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Family Medicine > Anemia + Asthma + CVD + MSK + Joint > Flashcards

Anemia + Asthma + CVD + MSK + Joint Flashcards

1
Q

Correct definition about anemia is:

A
  • decrease in O2 carrying capacity
  • decrease in RBC
  • decrease in getting rid CO2
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2
Q

Most common cause of anemia

A

IDA

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3
Q

How do drugs, acohol, and tobacco cause anemia?

A

Affect Stomach lining causing nutritional anemia

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4
Q

What cardiovascular complication is seen with anemia?

A

Ejection systolic murmur\ S3 gallop

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5
Q

What are the most important labs in anemia

A

CBC and smear

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6
Q

Best lab tool in IDA is:

A

Ferritin

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7
Q

Name high MCV + Normal RDW

A
  • folic & B12
  • Hypothyroidism
  • Drug-induced anticonvulsants.
  • MDS
  • BM failure
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8
Q

Name low MCV + high RDW

A
  • active hemolysis with brisk reticulocytosis
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9
Q

Name Normal MCV + Normal RDW

A
  • Chronic disease
  • Hemorrhage
  • Inflammation (acute)
  • Malignancy
  • Transient erytheroblastopenia childhood.
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10
Q

Name Normal MCV + high RDW

A
  • Hemolytic anemia (sickle cell\ G6pd\ membrane\ microangiopathies like DIC & HUS\ immune)
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11
Q

Name low MCV + Normal RDW

A
  • Sideroblastic anemia
  • Lead poisoning
  • IDA
  • Thalassemia trait
  • Chronic disease
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12
Q

Name low MCV + high RDW

A
  • Thalassemia (HBS-SB)

- HBC & HBE.

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13
Q

What will you order if you see low Hg and MCV

A

Lead level - Iron profile - Electrophoresis.

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14
Q

What will you order if you see low Hg and normal MCV

A
  • electrophersis
  • Coomb
  • Osmotic fragility
  • enzyme assays
  • other diseases.
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15
Q

What will you order if you see low Hg and high MCV

A
  • B12\folic\thyroid screen
  • BM aspiration
  • hemolysis
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16
Q

Normal MCV values is

A

80-100

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17
Q

Low:

  • MCV
  • Iron
  • Ferritin
  • TIBC

Is:

A

Anemia of chronic diseases

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18
Q 
Low: 
- MCV
- Iron
- Ferritin 
High
- TIBC

Is:

A

IDA

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19
Q 
Low: 
- MCV
High 
- Iron
- Ferritin

Is:

A

Thalassemia

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20
Q

What is the role of mentezer index?

A

Identify thalassemia:

  • MCV\RBC < 13
  • Iron levels >30
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21
Q

Less than (13, 12,11) is mild anemia in …. & … & …..

A

1- male
2- nonpregnant women
3- pregnant women..

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22
Q

Is ferritin always right to diagnose IDA?

A

No because it might increase in some cases in reactions

Even if increased, check for TIBC and iron

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23
Q

Common risk factors for IDA

A
  • increased intrauterine bleeding
  • celiac
  • NSAID
  • Hpylori or peptic ulcer
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24
Q

When should we suspect malignancy in IDA?

A
  • men
  • post menapausal
  • RF
  • elderly
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25
Q

Iron therapy is:

A

120 elemental iron for 3m

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26
Q

How to take iron supplements

A

Empty stomach, No PPI or calcium, vit D

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27
Q

Falsly elevated A1c is due to:

A

IDA

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28
Q

AAP recommends screening for IDA at

A

1 year

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29
Q

UPSTSF VS AAFP\CDC for pregnancy screening of IDA is:

A

USPSTF: not sufficent data

But rest recommend it

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30
Q

What happens with

1- 2 - 3 - and 4 deletions of Hemoglobin A

A

1: nothing
2: nothing except in pregnancy\illness
3: HBH “splenomegaly & avoid oxidative”
4: hydrops fetalis “not surviving”

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31
Q

What is the major drug that should be avoided in G6pd?

A

Nitrofuritoin for UTI > cause hemolysis

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32
Q

If b12 is boarderline low, order:

A

Homocystine +methylmalonoic

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33
Q

Risk factors for future episodes of asthma attacks.

A
  • pregnancy
  • use ICS, oral steroid, high use of inhaler
  • comorbidities - psychological
  • exposure to allergens - eosinphilia
  • low FEV1 - ICU admission
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34
Q

Most common ICS medication

A

Budsonide
Fluticasone
Ciclosonide

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35
Q

Most common reliever combination therapy is:

A
  • Sertride: salmeterol + fluticasone

- Simbicort: Formeterol + Budsonide

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36
Q

Explain the initiation process of asthma treatment:

A

1: >20 no RF
2: >20 yes RF - 16 to 19
3: <16
4: <16 severe go for referral.

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37
Q

Explain the maintainace process of asthma treatment

A
  • Maintain: >20 for 3 months.

- Step up: <19

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38
Q

How is step 3 different in child <5 than adults?

A

instead of laba+ICS we double dose the ICS

“Due to fear of bronchospam)

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39
Q

When to step down asthma treatment?

A

When pts is controlled after 3 months and we can find a minimum therapy to maintain good control

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40
Q

What do you recommend patients with adverse effect of medications?

A
  • change medics or decrease dose\frequency
  • anti-fungal therapy for severe thrush
  • wash mouth after use
  • use spacer
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41
Q

How to evaluate moderate asthma acute attack

A

Full sentence, agitated alert, may\not use accessory.

  • RR:20-30
  • HR:<120
  • SaO2: >92
  • PEFR: 50-70%
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42
Q

How to treat moderate asthma?

A 
1- O2 to keep saturation 
2- nebulization or MDI of salbutamol 
3- oral prednisone STAT 
4- discharge & Start on step 3 
5- close follow up
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43
Q

How to treat severe and life-threatning asthma

A 
1- O2 
2- Salbutamol nebulizer 
3- oral prednisone or 100-200 IV hydrocortisone
4- ipratropium 
5- referral
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44
Q

Pediatric assessment score for acute asthma attack

A
  • scalene muscle contraction
  • suprasternal retraction
  • air entry
  • O2 sat.
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45
Q

A child with acute asthma attack and pram 1-3, how to manage

A

1- O2
2- Salbutamol Q20 for 2 doses
3- ipratropium or oral steroid
4- reassess

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46
Q

What test is used to confirm bronchial asthma?

A

Spirometery with reversibility test

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47
Q

A patient with known asthma present with acute presentation, what could be the cause other than asthma?

A
  • Viral infection
  • pnemonia
  • smoke
  • exercise
  • rhinosinusitis
  • GERD
  • Obesity
  • B-blocker, asprin & NSAID usage.
  • sleep disorders
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48
Q

What are the findings in asthma examination

A
  • bilateral expiratory wheez

- high pitch

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49
Q

Reversibility improvement in spriometery with bronchodilator is:

A

FEV1 (12%) + 200ml

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50
Q

When to preform spiromentery in children?

A

At 6 years

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51
Q

How to diagnose child with asthma?

A

More than 3 attacks of SOB or Wheeze in one season with more than 2 weeks of cough

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52
Q

How to diagnose child below 6 years with asthma

A 
Wheeze of >3 episodes  
\+
(1 major) Atopy , Family hx, skin test
\+  
(2 minor) Eosinophilia, food allergy
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53
Q

How much is the recommended physical activity?

A
  • 150\w of moderate

- 75\w of vigorous

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54
Q

When do we start screening men for dyslipidemia?

A
  • No risk: 35

- Risk: 20

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55
Q

When do women start screening men for dyslipidemia?

A
  • No risk: 45

- Risk: 20

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56
Q

When are men and women are at similar risk for dyslipidemia?

A
  • post\early menapause

- premature ovarian failure

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57
Q

What are the secondary causes of dyslipidemia?

A
  • Diet: anorexia - high fat diet
  • Medications: Steroid - diuretics - amiodarone.
  • Medical conditions: hypothyroidism - pregnancy - nephrotic syndrome
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58
Q

Name high intensity statin agents:

and how much it decreases?

A
  • Atorvastatin 40-50
  • Rosuvstatin 20-40

(50%)

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59
Q

Name moderate intensity statin agents:

A
  • Atorva 10-20
  • Rosuva 5-10
  • Simva 20-40

30-49%

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60
Q

Name low intensity statin agents:

A

Simvastatin 10mg

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61
Q

When to start patients aged 0-19 on statin?

A

When they have hypercholestermia in the family

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62
Q

When to start patients aged 20-39 on statin

A
  • family history
  • premature ASCVD
  • LDL >160
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63
Q

Normal population to start statin:

A

Above 40

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64
Q

What is the cut-off point for diabetes starting high intensity statin?

A

20% or LDL >190

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65
Q

When to consider CAC?

A

Between 5-<7.5

Anything from 1 and above favors statin
If >100 initiate immidiatly

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66
Q

What are the risk enhancers for ASCVD risk score:

A
  • family history of premature
  • LDL >160
  • women condition
  • metabolic syndrome
  • ethnicity
  • inflammatory disease
  • kidney diseases
  • elevated CRP- LpA-ApoB
  • nephorpathy, retinopathy, neuropathy.
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67
Q

How to differentiate myalgia, myositis, rhabdomyolysis in statin therapy?

A
  • Myalgia: Normal CK
  • Rhabdomylsis: CK<10x ULN
  • Myositis: more than ULN
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68
Q

In which group of population do you expect to see myalgia?

A

Young - female - thin - athletes - alcohol - drugs on liver metabolism

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69
Q

Statin works primary on:

Liver - kidney

A

Liver

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70
Q

When to stop statin therapy?

A
  • If ALT\AST is elevated 3x ULN

- Before 3m of conception & in breast-feeding.

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71
Q

After statin therapy [initiation], when to repeat lipid profile test?

And for [maintenance]

A
  • After 1m - 3m.

- After 3-12m

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72
Q

Statin intolerance is common in:

A
  • Old
  • Female
  • Hypothyroidism
  • Alcoholic
  • Hemorrhagic stroke
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73
Q

What are the baseline laboratory investigations for statin therapy?

A

[TSH - BHCG - Liver\renal function - CK - Hb1c - vitamin D]

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74
Q

Do you stop statins if the GFR is below <30?

A

You only stop rousvastatin, but the rest decrease their doses.

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75
Q

What are the side effects of gum and lozange in smoking cessation therapy?

A

Hiccups and dyspepsia (avoid food\drinks)

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76
Q

When to initiate aspirin therapy?

A

Age 40-70 with no previous risk of bleeding and ASCVD of >20%

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77
Q

Most important risk enhancers for ASCVD are:

A
  • LDL>160

- Family Hx of premature ASCVD

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78
Q

What is your next step when you see your patient with BP >160\100

A

Look for target oran damage.

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79
Q

When can you immediately diagnose patients w\HTN without any further testing?

A
  • Hypertensive emergency
  • Asymptomatic severe HTN >180\120
  • target organ damage.
80
Q

Differences between left and right arm in BP measurement is due to:

A

Subclavian stenosis (PVD)

81
Q

Postural hypotension measurment should be in:

A

1- elderly >65
2- DM
3- dizziness

82
Q

Hypertension in African American is:

A
  • earlier
  • Severer
  • commoner
83
Q

Elevated systolic BP is usually attributed to which cause?

84
Q

Major categories of OTC medications to be avoided in HTN?

A
  • NSAIDs
  • OCP
  • Antacids
  • Decongestants
  • Corticosteroids
  • antidepressants & atypical antipsychotics
85
Q

A patient presents with [HTN + Hypokalemia + Metabolic alkalosis]
Is suspected to have:

A

Primary aldosteronism

86
Q

Endocrine disorders that may cause secondary HTN are

A
  • Hyper & hypothyroidism
  • Hyperparathyroidism
  • Cushing
  • Pheochromocytoma
  • primary aldosteronism
87
Q

When to screen for HTN annually and when to screen semi-annually?

A
  • annually: anyone above 18

- Semiannually: anyone with risk factor (prehypertensive - obese)

88
Q

Typical findings in HTN fundoscopy examinations?

A
  • Cotton wool spots
  • arteriolar narrowing\nicking
  • hemorrhage
  • papillodema.
89
Q

Initial tests in newly diagnosed HTN:

A
  • electrolyte & creatinine
  • urinalysis
  • glucose
  • TSH
  • lipid
  • ECG + ASCVD.
90
Q

Who should you start antihypertensive medications with

A

1- stage I: w\ [ASCVD 10% - DM - Kidney - 65 - CVD]

2- stage 2: any patient.

91
Q

Drug of choice for black patient with HTN?

A

Thiazide or CCB

92
Q

Drug of choice in renal impairment w\HTN:

A

ACE or ARB

93
Q

Drug of choice in HF w\HTN:

94
Q

Compelling indications for HTN in

  • Angina
  • Afib\flutter
  • CKD
A
  • B-blocker\CCB
  • B-blocker\CCB “non-hydro”
  • ACE\ARB
95
Q

Favorable indications for HTN in

  • BPH
  • tremor\Hyperthyroidism
  • Migrane
  • osteoprosis
  • raynoids
A
  • Alpha blocker
  • B-blocker
  • B-blocker
  • Thiazide
  • CCB
96
Q

antihypertensive Medications that are contraindicated in

- Bronchospastic disease:

97
Q

antihypertensive Medications that are contraindicated in

  • Liver disease:
A

Methyldopa

98
Q

antihypertensive Medications that are contraindicated in

- pregnancy:

A

ARBs or ACE

99
Q

antihypertensive Medications that are contraindicated in

  • Heart block
100
Q

antihypertensive Medications that are contraindicated in

  • Gout:
A

Thiazide diuretics

101
Q

antihypertensive Medications that are contraindicated in

  • Hyperkalemia
A

Aldosterone antagonist

102
Q

antihypertensive Medications that are contraindicated in

  • Hyponatermia
103
Q

antihypertensive Medications that are contraindicated in

  • renovascular disease
A

ACE and arb

104
Q

Most common combination therapy is:

A

ACE\ARB + CCB

105
Q

In which group of patients would you IMMEDIATELY start combination therapy?

A

+20 Systolic+10 diastolic of their goal BP.

106
Q

When do you switch amoldipine (Dihydropyridine) to verapmil\diltizam (non-Dihydropyridine)

A

Leg swelling

107
Q

What is drug resistant HTN?

A

[3 HTN medics] one of them is Diuretic.

108
Q

Function of the rotator cuff:

SITS

A

Supra: Abduction
Infraspinatus: external rotation
Teres minor: External rotation
Subscapularis: internal rotation.

109
Q

Posterior vs anterior shoulder dislocation:

A

Posterior: inability to external rotation
Anterior: inability to internal rotation

110
Q

Scapular winging is due to

A

Serratus anterior muscle injury + Thoracic nerve.

111
Q

Throwing atheletes are common to develop:

A

Labrum injury (cluncking shoulder in above head motion)

112
Q

The test for all ranges of motion

A

Apley scratch test

113
Q

Rotator cuff tests are:

A
  • Resisted external rotation
  • Drop arm
  • empty can test
114
Q

Impingement tests are:

A

Hawkins & neer

115
Q

Explain Hawkin’s - Neer test:

A
  • Flexion -flexion - internal rotation

- internal rotation - flexion

116
Q

How to test for biceps tendinitis:

A
  • Speed’s: Resist shoulder flexion after 30

- yargson’s: flexion + Resist pronation.

117
Q

To test for anterior shoulder laxity:

A

Apprehension test

118
Q

Sulcus sign indicate:

And is caused usually by which action?

A

Inferior shoulder instability.

Holding heavy object

119
Q
  • Overuse of shoulder
  • worse w\overhead
  • Night time pain

this is typical presentation of:
This is treated by:

A
  • Impingement

- conservative > corticosteroid injection > surgery (MRI)

120
Q
  • old patient
  • Fall in overstretched hand (trauma)
  • Pain in lateral shoulder
  • weakness w\external rotation

this is typical presentation of:
This is treated by:

A

Rotator cuff tear

- Surgery (unless not candidates)> rehab.

121
Q
  • Old + DM
  • Acute shoulder pain + no trauma
  • decrease in ROM (active\passive)

this is typical presentation of:
This is treated by:

A

Adhesive capsulitis

  • conservative (2y)> surgery
122
Q
  • Young - Fall on his shoulder
  • Can’t Abduct\Flex arm
  • Palpable coracoid process
  • Maintain arm on external rotation

this is typical presentation of:
This is treated by:

A

Anterior shoulder dislocation

  • Surgery if prone to recur (Athletes\military)\No surgery if not prone
123
Q
  • Numbness in first 3 fingers
  • worse w\working

this is typical presentation of:
This is treated by:

A

Carpal tunnel

- splinting\corticosteroid\physio\yoga \theraputic US > surgery if indicated.

124
Q
  • pain in dorsal of radial wrist
  • Painful ulnar deviation
  • worse w\working

this is typical presentation of:
This is treated by:

A

Dequiverian tensinovitis

  • Ice\Analgesic\Spica splinting > corticosteroid injection
125
Q
  • catching of thumb
  • can flex thumb
  • palpable nodule in MCP joint

this is typical presentation of:

This is treated by:

A

Trigger finger

  • NSAID\injection at flexor tendon sheath > surgery.
126
Q
  • Unilateral
  • worse w\moving
  • stiffness <30min
  • old\obese
  • effusion
  • pain in knee joint in medial side
  • crepitus\buckling

this is typical presentation of:

A

Osteoarthritis

127
Q
  • back pain after heavy lifting
  • no neurological deficit

this is typical presentation of:

A

MSK back pain

128
Q

Fall on outstretched arm usually causes which type of shoulder dislocation?

A

Posterior shoulder dislocation

129
Q

The core component for shoulder instability physiotherapy

A

Rotator cuff strengthening + scapular stabilization

130
Q

Best 2 tests to confirm Carpal tunnel?

A

1st: flick sign> pain relief w\shaking wrist
2nd: carpal compression

131
Q

In which patient will you only diagnose carpal tunnel clinically and not preform any further testing or surgical recommendation?

A
  • pain is mild

- pain is associated w\pregnancy

132
Q

Which muscles are affected in dequevarian tenosynovitis?

A
  • Abd pollices longus

- Extensory pollices brevis

133
Q

Spica splinting VS nocturnal splinting indications in MSK injuries:

A
  • Spica: Dequervian tenosynovitis

- Nocturnal: Carpal tunnel

134
Q

Name associated clinical findings of osteoarthritis in the knees:

A

Baker’s cyst + Varus\vulgus

135
Q

Name associated clinical findings of osteoarthritis in the hands:

A

Heberden\Bouchard

136
Q

Name associated clinical findings of osteoarthritis in the shoulder and hips:

A
  • shoulder: external rotation limitation

- Hip: internal rotation limitation

137
Q

What are the radiographic findings in osteoarthritis?

A

Joint narrowing - subchondral sclerosis - osteophytes

138
Q

An important advise you need to give your patients with acute low back due to MSK is to:

A

Continue with life activity.

139
Q

Oligoarthrtis is defined as

140
Q

Most common site for gout

A

1st metatarso - ankle

141
Q

If patient has joint pain\swelling and is known for IV drug abuse, you might suspect?

A

Septic arthritis by staph.

142
Q

Patient on diuretic is at high risk of developing attacks followed by resolution.

143
Q

In any patient with 1 joint effusion, next step is to:

A

Arthrocentesis

144
Q

In any patient with joint pain and trauma, next step is to:

145
Q

WBC in gout - osteoarthritis - septic arthritis:

A
  • > 2000
  • 200-2000
  • > 50,000
146
Q

Synovial fluid in gout vs psudogout:

A
  • gout: monosodium ureate crystal (needle shaped -ve bifergnce) + poly neutrophils
  • psudogout: calcium pyrophosphate & +ve, biferengent, rhomboid
147
Q

In septic arthritis, synovial fluid analysis should include:

A

Gram stain

148
Q

Gout is more common in

M/f

149
Q

Characterstics of gout

A
  • tophi
  • increased ureate levels (not always and no necessary in acute attacks)
  • pain and eryhtema and joint space narrowing
150
Q

Role of plasma ureate

A

Increase likelihood of gout

151
Q

What is first line treatment for gout

152
Q

Prophylaxis of gout is

A

Allopuranol

153
Q

What are the indications of prophylaxis in gout?

A
  • tophi
  • joint destruction
  • nephorlithasis
  • recurrent 2-3/y
  • patient preference
154
Q

Old man with minor (injury) develops joint swelling/pain/low grade fever reduced

Is likely to be:

155
Q

The most common causes for acute monoarthritis in elderly is:

156
Q

First line treatment in psudogout?

A

Intra-articular steroid injection

157
Q

Septic arthritis is due to
(Trauma - no trauma)
(Associated w/disease - not associated)
(Most prominent symptom is)

A
  • No trauma
  • associated
  • decrease ROM
158
Q

Diff between psudogout and septic arthritis

A
  • septic could be associated with fever.

- psudo: associated with trauma

159
Q

Spetic arthritis is usually due to

Gram (positive - negative) cocci

160
Q

Treatment of choice for septic arthritis is

A

AB emperic before results of culture

161
Q

What are the risk factors for septic arthritis?

A
  • old
  • immunosuppressed
  • OA/RA
  • infection spread (hematogeous - contagous)
  • prosthesis
  • low socioeconmic
  • ticks
162
Q

Gout is more common in

M/f

163
Q

Characterstics of gout

A
  • tophi
  • increased ureate levels (not always and no necessary in acute attacks)
  • pain and eryhtema and joint space narrowing
164
Q

Role of plasma ureate

A

Increase likelihood of gout

165
Q

What is first line treatment for gout

166
Q

Prophylaxis of gout is

A

Allopuranol

167
Q

What are the indications of prophylaxis in gout?

A
  • tophi
  • joint destruction
  • nephorlithasis
  • recurrent 2-3/y
  • patient preference
168
Q

Old man with minor (injury) develops joint swelling/pain/low grade fever reduced

Is likely to be:

169
Q

The most common causes for acute monoarthritis in elderly is:

170
Q

First line treatment in psudogout?

A

Intra-articular steroid injection

171
Q

Septic arthritis is due to
(Trauma - no trauma)
(Associated w/disease - not associated)
(Most prominent symptom is)

A
  • No trauma
  • associated
  • decrease ROM
172
Q

Diff between psudogout and septic arthritis

A
  • septic could be associated with fever.

- psudo: associated with trauma

173
Q

Spetic arthritis is usually due to

Gram (positive - negative) cocci

174
Q

Treatment of choice for septic arthritis is

A

AB emperic before results of culture

175
Q

What are the risk factors for septic arthritis?

A
  • old
  • immunosuppressed
  • OA/RA
  • infection spread (hematogeous - contagous)
  • prosthesis
  • low socioeconmic
  • ticks
176
Q

Your ddx for a monoarthrtitis would be

A
  • hemorthrosis
  • septic arthritis
  • gout\psudogout
  • osteoarthritis
177
Q

In patient with history of warfarin, and acute non-traumatic injury and a very swollen\warm knee is most likely to have

A

Hemathrosis

178
Q

Name examples of symmetrical and non-symmetrical polyarthritis:

A
  • Symmetrical: RA\SLE

- Non: OA\ psoriatic arthritis

179
Q

What kind of joints is usually affected in SLE (small - medium - large)?

A

Small to medium

180
Q

Name inflammatory diseases that are assocaited with oligoarthritis:

A

Psoriatic

Ankylosing

181
Q

What are the systemic features of RA?

A
  • Uveitis
  • pneumonitis
  • nodules
  • fever
182
Q

differentiate between RA and OA affecting Interphalangeal joints

A

RA: PIP
OA: DIP

183
Q

What are the systemic features of SLE?

A
  • malar rash
  • oral ulcer
  • pleurisy
184
Q

What are the systemic features of AS?

A
  • uveitis

- pneumonitis

185
Q

Lab test for RA:

A
  • Specific: Anti-ccp

- RF

186
Q

Lab test for vasculitis:

A
  • ESR >50
  • ANCA
  • Biposy
187
Q

Lab tests for SLE:

A
  • specific: Antismith
  • C3\C4
  • Anti- DsDNA
188
Q

Lab test for AS:

189
Q

Sacroilitis can present in which inflammatory joint diseases?

A
  • psoriatic arthritis

- Ankylosing spondylitis

190
Q

An important role in family medicine when dealing with RA diagnosis:

A

Is to diagnose early and treat early to avoid irreversible damage

191
Q

To manage patients with RA:

A

1- NSAID & steroid injection or oral

2- refer to rhumatology to presrcribe DMARDs “methotrexate”

192
Q

Polymylagia rhumatica affect which joint?

A

Hip and shoulder girdles

193
Q

Criteria for AS diagnosis:

A

Back pain in 20 +

  • morning stiffness relieved by exercise
  • alternating buttock pain
  • pain relieved by NSAID
  • waking at night due to pain
  • extrarticular: enthisitis\ uveitis\ fatigue
194
Q

Patient with Ankylosing spondylitis have

Kyphosis - lordosis

A

Kyphosis & decreased flexion

195
Q

In psoriatic arthritis

which is usually first (psoriasis or arthritis)?

A

Usually psoriasis but can be either way

Family Medicine (15 decks)

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