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T1 - Integrated (Full Review) > Histology - Pulmonary / Renal Block > Flashcards

Histology - Pulmonary / Renal Block Flashcards

1
Q

Of what main type of epithelium is the respiratory tract composed?

A

Pseudostratified ciliated columnar cells

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2
Q

How many types of cell touch the basement membrane in the respiratory tract?

A

5

  • (ciliated columnar cells,*
  • goblet cells,*
  • brush cells,*
  • small granule cells,*
  • basal cells)*
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3
Q

What is the most prevalent cell in the respiratory tract epithelium?

What are the other four types of cell found here?

A

Pseudostratified columnar cells;

goblet cells,

basal cells,

small granule cells,

brush cells

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4
Q

Goblet cells are full of ________

that mixes with ________

to form _________.

A

Mucin,

water,

mucus

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5
Q

What type of cell produces the mucus of the respiratory tract?

A

Goblet cells

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6
Q

You notice prominent goblet cells on a micrograph.

What organ systems could this be?

A

Respiratory tract;

GI tract

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7
Q

This micrograph shows respiratory tract epithelia.

What is the most abundant cell type?

What cell type is indicated by the arrows?

A

Pseudostratified columnar cells;

goblet cells

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8
Q

Describe the brush cells of the respiratory tract.

A

Chemoreceptor columnar cells with microvilli (non-ciliated)

–> interact with afferent nerves on the basal side

(cells indicated by small arrows)

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9
Q

What type of respiratory tract cell is here described:

chemoreceptors and microvilli cover the apical cell, and the cell interacts with afferent nerves on its basal side

A

Brush cells

(cells with microvilli in image)

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10
Q

What are the neuroendocrine cells of the respiratory tract?

A

Small granule cells

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11
Q

What are small granule cells (of the respiratory tract)?

A

Neuroendocrine cells

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12
Q

Which cells of the respiratory tract are small, round progenitor cells found close to the basement membrane?

A

Basal cells

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13
Q

What is the role of respiratory tract basal cells?

A

To serve as progenitor cells and support cells

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14
Q

Identify some basal cells in this micrograph of the respiratory tract.

A
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15
Q

What differentiates the olfactory epithelium of the nasal passage from the rest of the respiratory tract?

A
  • Microvilli on supporting columnar cells
  • No goblet cells (Bowman glands instead)
  • Olfactory cells (bipolar neurons)
  • Nerve bundles
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16
Q

What type of cell is an olfactory cell?

Where are they found?

A

A bipolar neuron;

the olfactory epithelium of the nasal passages

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17
Q

What type of secretory cell is found in the olfactory epithelium?

A

Bowman glands

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18
Q

Which are the visceral special senses?

A

Gustation, olfaction

(chemically activated)

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19
Q

Which are the somatic special senses?

A

Visual, vestibulocochlear

(mechanically activated)

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20
Q

Olfactory neurons regenerate every ____ - ____ months.

A

2, 3

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21
Q

What is an example of a neuron type that regenerates often (every 2 - 3 months)?

A

Olfactory neurons

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22
Q

The nasal cavity is mostly lined with what type of epithelium?

A

Respiratory (ciliated columnar)

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23
Q

The superior nasal concha is:

The middle nasal concha is:

The inferior nasal concha is:

A

Part of the ethmoid bone

Part of the ethmoid bone

Its own bone

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24
Q

What effect do odorant substances have on olfactory neurons?

A

They bind transmembrane chemoreceptors / ion channels to trigger action potentials

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25
Q

What are the swell bodies of the nasal concha?

(to the immediate right of the image cursor)

A

Collections of vasculature that:

(1) regulate air temp + (2) are erectile tissue

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26
Q

What are some unique factors about the glands of the lamina propria of the nasal olfactory region?

A

The presence of nerve bundles / Bowman’s glands;

the absence of goblet cells

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27
Q

Where are Bowman’s glands located?

In what layer of tissue?

A

The olfactory region;

the lamina propria

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28
Q

What is unique about the tissue of the nasopharynx?

A

Large aggregations of lymphocytes (tonsils)

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29
Q

Define lamina propria.

A

Connective tissue and glands underlying the epithelium

(separate from the connective tissue of the submucosa)

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30
Q

Define mucosa.

A

The epithelium

+

the basement membrane

+

the lamina propria

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31
Q

True/false.

Cartilage can be found in the lamina propria.

True/false.

Glands can be found in the lamina propria.

A

True;

true

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32
Q

Where does the non-keratinized stratified squamous epithelium of the mouth transition to the ciliated columnar epithelium of the respiratory tract?

A

The larynx

(between the epiglottis, vestibular (false) folds, and vocal (true) folds)

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33
Q

What type of epithelium does this section from the larynx demonstrate?

A

Respiratory epithelium

(Note the presence of goblet cells)

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34
Q

What type of epithelium is found in the larynx?

A

Both stratified squamous (non-keratinized) and pseudostratified columnar

(this is a transition point)

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35
Q

What type of epithelium is found on the epiglottis and true vocal cords?

A

Stratified squamous epithelium

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36
Q

Stratified squamous epithelium is found on which structures in particular in the larynx?

A

The epiglottis;

the true vocal folds

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37
Q

True/False.

The trachea has a very large number of sero-mucous glands in its lamina propria.

A

True.

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38
Q

What tissue layer surrounds the entire trachea?

A

The adventitia

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39
Q

The ends of the C-shaped hyaline cartilage in the trachea are connected by what?

A

Fibroelastic extensions of perichondrium

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40
Q

Which is the last segment of the respiratory tract to have highly abundant glands in its lamina propria?

A

The trachea

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41
Q

Describe the cartilage found in bronchi (as opposed to the trachea).

A

Small, irregular strips

(not C-shaped or continuous)

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42
Q

Most glands located in the bronchi are located in what tissue layer?

A

The submucosa

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43
Q

Besides size, in what two ways are bronchioles distinct from bronchi?

A

No cartilage

No glands in the submucosa

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44
Q

How does the epithelium change as bronchioles narrow?

A

Pseudo-stratified columnar —>

Simple columnar —>

Simple cuboidal

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45
Q

Which cell is present in preceding respiratory segments but not terminal bronchioles?

Which cell replaces it?

A

Goblet cells,

Club cells (exocrine bronchiolar cells)

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46
Q

How far into the respiratory tract can goblet cells be found?

A

The bronchioles before the terminal bronchioles

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47
Q

What is the function of Club cells?

How are they shaped?

A

Progenitor for pneumocytes (I and II), secrete surfactant components, detoxify inhaled substances;

dome-shaped

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48
Q

What type of innervation will cause smooth muscle contraction in the respiratory tract?

A

Vagal innervation

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49
Q

What type of innervation will cause smooth muscle relaxation in the respiratory tract?

A

Sympathetic innervation

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50
Q

How does a respiratory bronchiole appear on histology?

A

Thin layer of cuboidal epithelia + club cells,

a small number of single alveoli

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51
Q

What is the defining feature of respiratory bronchioles that make them respiratory?

A

The presence of a few single alveolar sacs

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52
Q

The conducting portion of the respiratory tract ends with what structure?

A

Terminal bronchioles

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53
Q

The respiratory portion of the respiratory tract is made of what structure(s)?

A

Respiratory bronchioles, alveolar ducts, alveolar sacs

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54
Q

Where are Club (Clara) cells found?

A

Small bronchioles (terminal + respiratory)

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55
Q

What is an older name for Club cells that is no longer used?

A

Clara cells

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56
Q

In what segment(s) is(are) goblet cells not found in the respiratory tract?

A

The terminal bronchioles to the alveoli

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57
Q

What is another name for alveolar macrophages?

A

Dust cells

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58
Q

How do the alveolar and pulmonary capillary basement membranes interact?

A

They are fused

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59
Q

Where are Club (Clara) cells found in the respiratory system?

A

Terminal and respiratory bronchioles

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60
Q

The alveolar connective tissue is a fibroelastic interstitium. What types of fibers are found here?

A

Collagen, reticular, and elastic

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61
Q

What are the three main components of alveoli?

A

Pneumocytes (I and II),

fibroelastic interstitium,

pulmonary capillaries

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62
Q

What percentage of the surface area of the lung alveoli is made up of type I pneumocytes?

A

95%

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63
Q

What percentage of the surface area of the lung alveoli is made up of type II pneumocytes?

A

5%

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64
Q

What percentage of the cell population of the lung alveoli is made up of type II pneumocytes?

A

66%

(Note: yet only 5% of the alveolar surface area is made of type II pneumocytes)

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65
Q

Describe the unique structures of type II pneumocytes seen on EM.

A

Lamellar bodies (striped organelles)

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66
Q

What are the components of surfactant?

A

Phospholipids (DPPC)

+

4 surfactant proteins (SPA, SPB, SPC, SPD)

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67
Q

Which is the most important surfactant phospholipid?

A

Dipalmitoyl phosphatidylcholine (DPPC)

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68
Q

Why is the alveolar fibroelastic interstitium important?

A

It provides the elastance / recoil of the alveoli

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69
Q

What type of cell is here shown?

A

Hemosiderin-laden macrophages (heart-failure cells) in the lungs

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70
Q

What tissue lines the outside of the lungs?

A

The visceral pleura

(a small layer of connective tissue + the mesothelium)

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71
Q
A

Alveolar duct

Alveolus

72
Q
A

Blue = Type II pneumocytes

Black = Type I pneumocytes

Green = Capillaries

73
Q

Note: The blood in the lumen is an artifact of preparation.

A

A bronchiole

74
Q
A

A = respiratory bronchiole

B = branch of pulmonary artery

75
Q
A

A = branch of pulmonary artery

B = a bronchiole

76
Q
A

Intrapulmonary bronchi

77
Q
A

A = Hyaline cartilage

B = Chondrogenic perichondrium

C = Fibrous perichondrium

78
Q

Identify the indicated structures.

A

A = Respiratory bronchiole

B = Alveolar duct

C = Atrium

D = Alveolar sac

79
Q

Note: this is a transverse cross-section.

A

Larynx;

A = Epiglottis

B = Ventricular fold

C = Vocal fold

D = Thyroid cartilage

Arrow = Vestibule

80
Q
A

Yellow bar = olfactory epithelium

A = bone

B = filia olfactoria (olfactory cells)

Black arrows = serous glands

81
Q
A

Black bar = Visceral pleura of lung

Black arrows = Mesothelium

82
Q
A

A = Respiratory bronchiole

B = Alveolus

C = Branch of pulmonary artery

83
Q
A

Blue arrows = Type II pneumocytes

Black arrows = Type I pneumocytes

White arrows = Macrophages

84
Q
A

A = Respiratory epithelium

B = Elastic lamina

C = Submucosa

D = Adventitia

85
Q

(Part of larynx)

A

A = Ventricle

B = Vocalis muscle

Arrows = Vocalis ligament

86
Q

What are some of the purposes of the respiratory system?

A

Conduct / warm / humidify / filter the air

Facilitate gas exchange

Enable speech

87
Q

Name the four more common bronchogenic carcinomas.

A

Squamous cell;

adenocarcinoma;

large cell;

small cell

88
Q

What are two common sources of metastases found in the lungs?

A

Breast carcinomas;

renal cell carcinoma

89
Q

What are the two main categories of vascular causes of pulmonary edema?

A

Hemodynamics (heart failure, volume overload, hypoalbuminemia, etc.);

microvascular injury (infections, aspiration, trauma, transfusion reactions, drug reactions, etc.)

90
Q

What type of tissue is this?

Is it healthy or diseased?

A

Lung;

diseased (pulmonary edema)

91
Q

How does pulmonary edema appear in a micrograph?

A
  • Widened alveoli filled with frothy, pink, proteinaceous transudate
  • Capillary congestion
92
Q

Where do most pulmonary infarctions occur?

A

The lower lobes (75%)

93
Q

True/False.

Pulmonary infarcts typically occur as single infarctions.

A

False.

As many as 50% occur multiply

94
Q

What shape is a typical pulmonary infarct of the lower lobes?

A

Wedge-shaped

(apex towards hilum; base towards pleura)

95
Q

Parallel, gray lines can often be seen in thromboemboli.

What are these lines?

A

Layers of red cells, platelets, and fibrin

(‘Lines of Zahn’)

96
Q

The majority of lung infections are caused by ________.

A

Viruses

97
Q

What is pulmonary consolidation?

What is a typical cause?

A

Fluid filling sections of the lung;

pneumonia

98
Q

What type of tissue is shown in this micrograph?

What is going on with this patient?

A

Pulmonary tissue;

pneumonia

(neutrophil-rich exudate shown in alveoli)

99
Q

How does pulmonary tissue appear on histology in a patient with an active tuberculosis infection?

A

Well-defined granulomas

Caseous necrosis

Several giant cells interspersed

100
Q

Describe the differences between smokers and non-smokers in terms of small cell, large cell, adeno-, and squamous cell carcinomas.

A
101
Q

Most lung cancers are __________ and arise around or near the lung _____.

What carcinoma does not typically follow this pattern and instead arises in the periphery (e.g. from terminal bronchioles)?

A

Bronchogenic,

hilum;

adenocarcinoma

102
Q

__ /4 of lung carcinomas arise from first-, second-, or third-order bronchi.

A

3

103
Q

Where do lung adenocarcinomas tend to arise?

A

The periphery

(often from septal cells or terminal bronchioles)

104
Q

Name the most common general location to find each of the following in the lungs:

Squamous cell carcinoma

Adenocarcinoma

Large cell carcinoma

Small cell carcinoma

A

Hilum

Periphery

Periphery

Hilum

105
Q

Which lung cancer is most common in non-smokers or those that have quit smoking?

A

Adenocarcinomas

106
Q

Which two hormones can be produced ectopically in which type of lung cancer?

A

ADH, ACTH;

small cell carcinoma

107
Q

Where are metastases to the lungs often found within the lungs?

A

Multiple discrete nodules in the periphery

108
Q

Carcinomas often spread initially via ___________.

Sarcomas often spread initially via ___________.

A

Lymphatics;

hematogenous routes

109
Q

What are two major risk factors for laryngeal carcinomas?

A

Smoking;

alcohol abuse

(synergistic effects)

110
Q

Where do laryngeal carcinomas typically arise?

What subtype of carcinomas are they usually?

A

Directly on the vocal cords;

squamous cell carcinomas (~95%)

111
Q

What type of histopathology is often seen in cases of squamous cell carcinomas (e.g. laryngeal or pulmonary)?

A

Infiltrating ‘tongues’ of atypical squamous cells;

squamous pearls

112
Q

True/False.

Podocytes are essentially a specialized connective tissue cell.

A

False.

They are specialized epithelial cells.

113
Q
A

C.

(fused basal lamina)

114
Q

Name the relevant changes in artery from the renal artery to the glomerulus and subsequent capillary beds.

A
  • Renal a. –>*
  • segmental a. –>*
  • interlobar a. –>*
  • arcuate a. –>*
  • interlobular a. –>*
  • afferent arteriole –>*

glomerulus –>

efferent arteriole –>

peritubular capillaries (cortex)

+

vasa recta (juxtamedullary)

115
Q

Describe what vessel changes occur after blood passes through the peritubular capillaries (cortical) and/or vasa recta (juxtamedullary).

A

Either:

Peritubular capillaries (cortical)

Or:

vasa recta (juxtamedullary)

  • –>*
  • interlobular v. –>*
  • arcuate v. –>*
  • interlobar v. –>*
  • renal v.*
116
Q

What section of tissue is shown here?

A

The renal cortex, medullary rays, and medulla

117
Q

What is a renal corpuscle?

A

A histological section containing the glomerulus and Bowman’s capsule

118
Q

What is the order of a nephron?

(See attached image for more detailed description)

A

Bowman’s capsule –>

PCT –>

Loop of Henle (descending and ascending) –>

DCT –>

Collecting duct

119
Q

What are some of the general functions of the kidneys?

A

Waste excretion;

BP regulation;

blood acid-base regulation;

hormone production;

vitamin D production

122
Q

What is unique about the fenestrated capillaries of the glomerulus?

A

The lack of a fenestration diaphragm;

presence of a nephrin-containing glomerular slit diaphragm instead

123
Q

What space can exists between podocyte foot processes (pedicles)?

A

Filtration slits

127
Q

What cells form the visceral layer of the glomerular capsule?

What contractile cells are also found in this region?

A

Podocytes;

mesangial cells

128
Q

What protein is essential to the glomerular filtration slit diaphragm?

A

Nephrin

129
Q

What is the glomerulus in terms of type of blood vessel?

A

A bed of fenestrated capillaries

130
Q

In order, what structures must a substrate in a glomerulus pass to reach the lumen of the Bowman’s capsule?

A

The endothelial fenestrations;

the basement membrane;

the podocyte filtration slit;

the podocyte filtration diaphragm

131
Q

Which limb of the loop of Henle (ascending or descending) has a thick portion?

A

Ascending

132
Q

Describe the epithelial histology of the proximal convoluted tubule and any distinctive characteristics.

Where are they found?

A

Simple cuboidal layer with brush border,

luminal debris,

indistinct cellular outlines,

very eosinophilic;

the renal cortex and medullary rays

133
Q

What type of renal tissue is this?

A

Proximal convoluted tubules

134
Q

What is the parietal section of the glomerular capsule?

A

Bowman’s capsule

137
Q

What are some major proteins and compounds found in the glomerulus basement membrane?

A

Collagen IV;

fibronectin;

laminin;

heparin sulfate (charge barrier)

138
Q

True/False.

Albumin can easily pass through the fenestrations / fenestration slits of the glomerulus.

A

False.

Although albumin can fit through the slits, it is difficult, and the charge barrier helps prevent it from occurring.

139
Q

How large is albumin in Daltons?

A

68 kDa

140
Q

What size proteins can pass through the glomerular filtration slits?

A

Albumin (68 kDa) or smaller

142
Q

A mutation in nephrin leads to what condition?

A mutation in collagen IV leads to what condition?

A

Congenital nephrotic syndrome;

Alport’s syndrome

144
Q

For what function are the pumps in the thick ascending loop of Henle responsible?

A

Pumping sodium out of the tubule

145
Q

Describe the appearance of the loops of Henle vs. collecting ducts on H&E light microscopy.

A
147
Q

How is the DCT different on H&E light microscopy when compared to the PCT?

A

Slightly smaller cuboidal cells;

no brush border;

little debris in lumen;

(still very eosinophilic, still indistinct cellular outlines, still simple cuboidal)

148
Q

Identify an example of each of the following in this image:

Glomerulus

PCT

DCT

A

Glomerulus (Purple)

PCT (Blue)

DCT (Green)

149
Q

The macula densa is on the _____ convoluted tubule and communicates with the ________ arteriole.

A

Distal;

afferent

150
Q

The _________ arteriole interacts with the _______ _______ of the distal convoluted tubule.

A

Afferent;

macula densa

152
Q

What are the three portions of the juxtaglomerular apparatus?

A

The macula densa (DCT);

juxtaglomerular smooth muscle cells (afferent arteriole);

extraglomerular mesangial cells (outside the renal corpuscle)

153
Q

Identify the macula densa and extraglomerular mesangial cells in this image.

(Note: both are part of the juxtaglomerular apparatus.)

A
155
Q

What effect does chronic renal disease (e.g. advanced polycystic kidney disease) have on the blood?

A

Decreased erythropoeitin release –> normocytic anemia

156
Q

Where, specifically, is erythropoeitin produced?

By what type of cell?

A

The interstitium surounding the PCT and peritubular capillaries;

interstitial fibroblasts

157
Q

Which portion of the nephron is involved in vitamin D activation?

Via what enzyme?

A

The PCT;

1-α hydroxylase

158
Q

What enzyme is unique to the PCT?

What does it do?

A

1-α hydroxylase;

turns 25-hydroxy vitamin D3 into 1,25-hydroxy vitamin D3

159
Q

1-α hydroxylase turns ___(OH) vitamin D3 into ___(OH) vitamin D3 in the ________________ of the kidney.

A

25-, 1,25-;

proximal convoluted tubule

160
Q

Activation of 25-(OH) vitamin D3 into 1,25-(OH) vitamin D3 occurs in what organelle(s) of the PCT epithelium?

Via what enzyme?

A

The mitochondria;

1-α hydroxylase

161
Q

What process occurs uniquely in the mitochondria of the renal PCT?

Via what enzyme?

A

Vitamin D activation

(25-(OH) vitamin D3 to 1,25-(OH) vitamin D3​);

1-α hydroxylase

162
Q

True/False.

The conversion of vitamin D from 1,25-(OH) vitamin D to 25-(OH) vitamin D occurs in the PCT via the enzyme 1-α hydroxylase.

A

False.

The conversion of vitamin D from 25-(OH) vitamin D to 1,25-(OH) vitamin D occurs in the PCT via the enzyme 1-α hydroxylase.

163
Q

What three stimuli activate the tubuloglomerular feedback system (juxtaglomerular apparatus)?

A
  1. Hypovolemia
  2. Hypotension
  3. Decreased Na+ in the DCT
164
Q

What type of epithelium is found in the loop of Henle?

A

Simple squamous cells

165
Q

What type of epithelium lines the PCT?

What type of epithelium lines the loop of Henle?

What type of epithelium lines the DCT?

A

Simple cuboidal, brush border;

simple squamous;

simple cuboidal, no brush border

167
Q

Describe the histology of the collecting ducts.

A

Simple cuboidal cells, becoming taller towards the papilla;

clear borders between cells (as opposed to PCT or DCT)

principal cells (light-staining);

intercalated cells (dark-staining)

168
Q

Identify the renal structures in the image.

A

1 - Collecting ducts

2 - Loop of Henle

3 - Vasa recta

170
Q

Describe the urothelium histology.

A

Transitional epithelium

+

2-3 layers of smooth muscle

+

connective tissue

171
Q

What is the term used to describe the luminal layer of transitional epithelium in the ureters/bladder/urethra?

A

Umbrella cells

172
Q

After passing the loop of Henle, what mechanism is responsible for all further water and ion regulation in the DCT and collecting duct?

A

Hormonal action

(e.g. aldosterone, ADH)

174
Q

What structure is this most likely to be?

A

A ureter

178
Q

Why is it important that the macula densa (of the juxtaglomerular apparatus) interact with the afferent arteriole?

A

Filtrate flow is regulated according to the speed / concentration of Na+ in the DCT

181
Q

Scenario: the macula densa senses a low concentration of NaCl in the DCT.

What does this indicate, and how does the juxtaglomerular apparatus respond?

A

The flow of filtrate is too slow;

the afferent arteriole relaxes, increasing bloodflow into the glomerulus

182
Q

What can juxtaglomerular cells (modified smooth muscle) release in response to low blood pressure?

A

Renin

183
Q

What organ releases angiotensinogen?

What organ releases renin?

What organ releases angiotensin-converting enzyme?

What organ releases aldosterone?

A

Liver;

kidney;

lung;

adrenal zona glomerulosa

184
Q

Describe the portions of the renin-angiotensin system released by each of the following:

Kidney

Lung

Adrenal zona glomerulosa

Liver

A

Renin

ACE

Aldosterone

Angiotensinogen

185
Q

What main hormone-releasing functions does angiotensin II perform?

What main vascular and ionic functions does angiotensin II perform?

A

Stimulates aldosterone synthase in the zona glomerulosa of the adrenal gland;

stimulates ADH release;

stimulates AT1R receptors to cause arteriolar vasoconstriction;

stimulates NaCl reabsorption in the PCT

186
Q

What main hormone-releasing functions does angiotensin II perform?

A

Stimulates aldosterone synthase in the zona glomerulosa of the adrenal gland;

stimulates ADH release;

187
Q

What main vascular and ionic functions does angiotensin II perform?

A

Stimulates AT1R receptors to cause arteriolar vasoconstriction;

stimulates NaCl reabsorption in the PCT

188
Q

What location(s) of the nephron is(are) targets for aldosterone?

A

The ascending limb of the loop of Henle;

the DCT;

the collecting duct

189
Q

Scenario: the macula densa senses a high concentration of NaCl in the DCT.

What does this indicate, and how does the juxtaglomerular apparatus respond?

A

The flow of filtrate is too rapid;

the afferent arteriole constricts, reducing bloodflow into the glomerulus

190
Q

What process is the main regulator for the GFR?

A

Na+ reaching the macula densa

191
Q

What location(s) of the nephron is(are) targets for ADH?

A

The collecting tubule (late DCT) and collecting duct

192
Q

What are the two main cell types of the collecting ducts?

What general function does each perform?

A

Principal cells (light-staining) (more) - water reabsorption via aquaporin2 (ADH-regulated)

Intercalated cells (dark-staining) (fewer) - secrete H+ and absorb HCO3-

195
Q

What is the name of the capillary bed feeding the nephron?

What is the name of the capillary bed surrounding the collecting duct?

What is the name of the capillary bed surrounding the PCT and DCT?

A

Glomerulus;

vasa recta;

peritubular capillaries

198
Q

What three structures are characterized by urothelium (transitional epithelium + 2-3 layers smooth muscle + connective tissue)?

A

The ureters, bladder, and urethra

199
Q

How long is the average female urethra?

How long is the average male urethra?

A

5 cm

20 cm

T1 - Integrated (Full Review) (29 decks)

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