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EPPP Study > Physiological Psych & Psychopharmacology > Flashcards

Physiological Psych & Psychopharmacology Flashcards

1
Q

The 2 types of cells in the nervous system

A

Glial Cells and Neurons

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2
Q

What are the parts of a neuron

A

Dendrites, cell body/soma, axon

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3
Q

What is the space between the axon and receptor

A

Synapse

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4
Q

what part of the neuron transmits info to the post synaptic cells?

A

Axon

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5
Q

What is the myelin sheath made of

A

glial cells

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6
Q

What is multiple sclerosis

A

destruction of the myelin sheath and a malfunctioning immune system that destroys the myelin; sxs include impaired vision, pain, fatigue, impaired coordination, slurred speech, tremor

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7
Q

Chemicals that transfer info from the presynaptic neuron to the post synaptic neuron

A

Neurotransmitters

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8
Q

Increases the likelihood that action potential will occur in the post synaptic cell

A

Excitatory effect of a neurotransmitter

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9
Q

Decreases the likelihood that action potential will occur in the post synaptic cell

A

Inhibitory effect of a neurotransmitter

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10
Q

The electrical impulse that travels the length of a cell and responsible for the release of a neurotransmitter into the synapse

A

action potential

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11
Q

All or Nothing responses that either occur or don’t occur when a neuron gets sufficient stimulation from the presynaptic neuron

A

Action potential

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12
Q

Mimic or increase effects of a neurotransmitter at receptors

A

Agonist

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13
Q

Produce effects similar to (but weaker than) the effects of agonist or neurotransmitter at receptors

A

Partial Agonists

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14
Q

Bind to the same receptors as a neurotransmitter or agonist, but produce effects that are opposite of a neurotransmitter or agonists

A

Inverse Agonist

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15
Q

Produce no effects on their own but block or reduce the effects of a neurotransmitter or agonist at the receptor

A

Antagonists

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16
Q

The Central Nervous System is made up of

A

The brain and spinal cord

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17
Q

The brain is divided into what 3 parts

A

forebrain, midbrain, hindbrain

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18
Q

This is the most primitive part of the brain

A

Hindbrain; contains medulla, pons, and cerebellum

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19
Q

Most complex & largest part of the brain

A

Forebrain; contains cortical and subcortical structure

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20
Q

Consists of sensory and motor neurons that are located outside of the central nervous system

A

Peripheral Nervous System

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21
Q

What is divided into the somatic and autonomic nervous systems?

A

Peripheral Nervous System

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22
Q

Transmits info from body’s sensory receptors to the central nervous system and from the central nervous system to the skeletal muscles; Responsible for voluntary actions

A

Somatic Nervous System

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23
Q

Responsible for actions that tend to be involuntary; transmits info between the central nervous system and smooth muscles of the organs and glands

A

Autonomic Nervous System

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24
Q

This consists of the sympathetic and parasympathetic branches

A

Autonomic Nervous System

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25
Q

Responsible for fight or flight responses to a stressful event; it causes pupil dilitation, sweating, increased heart rate and increased respiratory rates. Inhibits sexual activity and digestion

A

Sympathetic Branch of the Autonomic Nervous System

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26
Q

Responsible for rest, relaxation, and energy conservation. Causes the body to return to pre-emergency state after fight or flight response

A

Parasympathetic branch of the Autonomic Nervous System

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27
Q

Parts of the Hindbrain

A

Medulla, Pons, Cerebellum

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28
Q

Regulates autonomic nervous system functions necessary for survival including respiration, heart rate, blood pressure, and digestive processes. Also regulates reflexes including coughing, swallowing, sneezing.Damage here can result in death

A

Medulla

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29
Q

Connects the 2 halves of the cerebellum. Connects medulla to cerebellum and the cerebellum to the forebrain. Involved in arousal, regulation of deep sleep and REM sleep, and regulation of respiration. Coordinates inhalation and exhalation

A

Pons

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30
Q

Coordinates complex voluntary movements initiated in motor cortex. Responsible for maintaining posture and balance. Important for storing and processing procedural memory such as walking, driving, and riding a bike as well as reciting alphabet and multiplication tables

A

Cerebellum

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31
Q

Damage causes ataxia (impaired balance and coordination, slurred speech, and blurred/double vision)

A

Cerebellum

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32
Q

Midbrain consists of

A

Reticular Formation (which contains Reticular Activating System) and Substantia Nigra

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33
Q

Has network of neurons that extends from medulla to midbrain and alerts the cerebral cortex to incoming sensory signals. Mediates behavioral arousal and consciousness, controls sleep/wake cycle. Damage here causes coma

A

Reticular Formation (which contains Reticular Activating System)

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34
Q

Diagnosis requires at least 1 manic episode that may or may not have been preceded or followed by one or more major depressive or hypomanic episodes

A

Bipolar I

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35
Q

Diagnosis requires at least one hypomanic episode and at least one major depressive episode

A

Bipolar II

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36
Q

Diagnosis requires numerous period of hypomanic sxs that don’t feet criteria for a hypomanic episode and numerous periods of depressive sxs that don’t meet criteria for major depressive episode

A

Cyclothymic Disorder

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37
Q

Diagnosis of Cyclothymic Disorder requires the presence of sxs for at least how long

A

2 years

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38
Q

Abnormally and persistently elevated, expansive, or irritable mood, increased activity or energy, and 3 or more sxs of mania for at least 4 consecutive days

A

Hypomania

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39
Q

1 of these 2 sxs must be present for a diagnosis of major depressive episode

A

Depressed mood or loss of interest or pleasure in all or most activities

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40
Q

Sxs have to be present for how long and cause significant distress or impairment to meet criteria for MDD

A

2 weeks

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41
Q

Cluster A Personality Disorders

A

Paranoid, Schizotypal, and Schizoid

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42
Q

Cluster B Personality Disorders

A

Antisocial, Borderline, Histrionic, And Narcissistic

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43
Q

Cluster C Personality Disorders

A

Avoidant, Dependent, and OCPD

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44
Q

Which personality disorder cannot be diagnosed under the age of 18

A

Antisocial Personality Disorder

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45
Q

To be diagnosed with a personality disorder, sxs must be present for at least how long

A

1 year

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46
Q

Pervasive Pattern of Distrust and suspiciousness that interprets the motives of others as malevolent

A

Paranoid Personality Disorder
Must have 4/7 sxs:
-suspects w/o sufficient reason
-preoccupied with unjustifiable doubts about loyalty or trustworthiness of others
-reluctant to confide in others
-reads demanding content into benign comments
-persistently holds grudges
-perceives attacks on character and reputation and is quick to anger

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47
Q

Pervasive pattern of detachment from social rxs and a restricted range of emotional expression in interpersonal settings

A

Schizoid Personality Disorder

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48
Q
  • Doesn’t desire or enjoy close relationships
    -almost always chooses solitary activities
    -has little or no interest in sexual relationships
  • takes pleasure in few activities
    -Lacks close friend or confidants other than first degree relatives
    -Appears to be indifferent to praise or criticism
  • Emotionally cold or detached or has flat affect
A

Schizoid Personality Disorder

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49
Q

Pervasive pattern of social and interpersonal deficits involving acute discomfort with a reduced capacity for close relationships, distortions in cognition, and perception, and eccentricities in bx

A

Schizotypal Personality Disorder

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50
Q
  • Exhibits ideas of reference
  • Odd believes or magical thinking that influence bx
  • Has bodily illusions or other unusual perceptions
  • Suspicious or has paranoid ideation
  • Inappropriate or constricted affect
    Peculiarities in bx and appearance
  • Lacks close friends or confidants other than first degree relatives
  • Has excessive social anxiety that doesn’t diminish w/ familiarity
    (may express unhappiness about lack of friends, but are uncomfortable around other people and usually interact with others only when necessary)
A

Schizotypal Personality Disorder

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51
Q

Involves pervasive patterns of disregard for and violation of the rights of others

A

Antisocial Personality Disorder

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52
Q
  • Fails to conform to social norms with respect to lawful bx
  • Deceitful
  • Impulsive and fails to plan ahead
  • irritable and aggressive
  • reckless disregard for the safety of self and others
  • consistently irresponsible
  • Lack of remorse
A

Antisocial Personality Disorder

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53
Q

Antisocial PD tends to be comorbid with what disorders

A

Substance use disorder is common; also mood disorder, borderline, and anxiety disorder

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54
Q

Must have a hx of conduct disorder before age 15 to meet criteria

A

Antisocial Personality Disorder

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55
Q

What intervention has received empirical support to treat Antisocial PD

A

No intervention has received consistent empirical support. This is one of the most difficult disorders to treat bc ppl with this disorder don’t believe they have a problem and rarely seek treatment; Some evidence for CBT, especially in groups to reduce re-offending, contingency management which reinforces desirable bxs, and pharmacological treatments to treat co-morbidities

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56
Q

Requires pervasive pattern of instability in interpersonal relationships, self-image, affect, and marked impulsivity

A

Borderline Personality Disorder

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57
Q

Which personality disorders can remit or become less severe around age 40

A

Antisocial Personality Disorder (less criminal bx)
Borderline Personality Disorder (up to 75% no longer meet full diagnostic criteria by 40)

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58
Q

-engages in frantic bx to avoid abandonment
- has a pattern of unstable and intense interpersonal relationships that involve fluctuation in idealization and devaluation
-identity disturbance that involves persistent instability in sense of self
-impulsive in at least 2 areas that are potentially self damaging
-has recurrent suicide threats or gestures or engages in self-mutilating bx
- Exhibits affective instability
-experiences chronic feelings of emptiness
-exhibits inappropriate anger
-transient stress related paranoid ideation or severe dissociative sxs

A

Borderline Personality Disorder

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59
Q

What is the typical onset for Borderline Personality Disorder

A

late adolescence and sxs most severe in early adulthood

60
Q

Common treatment for Borderline Personality Disorder

A

DBT created by Linehan

61
Q

DBT is based on the assumption that Borderline is due to emotional dysregulation that is a combination of ______________ and ______________ factors

A

biological and environmental

62
Q

In DBT, being late, not completing homework, frequently threatening to quit therapy are all examples of what

A

Therapy interfering bxs

63
Q

In DBT, relationship problems, financial problems, and housing problems are examples of what

A

Quality of Life interfering bxs

64
Q

3 components of DBT

A

Group skills training (mindfulness, distress tolerance, relationship effectiveness, emotional regulation) individual psychotherapy (increase skills, decrease suicidal bx, decrease therapy interfering bxs, and decrease quality of life interfering bxs), Intersession coaching (telephone coaching to deal with crises and to generalize skills)

65
Q

Pervasive pattern of excessive emotionality and attention seeking

A

Histrionic Personality Disorder

66
Q

People with this disorder have exaggerated emotions and are manipulative to gain nurturance

A

Histrionic Personality Disorder

67
Q

People with this disorder are manipulative to gain power or material gratification

A

Antisocial Personality Disorder

68
Q

-uncomfortable when not the center of attention
-Inappropriately sexually seductive or provocative when interacting with others
-rapidly shifting and shallow emotions
-consistently uses physical appearance to gain attention
-exhibits speech that is excessively impressionistic and lacking detail
-easily influenced by others
-considers relationships to be more intimate than they are

A

Histrionic Personality Disorder

69
Q

Pervasive pattern of grandiosity, need for admiration, lack of empathy

A

Narcissistic Personality Disorder

70
Q
  • grandiose sense of self-importance
    -Preoccupied with fantasies of unlimited success, power, beauty, and love
    -believes they are unique and can be understood only by special or high status ppl
    -has a sense of entitlement
    -interpersonally exploitative
    -lacks empathy
    -often envious of others or believes others are envious of them
    -exhibits arrogant behaviors or attitudes
A

Narcissistic Personality Disorder

71
Q

Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

A

Avoidant Personality Disorder

72
Q
  • avoids occupational activities that involve interpersonal contact due to fear of criticism, disapproval, or rejection
  • unwilling to get involved with people unless certain of being liked
    -shows restraint in intimate relationships due to fear of being ridiculed
    -preoccupied with concerns about being criticized or rejected in social situations
    -inhibited in new rxs due to feelings of inadequacy
    -usually reluctant to engage in new activities because they may be embarrassing
A

Avoidant Personality Disorder

73
Q

Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fear of separation

A

Dependent Personality Disorder

74
Q

-difficulty making every day decisions without advice and reassurance from others
-needs others to assume responsibility for most areas of their life
-avoids disagreeing with others due to fear of losing support or approval
-difficulty doing things alone
-goes excessive lengths to obtain nurturance and support
-feels uncomfortable or helpless when alone
-urgently seeks another relationships for care and support when a close relationship ends
unrealistically preoccupied with feelings of being left to care for themselves

A

Dependent Personality Disorder

75
Q

Pervasive pattern of preoccupation orderliness, perfectionism, and mental and interpersonal control that severely limits flexibility, openness, and efficiency

A

Obsessive Compulsive Personality Disorder

76
Q
  • preoccupied with details, rules, schedules so that major point of an activity is lost
    -shows perfectionism that interferes with task completion
    -excessively devoted to work and productivity to the exclusion or leisure activities and friendships
    -overly conscientious, scrupulous, and inflexible about morality, ethics, or values
    0unable to discard worn out or worthless objects even when they don’t have sentimental value
    -reluctant to delegate work to others unless they’ll do it their way
    -adopts a miserly spending style towards self and others
    -shows rigidity and stubborness
A

Obsessive Compulsive Personality Disorder

77
Q

Does OCPD involve true obsessions and compulsions?

A

No

78
Q

The process by which sensory receptors and nervous system receive and represent stimulus energies in our environment

A

sensation

79
Q

The process of organizing and interpreting sensory information which enables us to recognize meaningful objects and events

A

perception

80
Q

This type of processing is data driven begins with incoming sensory information and continues upward to the brain where it’s perceived, interpreted, and stored

A

Bottom up

81
Q

This type of processing is concept driven and refers to processing that begins with the brain’s use of preexisting knowledge and expectations to interpret incoming sensory information

A

Top down

82
Q

What are the two types of photoreceptors

A

rods and cones

83
Q

Which type of photoreceptor works best in bright light and is responsible for visual acuity (sharpness and precise detail) and perception of color

A

Cones

84
Q

Which type of photoreceptor are most important for peripheral vision and are more sensitive to light so they are responsible for vision in dim light

A

Rods

85
Q

According to the trichromatic theory of color vision, the retina contains 3 types of color receptors (cones). What colors are there? This process applies to initial processing in the retina

A

Red, blue, green

86
Q

According to the opponent process theory, there are three types of opponent process cells. What are they? This process explains after images and 2 types of color blindness

A

red/green, blue/yellow, and white/black

87
Q

What is the most frequent type of color blindness and what gender does it most effect?

A

Red/green ; males (this genetic form of color blindness is caused by a recessive gene on the x chromosome; males get from their mothers)

88
Q

Who do females who have red/green color blindness inherit the gene from

A

They inherit the mutated X gene from both parents

89
Q

What type of color blindness is caused by an autosomal (non-sex) dominant gene so it effects both males and females equally

A

blue/yellow color blindness

90
Q

Binocular depth cues are responsible for depth perception of close objects. It includes what

A

Retinal disparity and convergence

91
Q

The tendency of our eyes to turn inward as an object gets closer and vice versa

A

Convergence (a binocular cue)

92
Q

Occurs because our two eyes see objects from 2 different views, and the closer the object the greater the disparity

A

Retinal Disparity (a binocular cue)

93
Q

Monocular cues depend on one eye and are responsible for depth perception of objects where

A

at greater distances

94
Q

The relative size of objects, the overlap of objects (interposition), linear perspective, texture gradients, and relative motion of objects (motion parallax) is related to depth perception of objects where and related to what types of cues

A

greater distances and monocular cues

95
Q

Perception of pain is moderated by what factors

A

current emotional state and past experiences of pain

96
Q

Which theory posits that small unmyelinated fibers are responsible for transmitting most pain signals to the brain and larger myelinated fibers transmit other sensory signals

A

Gate theory ; whether or not pain in transmitted by small fibers depends on a “gate” that is normally opened to incoming pain but closed to other sensory signals

97
Q

Gate theory posits that pain can be relieved by what?

A

Applying heat or cold to the affected area of by using distraction techniques (guided imagery or hypnosis)

98
Q

A condition in which sensations in one sensory modality spontaneously trigger an associated sensations in another modality

A

Synesthesia (most common type is grapheme-color synesthesia in which numbers or letters are associated with specific colors)

99
Q

The study of the relationship between the magnitude of physical stimuli and psychological sensations

A

Psychophysics (explanations provided by Weber’s law, Fechner’s Law, Steven’s Power Law and Signal Detection Theory)

100
Q

This law predicts that the just noticeable difference (JND) for a stimulus is a constant proportion, regardless of the intensity of the original stimulus (Exp: the proportion is always 2% for weight which means to notice a change in weight, a second object must be at least 2% lighter or heavier than the first object)

A

Weber’s law

101
Q

This law of psychological sensation and the magnitude of a physical stimulus is more accurate than Weber’s law for extreme intensities (also uses just noticeable difference JND)

A

Fechner’s law

102
Q

This psychophysics law is related to method of magnitude estimation and found that the relationship between physical stimuli and psychological sensation differs for different stimuli

A

Stevens Power Law

103
Q

This psychophysics theory has been applied to psychology (recognition, memory, attention, speech perception, and clinical diagnosis) and assumes that perception of a stimulus is the outcome of both sensory and decision making processes

A

Signal Detection Theory

104
Q

Signal detection theory posits that decision making processes are accompanied by some degree of uncertainty due to the presence of what ___________ as well as the perceiver’s _____________ and decision criterion

A

background noise (random neural activity affecting perception, levels of motivation and fatigue, distractions in the environment)
sensitivity

105
Q

The estimate of sensitivity related to signal detection theory

A

d’ (d-prime)

106
Q

characterized by symptoms associated with alcohol intoxication and include lack of muscle control, impaired balance and coordination, slurred speech, nystagmus (jerky eye movements), blurred or double vision

A

Ataxia

107
Q

This brain area plays a role in reward seeking, drug addiction, and motor control. Degeneration of dopamine producing wells here is a cause of slowed movement, tremors, rigidity, and mother motor symptoms associated with Parkinson’s

A

Substantia Nigra (midbrain)

108
Q

Relay station for sensory information to the cortex for all senses except smell. Also plays a role in coordination of sensory and motor functioning, language, speech, and declarative memory

A

Thalamus

109
Q

This syndrome is caused by a thiamine deficiency that’s often the result of chronic alcoholism that damages neurons in the thalamus and mammillary bodies. It’s primary symptoms are anterograde amnesia, retrograde amnesia, and confabulation (memory gaps with false information that a person believes is true)

A

Korsakoff Syndrome

110
Q

This subcortical brain structure consists of the caudate nucleus, putamen, nucleus accumbens, and globus pallidus and is involved in the initiation and control of voluntary movements, procedural and habit learning, cognitive functioning, and emotions.

A

basal ganglia

111
Q

The caudate nucleus, putamen, and nucleus accumbens are refered to as

A

striatum

112
Q

Damage here has been linked to mood disorders, schizophrenia, ADHD, OCE, Tourette’s, Huntington’s and Parkinson’s

A

Basal Ganglia

113
Q

This part of the limbic system plays an important role in the experience of emotions, recognition of fear and other emotions in facial expressions, acquisition of conditioned fear responses, evaluation of the emotional significance of events, and attachment of emotions to memories

A

Amygdala

114
Q

Vivid and enduring memories for surprising and shocking events

A

flashbulb memories (amygdala is involved in the formation of these)

115
Q

PTSD is associated with abnormal functioning of what

A

the amygdala and ventromedial PFC
hyperactivity in the amygdala and hypoactivity in the ventromedial PFC

116
Q

This syndrome is associated with sxs of hyperphagia (incessant sensation of hunger), Hyperorality, reduced fear, hypersexuality, and visual agnosia (psychic blindness). Research was done on Rhesus monkeys

A

Kluver-Bucy syndrome

117
Q

This structure plays a role in motivation, memory, and emotions including emotional reactions to pain. Damage here can cause people to experience pain but not be emotionally distressed by it.

A

Cingulate Cortex (contains cingulate gyrus and cingulate sulcus)

118
Q

This structure is responsible for transferring declarative memories from short term to long term memory and plays an important role in spatial memory

A

Hippocampus

119
Q

Research has found that the more extreme the traumatic event and the more severe the sxs of PTSD, the person is more likely to have reduced volume where

A

Hippocampus

Hippocampal abnormalities may contribute to MDD, bipolar, schizophrenia, and PTSD

120
Q

This area of the brain helps maintain many aspects of the body’s homeostasis including body temperature, blood pressure, hunger, thirst, and sleep through it’s effects on the autonomic nervous system, somatic nervous system, and endocrine system

A

hypothalamus

121
Q

Where are the mammillary bodies and suprachiasmatic nucleus located

A

hypothalamus

122
Q

This brain structure influences the pituitary gland by releasing oxytocin and producing hormones that stimulate or inhibit the release of hormones and initiates the development of secondary sex characteristics (gonadotropin releasing hormone)

A

hypothalamus

123
Q

This stimulates uterine contractions during childbirth and lactation after childbirth. This also plays a role in social bonding and affiliation, rust and cooperation, and social recognition

A

oxytocin

124
Q

This has been found to have beneficial effects for people with ASD, schizophrenia, and other disorders that involve deficits in recognizing emotions. However, there’s evidence that for healthy adults too much can make them overly sensitive to facial expression and cause them to misidentify them

A

oxytocin

125
Q

A cerebrovascular accident is caused by sudden interruption of blood flow to the brain the causes a loss in neurological functioning. This is also called a ______________

A

stroke

126
Q

Hypertension is the leading risk factor for this. Other factors include hardening of arteries, heart disease, diabetes, cigarette smoking, heavy alcohol consumption, obesity, older age, male gender, African American race, and family hx

A

Stroke/ cerebrovascular accident

127
Q

There are 2 types of TBIs, what are they? which one tends to cause more widespread damage?

A

Open and Closed ; Closed tends to cause more widespread damage

128
Q

When retrograde amnesia occurs due to a TBI, which are affected more? Recent long term memories or remote memories. Which memories are recovered first

A

Recent long term memories are affected more than remote memories; when memories return, the most distant past ones are recovered first

129
Q

Nausea, vomiting, headaches, sleep disturbances, depression, irritability, seizures, and inability to understand prosody (variations in rhythm, pitch, liming, and loudness of speech) are sxs of what?

A

Traumatic Brain Injury

130
Q

Post traumatic seizures usually occur within how long of a TBI and can often be treated successfully with anti-seizure meds

A

1 week
Post traumatic epilepsy occurs when seizure occur more than one week after a TBI

131
Q

For college students without ADHD who take psychostimulants, does it have an impact on attention? mood? GPA?

A

it has positive effects on attention and mood, but no beneficial effects on GPA

132
Q

Who spends the greatest proportion of their sleep time in REM

A

infants (about 50% of sleep time in REM)

133
Q

Diazepam, alprazolam, and lorazepam treat what?

A

benzodiazepines that increase GABA activity to treat anxiety, insomnia, seizures, and alcohol withdrawal

134
Q

Levodopa (L-dopa) is useful for treating what?

A

Parkinson’s (beginning stages)

It increases dopamine levels

More impact on bradykinesia than tremors

135
Q

What is considered first line pharmacological treatment for MDD

A

SSRI and SNRI

136
Q

Implicit memories are stored where in the brain

A

cerebellum and basal ganglia

both of these areas mediate motor responses (procedural memory)

137
Q

Risperidone and other second generation (atypical) antipsychotics are serotonin and dopamine ______________

A

Antagonists

block effects of dopamine and serotonin receptors

138
Q

This is known as the “body’s clock” because of it’s regulation of the sleep wake cycle and other circadian rhythms

A

superchiasmatic nucleus

139
Q

This kind of aphasia causes fluent (but paraphastic) speech, relatively impact comprehension, poor word repetition, and impaired naming

A

Conduction aphasia

caused by damage to the arcuate fasciculus

140
Q

Inability to recognize the faces of familiar people, and in some cases, the faces of pets and other familiar animals

A

prosopagnosia

141
Q

Parkinson’s disease is caused by a loss of ______ producing cells in the _________

A

Dopamine ; substantia nigra

142
Q

Tardive dyskinesia is more likely for which class of antipsychotics

A

First Generation

143
Q

This type of antidepressant treats Depression, neuropathic pain, anxiety, and OCD

A

Tricyclic Antidepressants (TCAs)

144
Q

Lack of interest in or recognition of one or more parts of one’s own body

A

asomatognosia

145
Q

involves inability to make precise, coordinate movements using a finger, hand, arm, or leg

A

limb-kinetic apraxia

146
Q

This is caused by damage to the left (dominant) parietal love and involves right-left disorientation, finger agnosia (inability to identify one’s own fingers) agraphia and acalculia

A

Gerstmann’s syndrome

147
Q
A

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