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S3 - Pathophysiology > Hematologic Pathologies > Flashcards

Hematologic Pathologies Flashcards

1
Q

PART 1

A

PART 1

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2
Q
  • One of the bigger issues as we age, is that there is a progressive decrease in the percentage of the _________ space occupied by hematopoietic (blood-forming) tissue.
  • What are the implications of this?
A
  • marrow

- As we age, we are at higher risk for anemia and reduced number of WBCs.

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3
Q
  • As we age there is a decrease in _______ serum iron, total iron-_____ capacity, and intestinal iron ____________.
  • What are the implications of this?
A
  • total, binding, absorption

- As these abilities decline, the ability to synthesize RBCs declines. Anemia.

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4
Q
  • As we age there is a rise in _______ and increased platelet adhesiveness, as well as an increase in red cell ___________.
  • What are the implications of this?
A
  • fibrinogen, rigidity

- Increased clot formation risk. Strokes.

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5
Q

Do hemoglobin and hematocrit levels decrease as we age?

A

Yes, however, the levels remain within the normal adult range.

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6
Q

Collectively, the changes caused by age contribute to _____perfusion and/or aggravation of various circulatory disorders including: ______tension, _________, diabetes and __________ changes.

A
  • hypoperfusion

- hypertension, stroke, cognitive changes

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7
Q

Is blood transfusion an organ transplant?

A

-YES

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8
Q

Blood transfusion involves inserting _________ proteins into an individual (risk of eliciting an _________ reaction).

A
  • foreign

- adverse

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9
Q

What is the most common blood transfusion related pathology?

A

Febrile, non-hemolytic transfusion reaction

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10
Q

Febrile, non-hemolytic transfusion reaction is an _______ reaction against the transfused RBCs and occurs in __% to __% of erythrocyte transfusions and __% of platelet transfusions.

A
  • immune
  • .5% to 1%
  • 30%
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11
Q
  • Febrile, non-hemolytic transfusion reaction is characterized by an increase in ____________ by more than 1°F during or soon after the transfusion.
  • Is this reaction hemolytic? What does this mean?
A
  • temperature

- No, this means the RBCs survive and are not ruptured.

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12
Q

What is the treatment for a febrile, non-hemolytic transfusion reaction?

A
  • stopping the transfusion

- administering antipyretics or corticosteroids (reduce temp)

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13
Q

What are the S/S of febrile, non-hemolytic reactions?

A
  • fever, chills
  • headache
  • nausea, vomiting
  • hypertension
  • tachycardia
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14
Q

What is an acute hemolytic transfusion reaction?

A

quick acting RBC rupturing

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15
Q

Acute hemolytic transfusion reaction is due to an ABO ______________ between donor and recipient. In this erythrocytes are destroyed intravascularly with resultant red plasma and red urine (___________).

A
  • incompatibility

- hemituria

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16
Q

What is the mortality rate of an acute hemolytic transfusion reaction?

A

-17-60%

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17
Q

Why can an acute hemolytic transfusion reaction result in renal failure?

A

Antigen/antibody reaction forms clumps that can get caught at kidney.

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18
Q

What are the S/S of acute hemolytic transfusion reactions?

A
  • fever, chills
  • nausea, vomiting
  • flank and abdominal pain
  • headache
  • dyspnea
  • hypotension
  • tachycardia
  • red urine (hematuria)
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19
Q

PART 2

A

PART 2

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20
Q
  • What is erythropoiesis?

- Where does erythropoiesis occur and how many are produced/sec?

A
  • The production of RBCs

- Occurs in the marrow of long bones and produced at a rate of 2.4m/sec (200b/24hrs)

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21
Q

RBC destruction occurs in the ____________ and involves the recovery of _____ and production of ________.

A
  • macrophages
  • iron
  • bilirubin
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22
Q

RBC production = RBC ________

A

destruction

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23
Q

What is the most common blood condition in the U.S. and what is it?

A

Anemia- A condition that develops when one’s blood lacks enough healthy functional RBCs or hemoglobin.

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24
Q

What populations are at increased risk for anemia?

A
  • Women (blood (Fe++) loss during menstruation)
  • People with chronic diseases
  • Older adults (poor diet, comorbidities)
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25
Q
  • The diagnostic criteria for anemia for males is a Hb of what?
  • The diagnostic criteria for anemia for females is a Hb of what?
A
  • 14g/100ml, 42%

- 12g/100ml, 35%

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26
Q

Is anemia a disease?

A

No, but rather a symptom of another disorder.

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27
Q

Causes of Anemia Include:

  • Blood loss (acute or chronic)
  • Decreased or faulty red blood cell ____________
  • Excessive _________ of RBCs
  • _______ deficiency (Vitamin B12)
  • Congenital defects of hemoglobin (sickle cell disease)
  • Exposure to industrial poisons (CCl4)
  • Diseases of the bone _____________
  • Chronic inflammation, infection or neoplastic disease
A
  • production
  • destruction
  • dietary
  • marrow
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28
Q

Causes of Anemia Resulting from Excessive Blood Loss:

  • _________, _______
  • Peptic and duodenal ulcers
  • Gastritis
  • ___ cancers
  • Hemorrhoids
  • Ulcerative colitis
  • Colon polyps
  • Parasitic worms (pediatric patients)
A
  • NSAIDS, Aspirin

- GI

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29
Q

How do NSAIDS/Aspirin cause anemia?

A

Damage to the wall of the stomach, leading to blood loss.

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30
Q

Causes of Anemia Resulting from an Increased Destruction of RBCs:

  • ___________ damage (damage by a mechanical heart valves)
  • Autoimmune hemolytic anemia (AIHA)
  • Parasites (e.g., malaria)
  • ____________ (an overactive spleen, spleen degrades RBCs)
  • _________________
A
  • mechanical
  • hyperspleenism
  • thalassemias
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31
Q

Thalassemia is a _________ disorder in which the body makes an abnormal form of _________ resulting in abnormal RBCs. These RBCs are quickly removed, which results in excessive _________ of RBCs.

A
  • genetic
  • hemoglobin
  • destruction
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32
Q

Causes of Anemia Resulting from a Decreased Production of RBCs:

  • __________ deficiency (e.g., iron, vitamin B12, alcohol abuse, folic acid deficiency
  • Cytotoxic or antineoplastic drugs
  • Decreased _____ ________ stimulation (e.g., -hypothyroidism, decreased erythropoietin production)
  • Bone marrow _________ (e.g., leukemia, aplasia)
  • ____________ syndromes
A
  • nutritional
  • bone marrow
  • failure
  • myelodysplastic
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33
Q
  • Anemias can result from a lack of __________ or loss of responsiveness to ______________.
  • It may occur secondary to _________ diseases including RA, TB, cancer.
A
  • erythropoietin (EPO), erythropoietin (EPO)

- chronic

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34
Q

Ways that Anemia is Diagnosed:

  • _____
  • Low ___ and ____
  • Abnormal RBC ______ (mean volume & width) and RBC development
  • _______ levels (intracellular protein that stores iron and releases it - low in anemia)
  • Serum ____-________ protein levels (binds iron and transports it through the blood, elevated in periods of iron deficiency)
A
  • CBC
  • Hb and Hct
  • geometry
  • Ferritin
  • iron-binding
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35
Q

What are the S/S of anemia?

A
  • Pallor
  • Fatigue
  • Lightheadedness
  • Weakness
  • Dyspnea
  • Angina
  • Fainting
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36
Q

What does treatment of anemia look like?

A
  • Understanding the causes and alleviating them
  • Relieving the symptoms
  • Preventing complications
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37
Q

Prognosis of patients with anemia depends on the ________ factors and potential treatment for the underlying disease.

A

-etiologic

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38
Q

__________ exercise tolerance and _______ fatigability may be expected in anyone with anemia.

A
  • diminished

- easy

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39
Q
  • Prevalence of iron-deficiency anemia is likely to be higher in _______ populations.
  • Anticipate anemia in chronic ______ failure patients.
  • Anemia may be accompanied by ___ pathology and/or disease.
A
  • athletic
  • renal
  • CV
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40
Q

Anemia causes a decrease in ____ delivery which affects skin healing, exercise capacity, and functional capacity.

A

O2

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41
Q

PTs should also monitor for tachycardia, why?

A

Heart is compensating for low O2 by increasing the cardiac output.

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42
Q

PART 3

A

PART 3

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43
Q

Leukocytes is a comprehensive term for what?

A

All WBCs (agranular vs granular)

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44
Q
  • What are the 2 agranular WBCs?

- What are the 3 granular WBCs?

A
  • lymphocytes, monocytes

- basophils, neutrophils, eosinophils

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45
Q

Disorders of leukocyte or WBC concentration and in the relative proportions of the leukocyte types are recognized as measures of the reaction of the body to ________, ___________, _________ damage, or degeneration.

A
  • infection
  • inflammation
  • tissue damage
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46
Q

What is leukocytosis?

A

An increase in the number of leukocytes in the blood (too many!).

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47
Q

Leukocytosis occurs with ___________ and chronic ____________.

A
  • infections

- inflammation

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48
Q

Is an increase in leukocytes okay?

A

Yes, it is a normal response to things such as inflammation and infection.

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49
Q

Leukocytosis can also occur in response to physiological ________ and can result from an acute _________.

A
  • stressors

- hemorrhage

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50
Q

Leukocytosis can cause both ______philia and ______philia.

A
  • basophilia

- eosinophilia

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51
Q

Basophilia is involved in inflammatory and ________ reactions. Basophils degranulate when stimulated by an _________ and release _________ and other inflammatory cytokines.

A
  • allergic
  • allergen
  • histamines
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52
Q

Eosinophils are recruited to areas of __________ and participate in the response. However, they play key roles almost exclusively in fighting ________ infections.

A
  • inflammation

- parasitic

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53
Q

Lymphocytosis is an increase in lymphocytes and is associated with the presence of an _________.

A

infection

54
Q

What is lymphocytopenia?

A

Abnormally low level of lymphocytes in the blood.

55
Q
  • What is the most common cause of temporary lymphocytopenia?
  • What are some other causes?
A
  • recent infection

- chemotherapy, corticosteroid use, leukemias and lymphomas, radiation

56
Q

Neutropenia is a condition associated with the number of neutrophils being fewer than _____ cells/mm³ and results in a reduced capacity to mount an _______ response.

A
  • 1500 cells/mm³

- immune

57
Q

Causes of Neutropenia:

  • Viral ________
  • _____ abuse
  • __________ deficiencies
  • ____________ disorders (e.g., SLE), chemotherapy agents
  • Radiation therapy
  • Overwhelming infections
A
  • infections
  • ETOH
  • nutritional
  • connective tissue (CT)
58
Q

Is leukopenia ever beneficial?

A

NO, in contrast to leukocytosis

59
Q

Neutropenia Numbers of Interest:

  • 4000-10000 WBC/mm³
  • > 10000 WBC/mm³ (_________)
  • <2500 WBC/mm³ (_________)
  • <500 neutrophils/mm³ is abnormal placing patient at significant risk of infection
A
  • neutrophilia

- neutropenia

60
Q

Neutropenia Implications for PT?

A
  • hand hygeine
  • cleanliness of the facility
  • patient restrictions (family/community contact, no large gatherings, avoid fresh fruits and vegetables)
61
Q

Patients with neutropenia may not present in a manner consistent with an infection or inflammation (stem cell recipients), why?

A

Neutrophils are largely responsible for the S/S of an inflammatory response. Neutrophils are in short supply in neutropenia which may reduce S/S of inflammation.

62
Q

PART 4

A

PART 4

63
Q

What is cancer?

A

Uncontrolled cell growth

64
Q

Both RBCs and WBCs are constanly being ___________ and remain within predictable ranges suggesting careful regulation of blood cell production and removal. This suggests that over/under production of blood cells may be __________.

A
  • replenished

- pathologic

65
Q

What gives rise to all adult blood cells in our bodies?

A

Hemopoietic Stem Cells

66
Q

Hemopoietic stem cells undergo steps of __________ to become blood cells.

A

maturation

67
Q

Some hemopoietic stem cells intermediate cells develop gene defects which can cause what?

A

Lock the cells into an intermediate stage while still allowing them to reproduce, resulting in non-functioning cells.

68
Q

Leukemia is a disease of _______. It occurs when an intermediate blood-forming cell line that gives rise to adult/mature _______ is replaced with a malignant clone of an intermediate lymphocytic or myelogenous cells.

A
  • WBCs

- WBCs

69
Q

What is malignant?

A

Very virulent or infectious mass of cells that often has spread

70
Q

What is neoplasm?

A

A new and abnormal growth of tissue in some part of the body (especially as a characteristic of cancer).

71
Q

Cells arising from the malignant cells (clones) are ___-__________ and prevent/limit the development of healthy/normal replicating intermediate stage blood cells.

A

non-functional

72
Q

As malignant cells (clones) increase in number, they physically crowd out normal blood cells in the ______ and prevent/limit normal blood cell production.

A

marrow

73
Q

Leukemia may be ______ or ________ based on its natural course.

A

acute or chronic

74
Q

Classifying Leukemia Acording to Morphology:

  • ________-:, for leukemias arising from lymphoid stem cells or progenitor cells
  • ______-: for leukemias arising from defective myeloid stem cells or progenitor cells
  • ________-: for leukemia involving large, immature (functionless) cells [these cells are often called blast cells]
  • _______-: for leukemia involving mature, smaller cells.
A
  • lympho-
  • myelo-
  • blastic-
  • cytic-
75
Q

______ leukemia is a rapid accumulation of neoplastic, immature lymphoid or myeloid cells in the bone marrow and peripheral blood. It is defined as more than __% of the bone marrow cells are blasts cells.

A
  • Acute

- 30%

76
Q

_______ leukemia is a slower accumulation of defective mature lymphoid or myeloid elements of the blood than with acute leukemia neoplastic, immature lymphoid or myeloid cells in the bone marrow and peripheral blood.

A

chronic

77
Q

What are the 3 primary symptoms of leukemia?

A
  • anemia/dyspnea or SOB
  • infection (neutropenia)
  • bleeding tendencies/ easy bruising
78
Q

The diagnosis of leukemia is predicated on:

  • Medical _______
  • _________ examination
  • ___
  • Bone _______ aspiration
  • Cyto_______ (Blood cells are stained allowing for the identification of leukemic cells)
  • Cyto________ (Visualization of chromosomes)
A
  • history
  • physical
  • CBC
  • marrow
  • cytochemistry
  • cytogenetics
79
Q

Treatments for leukemia include what 3 things?

A
  • Chemotherapy
  • Radiation
  • Bone marrow transplant
80
Q

PART 5

A

PART 5

81
Q
  • Acute Myelogenous (myeloid) Leukemia (AML) is a cancer of immature cells in the _________ line of WBCs.
  • AML makes up __% of all leukemias (__% adults).
  • The mean age at Dx is __ yo.
  • Cure rates are between __ and __%.
A
  • myeloid
  • 40%, (80%)
  • 63yo
  • 20-45%
82
Q
  • Acute Lymphocytic (lymphoblastic) Leukemia (ALL) makes up __% of all leukemias (__% of pediatrics)
  • With ALL, pediatrics has a __% chance of survival while adults have __%.
  • ALL is ________ progressing and patients will present with _____/______ pain from leukemic infiltration.
A
  • 20%, (70%)
  • 80%, 40%
  • rapidly, bone/joint
83
Q
  • Chronic Lymphocytic Leukemia (CLL) makes up __% of all leukemias with adults making up 100% of the cases.
  • CLL is associated with __________ abnormalities.
  • The overall medual survival is between __-__ years.
A
  • 25%
  • chromosomal
  • 10-14 years
84
Q

-Chronic Myeloid Leukemia (CML) makes up __% of all new leukemias with adults accounting for most-all cases.
-What chromosomal abnormality will be present in patients with CML?
CML is _____ to _______ progressive.

A
  • 20%
  • Philadelphia (reciprocal translocation between chromosome 9 and 22)
  • slow to moderate
85
Q

Leukemia Subtypes General:

  • What are the 4 subtypes of leukemia?
  • Which affects children more?
  • Which subtype is associated with Philadelphia chromosome defect?
A
  • AML, ALL, CLL, CML
  • ALL
  • CML
86
Q

Leukemia patients tend to be _______ (both adult and children), this _____ a reason to not treat. Chemotherapy for these patients tends to be _______ as opposed to being local.

A
  • inactive, isn’t

- systemic

87
Q

What is lymphoma?

A

General term for cancers that develop in the lymphocytes. These cells are found in the lymph system ie. lymph nodes, spleen, thymus, bone marrow.

88
Q
  • What are the 2 main types of lymphoma?

- Which is the most common?

A
  • Hodgkin’s Lymphoma (HL), Non-Hodgkin’s Lymphoma (NHL)

- Non-Hodgkin’s Lymphoma (90% of all cases)

89
Q

Are Reed-Sternberg Cells associated with Hodgkin’s Lymphoma or Non-Hodgkin’s Lymphoma?

A

Hodgkin’s Lymphoma

90
Q
  • What is the main sign of lymphoma?

- What are the most common locations?

A
  • Enlarged lymph nodes

- Cervical, axillary, para-aortic

91
Q

HL is a __-cell type malignancy with clonal expansion of a malignant B cell. It occurs in both children and adults (rarely in kids) and is _______ curable. The prognosis depends on the ________ of the disease.

A
  • B
  • highly
  • staging
92
Q

Splenic involvement is seen with __-__% of people with HL.

A

30-40%

93
Q

Hodgkin’s Lymphoma PT Implications:

  • Impaired _______ (bone pain)
  • Impaired _________ Performance
  • Impaired __________ Capacity/Endurance Associated with Deconditioning
  • Infection control
  • Monitor lymph nodes for changes in size, shape, tenderness, consistency
  • Assessing and addressing impairments, functional limitations, and disabilities
A
  • posture
  • muscle
  • aerobic
94
Q

Non-Hodgkin’s Lymphoma is a large group (about 30 specific types described) of lymphoid malignancies (excludes HL) that present as solid _______ arising from cells of the lymphatic system.

A

tumors

95
Q

NHL Clinical Presentation:

  • _________ enlargement of isolated or generalized lymph nodes (Lymphadenopathy) of the cervical, axillary, supraclavicular, inguinal, and femoral (pelvic) chains
  • Extranodal sites: nasopharynx, GI tract, bone (accompanied by bone pain), thyroid, testes, and soft tissue
  • Abdominal NHL: abdominal pain and fullness, ____ obstruction or bleeding, ascites, back pain, and leg swelling.
A
  • painless

- GI

96
Q

What are some treatment strategies for Lymphoma?

A
  • Chemotherapy
  • Antibody therapy/ targeted therapy
  • Radiation therapy
  • Stem Cell transplantation
  • Steroids
  • Surgery (removal of spleen/other organs)
97
Q

Multiple Myeloma is a primary malignant neoplasm (an abnormal growth of tissue) of ________ cells (precursor lymphocytes) arising in the bone marrow which can then turn into a tumor

A

plasma

98
Q

Weight Bearing for Patients with Bone Tumors:

  • > 50% cortical metastatic involvement = _____
  • 25-50% = _____
  • 0-25% = ______
A
  • NWB (non)
  • PWB (partial)
  • FWB (full)
99
Q

With multiple myeloma, the tumor initially affects the _______ and bone __________ of the vertebrae, ribs, skill, pelvis, and femur.

A

bones and bone marrow

100
Q
  • What is the primary presenting symptom of multiple myeloma?
  • Multiple myeloma is a ________ tumor.
A
  • bone pain

- BLOOD

101
Q

Normal cell growth results in cell ______ while myeloma cell growth results in ________ cell growth.

A
  • death

- uncontrolled

102
Q

The onset of multiple myeloma is gradual and _________. The presenting features include ______, ____ pain, and recurrent _________.

A
  • insidiouos

- fatigue, bone pain, recurrent infections

103
Q

What are patients with multiple myeloma at increased risk for?

A
  • pathological fractures
  • bone destruction/osteoporosis
  • life threatening hypercalcemia
  • muscular weakness and atrophy
104
Q

What is the first line of treatment for patients with multiple myeloma?

A

Chemotherapy

105
Q

Is multiple myeloma curable?

A

No, median survival is about 3 years.

106
Q

Multiple Myeloma PT Implications:
-Primary Prevention/Risk Reduction for __________ Demineralization (bone loss and osteoporosis)
-Impaired _________ (skeletal deformity; bone pain)
-Impaired Joint Mobility, Muscle Performance, and
Range of Motion Associated with Fracture
-Pathologic __________

A
  • skeletal
  • posture
  • fractures
107
Q

PART 6

A

PART 6

108
Q

Hemostatis involves the arrest of _______ after blood vessel injury. It involves initiating ____ formation to stop hemorrhaging. It also involves the interaction of components of the blood vessel wall, platelets and plasma coagulation proteins and a number of signaling molecules and intermediates.

A
  • bleeding

- clot

109
Q
  • Von Willebrand’s Disease is caused by a lack of or dysfunction of _____.
  • vWF is released from __________ following vascular injury and mediated the adhesion of platelets to sites of ________ injury. It binds and stabilizes the procoagulant protein _______.
A
  • vWF (Von Willebrand’s Factor)

- platelets, vascular, Factor VIII

110
Q
  • Von Willebrand’s Disease causes a reduced concentration of vWF which results in ______ and ____ bleeding.
  • It can give rise to petechiae, what is this?
  • It can also lead to frequent nose bleeds (__________), gum bleeding, and GI bleeding.
A
  • mucosal and skin
  • Red or purple spot on the skin caused by a minor hemorrhage.
  • epistaxis
111
Q

Both purpura and petachiae reflect a bleeding disorder, which is larger?

A

Purpura > Petachiae (pinpoint)

112
Q
  • What medication stimulates the release of Willebrand factor stores cells in the lining of blood vessels?
  • _________ therapies are also ways to treat Von Willebrand’s Disease by infusion of concentrated blood clotting factors (vWF/ Factor VIII)
A
  • Desmopressin

- Replacement

113
Q

What is hemophilia?

A

A bleeding disorder inherited as a sex-linked autosomal recessive trait.

114
Q

The genes for hemophilia are carried on the _ chromosome. Therefore females often present as _______ while males present with ________.

A
  • X
  • carriers
  • disease
115
Q

Hemophilia is caused by what?

A

Lack/deficiency of/in 1 or more clotting factor

116
Q

How is hemophilia classified?

A

According to the percentage of clotting factor present in plasma:

  • Mild = 6-30% of normal factor VIII activity
  • Moderate = 1-5% of normal factor VIII activity
  • Severe = less than 1% of normal factor VIII activity
117
Q

25-30% of all hemophilia cases are ____________.

A

spontaneous

118
Q

Hemophilia Clinical Manifestations:

  • Occurrences of __________
  • Newborns- occur with heel sticks, immunizations, blood draws, circumcision
  • Bruising, bleeding from the mouth or frenulum, intracranial bleeding, hematomas of the head, and hemarthrosis with ambulation
A

bleeding

119
Q

What is hematoma?

A

Collection of blood outside of blood vessels (bruise)

120
Q

Patients with hemophilia have an increased risk of bleeding into _________.

A

joints

121
Q

Women with hemophilia will present with excessive uterine bleeding during their ________ cycle, and may be the first symptom.

A

menstrual

122
Q

Bleeding into the _______ spaces (_________) is one of the most common clinical manifestations of hemophlia.

A
  • joint

- hemarthrosis

123
Q

List the sites of hemarthrosis from most common to least.

A

Knee>ankle>elbow>hip>shoulder

124
Q

If patients have hemophilia, ___________ may further damage the synovium.

A

weight bearing

125
Q
  • Can muscles hemorrhage?

- This often involves _______ muscle groups and results in _____ and limited ____.

A
  • Yes, and the blood may remain in the confines of that muscle.
  • flexor, pain and limited ROM
126
Q
  • Hemophilia A is a lack of clotting factor ___ and constitutes __% of all cases of hemophilia.
  • Hemophilia B is a lack of factor ___ and affects __% of all people with hemophilia.
A
  • VIII, 80%

- IX, 15%

127
Q

A regular ________ program is an important part of the comprehensive care of patients with hemophilia. Strength training is of benifit, but they want to avoid _______ sports.

A
  • exercise

- contact

128
Q

Signs of Early Bleeding:

  • Stiffening into the position of comfort (usually flexion, shortened position)
  • Decreased _____
  • Pain/tenderness
  • Joint swelling with increased ______
  • Gradually intensifying pain
  • Loss of _________
A
  • ROM
  • warmth
  • sensation
129
Q

Sickle cell disease is an autosomal __________ disorder characterized by the presence of an abnormal form of Hb S which causes the RBC to “sickle”.

A

recessive

130
Q

In sickle cell disease, when too many cells “sickle” vaso_________occurs and the individual has a ______.

A
  • vasoocclusion

- crisis

131
Q

Sickle Cell Diseasse Management:

  • _____ management/inpatient care, opioids, analgesics & blood transfusions
  • Exercise
  • _________
  • Teaching joint protection/prescribing assistive devices
A
  • pain

- depression

S3 - Pathophysiology (14 decks)

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