apoptosis-inhibitory protein in granulosa cells. Without this inhibitory protein, granulosa cells exit the cell cycle and activate hydrolytic enzymes. Death of the oocyte ensues, and the follicle is infiltrated by macrophages that remove apoptotic our bodies and necrotic tissue particles. Condensation of chromatin (pyknosis), degradation of chromatin (karyolysis), and eosinophilic apoptotic our bodies provide evidence of irreversible cell damage. Examination of the ovaries within the pathology division would therefore reveal evidence of necrosis and apoptosis, as nicely as evidence of therapeutic (collagen scar 248 Chapter 17 tissue). Atrophy of the ovaries happens in postmenopausal lady, owing to the lack of hormonal stimulation. Germ cell tumors (choice A), endometriosis (choice C), ovarian most cancers (choice D), and secondary lymphoid nodules (choice E) could affect the ovaries; nonetheless, these pathologic circumstances are less frequent than normal patterns of scar tissue. After ovulation, the stratum granulosum collapses and varieties a temporary endocrine organ that secretes progesterone and estrogen. This steroid hormone factory is referred to as the corpus luteum (L: yellow body). With conception, the corpus luteum of being pregnant produces steroid hormones for 4 to 5 months. Most of the cells comprising the corpus luteum are derived from the stratum granulosum of the mature (graafian) follicle. After ovulation, theca interna cells acquire the ability to synthesize progesterone. They are usually found as small aggregates in folds of the wall of the corpus luteum. In the absence of pregnancy, the corpus luteum of menstruation begins to degenerate about 10 to 12 days after ovulation. These cells deposit massive quantities of dense collagen scar tissue to form a corpus albicans (white body). Tunica albuginea (choice D) is a collagenous tunic that surrounds the testes and ovaries. None of the other selections exhibit the distinctive (hypocellular) morphology of the corpus albicans. Keywords: Ovaries, corpus luteum, syncytiotrophoblast 29 the answer is C: Macrophages. Apoptotic our bodies and necrotic particles from the degenerating corpus luteum are removed by tissue macrophages. The paired uterine tubes (commonly referred to as fallopian tubes) lengthen 10 to 12 cm from the body of the uterus toward the ovaries.

Hyaline (choice D) is a descriptive time period for eosinophilic inclusions and deposits which are related to various regular and pathologic conditions treatment for nerve pain in dogs purchase 10 mg toradol visa. Mucins (choice E) are hydrophilic polysaccharide chains that shield and lubricate delicate mucous membranes pain treatment center johns hopkins safe toradol 10 mg. The principal biochemical part of colloid is thyroglobulin regional pain treatment medical center discount toradol 10 mg with mastercard, a large (660 kDa) glycoprotein pain medication for dogs dosage cheap toradol 10 mg fast delivery. This prohormone undergoes sequential oxidation (via thyroid peroxidase) and iodination of specific tyrosine residues. Proteoglycans (choice D) are composed of a core protein and particular glycosaminoglycan aspect chains. Keywords: Thyroid gland, colloid, thyroglobulin 24 the answer is B: Lysosomal protease. Endosomes containing thyroglobulin are referred to as "colloidal resorption droplets. Proteases within lysosomes degrade high molecular weight thyroglobulin and launch the low molecular weight active hormones: triiodothyronine (T3) and thyroxine (T4). It is transformed to T3 (the stronger hormone) within target organs such because the kidney, liver, and heart. None of the opposite enzymes take part within the intracellular processing of thyroglobulin to generate thyroid hormones. Keywords: Thyroglobulin, thyroid gland, follicular cells 25 the answer is E: Parafollicular cells. Levels of blood calcium regulate the secretion of calcitonin by parafollicular cells. Keywords: Thyroid gland, parafollicular cells 26 the reply is E: Parafollicular cells. The circle within the picture identifies large clear cells (C cells) in the connective tissue between adjacent thyroid follicles. They are current inside the basal lamina of follicles and as isolated clusters between follicles. The thyroid gland varieties throughout early improvement as an endodermal outpouching (thyroglossal duct) of the foregut (choice E). Parafollicular cells, however, arise from neural crest cells which are put aside as "ultimobranchial bodies" inside paired branchial pouches. These ultimobranchial bodies finally fuse with the primordium of the thyroid gland, and the neural crest cells are dispersed among the many developing thyroid follicles. Paraxial mesoderm (choice D) arises throughout gastrulation and provides rise to the paired somites. None of the opposite decisions describe the embryonic origin of parafollicular cells of the thyroid gland. Keywords: Neural crest, parafollicular cells 28 the answer is E: Increased thyroglobulin uptake. The clear vacuoles observed on this image are visual evidence of thyroglobulin uptake by activated epithelial cells. None of the opposite choices describe the process of thyroglobulin uptake by follicular epithelial cells. Keywords: Goiter, thyroid gland, colloid Endocrine System 29 the answer is C: Simple squamous. Morphology of cells and tissues offers necessary clues to understanding biological operate. For instance, active thyroid glands have follicles lined by columnar cells (choice B), whereas hypoactive glands have follicles lined by squamous or low cuboidal epithelial cells (correct reply, alternative C). Keywords: Thyroid gland, follicular cells 30 the answer is D: Basolateral membranes of follicular epithelial cells. This transmembrane protein localizes to the basolateral membranes of epithelial cells and is therefore in shut proximity to the blood provide. Once inside the cytoplasm of the epithelial cells, iodide is pumped into the lumens of thyroid follicles by an iodide/chloride transporter termed pendrin. Here, iodide undergoes oxidation to type iodine-the energetic chemical component that varieties covalent bonds with tyrosine residues of thyroglobulin. Keywords: Thyroid gland, colloid, thyroid hormone 31 the reply is C: Parathyroid gland. These small, oval-shaped glands are sometimes situated in the connective tissue alongside the posterior wall of the thyroid gland, however they could be present in varied ectopic locations. None of the opposite anatomic structures describe the distinctive morphologic options of the parathyroid glands. Keywords: Parathyroid glands 32 the answer is A: Cords of epithelial cells separated by fenestrated capillaries. The parathyroid glands are composed of small nests or cords of densely packed glandular epithelial cells, separated by discontinuous fenestrated capillaries. Pyramidal-shaped acinar cells (choice D) are a attribute characteristic of many exocrine glands. Simple squamous epithelial cells lining open vascular areas (choice E) describes endothelial cells of the circulatory system. Parenchymal cells of the parathyroid glands embrace chief cells and oxyphil cells. The scientific manifestations of hyperparathyroidism vary from asymptomatic hypercalcemia to major constitutional signs related to renal stones, bone loss, mental standing modifications, and belly pain. This constellation of clinical features is summarized (memorably) as "stones, bones, moans, and groans. Keywords: Parathyroid glands, chief cells, hyperparathyroidism 34 the reply is C: Oxyphil cells. The large eosinophilic cells indicated by the arrows in the image are oxyphil cells. They are nonsecretory cells, and their perform (if any) remains to be determined. They are seen in this image as densely packed polygonal cells with basophilic central nuclei. Follicular and parafollicular cells (choices B and D) are found within the thyroid gland. The abundance of oxyphil cells and adipocytes in the parathyroid glands increases with advancing age. None of the other cells have been reported to endure age-related modifications within the endocrine organs. The adrenal (suprarenal) glands are small, flat organs, embedded in fat near the superior poles of the kidneys. This photomicrograph of the adrenal gland shows a pink-stained cortical area surrounding a pale-stained central (medullary) region. These large epithelioid cells secrete catecholamines-commonly referred to as the "flight-orfight" hormones. The adrenal medulla has a dual blood provide that arises from (1) medullary arterioles that bypass the adrenal cortex and (2) capillary sinusoids that perfuse the adrenal cortex (adrenocortical sinusoids). The central adrenomedullary vein indicated by the arrow on this image drains to the inferior vena cava. Keywords: Adrenal medulla, chromaffin cells 266 Chapter 18 37 the answer is C: Neural crest. Chromaffin cells of the adrenal medulla come up from the neural crest lineage during embryonic development. They symbolize postganglionic cells of the sympathetic nervous system that populate the adrenal glands. These tumors secrete catecholamines, which trigger episodic, malignant hypertension. Mesothelial cells of the coelomic epithelium (choice A) contribute to the event of male and female gonads. Endoderm of the primitive intestine (choice B) varieties many inner organs, together with the liver, gallbladder, and pancreas. Oral ectoderm (choice D) gives rise to Rathke pouch that types the anterior pituitary. Pharyngeal pouch mesenchyme (choice E) offers rise to many buildings in the head and neck, together with the thyroid and parathyroid glands.

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