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ch21 lymphatic Flashcards

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1
Q

what is the immune system?

A

a cell population that inhabits all organs and defends the body from agents of disease

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2
Q

What is the lymphatic system?

A

Network of organs and vein-like vessels that recover fluid

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3
Q

What are the functions of the lymphatic system?

A

Fluid recovery
Immunity
Lipid absorption

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4
Q

What is lymph?

A

A clear colourless fluid, similar to plasma, but low in protein.
Chemical composition varies in different locations

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5
Q

Where/How does lymph originate?

A

It originates as extracellular fluid drawn into lymphatic capillaries

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6
Q

what is a specific feature of lymphatic capillaries that differentiates them from other capillaries ?

A

They are non continuous (Terminal lymphatics)

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7
Q

What is the lymphatic capillary wall made up of?

A

Endothelial cells overlapping eachother like roof tiles

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8
Q

Lymphatic capillaries are found in most tissues, apart from?

A

CNS, cartilage, cornea, bone, and bone marrow

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9
Q

How are lymphatic capillaries tethered to surrounding tissues?

A

protein filaments

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10
Q

The gaps between cells in the wall of a lymphatic capillary are large enough to allow what to pass through?

A

Bacteria and cells

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11
Q

What is the mechanism of fluid moving in and out of lymphatic capillaries?

A

Endothelium creates valve-like flaps that open when interstitial fluid pressure is high and close when it is low

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12
Q

describe the anatomy of the larger lymphatic vessels.

A

Composed of three layers
Tunica interna
Tunica media
Tunica externa

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13
Q

Other than moderating flow of fluid in and out of vessels, what is another function of lymphatic valves?

A

prevent backflow of lymph

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14
Q

How many lymphatic trunks are there?

A

6

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15
Q

Name the lymphatic trunks

A

Jugular
subclavian
bronchomediastinal
intercostal
intestinal (unpaired)
lumbar

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16
Q

Name the 2 collecting ducts

A

Right lymphatic duct
Thoracic duct

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17
Q

What is the function of the right lymphatic duct?

A

receives lymph from right arm, right side of head and thorax; empties into right subclavian vein

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18
Q

What is the function of the thoracic duct?

A

receives lymph from below diaphragm, left arm, left side of head, neck, and thorax; empties into left subclavian vein

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19
Q

Which of the collecting ducts is the larger?

A

Thoracic duct

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20
Q

Where does the thoracic duct originate?

A

begins as a prominent sac in abdomen called the cisterna chyli

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21
Q

What significantly increases lymphatic return?

A

Exercise

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22
Q

Does lymph flow at low pressure low speed, or high pressure high speed?

A

Low pressure
Low speed

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23
Q

What mechanisms aid the flow of lymph?

A

rhythmic contractions of lymphatic vessels
Skeletal muscle pump
Arterial pulsation

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24
Q

Plasma cells are also known as

A

B cells

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25
Q

What are B cells also known as

A

plasma cells

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26
Q

What are natural killer (NK) cells?

A

Large lymphocytes that attack and destroy bacteria, transplanted tissue, host cells infected with viruses or that have turned cancerous

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27
Q

What are B lymphocytes? (B cells)

A

lymphocytes that when activated, become plasma cells that produce antibodies

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28
Q

What are T lymphocytes (T cells)

A

Lymphocytes that mature in the thymus

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29
Q

What are macrophages?

A

Large phagocytic cells of connective tissue

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30
Q

What cell does a macrophage develop from?

A

Monocytes

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31
Q

Name the functions of macrophages

A

Phagocytize tissue debris, dead neutrophils, bacteria and other foreign matter
Antigen presenting cell

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32
Q

What is an antigen presenting cell (APC)?

A

A cell that processes foreign matter and displays antigenic fragments to certain T cells alerting immune system to the presence of the enemy

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33
Q

What are dendritic cells?

A

Branched, mobile APCs found in epidermis, mucous membranes, and lymphatic organs

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34
Q

What is the function of a dendritic cell?

A

Alert immune system to pathogens that have breached the body surface

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35
Q

What is a reticular cell?

A

Branched stationary cells that contribute to the stroma of a lymphatic organ

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36
Q

How does a reticular cell function?

A

Engulfs pathogens using receptor mediated endocytosis

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37
Q

What is lymphatic (lymphoid tissue)

A

aggregations of lymphocytes in the connective tissues of mucous membranes and various organs

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38
Q

What is diffuse lymphatic tissue?

A

Lymphocytes are scattered (not clustered)
Prevalent in body passages open to the exterior
Respiratory, digestive, urinary, and reproductive tracts
Mucosa-associated lymphatic tissue (MALT)

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39
Q

What are lymphatic nodules?

A

Dense masses of lymphocytes and macrophages that congregate in response to pathogens
Constant feature of the lymph nodes, tonsils, and appendix

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40
Q

What are the types of lymphatic tissue?

A

diffuse lymphatic tissue
lymphatic nodules
peyer patches

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41
Q

What is a peyer patch?

A

dense clusters of lymphocytes in the ileum, the distal portion of the small intestine

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42
Q

How are lymphatic organs anatomically defined?

A

By the connective tissue capsule that separates the lymphatic tissue from neighbouring organs

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43
Q

Which are the primary lymphatic organs?

A

Red Bone marrow and thymus

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44
Q

What happens in the primary lymphatic organs?

A

T and B cells become immunocompetent: able to recognize and respond to antigens

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45
Q

Which are the secondary lymphatic organs?

A

Lymph nodes, tonsils and spleen

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46
Q

Where do all lymphocytes originate?

A

Red bone marrow

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47
Q

What happens in the secondary lymphatic organs?

A

Immunocompetent cells populate the tissues

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48
Q

Which organ systems does the Thymus belong to?

A

endocrine, lymphatic and immune

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49
Q

Reticular epithelial cells seal off cortex from the medulla forming which barrier?

A

Blood Thymus Barrier

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50
Q

What are the functions of the Thymus in the lymphatic system?

A

Houses developing lymphocytes
secretes hormones, regulating their activity

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51
Q

which signalling molecules does the Thymus produce?

A

interleukins
Interferon
thymosin
thymopoietin
thymulin

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52
Q

How many lymph nodes does the average young adult have?

A

450

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53
Q

What are the functions of the lymph nodes?

A

Cleanse the lymph
Act as a site of T and B cell activation.

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54
Q

What occurs in the the Germinal center?

A

B cells multiply and differentiate into plasma cells

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55
Q

Describe the anatomy of a lymph node

A

Elongated, bean-shaped structure with hilum

Enclosed with fibrous capsule with trabeculae that divide interior into compartments

Stroma of reticular fibers and reticular cells

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56
Q

What is the function of afferent lymph vessels?

A

Bring lymph into the node along its convex surface

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57
Q

How many efferent vessels are on a lymphatic node?

A

1-3

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58
Q

What is the function of efferent lymphatic vessels?

A

Lymph leaves the node through these

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59
Q

Which lymph nodes are especially concentrated within the body?

A

Cervical lymph nodes
Axillary lymph nodes
Thoracic lymph nodes
Abdominal lymph nodes
Intestinal and mesenteric lymph nodes
Inguinal lymph nodes
Popliteal lymph nodes

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60
Q

Where do you find cervical lymph nodes and what is their function?

A

in deep and superficial groups in the neck,

monitor lymph coming from the head and neck.

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61
Q

Where do you find axillary lymph nodes and what is their function?

A

in the armpit (axilla)

receive lymph from the upper limb and breast.

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62
Q

Where do you find thoracic lymph nodes and what is their function?

A

in the thoracic cavity, mediastinum,

receive lymph from the mediastinum, lungs, and airway.

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63
Q

Where do you find Abdominal lymph nodes and what is their function?

A

in the posterior abdominopelvic wall

receive lymph from the urinary and reproductive systems.

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64
Q

Where do you find Intestinal and mesenteric lymph nodes and what is their function?

A

in the mesenteries and adjacent to the appendix and intestines;

they receive lymph from the digestive tract.

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65
Q

Where do you find Inguinal lymph nodes and what is their function?

A

in the groin

receive lymph from the entire lower limb.

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66
Q

Where do you find popliteal lymph nodes and what is their function?

A

at the back of the knee

receive lymph from the leg proper.

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67
Q

What is Lymphadenitis?

A

swollen, painful node responding to foreign antigen

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68
Q

What is Lymphadenopathy?

A

collective term for all lymph node diseases

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69
Q

what is a Metastasis of cancer?

A

cancerous cells break free from original tumor, travel to other sites in the body, and establish new tumors

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70
Q

What is the typical path of metastasized cancer cells through the lymph nodes?

A

Metastasizing cells easily enter lymphatic vessels

Tend to lodge in the first lymph node they encounter

Multiply there and eventually destroy the node

Tend to spread to the next node downstream

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71
Q

What are tonsils?

A

patches of lymphatic tissue located at the entrance to the pharynx

Covered with epithelium

Have deep pits: tonsillar crypts lined with lymphatic nodules

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72
Q

What is the main function of tonsils?

A

Guard against ingested or inhaled pathogens

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73
Q

What is Tonsillitis?

A

Acute Inflammation due to Strep infection

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74
Q

What is a Tonsillectomy?

A

Surgical removal of the tonsils

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75
Q

Name the three sets of tonsils

A

Palatine tonsils
Lingual tonsils
Pharyngeal tonsils (adenoids)

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76
Q

Where are the Palatine tonsils located?

A

At posterior margin of oral cavity

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77
Q

Where are the Lingual tonsils located?

A

at root of tongue

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78
Q

Where are the Pharyngeal tonsils (adenoids) located?

A

Single tonsil on wall of nasopharynx

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79
Q

What is the largest lymphatic organ?

A

The spleen

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80
Q

What are the two types of parenchyma of the spleen?

A 
Red pulp (erythrocytes) 
White pulp (lymphocytes, macrophages)
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81
Q

What are the functions of the spleen?

A

Healthy RBCs come and go
RBC graveyard
Blood cell production in fetus
White pulp monitors blood for foreign Ags and keeps an army of monocytes for release when needed
Stabilizes blood volume through plasma transfers to lymphatic system

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82
Q

What are the two types of immune response?

A

Non-specific (innate)
Specific (immune system)

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83
Q

What are the bodies’ 3 lines of defenses against pathogens?

A

1: skin and mucous membranes
2: several nonspecific defense mechanisms

3: the immune system
(Defeats a pathogen, and leaves the body with a “memory” of it so it can defeat it faster in the future)

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84
Q

What is the function of Nonspecific defenses?

A

guard equally against a broad range of pathogens
They lack capacity to remember pathogens

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85
Q

What are the 3 kinds of nonspecific defenses?

A

Protective proteins
Protective cells
Protective processes

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86
Q

What is Specific or adaptive immunity?

A

body must develop separate immunity (memory) to each pathogen

Body adapts to a pathogen and wards it off more easily upon future exposure

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87
Q

Name the external barriers of the non-specific immune system

A

skin
acid mantle
peptides in skin
mucus membranes
lysosymes

88
Q

what is the acid mantle?

A

thin film of lactic and fatty acids from sweat and sebum that inhibits bacterial growth

89
Q

Name the peptides in the skin that kill microbes

A

Dermicidin, defensins, and cathelicidins

90
Q

Where are the mucus membranes located?

A

Digestive, respiratory, urinary, and reproductive tracts

91
Q

What are the 5 types of leukocytes?

A

Neutrophils
Eosinophils
Basophils
Monocytes
Lymphocytes

92
Q

What are phagocytes?

A

cells that engulf foreign matter

93
Q

What is the function of neutrophils?

A

Wander in connective tissue killing bacteria
Can kill using phagocytosis and digestion

94
Q

What is the function of eosinophils?

A

Found especially in mucous membranes
Guard against parasites, allergens

95
Q

What are mast cells?

A

Type of connective tissue cell very similar to basophils

96
Q

What is the function of basophils?

A

Secrete chemicals that aid mobility and action of other leukocytes

Leukotrienes
Histamine
Heparin

97
Q

What are the three categories of lymphocytes?

A

T cells, B cells, NK cells

98
Q

What is the function of Monocytes?

A

emigrate from blood in to connective tissue and transform in to macrophages.

99
Q

What are the two types of Macrophages?

A

Wandering macrophages: actively seek pathogens
Fixed macrophages: phagocytize only pathogens that come to them:

100
Q

Where do you find microglia?

A

in CNS

101
Q

Where do you find alveolar macrophages?

A

in lungs

102
Q

Where do you find hepatic microphages?

A

in liver

103
Q

What are antimicrobial proteins?

A

Proteins that inhibit microbial reproduction and provide short-term, nonspecific resistance to pathogenic bacteria and viruses

104
Q

What are the two types of antimicrobial proteins?

A

Interferons
Complement system

105
Q

What is the function of interferons?

A

Alert neighboring cells and protect them from becoming infected

Bind to surface receptors on neighboring cells
Activate 2nd-messenger systems within

The alerted cell synthesizes various proteins that defend it from infection

Also activates NK cells and macrophages

106
Q

What is the complement system?

A

a group of 30 or more globular proteins that make powerful contributions to both nonspecific resistance and adaptive immunity

107
Q

What are the four methods of pathogen destrtuction in a complement system?

A

Inflammation
Immune clearance
Phagocytosis
Cytolysis

108
Q

what are the 3 routes of complement activation?

A

Classical pathway
Alternative pathway
Lectin pathway

109
Q

Which complement pathway is antibody dependant?

A

Classical pathway

110
Q

Which complement pathways are not antibody dependant?

A

Alternative pathway
Lectin pathway

111
Q

Where do all complement pathways merge?

A

The point at which C3 is activated

112
Q

Which mechanism results from the C3a path?

A

inflammation

113
Q

Which mechanisms result from the C3b path?

A

Immune clearance
Phagocytosis
Cytolysis

114
Q

What is the membrane attack complex?

A

Complement proteins form ring in plasma membrane of target cell causing cytolysis

115
Q

How does the membrane attack complex destroy a cell?

A

The complex forms a hole in the target cell

electrolytes leak out, water flows rapidly in, and the cell ruptures.

(Cytolysis)

116
Q

Are NK cells stationary or mobile cells?

A

Mobile. they continually patrol body looking for pathogens and diseased host cells

117
Q

How do NK cells kill pathogenic cells?

A

Recognize enemy cell and bind to it

Release proteins called perforins

Secrete a group of protein-degrading enzymes—granzymes

Enter through pore and degrade cellular enzymes and induce apoptosis (programmed cell death)

118
Q

What are antipyretics?

A

fever-reducing medications (aspirin)

119
Q

How does fever aid the adaptive immune response?

A

Promotes interferon activity

Elevates metabolic rate and accelerates tissue repair

Inhibits reproduction of bacteria and viruses

120
Q

What are the stages of fever?

A

onset
stadium
effervescence

121
Q

what is apoptosis?

A

programmed cell death

122
Q

What is inflammation?

A

local defense response to a tissue injury caused by trauma or infection

123
Q

What is the function of inflammation?

A

Limits spread of pathogens, then destroys them

Removes debris from damaged tissue

Initiates tissue repair

124
Q

What are the 4 signs of inflammation?

A

redness
swelling
heat
pain

125
Q

Name the 5 steps of an inflammatory reaction

A
  1. release of inflammatory chemicals
  2. margination
  3. diapedesis
  4. chemotaxis
  5. phagocytosis
126
Q

Which inflammatory chemical is released in an inflammatory reaction?

A

Histamine

127
Q

What are the three sources of inflammatory chemicals?

A

Basophils
mast cells
blood plasma

128
Q

What is leukocyte margination?

A

adhesion of a leukocyte to the capillary wall

129
Q

What is diapedesis?

A

Process of a leukocyte crawling through the wall of a capillary

130
Q

What is chemotaxis?

A

movement of a leukocyte towards inflammatory chemicals

131
Q

What are the two distinguishing characteristics of the adaptive immune system?

A

Specificity
Memory

132
Q

What do we mean by specificity in the immune system?

A

immunity directed against a particular pathogen

133
Q

What do we mean by memory in the immune system?

A

when re-exposed to the same pathogen, the body reacts so quickly there is no noticeable illness

134
Q

What are the two types of adaptive immunity?

A

Cellular, cell mediated
Humoral, antibody mediated

135
Q

How does cellular immunity work?

A

Lymphocytes directly attack and destroy foreign cells or diseased host cells

Rids the body of pathogens

Kills cells that harbor them

136
Q

How does Humoral immunity work?

A

Mediated by antibodies (Abs) that tag pathogens for destruction

Many Abs are dissolved in body fluids (“humors”)

Can only work against the extracellular stages of infections by microorganisms

137
Q

What is Natural active immunity?

A

Production of one’s own Abs or T cells as a result of infection or natural exposure to antigen (Ag)

138
Q

What is Artificial active immunity?

A

Production of one’s own Abs or T cells as a result of vaccination against disease

139
Q

What is Natural passive immunity ?

A

Temporary immunity that results from Abs produced by another person (Fetus acquires Abs from mother through placenta, milk)

140
Q

What is Artificial passive immunity?

A

Temporary immunity that results from the injection of immune serum (Abs) from another person or animal
Treatment for snakebite, botulism, rabies, tetanus, and other diseases

141
Q

What is an antigen?

A

any molecule that triggers an immune response

142
Q

What are epitopes?

A

certain regions of an Ag-molecule that stimulate immune responses

143
Q

What are haptens?

A

Are too small to be an antigen, but can trigger an immune response by combining with a host macromolecule and creating a complex that the body recognizes as foreign

144
Q

Name the major cells of the immune system

A

Lymphocytes
macrophages
dendritic cells

145
Q

Which cells within the thymus stimulate maturation of a T Lymphocyte?

A

Reticular epithelial cells (RE)

146
Q

What do T lymphocytes have to develop to be considered mature?

A

surface Ag receptors (TCRs)

147
Q

once a T lymphocyte is mature, what does it become?

A

immunocompetent

148
Q

T-cells that fail the self antigen test are eliminated by what type of selection?

A

Negative selection

149
Q

How can a T cell fail the self antigen test?

A

Failure to recognize the self antigen
reacting to the self antigen

150
Q

What are the removal processes of negative selection?

A

Clonal deletion
Anergy

151
Q

What happens to T-cells that survive negative selection in the thymus?

A

They undergo positive selection

152
Q

What is the naive lymphocyte pool

A

immunocompetent T cells that have not yet encountered foreign antigens

153
Q

What is lymphocyte deployment ?

A

Naive T cells leave thymus and colonize lymphatic tissues and organs everywhere in the body

154
Q

Where do B Cells mature?

A

bone marrow

155
Q

What are the processes of elimination for B-cells that react to self antigens?

A

anergy
clonal deletion

156
Q

What is the function of self tolerant B cells?

A

synthesize antigen surface receptors (BCRs)
divide rapidly
produce immunocompetent clones

157
Q

Which cells function as Antigen Presenting Cells?

A

Dendritic cells
macrophages
reticular cells
B cells function

158
Q

Function of an APC depends on which protein?

A

major histocompatibility (MHC) complex proteins

159
Q

What are the 6 steps of Antigen processing and presenting?

A
  1. Phagocytosis of antigen
  2. Lysosome fuses with phagosome
  3. Antigen and enzyme mix in phagolysosome
  4. Antigen is degraded
  5. Exocytosis
  6. Epitope displayed
160
Q

What are the four types of T-cells?

A

Cytotoxic
Helper
Regulatory
Memory

161
Q

What is the function of Tc (Cytotoxic T-cells)

A

Effectors, carry out the attack on pathogens

162
Q

What is the function of TH (Helper T-cells)

A

Promote T and B cell action/ non specific resistance

163
Q

What is the function of TR (Regulatory T-cells)

A

inhibit multiplication and cytokine secretion by other T cells. Limit immune response

164
Q

What is the function of Tm (Memory T-cells)

A

Responsible for memory in cellular immunity

165
Q

What are the three R’s of Cellular and Humoral immunity?

A

Recognize
React
Remember

166
Q

what are the steps of antigen recognition in cellular immunity?

A

APC encounters and processes an Ag

Migrates to nearest lymph node

Displays it to the T cells

When T cells encounter displayed antigen on the MHC protein, and initiate the immune response

167
Q

What are the two classes of MHC proteins?

A

MHC I
MHC II

168
Q

Where are MHC I proteins found?

A

on all nucleated cells

169
Q

Where are MHC II proteins found?

A

only on APC’s and displayed on foreign antigens

170
Q

Which T-cells react to MHC I?

A

Tc (cytotoxic) cells

171
Q

Which T-cells react to MHC II?

A

TH (helper) cells

172
Q

What is happening at number 1?

A

Antigen recognition

173
Q

What is happening at number 2?

A

Costimulation

174
Q

What is happening at point 3?

A

clonal selection

175
Q

What is happening at point 4 for the MHC I protein path?

A

T-Cells attack

176
Q

What is happening at point 4 for the MHC II path?

A

Interleukin secretion

177
Q

What is the result of the MHC I path shown in the green box?

A

Destruction of the enemy cell

178
Q

What is the result of the MHC II protein path as shown in the pink box?

A

Activation of NK T or B cells

Inflammation and other non specific defenses

Development of memory T cells

179
Q

which types of immunity do TH (Helper T cells) activate?

A

Non-specific

Humoral

Cellular

(All)

180
Q

How do TC (Cytotoxic )cells kill foeriegn cells?

A

Same as NK cells

Docks to HC I protein

secretes perforin and granzymes into cell

Apoptisis occurs

181
Q

What is the function of interferons?

A

inhibit viral replication

Recruit and activate macrophages

182
Q

What is the function of Tumor Necrosis factor?

A

aids in macrophage activation and kills cancer cells

183
Q

What is the functional difference between the Cellular and Humoral immune responses?

A

Humoral uses B cells to tag foreign cells for destruction by T cells, Cellular immunity attacks the cells directly

184
Q

What is happening at point 1

A

Antigen recognition

185
Q

What is happening at point 2

A

Antigen presentation

186
Q

What is happening at point 3

A

Clonal selection

187
Q

What is happning at point 4?

A

Differentiation

188
Q

What is happening at point 5?

A

Attack

189
Q

What is the structure labelled A?

A

Disulfide bonds

190
Q

What is the structure labelled B?

A

Antigen binding site

191
Q

What is the structure labelled C?

A

Light chain

192
Q

What is the structure labelled D?

A

hinge region

193
Q

What is the structure labelled E?

A

Complement binding site

194
Q

What is the structure labelled F?

A

Heavy chain

195
Q

What is the structure labelled G?

A

Constant regions

196
Q

What is the structure labelled H?

A

Variable regions

197
Q

What are the five classes of antibodies?

A

IgA

IgD

IgE

IgG

IgM

198
Q

What are the two mechnisms by which the variety of proteins are accomplished?

A

Somatic recombination

Somatic hypermutation

199
Q

What are the Antibodies 4 mechanisms of attack againts Ags?

A

Neutralization

Complement fixation

Agglutination

Precipitation

200
Q

What are the two types of adaptive immune response?

A

Primary immune response

Secondary immune response

201
Q

When does the primary immune response occur?

A

On first exposure to a pathogen

202
Q

when does the secondary immune response occur?

A

when re-exposed to the same antigen

203
Q

What are the characteristics of a primary Immune response?

A

Takes 3-5 days for antibodies to activate

IgM appears first and peaks after 10 days

IgG comes after

Leaves immune system with memory of the Ag

204
Q

What are the characteristics of a Secondary immune response?

A

Plasma Abs form within hours not days

IgG rises sharply and peaks in a few days

Lower levels of IgM secreted and quickly decline

No illness occurs

205
Q

What type of response does this graph show?

A

Primary response

206
Q

What type of response does the graph show?

A

Secondary response

207
Q

What is hypersensitivity?

A

an excessive immune reaction against Ags that most people tolerate

208
Q

What is type 1 hypersensitivity?

A

Food allergies and Asthma

209
Q

What is type II Hypersensitivity?

A

Blood transfusion reaction and Drugs

210
Q

What is type III Hypersensitivity?

A

Autoimmune diseases

211
Q

What is type IV sensitivity?

A

TB skin test reaction and Type I Diabetes mellitus

212
Q

What is anaphylaxis?

A

–Immediate, severe type I immune reaction

213
Q

What is an autoimmune disease?

A

failure of immune system to distinguish self-antigens from foreign ones. (Self tolerance)

214
Q

What are the reasons for failure of self-tolerance?

A

–Cross-reactivity

–Abnormal exposure of self-Ags in the blood

–Changes in structure of self-Ags

–Not all are eliminated in thymus and are normally kept in check by regulatory T (TR) cells

215
Q

What is an immunodeficiency Disease?

A

Immune system fails to react vigorously enough

216
Q

What is the most common immunodeficiency Disease?

A

Severe Combined Immunodeficiency Disease (SCID)

217
Q

What is Acquired immunodeficiency syndrome (AIDS)

A

– Nonhereditary disease

– severely depresses the immune response

–caused by infection with the human immunodeficiency virus (HIV)

–Invades helper T cells, macrophages, and dendritic cells

  • strikes at the central coordinating agent of nonspecific defense, humoral immunity, and cellular immunity
  • Incubation period several months to 12-15 years

Bio 151 (12 decks)

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