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NP Prep > Sexually transmitted diseases > Flashcards

Sexually transmitted diseases Flashcards

1
Q

The median time between initial HIV infection and eight is how many years

A

10 years

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2
Q

AIDS is defined by an absolute CD4 count of less than how many cells

A

200

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3
Q

Signs and symptoms that suggest aids are

A

Oral candidiasis i.e. thrush, fever, weight loss, diarrhea, cough, so it’s a breath, purple to bluish-red bumps on the skin, and certain infections

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4
Q

What infection causes the most deaths in HIV

A

Pneumocystis jirovecii

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5
Q

And acute and brief illness that occurs in 50% to 80% of persons within a few weeks of exposure to the HIV virus

A

ACute retro viral syndrome

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6
Q

Is a cute retro viral syndrome infectious

A

Yes due to high viral load greater than 100,000 copies ML and high concentration of virus in general secretions. The initial immune response made me make mono nucleus low-grade fever, fatigue, generalized red rash, and lymphadenopathy.

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7
Q

What would an HIV anti-body test show with a cute retro viral syndrome

A

Negative possibly.

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8
Q

If strongly Suspect acute HIV infection, order

A

Polymerase chain reaction

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9
Q

What is the usual time to develop antibodies after HIV exposure

A

Three months

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10
Q

Is universal screening for HIV recommended

A

Yes

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11
Q

Screening test is An Elisa

A

HIV

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12
Q

Produces a malodorous vaginal discharge

A

BV

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13
Q

DNA probe is used for screening

A

Gonorrhea and chlamydia

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14
Q

RPR is used for screening

A

Syphilis

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15
Q

FTA-ABS, MHA-TP Are diagnostic test for this STI (treponema pallidum)

A

Syphilis

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16
Q

Treated with 2.4 million units of penicillin IM. This treatment is for early disease

A

Syphilis early

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17
Q

Treated with three doses of benzathine penicillin spaced out weekly intervals. Hint treatment for late or unknown duration of this disease

A

Syphilis later

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18
Q

Associated with positive whiff-amine test

A

BV

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19
Q

Confirmatory test is western blot

A

HIV

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20
Q

Treated with metronidazole 500 mg b.i.d. for seven days

A

BV and trichomonas

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21
Q

Etiologic agent is a virus

A

HIV, herpes and HPV

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22
Q

Clue cells present on saline wet mount

A

BV

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23
Q

This STD produces a discharge

A

HPV, gonorrhea, chlamydia, BV, herpes, trichomonas

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24
Q

Absent or decreased lactobacilli

A

BV

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25
Q

Wet prep used for diagnosis

A

Trichomonas, BV, and yeast

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26
Q

Treated with acyclovir, valacyclovir, and famciclovir with equal efficacy

A

Herpes

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27
Q

Trading with 2 g of metronidazole as a single dose

A

Trichomonas

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28
Q

May be associated with involuntary weight loss

A

HIV

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29
Q

Can produce rash on palms of the hands soles of feet

A

Syphilis

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30
Q

What STI is associated with a positive chandelier test

A

PID

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31
Q

What is a positive chandelier test

A

Tender cervical area

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32
Q

What STD produces a chanere

A

Syphilis

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33
Q

What STD produces vesicles on mucous membranes

A

Herpes type one

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34
Q

What are the screening test for HIV

A

EIA or ELISA

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35
Q

What is the confirmatory test for HIV

A

Western blot

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36
Q

When do you do an HIVRNA

A

If the screening tests are negative or if a cute retro viral syndrome is suspected

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37
Q

If you receive a patient that is HIV-positive what records do you need to request

A

Treatment history, prior drug resistance testing, virologic and immune responses to treatment

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38
Q

In HIV infected patients what disease progresses faster

A

Liver disease and it affects the choice of anti-retroviral therapy

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39
Q

What is a significant risk factor for reactivation of latent TB

A

HIV

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40
Q

What vaccines do HIV infected patients need annually

A

Pneumococcal, tetanus, hepatitis A and B, and flu

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41
Q

Do you administer alive or attenuated vaccine’s to HIV infected patients

A

No

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42
Q

How often do you obtain a CD4 count in an HIV infected patient

A

First CD4 count baseline then repeat once and usually every 3 to 4 months.

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43
Q

How often to check viral load and HIV infected patient

A

Need baseline and then every 3 to 4 months

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44
Q

If on ART, How long does it take for the viral load to be undetectable

A

Within 16 to 24 weeks of therapy

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45
Q

What other screening tests do HIV infected patients need

A

Hepatitis A, B and C, glucose and lipid panel, and STD assessment

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46
Q

If an HIV infected patient has a CD4 count of less than 200 what are they at risk for

A

Pneumocystis carinii

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47
Q

What is the prophylactic treatment for pneumocystis carinii with a CD4 count less than 200

A

TMP-SMX

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48
Q

What is the prophylactic treatment for pneumocystis carinii with a cd4 count less than 50

A

MAC

Azithromycin, clarithromycin once daily

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49
Q

A patient with new onset HIV would present with what symptoms

A

Fever, pharyngitis, nonpruritic macular skin rash, malaise, headache, lymphadenopathy

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50
Q

A 20-year-old male has suspected acute infection of HIV. How should he be screened?

A

What a western blot

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51
Q

Anemia, leukopenia, thrombocytopenia, involuntary weight loss, persistent diarrhea, severe chronic fatigue, dementia, peripheral neuropathy, herpes zoster, presence of opportunistic infections are all assessment findings for

A

Established HIV

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52
Q

Sexually active adult from high-risk population complains of petechial or pustular skin lesions of hands and soles, swollen, red, and tender joints in one joint such as the knee. Maybe accompanied by signs of STD i.e. cervicitis, urethritis.

A

Gonorrhea

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53
Q

Poly microbial clinical syndrome resulting from the replacement of the normal vaginal flora with high concentrations of anaerobic bacteria. Associated with multiple sex partners, new partners, douching, IUCs. Sexually associated not sexually transmitted

A

BV

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54
Q

What is the condition you are at Increased risk of acquiring STDs, UTIs, post gynecologic surgery infection, and preterm labor

A

Bacterial vaginosis

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55
Q

What are the causes of organisms of bacterial vaginosis

A

Prevotella, Mobiluncus, G. vaginalis, atopobium, and others

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56
Q

Asymptomatic in about 50% of women, profuse grayish white malodorous vaginal discharge, unpleasant, fishy, or musty vaginal odor, increased odor after intercourse, pruritus and burning of Vulvo vaginal area

A

Bacterial vaginosis

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57
Q

Homogeneous, white, discharge coating vulva/vagina, vaginal pH of greater than 4.7, fishy odor of vaginal discharge before or after addition of KOH, clue cells on Micro scopic exam, one or more epithelial cells coated with bacteria, obscuring borders

A

BV

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58
Q

How should BV this be treated

A

Screen for other STDs, metronidazole 500 mg b.i.d. for seven days. Avoid Sexual intercourse until after treatment. Condom use increases cure rates. Avoid douching to prevent reoccurrences. Treat symptomatic patients including pregnant patients

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59
Q

What medication should be avoided in pregnancy

A

Tinidazole As it is category C

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60
Q

When taking metronidazole or tinidazole what precautions need to be taken

A

No alcohol until 24 hours after her last dose

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61
Q

With recurrent bacterial vaginosis what must be ruled out

A

HIV

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62
Q

What is the most frequently reported infectious disease in the United States

A

Chlamydia

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63
Q

At what age is chlamydia most common

A

Less than 25 years old

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64
Q

What can cause PID, ectopic pregnancy, infertility, and pelvic pain

A

Chlamydia

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65
Q

Mucopurulent cervicitis, edematous, congested, friable cervix, vaginal discharge, cervical motion tenderness, dysuria/urethritis, salpingitis, proctitis, epididymitis, abnormal vaginal bleeding, pelvic pain, prostatitis are all assessment findings of

A

Chlamydia

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66
Q

How do you diagnose chlamydia

A

NAAT, DNA probe, culture, urine testing

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67
Q

Who should be screened for chlamydia and how often

A

Screen all sexually active females less than 25 years of age and all pregnant women. Re-screen in three months after treatment due to higher rates of reinfection. Follow up in one month if pregnant and symptoms persist they can cause reinfection

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68
Q

How do you treat chlamydia In a pregnant patient

A

Azithromycin 1 g or early times one Or amoxicillin 500 mg orally TID times seven

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69
Q

How do you treat a non-pregnant patient for chlamydia

A

Doxycycline 100 mg b.i.d. for seven days

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70
Q

When treating a male for chlamydia and epididymitis is involved how do you treat

A

Doxycycline times 10 to 14 days

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71
Q

When being treated for chlamydia what measures should be taken

A

Refrain from intercourse for seven days after treatment is completed. Referral sexual contacts in last 60 days.

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72
Q

A sexually-transmitted infection producing a purulent inflammation of mucous membranes. Underdiagnosed in US. Uncommon among monogamous heterosexual populations. Risks are men having sex with men, IV drug use and other high-risk behaviors

A

Gonorrhea

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73
Q

In males a finding of purulent urethral discharge, dysuria, testicular pain and some asymptomatic symptoms are assessment findings of

A

Gonorrhea

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74
Q

In females findings of asymptomatic symptoms, endocervical discharge, dysuria, Bartholin’s gland abscess, abnormal vaginal bleeding, abdominal pelvic pain, adnexal tenderness, and cervical motion tenderness are all assessment findings of

A

Gonorrhea

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75
Q

What are the diagnostic studies for gonorrhea

A

Gram stain of exudate, DNA probe, NAAT, culture of exudate or joint aspirate on Thayer-Martin agar (chocolate agar)

76
Q

How do you treat gonorrhea

A

Ceftriaxone i.e. Rocephin 250 mg or Cefixime. Test of cure required two weeks. Plus azithromycin 1 mg oral or doxycycline 100 mg oral b.i.d. for seven days and this is for dual purpose of the chlamydia and gonorrhea

77
Q

Does a minor require parental consent for STD care

A

No

78
Q

Red colored bumpy surface that emerges out of the cervical os

A

Cervical ectropion

79
Q

Epididymitis and prostatitis are possible sides of which type of infection

A

Chlamydia

80
Q

What STD causes Reiters syndrome in males

A

Chlamydia

81
Q

How do you collect a urine sample for chlamydia test

A

Collect the first part of the urine stream 15 to 20 ML

82
Q

What antibiotic is associated with nausea, G.I. upset, photosensitivity, and stains growing tooth enamel in fetuses

A

Doxycycline

83
Q

Is doxycycline safe to use in pregnancy

A

No category D

84
Q

A gram-negative bacterium that infects the urinary and general tracts, rectum, and pharynx. Unlike chlamydia this disease can become systemic or disseminated if left untreated

A

Gonorrhea

85
Q

If a patient is positive for gonorrhea what must they be co-treated for

A

Chlamydia

86
Q

Sexually active teenage to young adult female complains of purulent green colored vaginal discharge. Speculum examination reveals purulent discharge on the cervix, which may be friable. Males will have penile discharge and dysuria and may report staining of underwear with purulent discharge. History of new partner or multiple sex partners. In consistent condom use.

A

Gonorrhea

87
Q

Treat male partners of women with PID if sexual contact during How many days preceding the patient’s symptoms

A

60 days and avoid sex until both finished treatment and no longer have symptoms

88
Q

What may reduce the risk of PID

A

Oral contraceptives

89
Q

Chlamydia and/or gonococcal and infection of the liver capsule resulting in expensive scarring between the liver capsule and abdominal contents. Scars look like a violin strings. A complication of disseminated gonorrhea or PID

A

Fitz-Hugh-Curtis Syndrome (perihepatitis)

90
Q

Sexually active female with symptoms of PID complains of right upper quadrant abdominal pain and tenderness on palpation. The liver function test is normal.

A

Fitz-Hugh-Curtis Syndrone

91
Q

How do you treat Fitz-Hugh-Curtis syndrome

A

Treated as a complicated got a real/chlamydial infection for 14 days

92
Q

Acute febrile reaction that can occur during the first 24 hours after treatment. More likely to occur after treatment for early syphilis. Look for fever, chills, headache, myalgias. And immune mediated reaction that usually resolves spontaneously. Treatment is supportive.

A

Jarisch-Herxheimer Reaction

93
Q

More common in males. And immune mediated reaction secondary to infection with certain bacteria i.e. chlamydia that spontaneously resolved. Treatment is supportive i.e. NSAIDs

A

Reiters syndrome

94
Q

A male with current history of chlamydia genital infection i.e. urethritis complains of red and swollen joints that come and go and ulcers on the skin of the glans penis

A

Reiters syndrome

95
Q

Mneumonic. I can’t to see, Pee, or climb up a tree

A

Reiters syndrome

96
Q

If a patient has chlamydia do you treat for gonorrhea

A

No

97
Q

What drug is used for patients that are pregnant who have chlamydia

A

Azithromycin and test of cure after treatment

98
Q

When do you use a GenProbe

A

Only for cervix or urethral chlamydia or gonorrhea symptoms

99
Q

If STD symptoms with new onset of swollen red knee on side, maybe caused by

A

Disseminated gonorrheal infection

100
Q

Is PID a clinical diagnosis

A

Yes i.e. cervical motion tenderness. Even if gonorrhea and chlamydia test are negative treat a sexually active patient who has signs and symptoms of PID

101
Q

After treating a patient for PID when should the patient follow up

A

2 to 3 days and perform vaginal bimanual examination. Symptoms should be improve within 2 to 3 days

102
Q

For STDs that are treated with azithromycin such as chlamydia or syphilis what must the patient be instructed

A

Patient and partner are not to have sex for at least seven days afterwards

103
Q

Sexually transmitted disease which can infect vagina, Skene’s ducts, and lower GU tract in women and lower GU tract in men

A

Trichomonas

104
Q

Asymptomatic sometimes for decades, that will discharge frothy, yellow green, vulvar irritation, dysuria, cervical petechiae i.e. strawberry cervix

A

Trichomonas

105
Q

Asymptomatic, urethral discharge, dysuria, epididymitis, prostatitis are all assessment findings in males for

A

Trichomonas in males

106
Q

Wet prep Showing trichomonads as flagellated, motile cells slightly larger than white blood cells and polymorphonuclear cells. Vaginal pH is greater than 4.6. These are diagnostic studies for

A

Trichomonas

107
Q

Affirm and Osom are POC testing for

A

Trichomonas

108
Q

How do you treat Trichomonas

A

Metronidazole i.e. Flagyl 2 grams single-dose orally which is OK and in all trimesters of pregnancy or Tinidazole 2 grams single-dose orally category C for pregnancy or metronidazole 500 mg oral b.i.d. for seven days for HIV-positive. Abstinence until treated completed. Treat sexual partners. Abstain from drinking alcohol 72 hours post RX

109
Q

Sexually transmitted disease characterized by sequential stages and involving multiple system. Stages are primary secondary Latent and teritiary

A

Syphilis

110
Q

Chancre at site of inoculation begins as papule then also ulcerates with a hard edge and clean yellow base, indurated and painless usually located on the genitalia, maybe solitary or multiple. Persists 1 to 5 weeks and heals spontaneously. Chancre may go unnoticed in females. And regional lymphadenopathy

A

Primary syphilis

111
Q

Rash that is bilaterally symmetrical, polymorphic, nonpruritic, frequently on soles and palms, and usually persists for 2 to 6 weeks then spontaneously resolved. Condyloma lata moist, pink, peripheral warty lesions present on glans, perianal, vulvar areas, and intertriginous areas.

A

Secondary syphilis

112
Q

In this stage of this STD the patient is asymptomatic

A

Latent syphilis

113
Q

And this stage of this STD patient presents with cardiac manifestations such as aortic valve disease, aneurysms, neurological manifestations such as meningitis, encephalitis, dementia and integumentary manifestations such as gummas and orthopedic manifestation such as Charcot joints and osteomyelitis

A

Tertiary syphilis

114
Q

What is the screening test for syphilis

A

RPR or VDRL

115
Q

For patients with syphilis prophylaxis for all sexual contacts should be given in the last how many days

A

90

116
Q

What is the treatment for syphilis

A

Benzathine penicillin G 2.4 million units IM in adults and children 50,000 units per kilogram IM

117
Q

What is the treatment for neurosyphilis

A

Aqueous Crystaline penicillin G IV or procaine penicillin with probenecid IM

118
Q

What is the treatment for congenital syphilis

A

Aqueous Crystaline penicillin G IV or procaine penicillin IM

119
Q

If Syphilis patient is allergic to penicillin and compliance or follow what is uncertain what is recommended

A

Desensitization

120
Q

When should you scream A patient for syphilis

A

Screen for syphilis if HIV infection, men who have sex with men, presence of any general ulcer, previous STD, pregnancy, IV drug use or a high-risk

121
Q

Treponema infection is associated with

A

Syphilis

122
Q

What is gumma in syphillis

A

Soft tissue tumors

123
Q

What is the diagnostic test for syphilis

A

Fluorescent antibody absorption antibody (FTA-ABS) Directs fluorescent antibody testing i.e. DFA – TP, dark field microscopy

124
Q

What is the order of screening test for syphilis

A

First order screening test is RPR or VDRL. If reactive, next step is to confirm with FTA – ABS.

125
Q

If both the RPR and FTA-ABS or positive

A

This is diagnostic for syphilis

126
Q

When do you recheck the RPR or VDRL after treatment

A

At six and 12 months

127
Q

How do you treat patients with Latent and teritiary Syphillis

A

Referral to infectious disease specialist

128
Q

RPR and VDRL are screening tests for

A

Syphilis

129
Q

If RPR or VDRL a positive how do you confirm

A

FTA – ABS (treponemal test)

130
Q

RPR or VDRL shows how much of a decrease in titers if patient is responding to treatment

A

Fourfold or higher

131
Q

All patients with syphilis or men having sex with men must be tested for

A

HIB

132
Q

maculopapular rash on the palms and soles or signs and symptoms of

A

Secondary syphilis

133
Q

Condyloma Lata is associated with

A

Secondary syphilis

134
Q

False positive RPR can be caused by

A

Autoimmune diseases, chronic or acute disease

135
Q

The most common criterion collection is used to diagnose PID is

A

Cervical motion tenderness

136
Q

In the United States what type of HIV is most common and what type of HIV is most common in Africa

A

In the United States it’s HIV-1 and in Africa is HIV 2

137
Q

Number of HIV RNA copies in one ML of plasma. Test measures actively replicating HIV virus, progression of disease and response to anti-retroviral treatment

A

Viral load

138
Q

Used to stage HIV infection and to determine when to start prophylaxis. Check at the same time of the day using the same laboratory each time

A

CD4 T cells counts

139
Q

What is the screening test for HIV

A

ELISA Enzyme Linked Immunosorbent Assay

140
Q

What is the confirmatory test for HIV

A

Western blot

141
Q

What antibodies are detected by the Western blot and ELISA

A

IgG antibodies

142
Q

If the EL I S a and western blot tests are both positive what is the next test to order

A

HIV PCR – HIVRNA

143
Q

PCP prophylaxis one CD4 is less 200 is

A

Bactrim P.O. daily

144
Q

Went a CD4 count is less than 100 Cells what kind of cause

A

Toxoplasma Gondii infections (Protozoa)

Causes brain abscesses. Avoid cleaning cat litter boxes and eating undercooked meats

145
Q

When a patient is on HAART and ART how should their viral load be monitored

A

Check every 1 to 2 months until viral load is undetectable then every 3 to 4 months

146
Q

What are the recommended vaccines for HIV and AIDS patients

A

HIV and AIDS patients can receive inactivated vaccines such as hepatitis A, hepatitis B, annual flu vaccine, pneumococcal vaccine, TD/TDAp

147
Q

Can HIV patients receive some live vaccines

A

Yes but if CD4 count is less than 200, It is contra indicated.

148
Q

What live virus vaccines are recommended for asymptomatic HIV patients

A

MMR vaccine is recommended for asymptomatic HIV infected children when the CD4 count of greater than 200 and varicella vaccine is recommended for seronegative children and adults if CD4 is greater than 200

149
Q

What is some HIV education teaching points

A

Do not handle cat litter or eat uncooked lamb, beef, or pork as this is a risk for toxoplasmosis. Avoid Bird stool, turtles and other amphibians, and use gloves or avoid gardening.

150
Q

When is PCP prophylaxis initiated in HIV patients

A

CD4 less than 200

151
Q

If a patient with HIV is allergic to sulfa what drug should be used for PCP prophylaxis

A

Dapsone 100 mg PO daily

152
Q

What is used for both prophylaxis and treatment of PCP

A

Bactrim DS

153
Q

When do HIV infected pregnant women start treatment

A

Start AZT in the second trimester

154
Q

If a patient presents with hairy leukoplakia on the tongue, recurrent candidiasis thrush what must be ruled out

A

HIV

155
Q

What is the safest drug for HIV patients that are pregnant

A

Zidovudine (Retrovir ZDV AZT)

156
Q

Can patients with HIV breast-feed

A

No

157
Q

When do newborns start HIV medications

A

Newborns start treatment with zidovudine AZT within the first 6 to 12 hours of delivery

158
Q

What is another name for genital warts

A

Condyloma acuminata

159
Q

Do HIV positive women need more frequent pap testing

A

Yes every six months to monitor

160
Q

Specialize microscope for evaluating and treating cervix

A

Colposcopy

161
Q

What is the gold standard in diagnosing cervical cancer

A

Biopsy of cervical tissue

162
Q

The majority of general HPV external warts are caused by which HPV strain

A

HPV 6 or 11

163
Q

How are genital warts treated

A

Imiquimod (Alfara), cryo-procedures, or podofilox (Condylox) contraindicated in pregnancy

164
Q

Asymptomatic shedding also occurs intermittently and patient is still contagious

A

Herpes simplex

165
Q

What are prodrome herpes simplex symptoms

A

Itching, burning, and tingling

166
Q

Sudden onset of groups of small vesicles sitting on an erythematous base. Easily ruptures and it’s painful. Primary episode more severe and can last from 2 to 4 weeks. Vesicle fluid and crust are contagious.

A

Herpes simplex

167
Q

What is the diagnostic test for herpes

A

Herpes virus culture or RPR assay for HSV one and HSV-2 DNA (more sensitive)

168
Q

What is an older test for herpes diagnosis

A

Tzanck Smear

169
Q

For all cases of genital ulcers always rule out

A

Syphilis and HSV infection

170
Q

What is the first episode treatment for herpes

A

Zovirax five times a day or Valtrex three times a day or famvir b.i.d. for 7 to 10 days

171
Q

How do you treat episodic or herpes flareups

A

Zovirax or Valtrex or Famvir BID for five days

172
Q

How do you use Imiquimod for genital warts

A

Apply a thin layer three times a week at bedtime for up to 16 weeks. Do not cover with dressing. Leave cream on skin for 6 to 10 hours. Wash off skin with soap and water after. Side effects include irritation, ulceration, erosions, and hypo pigmentation

173
Q

What HPV strains are carcinogenic

A

16 and 18

174
Q

How do you Evaluate a patient after sexual assault

A

Prophylactic postexposure treatment if refused then screen
NAATS for gonorrhea, chlamydia.
Wet mount and culture for trich, BV, Candida.
Serum HIV, hepatitis B and C, syphilis, consider HSV type 2 i.e. IgG

175
Q

What is the appropriate follow-up care for a patient after sexual assault

A

1 to 2 weeks repeat the swab and wet mount.

Repeat the serology at six weeks, three and six months

176
Q

What is the appropriate aftercare for A Sexual assault patient

A

Hepatitis B immunization, HPV vaccination.
Empiric treatment for chlamydia, gonorrhea, trichomonas, and BV.
Consider pep for HIV with zidovudine.
Emergency contraception i.e. pregnancy test

177
Q

What medication should be given to patients after sexual assault or exposure

A

Ceftriaxone 250 mg IM plus metronidazole 2 grams oral plus azithromycin 1 g oral or doxycycline 100 mg b.i.d. for seven days

178
Q

How long should a patient be treated with antibiotics if he has prostatitis secondary to an STD

A

14 days or longer

179
Q

According to the CDC recommendations for non-occupational HIV exposure, a screening interval of how many weeks is recommended following initial negative testing

A

4-6 weeks

180
Q

What Risk factor has the highest impact on HIV transmission

A

Viral load

181
Q

A 32 year-old female was exposed to HIV after sexual intercourse. When do the majority of patients seroconvert if they are going to do so

A

Within three months

182
Q

Chancroid is considered a cofactor for transmission of

A

HIV

183
Q

HPV infection of the larynx has been associated with

A

Laryngeal Neoplasma

184
Q

Complication of having pelvic inflammatory disease that was caused by vaginal infection such as gonorrhea or chlamydia

A

Fitz-Hugh-Curtis

185
Q

How do you reveal subclinical lesions on the penile skin of a patient that presents with HPV infection

A

Apply acetic Acid to the penile shaft and look for Ace to white changes

186
Q

The diagnosis of human papilloma virus infection in males is usually made by

A

Clinical appearance

187
Q

An appropriate initial treatment for external genital warts caused by HPV in a non-pregnant patient is

A

Topical trichloroacetic acid (TCA)

NP Prep (20 decks)

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