Brainscape's Knowledge GenomeTM

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


See full index

PCM > Midterm > Flashcards

Midterm Flashcards

1
Q

what is the diaphragm of the stethoscope used for?

A

high pitched sounds

heart/lungs

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

what is a normal reflex grade?

A

2/4

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

what nerve root is tested for in biceps reflex strike?

brachioradialis?

triceps?

A

C5

C6

C7

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

what nerve root is tested for in an achilles reflex strike?

patella?

A

S1

L4

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

something you get on a physical exam or see goes where?

A

Objective

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

diagnosis goes where?

A

assessment

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

something you get from talking to patients goes where?

A

subjective

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

what you will do for patient goes where?

A

plan

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

when encountering a patient’s emotions what do you do?

A 
NURS
name the pt's expressed emotion
understanding
respect them
support them
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CAGE questionnaire?

A

need to cut back
annoyed by criticism
guilty about drinking
need a drink for an EYE opener

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

if someone has been smoking for 30 years and smokes 3 packs a day, how many pack years do they have?

A

90

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

what are the 5 Ps of sex?

A 
partners
prevention of pregnancy
protection from stds
sex Practices (vag, anal, oral)
past hx of stds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SAFE questionnaire?

A

stress/safety
afraid/abused
family/friends
emergency plan

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

what to ask in domestic abuse situation?

A

have you ever been hit, slapped, kicked or otherwise hurt

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

how much exercise does the cdc recommend?

moderate activity and strength?

A

150 min/week

2 days/week

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

for pt’s faith what do you ask?

A 
FICA
faith and believe
importance
community
address in care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what di da Vinci do?

A

1st to study anatomy w/mechanics

analyzed m. forces and joint fx

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

what do Galilei do?

A

anything with bone strength/load bearing

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

what did Borelli do?

A

action of walk/run/heart
center of gravity
inspiration is m. driven
expiration due to tissue elasticity

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

what did A.T. Still do?

A

millwright

waved the banner of D.O.s June 22, 1874

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

what is classified with hard biomaterials?

what can it undergo?

what law associated with hard?

A

bones

mechanical deformation

Wolf’s law - remodels where it’s needed

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

what is classified as soft biomaterial?

A

cartliage, tendon, muscle, skin

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

what kind of biomaterial does a runner experience?

what about old men?

A

soft: stronger, stiffer ligaments
soft: cartilage wearing

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

example of hard biomaterial?

A

heel spur due to plantar fasciitis

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

what are the 3 types of machines in the body?

A

levers (most common)

wheel axis

pulleys (ex. knee cap)

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

what is the most common lever in body?

ex?

A

3rd class

bicep curl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when force is being applied plus the moment arm is called what?

A

moment

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

sum of moments and the force of contracting m. is what

.

A

joint reaction force

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

the amt of force necessary to bend an object is what?

A

stiffness

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

what is associated w/viscosity?

A

CREEP

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

what kind of force is shearing?

A

parallel

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

folding about an axis is what?

A

bending

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

twisting around an axis is what?

A

torsion

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

system in constant state of motion with no acceleration is what?

A

static

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

system with acceleration is what?

A

dynamic

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

if a pt walks into clinic with back ache and an xray reveals a hip deformity or tear, what is the most likely diagnosis?

A

back pain due to GUARDING of hip

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

what are the 2 suture edge types?

A

squamous (overlapping)

serrated (interlocking)

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

fibrous joints include what?

A

crianial
syndesmosis
gomphosis

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

2 types of cartilaginous joints?

A

hyaline (costochondral joint and epip plate)

fibrocartilage (intervertebral discs)

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

characteristic of plane joint

example

A

minimal sliding

carpal bones

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

hinge joint characteristic

example

A

ginglymus, large degree of freedom in 1 plane

elbow

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

saddle/seller characteristic

example

A

1 concave and 1 convex bone allows motion in all planes

thumb

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

ball and socket alternate name?

example

A

spheroidal

convex head articulates with concave surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

condylar characteristic

example

A

partial flattening of both articular surfaces that limits motion

MCP joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

pivot alter name, characteristic

example

A

trochoid, primary motion is rotation

atlas and axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

nerves supplying a joint also supply muscles moving the joint and skin covering muscles is called what?

A

Hilton’s law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what controls muscles acting on joints?

A

reflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what is found in the articular capsule?

A

nerve endings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what happens in inflammatory joint degeneration?

A

rheumatoid arthritis

condition in which the immune system attacks synovium and cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

characteristics of osteoarthritis

A

joint disease that gets worse over time, NOT inflammatory

cartilage eroding

effects 16 million people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what causes avascular necrosis

A

traumatic joint injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what condition has loss of proteoglycans
erosion of cartilage
ground glass appearance

A

Fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what has loss of articular cartilage, thickening of subchondral bone
hardened and polished bone
permanent lesion
pain on weight bearing

A

eburnation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what is assoc. with catching or locking of joint

fragments of bone floating in synovial fluid

A

joint mice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what % is stance phase

swing phase?

A

60

40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what has the greatest % during stance phase

A

50-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what are the 5 requirements for gait?

A

Pre SAFE

stability
foot clearance
pre-position
adequate step length
energy conservation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is an antalgic gait

A

painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what is a stiff pathological gait?

A

arthogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what kind of pathologic gait is unstable?

A

ataxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is characteristic of a parkinson’s pathological gait

A

shuffling, slow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what kind of pathological gait has high knees to compensate for foot drop?

A

steppage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what kind of gait is associated with polio and syphillis

A

steppage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what is characteristic of of hemiplegic gait

A

no flexion of knee or ankle, semicircle made w/hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what muscles are responsible for shoulder ext. rotation

A

infraspinatus

teres minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what muscles responsible for shoulder extension

A

latissimus dorsi and teres major

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what muscles for shoulder flexion?

A

coracobrachialis and deltoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what muscles for shoulder adduction?

A

pec major

lat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

muscles for shoulder abduction?

A

supraspinatus, deltoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what motion at wrist is coupled with flexion?

extension?

A

dorsal carpal glide

ventral carpal glide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what muscles are responsible for ext rotation at hip?

A

glud med, min, sartorius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what nerve innervates the hip extension muscles?

what is the muscle?

roots?

A

inf. gluteal n.

glut MAX

L5-S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what innervates hip abduction muscles?

What is the muscle

nerve roots

A

sup. gluteal n

glut med and min

L5-S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what innervate hip adduction muscles?

what is the muscle

nerve roots?

A

obturator n.

adductor longus

L2-L4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what are the test for central compartment?

A 
San Fran Cisco LL
Scour
FABER
C-sign
Log roll
labral loading/distraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Peripheral compartment tests

A

Travis RELeford plays on the PERIPHERY

Rectus femoris
Ely’s test
Log roll

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Lateral compartment tests?

A

BOS Fucks The Pussy

Bursitis (jump sign)
Ober's
Straight leg raise
FABER
Trendelenburg
Piriformis
78
Q

Anterior compartment tests?

A

Fuck The Police

FABER
psoas
Thomas test

79
Q

trendelenburg hip drops on right side

which side has the dysfunction?

A

Left side

80
Q

what nerve root is tested in the achilles tendon?

A

S1

81
Q

what ear condition does not yet require antibiotics?

A

OME

82
Q

according to the Centor score, when should you give antibiotics for strep?

A

+4 score or more

83
Q

what does a tonsil score of +2 indicate?

A

tonsils are greater than 25% in the fossa but less than 50%

84
Q

when do frontal sinuses open?

A

7 years old

85
Q

what is the term for loss of higher frequencies as you age?

A

presbycusis

86
Q

what is the proper sequence of phys exam assessment for cardiac function?

A

inspect
palpate
percuss
auscultate

87
Q

what is responsible for the 1st heart sound?

where is it best heard?

A

closing of bi and tri cuspid valves

apex

88
Q

what is responsible for the 2nd heart sound?

where is it best heard?

A

closing of the pulmonary and aortic valves

base

89
Q

what are the 5 things you need to assess in a cardiovascular exam?

A 
PLEXH
physical
lab tests
ECG
Xray
history
90
Q

what is happening in the heart during the 1st heart sound?

A

beginning of ventricular systole

91
Q

what’s happening at 2nd heart sound?

A

end of systole, beginning of diastole

92
Q

where is the aortic valve located?

pulmonary valve?

A

2nd intercostal space Right of sternum

2nd intercostal space Left of sternum

93
Q

where is the tricuspid located?

bicuspid?

A

4th intercostal space at Left side base

apex of heart

94
Q

where is the point of maximal intensity located?

A

5th left intercostal space (at the apex)

95
Q

grade 1 murmur means what?

A

barely audible

96
Q

grade 2 murmur means what?

A

soft, but easily heard

97
Q

grade 6 murmur means what?

A

loud, can be heard w/out stethoscope, has thrill

98
Q

grade 4 murmur means what?

A

loud w/thrill

99
Q

grade 5 murmur means what?

A

loud w/minimal contact bw stethoscope and chest, has Thrill

100
Q

grade 3 murmur?

A

loud, NO thrill

101
Q

what is thrill

A

turbulent blood flow causing murmurs

102
Q

what is the bell of the stethoscope used for?

another name for it?

A

low pitched sounds

bruitis

103
Q

Who loves Parrott’s Promise more than anyone?

what is this person’s favorite club?

A

Brian LeSage

KCU climbing club with Marc Larsen-Halleck

104
Q

Who loves Parrott’s Promise more than anyone?

what is this person’s favorite club?

A

Brian LeSage

KCU climbing club with Marc Larsen-Halleck

105
Q

what makes up the joint reaction force?

A

sum of separate moments with the force

106
Q

what is the magnitude of force applied to something called?

A

strain

107
Q

impingement syndrome in the peripheral compartment has what 2 types associated with what anatomy?

A

Pincer - acetabulum

CAM - femoral neck

108
Q

what pathology is associated with jumper’s knee?

A

patellar tendonitis

109
Q

what pathology for overuse injury as in soccer, volleyball or running?

A

quadriceps tendonitis

110
Q

what is osgood-schlatter?

A

avulsion of secondary ossification center of tibial tubercle

111
Q

what is another name for osteochromatosis ?

A

joint mice/ loose bodies

112
Q

what does the eversion Test evaluate?

what do you do?

A

deltoid ligament

evert/pronate foot

113
Q

what does the talar tilt test evaluate?

what do you do?

A

calcaneofibular l. and ant. talofibular l.

invert foot

114
Q

what does the anterior drawer test of the foot evaluate?

A

anterior talofibular ligament

115
Q

what do you do in homan’s sign?

testing for what?

A

dorsiflex foot

DVT

116
Q

how do you do moses’s sign?

testing for what?

A

pt supine, ant. compression of gatroc

posterior tibial vein DVT

117
Q

what tests for long head of biceps?

A

Yergason
Speed

Getting Head - You Suck

118
Q

what tests for rotator cuff impingement?

A

Neer impingement
Hawkins Test

New Hampshire Roads

119
Q

what are the landmarks of the gravitational line?

A 
lateral malleolus
lateral condyle of knee
greater trochanter
ant. 1/3 of sacrum
3rd lumbar vertebrae
lateral head of humerus
external auditory canal
120
Q

where are pain fibers found in joints?

A

fibrous capsule

121
Q

where are nerve endings found in joints?

A

articular capsule

122
Q

ellipsoid joint characteristics?

example

A

head is ellipsoid

greater motion than condylar, less than spheroidal

radiocarpal

123
Q

What is the order of physical exam basic steps for a lower respiratory exam?

A

Inspect
Palpate
Percuss
Auscultate

124
Q

When does an acute cough usually occur?

A

At night

125
Q

When do people with chronic cough have the most trouble?

A

Mornings

126
Q

If the sputum has leukocytes and macrophages, where is the infection located?

A

Lower respiratory tree

127
Q

What does foul smelling sputum indicate?

A

Anaerobic infection

128
Q

What are the accessory muscles of breathing that can hypertrophy?

A

Traps
Scalenes
SCM

129
Q

What disease process are present with nail clubbing?

A

Hypoxia
Interstitial lung disease
Cystic and pulmonary fibrosis
IBD

130
Q

What is the most common type of chest deformity?

What is their CO and SV like?

A

Pectus excavatum

DEC CO and SV

131
Q

When is tactile fremitus increased?

A

Pneumonia or consolidations

132
Q

When is tactile fremitus decreased?

A

COPD, tumor, pleural effusion, pneumothorax

133
Q

When is a dull percussion sound heard?

A

Over fluid or solid tissue

134
Q

What does hyperrsonance indicate?

A

COPD

Pneumothorax

135
Q

When is a resonant sound heard?

A

Over air

136
Q

When percussing and you find a tympanic sound, what does this indicate?

A

Gastric air bubble

137
Q

Name the auscultation of the chest sounds from superior to inferior

A

Bronchial
Broncho-vesicular
Vesicular

138
Q

When do you hear crackles or rales?

A

Fluid in interstitial space

Pneumonia

139
Q

What is a pleural friction rub?

What does it sound like?

A

Visceral and parietal layers rub together and are irritated

Leathery, scratchy sound best heard in EXPIRATION

140
Q

What are rhonchi?

A

Secretions that can be heard in the chest

141
Q

What is Stridor?

A

Sound generated from the neck

142
Q

What does Stridor indicate?

A

Partial occlusion of the trachea or larynx
Emergency
Foreign body in airway

143
Q

What is egophony?

A

Spoken words become more distinct to auscultation

E becomes A

144
Q

Where are vesicular lung sounds heard?

What are they like?

A

Most inferior, over lung fields

Low pitch, soft and short expiration a

145
Q

Where are bronchial lung sounds heard?

What are they like?

A

Over the trachea

High pitch, loud and long expirations

146
Q

Where are bronchovesicular lung sounds heard?

What are they like?

A

Over main bronchus, over upper right post. Lung field

Medium pitch, expiration equals inspiration

147
Q

Where is the apex of the heart located?

A

5th ICS to the left

1cm medial to MCL

148
Q

Where is the PMI located?

A

4th-5th intercostal space at the Mid-clavicular line

149
Q

What vein is best used to estimate jugular venous pulse?

A

IJ

150
Q

What is the most common cause of an elevated JVP?

A

Elevated RV diastolic pressure

151
Q

What is normal JVP?

What does it indicate?

A

0-9

RAP

152
Q

When does the a wave occur?

What does it coincide with?

A

R atrial contraction, Tricuspid Valive open

S1

153
Q

What can cause a giant a wave?

A 
Obstruction bw RA and RV (stenosis)
Inc Pressure in RV
Pulmonary HTN
Pulmonary embolism
AV dissociation (RA contracts against the closed TV)
154
Q

What happens in the V wave?

A

Atrial filling

155
Q

When is a prominent V wave seen?

A

Tricuspid regurgitation

Pulmonary HTN

156
Q

When do you have increased JVP?

A

SVC obstruction
severe heart failure
Constrictive pericarditis, cardiac tamponade, RV infarction
Restrictive cardiomyopathy

157
Q

When do you see a positive HJR?

A

Constrictive pericarditis
Poorly compliant RV
Obstructive RV filling

158
Q

What is the S3 heart sound?

When is it pathologic?

A

Abrupt decceleration of inflow across mitral valve at the end of the rapid filling phase

Adults over 40 –> CHF

159
Q

What is the S4 sound?

A

Atrial gallop due to stiffened ventricle

160
Q

What is the 1st component of S1?
2nd?

Where is it the loudest?

A

MV closes
TV closes

apex of heart

161
Q

1st component of S2?
2nd component?

Where is it the loudest?

A

AV close
PV closes

Base of heart

162
Q

When is splitting of S1 between S2 heard?

A

Inspiration

163
Q

Location of Aortic valve?
Pulmonary valve?
Tricuspid?
Mitral?

A 
All Physicians Take Money
2nd ICS R (of sternum)
2nd ICS L
4th ICS L
5th ICS L
164
Q

Grading system for edema and depth for each level

Length of time indentation lasts?

A

0-4
Starting at 1: 2, 4, 6, 8mm

Starting at 2: 10-15s, 1 minute, 3-5 minutes

165
Q 
What does a pulse of 1 indicate?
2?
3?
4?
0?
A 
Barely palpable
Average intensity
Strong
Bounding
Absent
166
Q

Where is the carotid pulse located?

A

Medial to SCM m.

167
Q

Where are the best places to check peripheral edema?

A

Dorset of foot, ant. Tibia, behind medial malleolus

168
Q

Generally speaking, what does clubbing indicate?

A

Interstitial disease

169
Q

Where doe you insert a needle for decompression of pneumothorax?

A

2nd ICS

170
Q

Where do you insert chest tube?

A

4th ICS

171
Q

Where do you perform a thoracentesis?

A

7th ICS

172
Q

Pts with lung disease have a SD where?

A

T1-T6

173
Q

When can bronchial sounds best be heard?

A

Expiration

174
Q

When can vesicular sounds best be heard?

A

Inspiration

175
Q

What is a positive whispered pectorlioquy?

A

Whispered sound heard loud and clear during auscultation

176
Q

What type of genetics are associated with Renal Cell Carcinoma?

A

VHL - Von Hippel Lindau

177
Q

What is the most common type of renal cell carcinoma?

A

Clear-cell

178
Q

What does lloyd’s punch assess?

A

CVA - costovertebral angle

179
Q

How does pyelonephritis occur?

A

Vescioureteral reflux, intrarenal reflux, bad functioning of vesicoureteral junction

180
Q

Who is most prone to pyelonephritis?

What normally causes it?

A

Young women and old men

E.coli from the bladder

181
Q

What are the presentations of pyelonephritis?

A

Fever, flank pain, dyspraxia, polyuria, nocturnal

182
Q

What does increased capillary refill indicate?

What disease processes?

A

Under perfusion

Hypovolemia, hypothermia

183
Q

Shift of the trachea from midline indicates what?

A

Atelectasis or pneumothroax

184
Q

What is flat sounds pitch?

Duration?

Location

Intensity

A

High

Short

Thigh

Soft

185
Q

Intensity
Pitch
Duration of dull sound

Location?

A

All medium

Liver

186
Q

Intensity

Pitch

Duration

Location of resonant

A

Loud

Low

Long

Healthy lung

187
Q

Intensity

Pitch

Duration

Location of tympanitic sound

A

Loud

High

Longer

Gastric air bubble

188
Q

Where can transitional cell urinary tract cell cancers occur?

A

Renal pelvis to proximal 2/3 of the urethra

189
Q

What is a pay systolic (holosystolic) murmur?

A

Starts at S1 and stops at S2 without a gap bw murmur and heart sounds

190
Q

What is kussmauls sign?

Where is it seen?

A

JVP rises during inspiration rather than falling

Seen in R heart failure, RV infarction, pericarditis

PCM (1 decks)

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