Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pre Reg > GI > Flashcards

GI Flashcards

1
Q

What is the treatment for diverticular disease?

A

Bulk-forming laxatives if fibre diet not suitable or patients with persistent diarrhoea or constipation

Simple analgesia

Antispasmodics if abdominal cramping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the symptoms of diverticular disease?

A

Abdominal tenderness and/or
Intermittent lower abdominal pain
Constipation
Diarrhoea
Occasional large rectal bleeds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which drugs should you avoid if you have diverticular disease?

A

NSAIDs and opioids as this may increase risk of diverticular perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the treatment of H.pylori in patient who DO NOT have a penicillin allergy?

A

1st line for 7 days: (APC)
PPI + amoxicillin + clarithromycin/metronidazole

(Lansoprazole 30mg capsules B.D, Amoxicillin 1g capsules twice daily and Clarithromycin 500mg tablets twice daily)

2rd line for 7 days:
PPI + amoxicillin + tetracycline/levofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the treatment of H.pylori in patients who HAVE a penicillin allergy?

A

1st line for 7 days:
PPI + clarithromycin + metronidazole
or
PPI + bismuth + metronidazole + tetracycline

2nd line for 7 days:
PPI + metronidazole + levofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of crohns disease?

A

Abdominal pain
Diarrhoea
Fever
Weight loss
Rectal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the monotherapy treatment for acute Crohn’s disease?

A

Induce remission in first presentation or single inflammatory exacerbation in 12-month periods
- corticosteroid (prednisolone or methylprednisolone or iv hydrocortisone)

Patients with distal ileal, ileocaecal or right-sided colonic disease, consider:
- budesonide (less effective but causes less side effects)
- alternative: aminosalicylates (sulfasalazine and mesalazine)

Budesonide and aminosalicylates NOT suitable in severe presentations or exacerbations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is add-on treatment considered for acute Crohn’s disease?

A

If there are TWO or more exacerbations in 12 month period or the corticosteroid dose cannot be reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the add-on treatment for acute Crohn’s disease?

A

Azathioprine or mercaptopurine (unlicensed) - added to corticosteroids or budesonide to induce remission

In those who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity deficient
- methotrexate can be added to corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment for severe active Crohn’s disease who have not tolerated conventional therapies?

A

Adalimumab and infliximab following inadequate response to conventional treatments

Unsuccessful - Vedolizumab or Ustekinumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you maintain remission in Crohn’s disease?

A

Azathioprine or Mercaptopurine - can be used as monotherapy to maintain remission when previously needed to induce remission with a corticosteroid
- may also be used in patients who have not previously used drugs

Methotrexate can ONLY be used in patients who required it to induce remission

Corticosteroids and budesonide should not be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you maintain remission of Crohn’s disease after surgery?

A

Azathioprine in combination with up to 3 months’ post-op metronidazole should be considered in patients with ileocolonic Crohn’s disease who have had complete macroscopic resection within previous 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you manage diarrhoea associated with Crohn’s disease?

A

Diarrhoea associated with Crohn’s disease but do NOT have colitis
Loperamide
Codeine phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is severity of ulcerative colitis determined?

A

Truelove and Witt’s Severity Index

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why are loperamide and codeine contraindicated in diarrhoea in acute ulcerative colitis?

A

Increase the risk of toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What kind of laxative is recommended in proximal faecal loading in proctitis (inflammation of rectum) in ulcerative colitis?

A

Macrogol-containing osmotic laxative
e.g. 3350 with potassium chloride, sodium bicarbonate and sodium chloride
e.g. Laxido and Movicol and Cosmocol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you treat acute mild-moderate ulcerative colitis proctitis?

A

1st line: topical aminosalicylate

If remission not achieved after 4 weeks:
- add oral aminosalicylate

If response still inadequate:
- add topical or oral corticosteroid for 4-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you treat acute mild-moderate ulcerative colitis proctosigmoiditis and left-sided ulcerative colitis?

A

1st line: topical aminosalicylate

Remission not achieved within 4 weeks:
- add high dose oral aminosalicylate OR
- switch to a high-dose oral aminosalicylate and 4-8 weeks of a topical aminosalicylate

If response still inadequate:
- stop topical aminosalicylate
- offer oral aminosalicylate + 4-8 weeks of oral corticosteroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you treat extensive ulcerative colitis?

A

1st line: topical aminosalicylate and high-dose oral aminosalicylate

If remission not achieved within 4 weeks:
- stop topical aminosalicylate
- offer high dose oral aminosalicylate and 4-8 weeks of oral corticosteroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you treat acute severe ulcerative colitis?

A

Regarded as medical emergency
1st line:
- IV corticosteroid (hydrocortisone or methylprednisolone) given to induce remission
if contraindicated or not tolerated:
- IV ciclosporin or surgery

2nd line: when little or no improvement in 72 hours
- IV ciclosporin + IV corticosteroid
or surgery

If ciclosporin contraindicated/ clinically inapparopate - use infliximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do you maintain remission in ulcerative colitis?

A

After mild-moderate exacerbation of proctitis or proctosigmoiditis:
- rectal aminosalicylate alone OR in combination with oral aminosalicylate daily or as part of intermittent regimen (twice/three weekly or first 7 days of each month)
- oral aminosalicylate can be used alone also but not as effective

left-sided or extensive ulcerative colitis:
- low-dose oral aminosalicylate (single daily doses more effective than multiple daily doses but may experience more side effects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When would you consider azathioprine or mercatopurine in remission maintenance therapy?

A

Azathioprine or mercaptopurine can be considered to maintain remission if there has been two or more inflammatory exacerbations in 12 month period that required treatment with systemic corticosteroid, if remission not maintained by aminosalicylate or following a single acute sevre epsidoes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some common side effects of sulfasalazine?

A

Insomnia
Stomatitis
Taste altered
Tinnitus
Urine abnormalities

Blood disorders: haematological abnormalities usually occur within first 3-6 months of treatment - discontinue if occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some common side effects of budesonide?

A

Dry mouth
Muscle complaints
Oedema
Oral disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the symptoms of IBS?

A

Abdominal pain or discomfort
Disordered defaecation (either diarrhoea or constipation with straining, urgency and incomplete evacuation)
Passage of mucus
Bloating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the dietary advise for IBS?

A
  • limit fresh fruit consumption to 3 portions a day
  • if increased fibre intake required: soluble fibre e.g. ispaghula husk (fybogel) or foods such as oats are recommended
  • intake on insoluble fibre should be discouraged e.g. bran and ‘resistant-starch’
  • fluid intake should be increased to at least 8 glasses
  • intake of caffeine, alcohol and fizzy drinks should be limited
  • artificial sweetener sorbitol should be avoided in patients with diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the treatment options for IBS?

A

Antispasmodics (alverine, mebeverine and peppermint oil) with lifestyle changes
- 2nd line: low-dose TCA e.g. amitriptyline (if antispasmodics, anti-motility drugs or laxatives do not work)
- 3rd line: SSRI

Constipation: laxative
- if do not response to laxative from different classes and had constipation for at least 12 months: treat with linaclotide

Diarrhoea: loperamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Why should lactulose be avoided in IBS?

A

Can cause bloating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is a common electrolyte imbalance in short bowel syndrome?

A

Deficiency of magnesium
- oral or IV magnesium (oral may cause diarrhoea)

Intestinal motility
- loperamide or codeine (loperamide preferred)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How do you treat intestinal motility in short bowel synrome?

A

loperamide or codeine (loperamide preferred)

High doses of loperamide in patients:
- with short bowel due to disrupted enterohepatic circulation
- with rapid gastrointestinal transit time

Occasionally used:
- Co-phenotrope to help decrease faecal output but crosses BBB = CNS side effects (=limited use)
–> also has potential for dependence and anticholinergic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When is colestyramine used in short bowel syndrome?

A

In patient with intact colon and less than 100cm of ileum resected
- used to bind unabsorbed bile salts and reduce diarrhoea

Important to monitor evidence of fat malabsorption or fat-solube vitamin deficiencies if used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Give examples of drugs that need to be prescribed in higher doses in short bowel syndrome?

A

Some drugs are incompletely absorbed in patients with short bowel syndrome = need higher doses or given IV
e.g.
- levothryoxine
- warfarin
- oral contraceptives
- digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What type of formulations in unsuitable in patients with short-bowel syndrome?

A

Enteric coated
MR
= may not be sufficient release of active drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a consequence of laxative abuse?

A

Hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When are bulk-forming laxatives used?

A

When adults have small hard stools if fibre cannot be increased in diet

Adequate fluid intake must be maintained to avoid intestinal obstruction

e.g. ispaghula husk
Methylcellulose (also used as faecal softener)
sterculia (6 years +)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the onset of action of bulk-forming laxatives?

A

72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What symptoms do bulk-forming laxatives exacerbate?

A

Flatulence
Bloating
Cramping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When should stimulant laxatives be avoided?

A

Intestinal obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are examples of stimulant laxatives?

A

Bisacodyl
Sodium picosulfate
Co-danthramer
Co-danthrusate

Limited use of co-danthramer co-danthrusate in patients terminally ill because of potential carcinogenicity

Sodium docusate acts as stimulant and softener

Glycerol acts as lubricant and stimulant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are examples of osmotic laxatives?

A

Lactulose
Macrogols e.g. 3350 with potassium chloride, sodium bicarbonate and sodium chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is licensed for iBS associated constipation?

A

Linaclotide (if have tried 2 laxatives and have been constipated for at least 12 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is used for chronic constipation when other laxatives have failed?

A

Prucalopride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the management for short-duration constipation?

A

1st line: bulk-forming laxatives + fluids
2nd line: add or switch to osmotic
3rd line: if stools soft but difficult to pass or inadequate emptying ADD stimulant laxative

44
Q

How do you treat opioid-induced constipation?

A

1st line: osmotic laxative (or sodium docusate) + stimulant laxative

If no response:
- naloxegol recommended

45
Q

Which laxatives should you avoid in opioid-induced constipation?

A

Bulk-forming laxatives

46
Q

How do you treat hard stools in faecal impaction?

A

High-dose oral macrogol

47
Q

How do you treat soft or hard stools stools in faecal impaction after trying macrogols?

A

After a few days, start or add stimulant

If response to oral laxatives inadequate
- for soft stools rectal bisacodyl
- for hard stools glycerol alone or glycerol + bisacodyl OR enema of docusate sodium or sodium citrate may be used

48
Q

How do you treat chronic constipation?

A

1st line: bulk-forming laxative
2nd line: add or change to osmotic laxative (if macrogols ineffective, use lactulose)
3rd line: adjust dose to produce one or two soft stools per day
4th line: if 2 laxatives of different classes tried for 6 months and not adequate = treat with prucalopride (in women only)

49
Q

How do you treat constipation in pregnancy and breast-feeding?

A

1st line: fibre supplements in form of bran or wheat
2nd line: bulk-forming laxatives
3rd line: osmotic laxative - lactulose

50
Q

Can you use senna in pregnancy?

A

Bisacodyl and senna may be suitable if a stimulant effect is necessary but use of senna should be avoided near term or if there is a history of unstable pregnancy

51
Q

How do you treat constipation in children?

A

If no foecal impactation:
1st line: macrogol + dietary changes
2nd line: add or change to stimulant laxative
3rd line: add softening effects laxative e.g. docusate sodium or lactulose

52
Q

How do you treat faecal impaction in children?

A

1st line: macrogol - to establish and maintain soft well-formed stools
2nd line: add stimulant
3rd line: stimulant + osmotic laxative (e.g. lactulose)

53
Q

What are the red flag symptoms of diarrhoea?

A

Unexplained weight loss
Rectal bleeding
Persistent diarrhoea
Systemic illness
Recent hospital or antibiotic treatment
Following foreign travel (other than Western Europe, North America, Australia or New Zealand

54
Q

How do you treat acute diarrhoea?

A

Oral rehydration therapy
- disodium hydrogen citrate with glucose
- potassium chloride and sodium chloride
- potassium chloride with rice powder
- sodium chloride and sodium citrate

55
Q

What is first line for faecal incontinence?

A

Loperamide once underlying cause established

56
Q

What is the MHRA warning for loperamide?

A

Reports of serious cardiac adverse reactions (e.g. QT prolongation, torsades de pointes and cardiac arrest) with high doses of loperamide associated with abuse or misuse

57
Q

What are the three main groups of digestive enzymes pancreatin contains?

A

Lipase, amylase, and protease

58
Q

What is the treatment for exocrine pancreatic insufficiency?

A

Pancreatin - with meals and snacks

59
Q

What can be given in conjunction with adequate nutritional intake in patients with food allergies?

A

Sodium cromoglicate

Peanut allergy - peanut protein in peanut allergy in childhood

60
Q

What drug is licensed for symptomatic control of food allergy?

A

Chlorphenamine maleate

61
Q

What is used first line for food allergies?

A

Adrenaline/ epinephrine

62
Q

Which drugs can cause dyspepsia?

A

Alpha blockers
Antimuscarinic
Aspirin
Benzodiazepines
BB
Bisphosphonates
CCB
Corticosteroids
Nitrates
NSAIDs
Theophyllines
TCAs

63
Q

What is the initial management of uninvestigated dyspepsia and functional dyspepsia?

A

PPI for 4 weeks

64
Q

What should always be tested for before initiating medication of dyspepsia?

A

H.pylori

65
Q

What is the follow-up management of uninvestigated and functional dyspepsia?

A

Symptoms persistent or recur:
- PPI or Histamine H2-receptor antagonists at lowest dose needed, can be used on an ‘as needed’ basis

If on NSAID
- reduce dose if unable to stop drug
- use long-term gastro-protection with acid suppression therapy or switching NSAID to alternative

66
Q

What drugs can induce peptic ulceration?

A

NSAIDs
Aspirin
Bisphosphonates
Immunosuppressive agents (e.g. corticosteroids)
Potassium chloride
SSRIs
Recreational drugs e.g. crack cocaine

67
Q

How do you treat a peptic ulcer associated with an NSAID?

A

PPI or Histamine H2-receptor antagonists for 8 weeks

Followed by H.pylori infection eradication if patient has tested positive

68
Q

How do you treat a peptic ulcer not associated with NSAID or H.pylori?

A

PPI or Histamine H2-receptor antagonists for 4-8 weeks

69
Q

What is the MHRA warning for PPIs?

A

Low risk of subacute cutaneous lupus erythematosus (SCLE)

70
Q

Which vitamin can PPIs reduce?

A

Reduced absorption of B12

71
Q

Why do you need to be cautious of using PPIs in elderly patients?

A

Risk of osteoporosis - maintain adequate intake of calcium and vitamin d

72
Q

What is the initial treatment of GORD?

A

Patients with uninvestigated symptoms which suggest GORD should be managed as uninvestigated dyspepsia

Confirmed GORD:
- 1st line: PPI for 4-8 weeks
- 2nd line: Histamine H2-receptor antagonists

Severe oesopahitis:
- PPI for 8 weeks

73
Q

What drugs cause or exacerbate the symptoms of GORD?

A

Alpha blockers
Anticholinergics
Benzodiazepines
BB
Bisphonates
CCB
Corticosteroids
NSAIDs
Nitrates
Theophyllines
TCAs

74
Q

What is the follow-up management of GORD?

A

Option 1:
- additional 1 month course of PPI

Option 2:
- double initial PPI dose for 1 month

Option 3:
- addition of Histamine H2-receptor antagonists at bedtime for nocturnal symptoms or short-term use

75
Q

What should be given for GORD in pregnancy?

A

Antacid or alginate

Severe symptoms:
- omeprazole or ranitidine

76
Q

What is the treatment for cholestatic pruritus?

A

Colestyramine

Alternative: rifampicin (caution in patients with pre-existing liver disease due to risk of hepatotoxicity

Ursodeoxycholic acid - small but valuable impact of cholestatic pruritus

77
Q

How do you treat intrahepatic cholestasis in pregnancy?

A

(usually occurs in late pregnancy)

Ursodeoxycholic acid

78
Q

How do you treat gallstone pain?

A

Mild-moderate:
- paracetamol or NSAID

Severe:
- IM diclofenac sodium OR
- IM opioid e.g. morphine or pethidine

79
Q

When should waist-to-height ratio be measured?

A

BMI below 35kg/m2

80
Q

When might Orlistat be considered?

A

Individuals with BMI of equal to or >30kg/m2 in whom diet, exercise and behavioural changes fail

81
Q

Who might bariatric surgery be considered for?

A

Patients with BMI equal to or >40kg/m2 or between 35-39.9kg/m2 and a significant disease can be improved with weight loss and if all appropriate non-surgical measures have been tried

May be considered for patients with bMI of 30-34.9 who have recent-onset T2DM

82
Q

What is the treatment for acute anal fissure (present for less than 6 weeks)?

A

Focus on ensuring soft and easily passed stools:
- Bulk-forming laxative (ispaghuka husk)
- alternative: osmotic laxative (lactulose)

Short-term use of topical preparation containing local anaesthetic
- e.g. lidocaine
OR simple analgesic e.g. ibuprofen or paracetamol

83
Q

How do you treat chronic anal fissures (present for longer than 6 weeks)?

A

Glyceryl trinitrate rectal ointment 0.4% or 0.2% (associated with headache as adverse effect)

Alternative: topical diltiazem or nifedipine 0.2-0.5% which have lower incidence of adverse drug reactions than glyceryl trinitrate

Oral diltiazem or nifedipine may be as effective but are associated with higher risk of adverse effects

84
Q

How do you treat haemorrhoids?

A

Constipation reported - bulk-forming laxatives

Pain relief: simple analgesic (avoid NSAIDs if rectal bleeding)

Topical preparations containing local aesthetic only for a few days

Topical corticosteroids - maximum of 7 days treatment after exclusion of infection

84
Q

How do you treat haemorrhoids in pregnancy?

A

Bulk-forming laxatives - everything else is unlicensed

84
Q

What type of drug formulations are unsuitable in patients with a stoma?

A

Enteric-coated
MR

85
Q

What is the contraindication of azathioprine?

A

Absent thiopurine methyltransferase (TPMT) activity; very low thiopurine methyltransferase (TPMT) activity - risk of myelosuppression is increased

86
Q

Which laxative can be used in hepatic encephalopathy?

A

Lactulose

87
Q

Which drug colours urine yelow/orange?

A

sulfasalazine

88
Q

What are the contraindications of loperamide?

A

Active ulcerative colitis
Antibiotic-associated colitis

89
Q

How should cholestyramine be taken>

A

Cholestyramine should be taken at least 1 hour before, or 4–6 hours after other medications.

90
Q

How long does lactulose take to work?

A

Up to 48 hours

91
Q

What are the electrolyte imbalances of PPIs?

A

Hyponatraemia
Hypomagnesiaemia

92
Q

What is misoprostol used for, how do you take it and what are the adverse effects?

A

Used for peptic ulcers, including enzyme-induced peptic ulcer

400 mcgs twice daily with breakfast and at bedtime

Uterine contractions
Diarrhoea may occasionally be severe and require withdrawal, reduced by giving single doses not exceeding 200mcgs and by avoiding magnesium-containing antacids.

93
Q

What are the adverse effects of H2 receptor antagonists

A

Constipation, diarrhoea, dizziness, fatigue, headache, myalgia, skin
reactions

Erectile dysfunction, gynaecomastia (especially cimetidine), hallucination, hepatic disorders, tachycardia

94
Q

How should lansoprazole be taken?

A

30 minutes before food
Do not take indigestion remedies two hours before or after dose

Orodispersible - place on tongue and suck

95
Q

What are the adverse effects of aminosalicylates?

A

Blood dyscrasias- report unexplained bleeding, bruising, sore throat, fever and malaise
Nephrotoxicity
Salicylate hypersensitivity
Yellow/orange bodily fluids with sulfasalazine- soft contact lenses may be stained

96
Q

What colour does senna turn urine?

A

Yellow/brown

97
Q

How do you take stimulant laxatives?

A

At night to open bowel in the morning

Onset of action: 6-12 hours

Moisten suppositories with water before use

98
Q

What is the urgent referral for dyspepsa?

A

ALARM

Anaemia (sign of GI bleed)
Loss of weight (sign of malignancy)
Anorexia
Recurrent/recent changes, unresponsive to treatment, new in over 55 years old
Malaena (blood in stool), dysphagia, haematemesis, recurrent vomiting

99
Q

What is the antidote for loperamide?

A

Naloxone
Loperamide has a longer duration of action than naloxone so treatment with naloxone may need to be repeated
Monitor for at least 48 hours to look out for signs of CNS depression

100
Q

What colour can co-danthramer make urine?

A

Red

101
Q

How is H.pylori tested for?

A

Carbon urea breath test

102
Q

Which NSAID has the highest association of GI side effects?

A

Piroxicam - also long acting

103
Q

What are patients with coeliac disease at risk of?

A

Malabsorption of calcium and vitaminD
Osteoporosis

104
Q

What is the initial treatment for coeliac disease when waiting for specialist advise?

A

Prednisolone

Pre Reg (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions