Histo1 1. Nissl bodies correspond to which of the following cytoplasmic organelles ? A. B. C. D. E.

Golgi apparatus Mitochondria Nucleoli Rough endoplasmic reticulum Smooth endoplasmic reticulum

Explanation: The correct answer is D. This is a straightforward question relating to th e definition of Nissl bodies. Rough endoplasmic reticulum present in ne urons are called Nissl bodies. They stain intensely with basic dyes and are found in the cell body and proximal dendrites, but not in the axon hill ock or axon. 2. A premature infant develops progressive difficulty breathing over the fi rst few days of life. Deficient surfactant synthesis by which of the follow ing cell types may have contributed to the baby's respiratory problems? A. B. C. D. E. Alveolar capillary endothelial cells Bronchial mucous cells Bronchial respiratory epithelium Type I pneumocytes Type II pneumocytes

Explanation: The correct answer is E. The child has neonatal respiratory distress synd rome (hyaline membrane disease). This condition is caused by the inab ility of the immature lungs to synthesize adequate amounts of surfactan t. Surfactant, which reduces surface tension, helps keep alveoli dry and aids in expansion of the lungs, is synthesized by type II pneumocytes. Alveolar capillary endothelial cells (choice A) are important in main taining the capillary structure and permitting flow of gases into and out of t he blood stream. Bronchial mucous cells (choice B) produce the usually thin (in healthy individuals) coat of mucus that lines the bronchi. The ciliated bronchial respiratory epithelium (choice C) is responsible for moving the dust coated mucus layer out of the bronchi. Type I pneumocytes (choice D) are the squamous cells that line alveoli and permit easy gas exchange. These cells tend to be immature (and thic k) in premature infants, but do not producesurfactant. 3. A surgical pathology specimen from a 24-year-old woman seen at a reproductive medicine clinic demonstrates a ciliated columnar epitheliu m. From which of the following locations in the female genital tract was the biopsy obtained? A. Cervix B. Endometrium C. Fallopian tube D. Ovary E. Vagina Explanation: The correct answer is C. The fallopian tube is the only structure in the female genital tract with a ciliated columnar epithelium; the beating of the cilia helps move the egg into the uterus. This fact is also s ometimes clinically helpful since dilated and deformed fallopian tubes can be microscopically distinguished from cystic ovarian tumors by

the presence of the cilia. The cervix (choice A) and vagina (choice E) are lined by squamous epithelium. Th e endometrium (choice B) is lined by columnar epithelium (although a few ciliated cells may be present). The covering of the ovary (choice D) is cuboidal epithelium, and cysts within the ovary can be lined by cuboidal or non-ciliated columnar epithelium. 4. A 40-year-old women presents with a several year history of pro gressive abdominal colic and constipation. Colonic biopsy stained with h ematoxylin and eosin demonstrates deposition of a pink acellular materia l in the submucosa and around blood vessels. When sections from this biopsy are stained with Congo red, the acellular material exhibits gre en birefringence. The birefringence is thought to be most closely r elated to which of the following protein properties? A. B. C. D. E. Ability to bind to oxygen Beta-pleated sheet tertiary structure Electrophoretic mobility Hydroxyproline content Molecular weight

Explanation: The correct answer is B. The patient has amyloidosis, which can be present in the manner illustrated. Originally, it was thought that amyloid represented a single protein. How ever, as the various settings in which amyloidosis occurs were further exp lored, it was discovered that a variety of clearly distinct proteins coul d produce the material. Eventually, it was observed that what these d iverse proteins had in common was a beta-pleated sheet tertiary s tructure that apparently is reflected in the apple-green birefringence. None of the other properties are thought to contribute to birefringence wh en viewed with polarized light. The ability to bind oxygen (choice A) is important to hemoglobin. Electrophoreti c mobility (choice C) is used to separate serum proteins. Hydroxyproline content (choice D) is important to collagen structure. Molecular weight (choice E) is a basic protein property. 5. A 5-year-old boy falls off his bike and fractures his humerus. He is t aken to the emergency room, and the bone is set by one of the emergency room physicians. Which of the following is responsible for producing the majority o f the new bone that will reunite the two fragments? A. B. C. D. E. Cancellous bone Cartilage Compact bone Marrow Periosteum

Explanation: The correct answer is E. When the periosteum is torn during a fracture, i t supplies cells that develop into osteoblasts and are the major produce rs of the new bone that reunites the two ends. Heterotopic ossificatio n (bone formed outside the regular bone) can occur as a complica tion of fracture if some of the osteoblastic cells are misdirected into adjacent tissues. Preexisting cancellous bone (choice A) and compact bone (choice C) are no t the major source of osteoblasts that form the new bone. Cartilage (choice B) and marrow (choice D) do not contribute to new bone formati on after fracture.

6. Which of the following sites contains striated muscle that is not under voluntary control? A. B. C. D. E. Bladder Colon Esophagus Gallbladder Stomach

Explanation: The correct answer is C. Striated (skeletal) muscle not under voluntary control is an unusual feature of the upper third of the esophagus. The mi ddle third of the esophagus contains roughly half striated and half smoot h muscle; the lower third contains only smooth muscle. All the other st ructures listed in the answer choices contain smooth muscle. 7. A 27-year-old male presents to the doctor with complaints of "heartburn" and painful, sour-tasting acid reflux that has not been alleviated by o ver-the-counter medications. An endoscopic exam is performed and a biopsy of the distal esophagus is taken. Microscopic examination of the tissue shows normal tissue without pathologic changes. What type of mucosa is normal for the distal esophagus? A. B. C. D. E. F. Ciliated, columnar epithelium Keratinized, stratified, squamous epithelium Non-ciliated, columnar epithelium Non-keratinized, simple, squamous epithelium Non-keratinized, stratified, squamous epithelium Pseudostratified, columnar epithelium

Explanation: The correct answer is E. The esophagus is covered by non-keratinized, stratified, squamous epithelium for its entire length. Heartburn is usua lly a sign of gastric regurgitation of the acidic contents in the lower esophagus (acid reflux disease). Acid reflux disease is a serious problem that may be associated with a precancerous condition (Barrett's esophagus). 8. Histologic examination of normal skin demonstrates small numbers of perivascular cells, with darkly stained ovoid nuclei and granular cytopla sm on hematoxylin and eosin staining. The cells demonstrate metachromasia of the cytoplasm when stained with Giemsa stain. Which of the fol lowing products would these cells be most likely to secrete? A. B. C. D. E. Bradykinin Complement factor 3a Histamine Interleukin 2 Nitric oxide

Explanation: The correct answer is C. The cells in question are mast cells, which play an important role in IgE-mediated allergic responses. They are a normal ( minor) constituent of dermal skin and are most definitely identified w ith stains, such as the Giemsa stain, that highlight the granulari ty of their cytoplasm (mast cells are closely related to blood basophils) . Mast cells secrete histamine, serotonin, many leukotrienes, and platele t aggregating factor (PAF). Their histamine secretion after IgE stimulati on helps to trigger the acute inflammatory part of the allergic response. Bradykinin (choice A) is a nonapeptide found in the plasma. It is a po

tent vasodilator and stimulates pain receptors. Complement factor 3a (choice B ) is a plasma protein that induces vascular leakage as part of the acute inflamm atory response. Interleukin 2 (choice D) is secreted by lymphocytes and augments the immune resp onse. Nitric oxide (choice E) is released by macrophages and endothelium. It causes vasodilation and cytotoxicity. 9. A 35-year-old male presents to the urologist for an infertility evalua tion. A biopsy of his testis is performed to check sperm production and mat uration. A microscopic section reveals only a few germ cells near the b asal lamina in the seminiferous tubule. Which of the following cells is the germ cell closest to the basal lamina in the seminiferous tubule? A. B. C. D. E. Primary spermatocyte Secondary spermatocyte Spermatid Spermatogonia Spermatozoa

Explanation: The correct answer is D. Maturation of germ cells (spermatogenesis) wi thin the seminiferous tubules occurs in a concentric pattern with the les s mature spermatogonia near the basal lamina and the mature forms near the tubule center. Spermatogonia are 2N cells and mature into larger primary spermatocytes (4N) (choice A). These mature into secondary spermatocytes (2N) (choice B), and finally into spermatids (1N) (choice C). Spermatids undergo spe rmiogenesis to become mature spermatozoa (choice E). Acrosomes form from the Golgi apparatus and a flagellum forms from microtubules. Unneeded or ganelles are shed. The seminiferous tubules of a reproductive-age male sho uld exhibit all stages of maturation, with mature flagellated sperm in their cen ters. 10. timal ed? A. At B. In C. In D. In E. In Brunner's glands secrete an alkaline product that helps achieve op pH for the activity of pancreatic enzymes. Where are these glands locat the the the the the base of villi throughout the small intestine epithelium of the ampulla of Vater mucosa and submucosa of the jejunum submucosa of the duodenum submucosa of the ileum

Explanation: The correct answer is D. Brunner's glands are located in the submucosa o f the duodenum. These glands are connected to the intestinal lumen by ducts that open into certain crypts. They secrete an alkaline product t hat protects the duodenal mucosa from the acidic chyme and helps achieve optimal pH for pancreatic enzymes. Note that if you did not recall the location of Brunner's glands, the ques tion's description of their function allowed you to deduce it, based on y our knowledge of the anatomy of the small intestine. You should have imme diately ruled out choices C and E because they are too far from the panc reas. Choices B and D would therefore remain as the best possible answe rs because of their proximity to the pancreas. If you remembered the structure and functi on of the ampulla of Vater, you were left with the correct answer. Let's review some other key features of intestinal histology by way of the wrong answer choices. The small intestinal villi (choice A) are outgrowths o f the mucosa into the lumen. Their epithelium contains columnar absorpti ve cells and goblet cells (produce acid glycoproteins that protect and l

ubricate the lining of the intestine). Near the base of each villus, th ere are tubular glands called crypts whose lining is continuous with the simple columnar epithelium of the villus. The crypts include Paneth ce lls, which produce acidophilic cytoplasmic granules containing bacteriocid al enzymes. The lamina propria of the small intestine penetrates the core of the villi and is composed of blood vessels, lymphatics, fibroblast s, and smooth muscle cells. The ampulla of Vater (choice B) receives bile from the common bile duct and th e main pancreatic duct, delivering it to the duodenum through the major duodenal papilla. The mucosa and submucosa of the jejunum (choice C) are both included i n the permanent folds called the plica circulares. The submucosa of the ileum (choice E) is the home of Peyer's patc hes, which are large aggregates of lymphoid nodules. 11. Routine chest x-ray of a worker in a tuberculosis sanitorium reveals a focal calcification initially thought to be a lung lesion. However, xrays taken in different views establish that the abnormal calcification involves a structure other than the lung. Physiologic calcification of which of the following structures would most likely cause the radiologic shadow? A. Aorta B. Costal cartilage C. Intercostal arteries D. Intercostal veins E. Vena cava Explanation: The correct answer is B. Focal calcification of hyaline cartilage is comm on and may initially be troublesome in that it may suggest a path ologic rather than physiologic process. Calcification of the hyaline cartilage of the costal cartilages is notorious for producing "phantom" lung lesions. The aorta (choice A) can develop calcified atheromatous plaques, but these would not be localized to the chest wall. Calcification of the intercostal vessels (choices C and D) or vena cava (choice E) would be unusual. 12. Most fascia of the body that attach to bones attach by which of the foll owing mechanisms? A. Blending with the covering periosteum B. Inserting deeply into the cancellous bone C. Inserting deeply into the cartilage D. Inserting deeply into the diaphysis E. Inserting deeply into the marrow Explanation: The correct answer is A. Fascial straps (retinacula) and fascial coverings of m uscles or muscle groups characteristically attach to nearby bones by blend ing with the covering periosteum. No deep attachments are usually made by fascia. Cancellous bone (choice B) is spongy bone, which is usually found in ma rrow, and is not the site for fascial attachment. Fascia do not usually attac h to cartilage (choice C). Fascia attaches to bony shafts, or diaphyses (choice D), superficially via the periosteum. Fascia do not penetrate the bone to reach the marrow (choice E). 13. Microscopic examination of a PAS-stained histological section through a Graafian follicle demonstrates a bright reddish-pink, acellular ring aro und the ovum. Which of the following terms most accurately describes t his ring?

A. B. C. D. E.

Corona radiata Cumulus oophorus Theca externa Theca interna Zona pellucida

Explanation: The correct answer is E. The ring described is the zona pellucida, which surrou nds the ovum. The zona pellucida is rich in polysaccharides and glycoprotein s and hence stains brightly pink or red with PAS stain. Binding of the sperm cell membrane to the zona pellucida triggers the acrosome reacti on, during which acrosomal enzymes are released that digest the zona pel lucida, allowing the spermatozoon to contact and fuse with the ovum cell membran e. The follicular cells immediately outside the zona pellucida form the corona radiata (choice A). The larger cumulus oophorus (choice B) is the hill of fol licular cells that surrounds the ovum. The theca interna (choice D) and externa (choice C) are formed from the connective tissue surrounding the follicle. 14. A 24-year-old delivery driver is involved in an accident and sustains a wide abrasion over his left elbow. The abrasion results in the total loss of epidermis over a large area of his left arm, but one month later, t he abrasion has healed, with regrowth of the epidermis. Which of the fol lowing mechanisms accounts for the restoration of the epidermis over the abraded area? A. Growth of epidermis from hair follicles and sweat glands in the dermis B. Migration of endothelial cells from newly grown capillaries C. Transformation of dermal fibroblasts into epidermal cells D. Transformation of macrophages into epidermal cells E. Transformation of melanocytes into epidermal cells Explanation: The correct answer is A. The dermis contains skin appendages (e.g., hair follicles) that contain epithelial stem cells. In the process of hea ling a large area where the epidermis has been lost, but the dermis is intact, re epithelialization occurs by ingrowth of epidermal cells from the underlying skin appendages, as well as from the intact epide rmis along the wound edges. None of the other cell types are known to directly contribute to the reg eneration of epidermis over abraded skin. 15. Damage to which of the following structures might produce hair cell loss ? A. Basilar membrane B. Organ of Corti C. Reissner's membrane D. Scala tympani E. Scala vestibuli Explanation: The correct answer is B. The structure of the cochlea is complex. The organ of Corti contains hair cells from the cochlear branch of the vestibulocochlear nerve (CN VIII). These cells rest on the basilar membrane (choice A), which separates the scala tympani (choice D) from the scala media. The hairs o f the hair cells are embedded in the tectorial membrane, and movement of the basilar membrane below the cells tends to bend the hairs, which gener ates action potentials by the hair cells. The tectorial membrane that lie s on the hair cells does not form a boundary between the different scal a; the membrane separating the scala media from the scala vestibule (cho

ice E) is Reissner's (vestibular) membrane (choice C). 16. In the adult, neurons are an example of which of the following? A. Continuously dividing cells B. Labile cells C. Permanent cells D. Quiescent cells E. Stable cells Explanation: The correct answer is C. Permanent (non-dividing) cells have left the cell cycle and can no longer undergo mitotic division. Examples that are usu ally cited include neurons and cardiac myocytes. In contrast, labile (continuously dividing) cells, such as those that form most epithelial linings, continue to proliferate throughout life, and stable (quiescent) c ells, such as in the liver and other body organs, proliferate in response to st imuli such as injury. Examples of labile (continuously dividing) cells (choices A and B) include the epithelia of the body surface, gastrointestinal tract, and urinary tract. Examples of stable (quiescent) cells (choices D and E) include the c ells of the glandular organs of the body. 17. Which of the following hormones is secreted by anterior pituitary cells that stain with acidic dyes? A. ACTH B. FSH C. LH D. Prolactin E. TSH Explanation: The correct answer is D. The cells of the anterior pituitary can be clas sified as chromophils (love dyes) or chromophobes (do not stain with dyes ). The chromophils can be further divided into acidophils (stain with aci dic dyes) and basophils (stain with basic dyes). The acidophils include the somatotropes, which secrete growth hormone, and the mammo tropes, which secrete prolactin. The basophils include the corticotrope s, which secrete ACTH (choice A), the gonadotropes, which secrete FSH and LH (choices B and C), and the thyrotropes, which secrete T SH (choice E). 18. A researcher is examining the distribution of an ion channel protein in the kidney. She incubates slices of kidney tissue in dilute solution of a specif ic antibody directed against the protein, then uses immunoperoxidase method to localize the ion channel proteins. She notes the presence of brown pigment in a population of epithelial cells, which on closer examination, have a brush border. The researcher concludes that the protein is probably present in c ells of the A. collecting duct B. deep portion of loop of Henle C. distal convoluted tubule D. glomerulus E. proximal convoluted tubule Explanation: The correct answer is E. The immunoperoxidase method uses horseradish peroxida se to produce a visible pigment when a specific antibody binds to antigenic sites in the ti ssue. Binding of the antibody to the epithelial cells indicates that the protein in question is being expressed by those cells. The positive i

mmunoperoxidase results obtained here suggests that the channel protein is expressed in proximal convoluted tubular epithelium, since this is the only site in the kidney at which the epithelial cells have a "brush bo rder." The brush border is made of microvilli, which enhance the proxi mal tubules' ability to reabsorb plasma constituents filtered at the g lomeruli. 19. Which of the following is found in the respiratory zone of the lung? A. Goblet cells B. Main bronchi C. Mucous cells D. Terminal bronchioles E. Type I epithelial cells Explanation: The correct answer is E. There are two zones in the lungs. The conducting zone ( where there is no gas exchange) and the respiratory zone (where there is gas exchange). Of all of the structures listed, only Type I epithelial cells ar e seen in the respiratory zone. Type I epithelial cells are the 1 structural ce ll of the alveolar wall. Type II epithelial cells, also located in the alveol i, are the cells that produce surfactant. Goblet cells (choice A), which are mucus-secreting cells, are present in the con ducting airways. The main bronchi (choice B) are part of the conducting airways. Mucous cells (choice C), which are mucus-secreting cells, are present in the co nducting airways. Terminal bronchioles (choice D) are the most distal part of the conducting airwa ys. Respiratory bronchioles, which are just distal to the terminal bronchioles, are part of the respiratory zone. These two types of bronchioles can be differe ntiated from each other by whether they have alveoli budding from their walls. R espiratory bronchioles have alveoli, but terminal bronchioles do not. 20. An AIDS patient develops symptoms of pneumonia, and Pneumocystis carinii is suspected as the causative organism. Bronchial lavage is performed. Which of the following stains would be most helpful in demonstrating the organism's cysts on slides made from the lavage fluid? A. Alcian blue B. Hematoxylin and eosin C. Methenamine silver D. Prussian blue E. Trichrome stain Explanation: The correct answer is C. The appropriate stain is silver methenamine, and the requisition slip when submitting the wash fluid should have a reference t o either Pneumocystis or methenamine silver, since routine H&E does not ad equately demonstrate the organisms. The cysts, when stained with methenami ne silver, have a characteristic cup or boat shape; the trophozoites a re difficult to demonstrate without electron microscopy. It is also worth knowing that sputum samples are not nearly as effective as bronchial washes in demonstrating the organisms. Alcian blue (choice A) is good for demonstrating mucopolysaccharides. H&E (choic e B) is the routine tissue stain used in pathology laboratories. Prussian blue ( choice D) is good for demonstrating iron. Trichrome stain (choice E) is good for distinguishing fibrous tissue from nerve and muscle. 21. A gastric biopsy is taken from a 42-year-old man. As the pathologist ins pects the specimen, he observes numerous, normal cuboidal-to-columnar cells with apical membrane-bound secretion granules in the gastric glands. From wh ich area of the stomach was the biopsy most likely taken? A. Cardiac region

B. C. D. E.

Columns of Morgagni Fundic region Greater omentum Pyloric region

Explanation: The correct answer is C. The pathologist saw normal chief cells which are abund ant in the body and fundus of the stomach. Chief cells secrete pepsinogen, w hich is stored in apical membrane-bound granules. The body and fundus of the stomach contain high concentrations of four other types of cells in the epithelium. The parietal (oxyntic) cells are large, pyramidal, an d acidophilic with central nuclei (look like a "fried egg"). They make and secrete HCl. The mucous neck cells secrete mucus and appear clear. The entero endocrine cells have affinity for silver stains and exhibit a positiv e chromaffin reaction; these cells synthesize amines, polypeptides, or pro teins. The cardiac region (choice A) is a narrow, circular band at the tra nsition between the esophagus and stomach, consisting of shallow gastric pits and mucous glands. It does not normally contain an abundance of chief cells. The columns of Morgagni (choice B) are found in the rectum, not in t he stomach. These are mucous membrane infoldings in the submucosa of the p roximal anal canal. They would not contain chief cells. The greater omentum (c hoice D) is a four-layered fold of peritoneum that hangs from the greater curvature of the stomach and attaches to the transverse colon. It would not cont ain chief cells. The pyloric region (choice E) has deep gastric pits into which tubular glands open. The predominant secretion is mucus. It does not normally contain an abundance of chief cells. Note that in this question you could have automatically eliminated choices B and D, since they are not gastric structures. If nothing else, you would have improved your guessi ng odds to 33%. 22. Observation of a hematoxylin and eosin-stained microscope slide reveals that the nuclei are blue. What is the basis for this observation? A. Eosin binds to carbohydrates B. Eosin binds to lipids C. Eosin binds to nucleic acids D. Hematoxylin binds to lipids E. Hematoxylin binds to nucleic acids Explanation: The correct answer is E. Blue hematoxylin binds to polyanions such as RNA an d DNA. Nuclei contain large amounts of DNA and RNA, and they are consequen tly almost always blue. The nuclei of dysplastic and cancerous cells are ofte n enlarged and hyperchromatic (e.g., darker blue) compared to normal cells of similar cell lines, because these altered cells often have extra DNA (are aneu ploid) and/or RNA (are metabolically active). Pink eosin binds relatively nonselectively to cellular components, particu larly proteins. Cytoplasm of different cell lines can be pink, purple, or blue, depending principally on the number of ribosomes in the cytoplas m. Consequently, blue-tinged cytoplasm tends to suggest high synthetic acti vity (e.g., abundant ribosomes). 23. In which of the following organs are fenestrated endothelial cells commo n? A. Heart B. Liver C. Lungs D. Pancreas E. Stomach

Explanation: The correct answer is B. Fenestrated ("windowed") endothelial cells, which permit free flow of serum across the endothelium, are an unusual feature of the hepatic sinusoids. They are not seen in the other organs listed. 24. Which of the following tissues normally has the highest percentage of mu cus-secreting cells? A. Esophageal mucosa B. Oral mucosa C. Parotid gland D. Sublingual gland E. Submandibular gland Explanation: The correct answer is D. Salivary glands can contain mostly serous cells, predom inantly mucous cells, or both in their acini. As you proceed from the midli ne laterally, acini in the sublingual gland are almost pure mucous cells, while acini in the submandibular gland (choice E) contain a mixture of serous and mucous cells. Acini in the parotid gland (choice C) are mostly pure serous cells. The esophageal mucosa (choice A) and the oral mucosa (choice B) are squamous epithelia that do not form acini. 25. Microscopic examination of a section of a normal young adult ovary revea ls large numbers of unusually large cells surrounded by a single layer of flat epithelial cells. In which phase of the cell cycle are these cells arrested? A. Diplotene stage of the 1st meiotic division B. Diplotene stage of the 2nd meiotic division C. Metaphase stage of mitosis D. Prophase stage of mitosis E. Prophase stage of the 2nd meiotic division Explanation: The correct answer is A. The cells described are the primordial eggs, which rema in stopped in the diplotene stage of the first meiotic division from befo re birth until fertilization, a period which may be 40 or more years. Choices B and E are incorrect because the oocytes are stopped in the first, not 2nd m eiotic division. Choices C and D are incorrect because the cells described are o ocytes and are not in mitosis. 26. A 32-year-old renal transplant patient who had been doing well on azathi oprine and prednisone abruptly develops fever, chills and cough productive of ru st-colored sputum. A fiberoptic biopsy is performed that shows tissue destructi on and areas suspicious for fungus. Which of the following special stains would demonstrate fungal forms? A. Gram's stain B. Hematoxylin and eosin C. Masson's trichrome D. Methenamine silver E. Ziehl-Neelsen stain Explanation: The correct answer is D. The methenamine silver stain is a silver impregnation stain that is good for detecting both fungal organisms and hyphae. They appear black against a blue-green background. Gram's stain (choice A) is used in the general classification of bacteria. The Gram's stain is picked up by the bacte rial cell wall. Gram's iodine with safranine counterstain is most commonly used. Hematoxylin and eosin (choice B) is the standard pathology stain. As in the ca se above, it shows areas suspicious for fungi, but special stains are needed to confirm it. Masson's trichrome (choice C) is a connective tissue stain. It st ains the supporting tissues, especially collagen. The stain produces 3 colors: b

lue nuclei, green connective tissue, and red blood. The Ziehl-Neelsen stain (c hoice E), or acid fast stain, is used for certain acid fast organism such as mycobacteria. The stain is taken up by cell walls and remains in the cel l wall despite washing with acid. The organisms appear red against a blue backg round. 27. Infections in hyaline cartilage typically destroy the cartilage because A. cartilage contains chondroitin sulfate B. cartilage contains collagen C. cartilage is not innervated D. cartilage is relatively avascular E. cartilage tends to become calcified Explanation: The correct answer is D. Hyaline cartilage contains very few, sparsely distribut ed, small blood vessels. The tissue consequently is very vulnerable to infection because the immune system (white cells and serum with clotting factors and an tibodies) cannot access the cartilage in an efficient fashion. Chondroitin sul fate (choice A) is an important constituent of cartilage that can be attacked by bacteria, but this is not the cause of uncontrollable infections in the cartila ge, because if the infection is controlled, chondrocytes will continue to synthe size chondroitin. Collagen (choice B) is present in cartilage, but does not predispose the cartilage for uncontrollable infection. Collagen is not innerv ated (choice C), but this does not contribute to the development of un controllable infection. The tendency of cartilage to undergo calcification (choice E), even when not acting as the site of ossification, does not p redispose for uncontrollable infection. 28. Following a fracture of the humerus, an adult patient has a biopsy of t he healing area. Which of the following types of bone will the biopsy most likel y show? A. Cancellous B. Compact C. Spongy D. Trabecular E. Woven Explanation: The correct answer is E. Bone is formed by type I collagen fibers, ground substa nce, and hydroxyapatite crystals. The collagen is oriented in a layered or lamel lar fashion. It can be parallel (trabecular bone and periosteum) or concentri c (Haversian system). When bone is formed quickly, as in a healing fractu re site, metabolic bone disease, or tumor, the collagen is randomly ori ented and is called woven bone. Compact bone (choice B) is the dense calcified e xternal part of the bone. It is lamellar bone. Cancellous (choice A), spongy (choice C) and trabecular bone (choice D) are all synonymous terms fo r the thinner network of bone within the cortex. These are also lamellar bone. 29. A 36-year-old Asian male complains of difficulty swallowing. Esophagosco py reveals a polypoid mass that is subsequently biopsied. In addition to tumor c ells, the esophageal biopsy show normal smooth muscle and striated muscle in the same section. Which portion of the esophagus was the source of this biopsy? A. B. C. D. E. Lower esophageal sphincter Lower third of the esophagus Middle third of the esophagus Upper esophageal sphincter Upper third of the esophagus

Explanation:

The correct answer is C. The middle third of the esophagus contains both striate d and smooth muscle. The lower third (choice B) of the esophagus, includin g the lower esophageal sphincter (choice A) contain only smooth muscle. Some authors identify the cricopharyngeus muscle as an upper esophageal sph incter (choice D) despite the fact that unlike a true sphincter, this muscle does not completely encircle the esophagus. The cricopharyngeus i s composed exclusively of skeletal muscle, therefore, the biopsy could no t have been from this area of the esophagus. The muscularis of the upper third o f the esophagus (choice E) is composed entirely of striated muscle. 30. A pathologist is looking at a histological section of aorta stained to d emonstrate the many wavy fibers that provide the aorta with the flexibility to stretch and then return to its original shape. These fibers are also fo und in substantial numbers in the A. biceps muscle B. liver C. mesentery D. spleen E. vocal cords Explanation: The correct answer is E. The fibers are elastic fibers. You should remember thre e specific sites where these are found: large arteries (particularly the aorta ), vocal cords, and ligamenta flava (which connect the vertebrae). Small am ounts of elastic tissue are also found in skin, and to a much lesser degree in o ther tissues. Elastic tissue is not found in muscle (choice A) or mesentery (cho ice C). Elastic tissue is not found in substantial amounts in the liver (choice B) or spleen (choice D).

1. The photomicrograph shows a section of synovium from the knee joint of a patient with rheumatoid arthritis (RA). Which of the following are the most abundant cells in the inflammatory infiltrat e? A. Eosinophils B. Langhans type giant cells C. Lymphocytes and plasma cells D. Neutrophils E. Type A and B synovial cells Explanation: The correct answer is C. Lymphocytes and plasma cells aggregate near and around blood vessels (perivascular accumulation) in this example of chronic inflammati on of the synovium. Lymphocytes have dark nuclei with little visible cytoplasm. Plasma cells are larger with a distinct cytoplasm and an eccentric nucleus. The synovial lining is thickened from its normal 1-2 layers. Note that you did not h ave to be able to recognize lymphocytes and plasma cells in the photomicrograph to answer this question. Because RA is associated with a chronic inflammatory in filtrate, lymphocytes and plasma cells must be the correct answer. Eosinophils ( choice A) are not evident here and do not seem to play a role in RA. Langhans ty pe giant cells (choice B), or multinucleated histiocytes, are not evident here b ut may appear during th later stages of RA. Neutrophils (choice D) are not evid ent here; they are instead associated with acute inflammation. Type A and B syno vial cells (choice E) are the two cell types of the synovial lining. They increa se in number but arenot the cells of the perivascular infiltrate. 2. The leukocyte pictured above stains intensely with acidic dyes such as eosi n. Which of the following substances is contained in the crystalline core of the

granule at the arrow? A. B. C. D. E. Lactoferrin Major basic protein Myeloperoxidase Histamine Tartrate-resistant acid phosphatase

Explanation: The correct answer is B. The cell pictured is an eosinophil, a member of the gr anulocytic lineage of white blood cells. The crystalline core of the granule con tains a protein called the major basic protein, which appears to function in the destruction of parasites. Major basic protein also has deleterious effects on e pithelial cells in patients with asthmatic reactions. The light component around the dense crystalline core contains products such as histaminase, arylsulfatase , and other enzymes. Lactoferrin (choice A) is found in the specific granules o f the neutrophil. It inhibits the growth of bacteria by interfering with iron me tabolism. Myeloperoxidase (choice C) is found in the azurophilic (large) granule of the n eutrophil. This enzyme is also destructive to bacteria, destroying their cell wa lls. Histamine (choice D) is produced by the basophil and the mast cell. The histamin ase of the eosinophil regulates the inflammatory reaction of these two cell type s. Tartrate-resistant acid phosphatase (choice E) is a marker for hairy cell leu kemia, a neoplasm of the B lymphocyte line. 3. Axons found around the area indicated by the arrow in the figure above a re myelinated by A. astrocytes B. dorsal root ganglion cells C. microglia D. oligodendrocytes E. Schwann cells Explanation: The correct answer is D. The arrow is in the fasciculus cuneatus, a tract in the white matter of the spinal cord. Therefore, it is within the central nervous sy stem (CNS). Myelin in the central nervous system is formed by oligo-dendrocytes. Each oligodendrocyte myelinates several axons..Astrocytes (choice A) are stella te appearing cells possessing branching processes that associate with pia mater, neurons, and endothelial cells within the CNS. While they may provide a secondar y component of the blood-brain barrier (tight junctions account for the primary barrier), one of their main functions is to modulate the molecular composition o f extracellular fluid in the CNS. They do not produce myelin. Dorsal root ganglion cells (choice B) are pseudounipolar neurons that provide s ensory input to the spinal cord. Their axons may be myelinated, but they do not form the myelin. Microglia (choic e C) are part of the mononuclear phagocyte system, being derived from monocytes. They are phagocytic and do not produce myelin. Schwann cells (choice E) form myelin in th e peripheral nervous system. A Schwann cell forms myelin around a single axon. 4. The black line drawn across this photomicrograph of a seminiferous tubule repres ents the line of demarcation between which of the following? Immediately above Immediately below A. Cells undergoing meiosis II Cells undergoing meiosis I B. spermatocytogenesis spermiogenesis C. spermatogenesis Vascular system D. spermiogenesis Myoid cells

Explanation: The correct answer is C. The line represents the blood-testis barrier. Spermatogenesis occurs in three phases: spermatocytogenesis, meiosis, and spermi ogenesis. Progeny of spermatogonia formed during spermatocytogenesis move from b elow the line (basal compartment) to above the line (adluminal compartment). Cel ls commence meiosisI below the line and then move through the barrier before chr omosomal crossing over occurs during prophase of meiosis I. Tight junctions of S ertoli cells (which have prominent nucleoli) seal this barrier. Meiosis I contin ues in the adluminal compartment, followed by meiosis II and differentiation (sp ermiogenesis).Myoid, or contractile, cells are located outside of the basal lami na, beneath the spermatogonia. 5. The cell in the center of the electron micrograph above is important in wound he aling and plays a role in the pathological process underlying Dupuytren's contra cture. Which of the following cell types is depicted? A. Endothelial cell B. Myoepithelial cell C. Myofibroblast D. Pericyte E. Smooth muscle cell Explanation: The correct answer is C. The cell is spindle-shaped like a fibroblast; ho wever, the difference is that the cytoplasm contains several bundles of microfil aments. These bundles are parallel to the long axis of the cell and are seen imm ediately beneath the cell membrane and within the cytoplasm. Densities, comparab le to Z-lines, can be seen along some of these bundles. The microfilaments are r esponsible for the contractile properties of this cell. These contractile proper ties, in addition to the cell's ability to link with collagen, function in wound closure in the healing process. Dupuytren's contracture, which is a contracture of the palmar fascia, is caused by interaction of these cells with collagen fib rils of the fascia. The endothelial cell (choice A) lines vessels. There are no vessels in the photomicrograph. The myoepithelial cell (choice B) contains micr ofilaments and is contractile. However, it is closely associated with glandular epithelium (not apparent here). The pericyte (choice D) is a multipotential conn ective tissue cell found near or around blood vessels, but it does not contain m icrofilament bundles such as these. There are no vessels apparent in the photomi crograph.The smooth muscle cell (choice E) is joined by junctions to other smoot h muscle cells, arranged in bundles. Microfilaments make up most of the cytoplas m of such cells, with the nucleus in a central location. 6. The modified structures at the border of the epithelium shown above are immotile in a 23-year-old patient. Which of the following would be a consequence of this lack of motility? A. B. C. D. E. Implantation failure Kartagener's syndrome Malabsorption syndrome Reduction in number of disaccharidases Uptake and digestion of spermatid residual bodies

Explanation: The correct answer is B. The border modification consists of cilia on the surface of pseudostratified columnar epithelium. Cilia are shorter than stereoc ilia and usually appear bent or wavy in sections. Kartagener's syndrome is one t ype of immotile cilia syndrome in which the dynein arms of microtubules are miss ing or defective. Thus, cilia cannot move properly and all functions associated with them are affected (mucous sweeping or ciliary elevator functioning, sperm m

otility, embryonic cell movement, etc.). The result is infertility, situs invers us, bronchiectasis and/or sinusitis. Implantation (choice A) is not affected in patients with Kartagener's syn drome. The fertilized ovum can still reach the endometrium and implantation can occur. Also, this is not a section of the uterine tube; the uterine tube has a s imple columnar epithelium with peg cells (secretory) and ciliated cells. The border modification consists of cilia, not microvilli and the specime n is not a section of the intestine, therefore malabsorption (choice C) is incor rect. Both the small and large intestine have a simple columnar epithelium with microvilli. Microvilli are upright and irregular and resemble a "flat top" hairc ut across the top of cells. Disaccharidases (choice D) are present in the cell membrane of microvilli . Deficiencies in digestion occur with the loss of microvilli. Uptake and digestion of residual bodies of spermatids (choice E) occurs i n the epididymis. Even though the epididymis has pseudostratified columnar epith elium, the epithelial border contains stereocilia: long microvilli which may be two to three times the length of cilia. 7. Which of the following occurs at the darkly stained band indicated by th e arrow? A. Acrosome reaction B. Aromatase acts on testosterone C. Capacitation D. Implantation receptors are exhibited E. Meiosis is resumed Explanation: The correct answer is A. The photomicrograph depicts an oocyte. The zona pe llucida at the arrow is similar to a thick basal lamina and is composed of glyco proteins that bind to the cell membrane of the sperm head. This binding triggers the acrosome reaction, which involves fusion of the acrosomal membrane with the overlying sperm membrane. The acrosomal enzymes are released and digest the zon a pellucida, allowing the spermatozoon to make contact and fuse with the ovum ce ll membrane. The enzyme aromatase (choice B) is found in the granulosa cells, which sur round the oocyte and the follicular wall. Testosterone, produced by the theca ce lls, diffuses through the basal lamina of the follicle and is converted to estra diol by aromatase. Capacitation (choice C) refers to changes that occur in the spermatozoa du ring their transit through the female reproductive tract. These changes occur in the oviducts and the uterus. Sperm become motile in the epididymis. The oocyte divides many times as it moves toward the uterus, the zona pellu cida disappearing. A portion of these cells will exhibit implantation receptors (choice D) and become an implantation site for the cell mass in the uterine wall. Meiosis is resumed (choice E) in the oocyte shortly before ovulation. The n ucleus of the oocyte can be seen in the center. The oocyte and the surrounding granulosa cells make up this structure, k nown as an antral or secondary follicle. 8. In this section of a healing bone fracture, which of the following best describes the cell at the arrow? A. Apoptotic cell B. Bone-lining macrophage C. Dividing osteoblast D. Necrotic cell E. Typical osteoblast Explanation: The correct answer is A. Apoptosis refers to programmed cell death, and in this situation, appears to be a means for

the elimination of unneeded osteoblasts as the extracellular matrix is reshaped and the healing process continues. Two basic morphologic features of apoptosis a re seen in this cell. First, cytoplasmic blebbing, in which round, elongated str uctures (blebs) extend from the main cell body, is evident. Some blebs appear as though in clusters. Second, nuclear blebbing, in which the nucleus shows the sa me irregular type of blebs or protrusions, is apparent. This cell does not have features of a macrophage (choice B) such as lysosomes, or a heterogeneous cytopl asm. Ribosome-filled blebs are not features of macrophages. No chromosomes are p resent, hence this cannot be a dividing cell (choice C). Cytoplasmic and nuclea r blebbing are not features of necrosis (choice D). In necrosis, nuclei are wash ed out (karyolysis), markedly compact (pyknotic), or fragmented (karyorrhexis). A typical osteoblast (choice E) is seen to the left of the blebbing cell. This cell has extensive rough endoplasmic reticulum and a Golgi apparatus with ellipt ical and round granules. 9. Which of the following products do the cells indicated above produce? A. Alkaline phosphatase B. Hydrochloric acid C. Immunoglobulin D. Major basic protein E. Mucus F. Surfactant G. von Willebrand's factor H. Zymogen

Explanation: The correct answer is F. This is a photomicrograph of lung alveolar walls or septa. Type II pneumocytes are cuboidal-like with round nuclei and a washed-o ut or foamy cytoplasm. This cytoplasmic appearance is due to the lipid content. Lamellar bodies (secretory granules) of these cells contain a complex of phospho lipids, proteins, and carbohydrates known as surfactant. Alveolar macrophages ar e also present in the lumen of the alveolus. Osteoblasts, which produce alkaline phosphatase (choice A), might be confused with these cells. However, osteoblast s line bone and have more of an epithelial-lining appearance. Hydrochloric acid (choice B) is produced by gastric parietal cells. Such c ells are interspersed among protein producing cells. Other HCl producing cells are found in the body, but not in the alveolar wall environment. Immunoglobulins (choice C) are secreted by plasma cells, which are connect ive tissue cells. The cells in the micrograph are attached to a basal lamina. Major basic protein (choice D) is produced by eosinophils. These cells do not have the nuclear features of eosinophils. Mucus cells (choice E) would give a similar cytoplasmic appearance; howeve r, nuclei of such cells are usually shaped quite differently.The indicated cells are not flat (squamous) enough to be confused with endothelial cells. Such cell s produce von Willebrand's factor (factor VIII, choice G), and may be seen surro unding vessels in the alveolar walls. Zymogen granules (choice H) would not give this type of appearance with a typical H&E stain. 10. A cardiovascular physiologist is performing experiments using a new alph a1 adrenergic agonist to determine the amount of vasoconstriction the new drug can produce compared with a phenylephrine control. Which of the labeled structur es is the cellular target of both of these drugs? A. A B. B C. C D. D E. E Explanation:

The correct answer is E. Arrow E points to a smooth muscle cell in the me dia of the arteriole. Alpha1 agonists stimulate alpha1 receptors present on the smooth muscle, which leads to an increase in intracellular calcium via phosphati dylinositol hydrolysis. This increase in calcium is necessary for smooth muscle contraction. Arrow A indicates an endothelial cell located in the intima of the arte riole. Nitric oxide, also known as endothelial cell relaxing factor (EDRF), is p roduced from arginine by endothelial cells. A muscarinic agonist can lead to the evolution of NO, producing vasodilatation. Arrow B indicates a polymorphonuclear leukocyte in the bloodstream. Arro w C indicates the basal lamina underlying the endothelium. Arrow D indicates the arteriolar adventitia. 11. ? What is the primary function of the cell pointed to in the figure above A. B. C. D. E. It It It It It produces secretes secretes secretes secretes low-molecular weight polypeptides bactericidal enzymes lipases mucins pepsinogen

Explanation: The correct answer is B. The drawing depicts the histology of the small intestinal villus and crypts. The arrow points to a Paneth cell. Paneth cells are unique to the small intestine. They ar e found at the base of the crypts of Lieberkhn in the small intestinal villi, and have many secretory granules that contain enzymes with bactericidal activity. The enteroendocrine cells of the stomach produce low-molecular weight po lypeptides (choice A). There are no lipase-secreting cells in the small intestine (choice C). L ipases are secreted by cells in the salivary glands, stomach, and exocrine pancreas. So, even if you did not know tha t the arrow pointed to Paneth cells, you should have eliminated this choice based on the fact that the small inte stine does not secrete lipase. The goblet cells of the small intestinal villi are responsible for produ cing protective glycoproteins called mucins (choice D). After secretion, they ar e hydrated and become a mucous layer that protects the intestinal epithelium. There are many goblet cells depicted in this figure, but they are not lo cated at the bases of the crypts. Pepsinogen (choice E) is secreted by the chief cells of the stomach. 12. A 29-year-old man with reactive airway disease undergoes endobronchial biopsy. T he biopsy material is prepared for light microscopy as well as electron microscopy. The cell pictured above in an e lectron micrograph stains reddish purple with toluidine blue. The cell depicted is most likely a(n) A. alveolar macrophage B. histiocyte C. mast cell D. type II pneumocyte Explanation: The correct answer is C. The mast cell has uniform-sized, spherical granules that contain material arranged in a scroll-like pattern. In some granules, as ma ny as five scrolls in cross or longitudinal section can be seen. The cell membra

ne is irregular with several long microvilli, allowing for an increased number o f binding sites for IgE. The nucleus characteristically has a considerable amoun t of heterochromatin, and in this section, a nucleolus is evident. Collagen fibr ils are also scattered around the cell, another indicator that it is a mast cell , since mast cells are found in the connective tissue extracellular matrix. An alveolar macrophage (choice A) has a cytoplasm containing heterogeneous gr anules. It is larger in size than this cell and has a more irregular surface. Histiocytes (choice B) or connective tissue macrophages have heterogeneous gr anules of different sizes, and the cells are also much larger. Type II pneumocytes (choice D) contain granules, but they are not this abunda nt. The granules or lamellar bodies are larger and contain stacks (lamellae) of dense plate-like material, the phospholi pid or surfactant. The arrangement also resembles the EM appearance of myelin. The type II pneumocyte is related by junc tions to type I cells and other type II cells, which are not seen in this microg raph. 13. Which of the above labeled structures is responsible for the secretion o f renin? A. A B. B C. C D. D E. E Explanation: The correct answer is C. This question required that you know two pieces of information: (1) renin is secreted from the juxtaglomerular (JG) cells; and ( 2) the location of the JG cells in a picture that includes both the glomerulus a nd the juxtaglomerular apparatus. Remember that renin is responsible for convert ing angiotensinogen to angiotensin I, which is subsequently converted to angiote nsin II in the lungs by an important enzyme appropriately called angiotensin-con verting enzyme. Angiotensin II helps preserve blood pressure both by its potent vasoconstrictor properties and by its ability to stimulate aldosterone secretion from the adrenal cortex. The label for choice A points to the glomerular basement membrane. The label for choice B points to the epithelium of Bowman's capsule. The label for choice D points to the macula densa cells, which are though t to sense sodium concentration in the distal convoluted tubule. The label for choice E points to the Polkissen cells. Their function is u nknown. 14. A 25-year-old man presents with a 4-cm mass above the clavicle. Chest X -ray demonstrates marked mediastinal widening. Excisional biopsy of the supracla vicular mass demonstrates areas with the appearance shown in the photomicrograph below. The large cell (indicated with the arrow) is most likely which of the fo llowing? A. B. C. D. E. Langhans cell LE cell Mott cell Reed-Sternberg cell Touton cell

Explanation: The correct answer is D. The cell illustrated is a Reed-Sternberg cell. Th

ese cells characteristically are neoplastic giant cells with a bilobed mirror-im age nucleus that may have large ("owl-eyes") nucleoli surrounded by a clear halo . Most commonly, these cells are associated with Hodgkin's disease, but it is wo rth knowing that in real life, a surprising variety of other lymphomas and some other diseases may have at least occasional Reed-Sternberg look-alikes. For that reason, the diagnosis of Hodgkin's disease often requires confirmatory immunohi stochemical staining. The Langhans cell (choice A) is a giant cell with peripherally arranged nu clei found in granulomas. The LE cell (choice B) is a degenerating neutrophil seen in lupus erythema tosus in in vitro preparations. The Mott cell (choice C) is a "constipated" plasma cell filled with immuno globulins, producing a grape-cluster appearance to the cell. Mott cells are seen in multiple myeloma and some parasit ic infestations. The Touton giant cell (choice E) has distributed nuclei and is found in tu mors other than Hodgkin's lymphoma.