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Program Director, Northwestern University Feinberg School of Medicine

The gland is covered by a connective tissue capsule and divided into a cortex containing steroid-producing cells with prominent lipid droplets and a medulla containing chromaffin cells that secrete catecholamines and neuropeptides. Congenital virilizing adrenal hyperplasia results from the deficiency of an enzyme required for cortisol production. The thyroid gland is characterized by an extracellular hormone precursor (iodinated thyroglobulin) stored in its follicles. The follicular cells endocytose the storage product to form the thyroid hormones [triiodothyronine (T3) and thyroxine (T4)]. Scattered between the follicular cells are High-Yield Facts 33 "C" cells (parafollicular cells), which secrete calcitonin, a hormone that reduces blood calcium levels. Binding of antibodies to those molecules interferes with their uptake and function respectively. Infiltrating T cells and autoantibodies destroy the thyroid follicular cells resulting in hypothyroidism. The result is unregulated activation of the receptor and overproduction of thyroid hormones (hyperthyroidism). The pineal gland contains pinealocytes that secrete melatonin and is innervated by postganglionic sympathetic fibers. Endocrine cells of the pancreatic islets secrete primarily insulin and glucagon, hormones that regulate blood sugar by lowering and increasing gluocse respectively. Blood entering the islets bypasses the peripherally located glucagonsecreting cells to reach the more centrally-located insulin-producing beta cells. Blood leaving the beta cells contains insulin that influences glucagon secretion from the alpha cells. Blood leaving the islets travels to the surrounding exocrine pancreas and influences secretion from the acini. The beta cells are overworked and eventually lose their ability to secrete enough 34 Anatomy, Histology, and Cell Biology insulin in response to meals. Epithelial cells of the proximal tubule are specialized for absorption and ion transport. They remove most of the sodium and water from urine, as well as virtually all of the amino acids, proteins, and glucose. The cells of the distal tubule, under the influence of aldosterone, resorb sodium and acidify the urine. Transitional epithelium (allowing for stretch) is found lining the calyces, renal pelvis, ureters, and urinary bladder. Spermatogenesis involves the following lineage: spermatogonia (germ cells) (spermatocytogenesis) primary spermatocytes secondary spermatocytes (completion of meiosis) spermatids (spermiogenesis) mature sperm. The epididymis, like most of the male duct system, is lined by a pseudostratified epithelium characterized by modified microvilli (stereocilia). High-Yield Facts 35 the seminal vesicles produce fructose and other molecules that activate spermatozoa. The prostate is a fibromuscular organ that produces the enzymes responsible for the liquefaction of the ejaculate. Oocyte (germ cell) maturation involves several stages of follicular development (granulosa cells plus the oocyte): primordial follicle primary follicle secondary follicle mature, or Graafian, follicle. The theca interna synthesizes androgens, which are converted into estradiol by granulosa cells. After ovulation, these thecal cells form the theca lutein; the granulosa cells become the granulosa lutein, which produces progesterone (see figure below). During this phase, endometrial cells accumulate glycogen preliminary to the synthesis and secretion of glycoproteins. The vaginal epithelium is made up of stratified squamous cells and varies with maturity, phase of the menstrual cycle, pregnancy, and cancer (detected by vaginal Pap smear). During parturition, oxytocin secreted by the neurohypophysis stimulates the contraction of uterine smooth muscle. The breast (mammary gland) is a resting alveolar gland except during pregnancy, when the lactiferous ducts proliferate and milk production is initiated. Rhodopsin is a visual pigment found within lamellar disks of the outer segment of the rod cell.

Compare the values in question 18 and explain how they might be used to monitor heart conditions. Describe the ratio of packed cell volume to Hb (hemoglobin) obtained for the healthy male and female subjects. Describe the ratio of packed cell volume to Hb (hemoglobin) for the female with iron-deficiency anemia. Hemoglobin values increase in patients with polycythemia, congestive heart failure, 27. When transfusing an individual with blood that is compatible but not the same type, it is important to separate packed cells When only packed cells are transfused, from the plasma and administer only the packed cells. List which blood samples in this experiment represent people who could donate blood to a person with type B. Patient 4 should lower dietary intake of cholesterol (red and organ meats, eggs, 38. Low blood cholesterol can be caused by hyperthyroidism, liver disease, inadequate absorption of nutrients from the intestine, and malnutrition. It is helpful to instruct students in the proper operation of the mouse and menu system as part of the lab introduction. Encourage students to try to apply the concepts from the simulation to the human as they work through the program. If a demonstration computer screen is available, show students both main screens of the simulation and describe the basic equipment parts. Explain how the simulated pump is similar to the left ventricle (or the right ventricle) of the heart. Point out the fact that the pump operates much like a syringe, with adjustable starting and ending volumes. It is often helpful to explain the basics of end diastolic and end systolic volumes and their relationship to the simulated pump. Indicate the analogies between the parts of the simulation and the parts of the human cardiovascular system. Answers to Activity Questions Vessel Resistance Activity 1: Studying the Effect of Flow Tube Radius on Fluid Flow (pp. Because fluid flow is proportional to the fourth power of the radius, increases/decreases in tube radius cause increases/decreases in fluid flow. We alter blood flow in the human body by increasing or decreasing the diameter of blood vessels by the contraction or relaxation of smooth muscle tissue in vessel walls. After a heavy meal when we are relatively inactive, we might expect blood vessels in the skeletal muscles to be somewhat constricted while blood vessels in the digestive organs are probably dilated. Anemia would result in fewer red cells than normal, which would decrease the viscosity of the blood. Blood viscosity would increase in conditions of dehydration, resulting in decreased blood flow. Obesity would result in decreased blood flow because vessels must increase in length in order to serve the increased amount of adipose tissue in the body. The length versus flow rate plot is linear, whereas the plots for radius, viscosity, and length are all exponential. Changing pressure would not be a reasonable method of flow control because a large change in pressure is needed to significantly change flow rate. The amount of fluid ejected into the right beaker by a single pump cycle is analagous to (stroke volume, cardiac output) of the heart. The radius plot in this experiment appears different from the radius plot in the vessel resistance experiment because only the outflow of the pump was changed. Since the inflow remained constant during the course of the experiment, an entirely different flow pattern is established. As the right flow tube radius is increased, fluid flow rate (increases, decreases).

None of this administrative and error-prone work is required if moduleIds are used. Combining the moduleId with Reference Sets provides a powerful versioning mechanism. Each Synonym can then be assigned an Acceptability value of either Acceptable or Preferred when included in a language reference set. As a result of these changes, the preference for particular descriptions in a language or dialect is now represented using a Reference Set. Language reference sets also introduce the notion of overriding or inactivating particular Descriptions that may be appropriate in one dialect, but not appropriate in another dependent dialect or context. This is achieved by allowing Descriptions that are inherited from a parent language reference set to be overridden in a child language reference set. These fields are listed in the table below, with an explanation of why each field has been removed and to where it has been moved. This field duplicates one of the fully specified names represented in the Description file. It is a more scalable solution than appending columns as needed to the Concept file. In this instance, the Identifier file assists meeting the use case without burdening the descriptions file or concepts file with this content. Each Reference indicated the nature of the relationship between the inactive and persistent component. Instead, the simple map Reference Set pattern and alternate map Reference Set pattern should be used, in conjunction with other Reference Set patterns, to define Reference Sets for mapping purposes. Where the MapSetRealmId field is blank or null, then an intermediate concept should not be created, and the Map Reference Set concept should be created as a direct child of Complex map. The year of the nominal release should tie up with the year in the MapSetSchemeVersionfield in the CrossMapSets record. For each CrossMap table record, identify the related CrossMapTarget record using the MapTargetId field in the CrossMaps record. The TargetCodes field in the CrossMapTarget record will contain zero or more target codes, each separated by a separator character identified by the MapSetSeparator field of the CrossMapSets record. In contrast Release Format 2 supports three different Release Types including a full historical view of all components ever released and a delta release that contains only the changes from one release to another. The Release Format 2 Specification describes the Release types and the Terminology Services Guide (7) provides advice on importing different Release types. There is a close relationship between the requirements to support distribution of content and the requirements for exchanging components during content development. This extension will not be used in initial releases until the complexity of the underlying semantics has been fully tested, but once it is introduced, post coordinated expression syntax will also need to be extended to cater for this. It provides information about whether it is permissible to refine the value of a Relationship. This Reference Set is identified as 900000000000488004 Relationship refinability attribute value reference set (foundation metadata concept) and its Concept enumeration values are specified in Table 310. Table 310: Refinability value (foundation metadata concept) (900000000000226000) Id Term Comment the value provided by the destinationId may be used but none of the subtypes of this concept are permitted. The value may be refined by selecting a subtype of the concept referred to by the destinationId. The resulting changes to specifications and associated implementation guidance have been incorporated within the relevant sections of the Technical Implementation Guide from 2012-01-31. One part of this embedded information is the namespace-identifier which identifies the Extension in which the component originated. Prior to the change described by this note the namespace-identifier also determined the organization responsible for maintaining the component. The Identifier change resulting from moving a component from an Extension to the International Release causes disruption in the authoring environment. These changes had a negative impact on system operation and interoperability between systems.

The involved vessels progressively narrow producing inequality in pulses, claudication and ischemia. The diagnosis should be suspected in young women with a systemic inflammatory illness, altered arterial pulses, or bruits. The diagnosis is confirmed by angiography and in our recent experience, treatment is often accomplished by interventional radiology/angiography procedures such as angioplasty. The terms "purpura", "petechiae", and "ecchymosis" are frequently used in the clinical descriptions of vasculitic and other conditions. The implied difference is that purpura have a sharply demarcated border and imply that vasculitis is the etiology, while ecchymosis has a diffuse border which implies that trauma or a hemorrhagic diathesis is the etiology. He presents with his mother to your office with a two day history of bilateral eye drainage. He had been in good health until two days ago when he developed yellow drainage and mild periorbital swelling. Review of systems is negative except for the recent development of a cough that he "probably caught from his older brother". There is mild conjunctival injection with moderate amounts of mucopurulent drainage bilaterally. Coarse breath sounds are appreciated bilaterally with occasional rales and fine expiratory wheezes. You swab the conjunctiva for gram stain, culture and chlamydia direct fluorescence antibody staining. Initially shocked, she admits that six months ago she and her husband had separated briefly, but are now back together. Ophthalmia neonatorum is the most common ocular disease in the newborn, occurring in 2-12% of neonates (includes chemical conjunctivitis). The major causative agents of neonatal conjunctivitis are chemical, chlamydial and bacterial. The mode of infectious transmission is believed to be acquisition during passage through a colonized or infected birth canal (1,2). While nearly every bacterial species has been implicated, ocular infection with Neisseria gonorrhoeae is felt to be one of the most serious because of its potential to damage vision and cause blindness (1,3). Consequently, Chlamydia trachomatis is now the most common infectious agent causing neonatal conjunctivitis in approximately 0. Recognizing the irritant effects of silver nitrate (frequently causes chemical conjunctivitis), 0. However, none have been shown to consistently prevent chlamydial conjunctivitis or nasopharyngeal colonization (1-4,6-9). Inflammation due to chemical irritation (usually silver nitrate drops) is first appreciated 6-12 hours after birth with spontaneous resolution by 24-48 hours. Beginning with a mild inflammation and serosanguineous drainage, gonococcal ophthalmia soon results in thick, profuse purulent discharge and tense eyelid edema with marked chemosis (swelling of the conjunctiva) (2,10). Chlamydial conjunctivitis in the neonate can present from 3 days to beyond 6 weeks postnatal age, but most commonly occurs during the 2nd week of life. Infants present with conjunctival inflammation, mucopurulent discharge (that may be profuse), eyelid edema and pseudomembranes in the palpebral conjunctiva (5,10). Chest radiograph reveals bilateral, diffuse, patchy infiltrates and hyperinflation. The list of causative agents of ophthalmia neonatorum includes, but is not limited to , chemical irritants, Neisseria gonorrhoeae, Chlamydia trachomatis, Staphylococcus aureus, group A or B streptococcus, S. Shortly after birth, ophthalmic prophylaxis for gonorrhea should be administered to all infants, including those delivered by cesarean section since ascending infection can occur. Two drops of a 1% silver nitrate solution or a 1 cm ribbon of antibiotic ointment (0. Currently, there is no antibiotic agent effective for use as prophylaxis for Chlamydia ophthalmia neonatorum (1-4,6-9).

The coronary sinus (answer b), accompanying the circumflex artery in the left coronary sulcus, receives the great, middle (answer d), and small cardiac veins (answer e) before draining into the right atrium. This is generally done by removing the internal thoracic artery, which runs along the inner surface of the sternum. Its proximal end is attached to the ascending aorta and its distal end is connected to the occluded coronary artery, just distal to the blockage, thus bypassing the problem. Remember that the internal thoracic artery supplies blood to each subcostal artery, which are branches of the thoracic aorta. All of the other answers (answers b, d) involve attaching the blood vessel to a venous structure or in the case of the pulmonary trunk (answer a) attaching to relatively unoxygenated blood, which is not done. The first heart sound, heard just after the ventricles begin to contract, occurs when ventricular pressures exceed atrial pressures and thereby, closes the atrioventricular valves. Reverberation within the ventricles causes this S1 sound ("Lub") to have a low frequency and a relatively long duration. The second heart sound is heard at the beginning of ventricular diastole, when the aortic and pulmonary pressures exceed the respective ventricular pressures and snap the aortic and pulmonary semilunar valves shut. This S2 ("Dup") is relatively sharp when both aortic and semilunar valves close together. However, deep inspiration, which lowers intrathoracic pressure, results in delayed closing of the pulmonary valve and thus produces a split S2. Occasionally, a low, rumbling third heart sound may be heard during diastole and is attributable to ventricular filling. Stenosis or insufficiency of the valves produces turbulence and backflow, respectively, which are heard as murmurs. The aortic hiatus carries the aorta, the thoracic duct (answer e), and occasionally, an azygos (answer a) or hemiazygos (answer b) vein. Usually, the azygos and hemiazygos veins (answer c) either pass lateral to or through a crus of the diaphragm along with the respective left and right sympathetic chains. The phrenic nerves usually penetrate the diaphragm to gain access to the inferior surface; however, the right phrenic may accompany the inferior vena cava through the caval hiatus. Since the girl is 3 months old it is very unlikely that she would have survived transposition of the great vessels (answer c) without surgical intervention. Tetralogy of Fallot consists of three congenital conditions and a fourth acquired condition as a consequence of the first three. Tetralogy of Fallot consists of an overriding aorta that receives blood from both ventricles, pulmonary stenosis that tends to keep blood out of the lungs, and a ventricular septal defect (otherwise the aorta could "override"). As a consequence of the three conditions, the right ventricle tends to hypertrophy since it has to pump blood not only into the lungs, but also through the aorta to the rest of the body. Since the girl has normal blood pressure in her upper and lower limbs, coarctation of the aorta (answer b) is unlikely. In addition simple aortic stenosis (answer d) is unlikely to produce hypertrophy of the right ventricle which appears to be present. The sixth (answer a) intercostals space is too cranial and tenth (answer b) and twelfth (answer d) intercoastal spaces are too caudal. Other labeled structures are: 1, left ventricle; 7 aortic arch; 8 bifurcated pulmonary trunk (most likely left pulmonary artery in this image); 9 brachiocephalic artery; 10, left common carotid artery; 11 left subclavian artery; 12 ascending aorta; 13 descending aorta; and 14 right coronary artery (difficult to see). At delivery, the blood from the placenta decreases, thus reducing the pressure in the right atrium. As the air fills the lungs there is increased blood flow to the lungs and thus increased blood returning to the left atrium. This increase in left atrial pressure and decrease in right atrial pressure closes the septum primum against the septum secundum, thus closing the foramen ovale, and separating the two atrial chambers. In addition there is smooth muscle constriction within the walls of the ductus arteriosus, also sending more blood to the lungs. Because only one lung appears to have fluid accumulation and he is young and exercises regularly; pulmonary hypertension (answer a) is unlikely, especially give his physical findings and history and sudden onset of symptoms.