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USA-FNP: CMN 571 > unit 3: adulthood > Flashcards

unit 3: adulthood Flashcards

1
Q

USPSTF reccs for screening for AAA for CVD PREVENTION

A

“selectively” for NONSMOKING men under 65-75
“routine = 1 time US for men 65-75 w HX of smoking
none for women

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2
Q

USPSTF low dose statin use for CVD PREVENTION recc’d for use in pts:
A) aged _______
B) have _______ risk factors for CVD
C) have a 10y CV risk of _____ or more

A

A) 40-75
B) one or more (lipids, DM, HTN, smoking)
C) 10%

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3
Q 
USPSTF low dose ASA reccs for CVD AND COLORECTAL CA PREVENTION
A) adults aged \_\_\_\_
B)\_\_\_\_\_% or greater 10y risk
C) NOT at risk for \_\_\_\_\_\_
D) life expectancy of at least \_\_\_\_y
E) pt willingness
A 
A) 50-59
B) 10%
C) bleeding
D) 10y
E) pt willingness
MUST BE ALL OF THE ABOVE
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4
Q

USPSTF BP screening reccs for CVD PREVENTION:

A

everyone 18y and over. need to screen outside of office before initiating treatment.

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5
Q

USPSTF recs for counseling for CVD prevention

A

offer or refer adults who are overweight or obese AND have additional CVD risk factors to intensive behavioral counseling

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6
Q

USPSTF screening for DM for CVD prevention

A) all adults aged _____ & who are ______

A

A) 40-70 & overweight/obese

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7
Q

USPSTF screening for smoking for CVD prevention

A

ask ALL adults about tobacco use & encourage cessation. treat pharmacologically if needed.

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8
Q

smoking is linked to mutation of the _____ gene

A

p53

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9
Q

new antilipid meds (two of them) expensive, last resort, can lower LDL by 50-60%

A

evolocuman, alirocumab

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10
Q

_____ BP (sys/dia) is a better predictor of morbid events than _____ (sys/dia)

A

SYSTOLIC is a better predictor than DIASTOLIC

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11
Q

aspirin reduces risk of death from several cancers including:

A

colorectal, esophageal, gastric, breast, prostate, possibly lung

  • potential risks outweigh benefits for those w >10% 10y risk
  • antioxidant suppls do NOT reduce risk (vit E, C, beta-carotene)
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12
Q

primary prevention for osteoporosis

A

sufficient dietary calcium intake, Vitamin D supplementation, exercise

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13
Q

screening for osteoporosis recc’d for women ages:

A

65+

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14
Q

treatment for osteoporosis is: _______ which carry a risk of _______

A

biphosphonates.

femoral head fx, rare osteonecrosis of JAW

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15
Q

top two “contributing lifestyle FACTORS of preventable death”

A

tobacco & physical inactivity

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16
Q

5 A’s =

A 
Ask 
Assess
Advise
Assist
Arrange
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17
Q

metabolic syndrome is defined as presence of any three of 5 factors

1) waist msrmnt over ______
2) triglyceride levels _____+
3) HDL cholesterol less than _____/_____ (M/F)
4) BP over _____
5) fasting blood glucose over _____

A

1) 40 men, 35 women
2) 150
3) 40 men, 50 women
4) 130/85
5) 100

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18
Q

metabolic syndrome is defined as presence of 3+ of what 5 factors?

A

1) waist measurement >40 men, 35 women
2) triglyceride levels >150
3) HDL cholesterol <40 men, 50 women
4) BP >130/85
5) fasting blood glucose >100

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19
Q

lorcaserin is a pharmacologic intervention for:

A

weight loss in pts w BMI>30
OR
BMI >27 + one obesity-related condition (HTN, DM, HLD)

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20
Q

bariatric procedures reserved for pts w BMI >

A

40
OR
BMI 35-40 + one high-risk comorbid condition (OSA, pickwickian syndrome, cardiomyopathy, severe DM)

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21
Q

______ is the most common cause of injury-related deaths in older adults

A

accidental falls

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22
Q

all women ages _____ and up need to be screened for intimate partner violence and what is the question to ask?

A

childbearing age.

*at any time, has a partner ever hit you, kicked you or otherwise physically hurt you?” (per EB’s guide)

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23
Q

cues to mistreatment of older adults include:

A

ill-kempt appearance of pt, recurrent urgent-care visits, missed appts, suspicious physical findings, implausible explanations for injuries

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24
Q

what is the AUDIT tool?

A

Alcohol Use Disorder Identification Test: questions quantity & frequency of ETOH consumption, ETOH dependency symptoms, & ETOH-related problems

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25
Q

3 FDA approved drugs for ETOH dependence:

A

1) disulfiram
2) naltrexone
3) acamprosate

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26
Q

buprenorphine

A

decreases s/s of withdrawal from opioids and is effective in reducing concomitant cocaine + opioid abuse
*risk of OD is lower than methadone & preferred in pts at high risk of methadone toxicity

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27
Q

framingham risk calculator for women’s CVD risk? (LOOK UP)

A

look up

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28
Q

other breast cancer risk models:

A

the gail model, ontario family history risk assessment tool, the manchester scoring system, the referral screening tool, the pedigree assessment tool, the family history screen

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29
Q

PHARMACOLOGIC primary prevention for breast cancer in high risk pts

A

tamoxifen & raloxifene (weigh risks & benefits)

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30
Q

osteopenia is classified as BMD (bone mineral density) between ____ & ____ standard deviations below the mean for young adults

A

1-2.5

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31
Q

osteopenia is classified as BMD (bone mineral density) between ____ & ____ standard deviations below the mean for young adults

A

1-2.5 (T score of -1 to -2.5)

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32
Q

osteoporosis is classified as BMD over ___ standard deviations below the mean for young adults

A

2.5 (T score below -2.5)

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33
Q

severe osteoporosis is classified as BMD below _____ AND a ______

OR as a T score below _____

A
  • 2.5, fracture

- 3.5

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34
Q

FRAX (fracture risk assessment tool) predicts?

A

a woman’s 10y risk of having any osteoporotic fractures & the 10y risk of a hip fracture.

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35
Q

risk factors for osteoporosis include:

A

age, gender, personal hx of fracture, parental history of hip fracture, low BMI, use of oral corticosteroids, secondary osteoporosis (?? drug related?), current smoking, alcohol intake of 3+ drinks/day
**HELPFUL when deciding which women would benefit from treatment.

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36
Q

STD primary prevention: postponing sexual _____

A

debut

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37
Q

STD primary prevention: limiting ______

A

sexual partners

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38
Q

STD primary prevention: regular _____ or ______ condom use

A

latex or polyurethane

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39
Q

STD preventions: immunizations

A

guardasil, hep B, hep A (if indicated), what else?

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40
Q

consistent use of ______ by _______ sex partners is one of the most effective methods of preventing STDs

A

latex or polyurethane condoms by male sex partners

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41
Q

consistent condom use has shown to reduce risk of transmission of _______ by 80-95%

A

HIV

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42
Q

consistent condom use can prevent transmission of _____, _______, & ______

A

gonorrhea, chlamydia, trichomonas

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43
Q

condom use decreases risk of ______ infection

A

HPV

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44
Q

____ based lubricants can weaken latex, so ______ based lubricants should be used with latex condoms

A

oil, water

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45
Q

STD secondary prevention: screen for

A

Gonorrhea, Chlamydia, HIV, HEP B & C, syphilis

GCHBCS (go cardinals! home base for carlos syphil!)

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46
Q

STD tertiary prevention: limit ____ of disease, prevent _____

A
  • impact of disease: sequalae of PID, chronic pelvic pain, infertility
  • prevent transmission
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47
Q

quadravalent HPV vaccine:

A

protects against HPV types 6,11,16,18

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48
Q

bivalent HPV vaccine:

A

protects against HPV types 16,18

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49
Q

nine-valent HPV vaccine:

A

protects against HPV types 6,11,16,18,31,45,52,58

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50
Q

HPV routine vaccination:

A

girls 9-12
boys 11-12
adolescents <15 = 2 doses

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51
Q

HPV catch up:

A

after age 15 considered catch up
girls :up to age 26
boys: up to age 21

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52
Q

HPV vaccine prevents against:

A

genital warts, persistent HPV infections, and cervical intraepithelial neoplasia
**protection not proven for strains not included in virus or previously acquired by host

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53
Q

Hep B vaccine for STD prevention: routine schedule

A

given routinely to people ages 0-18. time btwn doses depends on which type of vaccine being given

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54
Q

Hep B vaccine for STD prevention: catch up sched indications

A

2-3 doses depending on type of vaccine.

adults without vaccination history, those at risk for sexual or blood-borne transmission, DM

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55
Q

Hep B rates are higher in _______ pts

A

DM. outbreaks AW blood glucose monitoring

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56
Q

hep A catch up for adults

A

2-3 doses depending on type of vaccine
*for adults requesting it (travelers, HCW, HIV+, homeless, IVDU, MSM, lab workers or those who may be exposed on the job)

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57
Q

HIV prevention

A

pre- exposure prophylaxis for those at high risk

post exposure prophylaxis can decrease risk

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58
Q

HSV prevention

A

acyclovir daily for those infected to reduce transmission

condoms

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59
Q

victims of sexual assault STI treatment

A

empiric =
*G&C = ceftriaxone 250mg IM
*trichomoniasis = azithro 1g PO AND metro or tinidazole 2g PO
*Hep B vaccine x3 = now, 1m, 6m
*HIV = post-exposure prophylaxis
HPV x2 = for age eligible pts not previously vax’d

IF A WOMAN DECLINES EMPIRIC TX THEN TEST FOR:

  • G&C, trich, blood test for syphillis/hep B/HIV
  • ideally w/i 72h s/p assault
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60
Q

USPSTF depression screening

A

only screen if you have HELP readily available to ensure accurate dx, tx, and f/u.
*if these supports are not in place DO NOT SCREEN

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61
Q

SECONDARY prevention: depression

A

PHQ2, PHQ9, Beck

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62
Q

TERTIARY prevention: depression

A

pharm, CBT, intervention groups

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63
Q

IPV primary prevention & risk factors

A

change modifiable risk factors

*<35yo, female, pregnancy, single/divorced/separated, ETOH or drug use in either partner, smoking, poverty

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64
Q

secondary prevention IPV

A

appropriate screening @ visits

counseling

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65
Q

tertiary prevention IPV

A

counseling to change behavior of perpetrator (no evidence to support),
social services to assist w legal issues,
permanent plans/solutions to limit contact

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66
Q

USPSTF recs screening for IPV

A

all women of childbearing age. provide or refer to intervention services

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67
Q

interventions for IPV

A
  • encourage woman to leave when safe,
  • ensure that she has a safe place to go
  • counsel her to assess risks/create safety plan
  • victim referal to social services & national domestic abuse hotline (1-800-799-SAFE)
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68
Q

do clinicians have a duty to report suspected or confirmed IPV?

A

No, it varies by state but if the woman is COMPETENT it is not req’d in MOST states

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69
Q

screening tools for IPV:

A
  • HITS (hurt, insult, threaten, scream)
  • WAST (women abuse screening tool)
  • PVS (partner violence screen)
  • AAS (abuse assessment screen)
  • WEB (women’s experience w battering) scale
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70
Q

inclusion of WHAT specific question when taken w the MEDICAL HISTORY is proven to increase identification of IPV?

A

“have you ever been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?”

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71
Q

clues that suggest abuse:

A

injury/explanation mismatch, frequent visits to ED, somatic complaints (chronic HA, abd pain, fatigue), may be vague about s/s, may avoid eye contact, abusing partner may answer questions for the pt or refuse to leave the room

72
Q

it is imperative the pt have the opportunity to?

A

speak with the clinician ALONE

73
Q

it is imperative the clinician document what?

A
  • the pts description of the event (for legal purposes)
  • all physical findings to reveal injuries usually on central areas of body, forearms if defending, bruises in VARIOUS STAGES OF HEALING
  • PTSD, depression, anxiety, ETOH/substance may develop in victims
74
Q

DASH diet: choose foods low in ______ & _____and rich in _____, _____, ______, ______, _______

A

saturated/trans fats, sodium

potassium, calcium, magnesium, fiber, protein

75
Q

recc’d daily servings GRAINS

A

6-8

76
Q

recc’d daily servings meats/poultry/fish

A

6 or less

77
Q

recc’d daily servings veggies

A

4-5

78
Q

recc’d daily servings fruits

A

4-5

79
Q

low fat/fat free dairy

A

2-3

80
Q

fats & oils

A

2-3

81
Q

sodium

A

2300mg

82
Q

WEEKLY recc’d servings nuts/seeds/dry beans/peas

A

4-5

83
Q

WEEKLY recc’d servings sweets

A

5 or less

84
Q

caloric needs for women ages 19-30

A

sedentary: 2000
mod active: 2000-2200
active: 2400

85
Q

caloric needs for women ages 31-50

A

sedentary: 1800
mod active: 2000
active: 2200

86
Q

caloric needs for women ages 51+

A

sedentary: 1600
mod active: 1800
active: 2000-2200

87
Q

caloric needs for men ages 19-30

A

sedentary: 2400
mod active: 2600-2800
active: 3000

88
Q

caloric needs for men ages 31-50

A

sedentary: 2200
mod active, 2400-2600
active: 2800-3000

89
Q

caloric needs for men ages 51+

A

sedentary: 2000
mod active: 2200-2400
active: 2400-2800

90
Q

benefits of DASH

A

lower BP & LDL

91
Q

beneficial popn of DASH + reducing sodium

A

HTN, HLD, obesity

92
Q

daily target potassium to enhance effects of reducing sodium on BP

A

4700mg

93
Q

foods high in potassium:

A

POTATOES, yogurt, OJ, apricots, pintos, pork, lentils, lima, soy, banana, fish, tomato sauce, prunes, skim milk, kidney beans, split peas, almonds

94
Q

health and exercise recommendations prevents chronic diseases like:

A

CVD, DM2, some cancers

95
Q

regular moderate-vigorous physical activity reduces feelings of ________ and improves _______

A

anxiety & depression

sleep & QOL

96
Q

refer to opthamalogist:

A
  • abnormal findings on exam (myopia, hyperopia, presbyopia, astigmatism, abn funduscopic exam)
  • risk factors for vision disease
  • DM for annual exams
97
Q

risk factors for vision issues:

A

older age, AA race, fam hx of glaucoma

98
Q

normal vision development:

A
  • eye/vision system devel complete by early 20’s
  • remains steady thru 30’s (women may experience fluctuations during pregnancy
  • *lasik surgery should be performed in this stage
  • glasses/contacts rx vary slightly if at all in this stage
99
Q

vision screening recomendations <40y

A

if healthy w good vision: once in 20’s & twice in 30’s
*OPTHO urgently for: infection, injury, pain, unusual flashes/patterns of light
optho annually: contact lenses
*refer DM or fam hx of eye disease

100
Q

tips for digital eye strain

A
  • 20-20 rule: every 20m looking at screen, look 20 feet way for a full 20s
  • look up and out windows every 2 chapters
101
Q

vision related recc’s adults <40

A
  • wear protective eyewear
  • eat properly & exercise
  • if at risk for glaucoma, see OPTHO early
  • dont smoke
  • adequate sleep
  • avoid eye STDs
102
Q

risk factors for glaucoma

A

AA, DM, AI, STIs, some cancers

103
Q

illness detected in eyes:

A

potential stroke, DM, HTN, AI diseases, STIs, some cancers

104
Q

adults age 40-60 normal vision development

A

come back to

105
Q

_____ BP better predictor of MORBID events than ________ BP

A

SYSTOLIC is better than diastolic

106
Q

high risk popns for HTN:

A

fam hx, AA, physical inactivity, excessive consumption of salt, ETOH, calories, and deficient intake of K+

107
Q

PRIMARY PREVENTION of HTN

A
  • reduce sodium & ETOH
  • weight loss, regular excercise
  • diet high in fruits & veggies, low in fat/red meats/SSBs
108
Q

______ monitoring correlates BETTER with target end organ damage than ______ monitoring

A

HOME is better than clinical

109
Q

recommendations for most adults newly diagnosed w STAGE 1 HTN (130-139/80-89):

A

LIFESTYLE MODIFICATIONS ONLY unless pt has existing CVD or increased risk then add pharm

110
Q

nonpharm interventions for adults w elevated BP or HTN

A
  • weight loss
  • heart healthy diet to reduce BP
  • sodium restriction
  • K+ suppl (pref by diet)
  • increased phys. activity w structured exercise program
  • abstain from or practice moderation w alcohol (women <1/d, men <2/d)
111
Q

antihypertensives as secondary intervention for a pt w CVD & an avg BP over

A

130+/80+

112
Q

antihypertensives as primary intervention for a pt w estimated _____year ASCVD risk >_____% & an average BP over

A

10 year 10% ASCVD risk

130+/80+

113
Q

antihypertensive meds for PRIMARY prevention of CVD n adults WITHOUT CVD and estimated _____year ASCVD risk > _____%

A

10, 10%

114
Q

what is the current “goal BP” for adults?

A

<130/80

115
Q

meds that may interfere with antiHTN therapy:

A

NSAIDS, stimulants, oral contraceptives

116
Q

OSA increases risk for:

A

CVD diseases: HTN, CAD, cerebrovascular

117
Q

treating OSA helps reduce BP in _____ HTN

A

resistant

118
Q

def of primary prevention:

A
  • REDUCE OR REMOVE RISK FACTORS
  • intervening BEFORE health effects occur, measures such as VAX, altering risky behaviors, banning substances AW disease
  • ex: giving up or not staring smoking
  • **MOST COST EFFECTIVE
119
Q

def of secondary prevention:

A
  • promote early detection of disease or precursor states
  • screening to ID disease in the earliest stages
  • minimize impact
  • ex: routine cervical pap to detect CA or dysplasia of cervix
120
Q

def of tertiary prevention:

A
  • aimed at limiting impact of established disease
  • mgmt of disease s/p dx to slow or stop progression
  • minimize impact of cost
  • ex: partial mastectomy, radiation, chemo, rehab, screen for complications
121
Q

CVD risk factors:

A

HTN, HLD, age, fam hx, smoking, obesity, DM

122
Q

CVD screening tools:

A
  • framingham risk calculator
  • ACC risk calculator
  • I’m unable to really find the diff btwn the two- they both calculate 10 year ASCVD risk
123
Q

CVD primary prevention:

A

change modifiable risk factors:

  • exercise
  • adequate sleep
  • reduce stress
  • aspirin in certain circumstances?
124
Q

CVD secondary prevention:

A

detection:

  • ECG
  • Stress test
  • cardiac cath
  • calcium score is controversial
125
Q

CVD tertiary prevention:

A

after an event:

  • pharmacological recommendations (ACE & BB)
  • I’m assuming coronary interventions & CABG as well?
126
Q

BREAST CA primary prevention:

A
  • change modifiable risk factors (age, fam hx, ETOH, smoking, dense breast tissue)
  • pharm therapy for high risk pts (selective estrogen receptor modifiers (SERMS) tamoxifen & raloxifene for high risk pts)
  • preventative mastectomy (if high risk/have BRCA gene)
127
Q

BREAST CA secondary prevention:

A

clinical breast exam, mammography, self breast exam

128
Q

BREAST CA tertiary prevention:

A
  • mastectomy

* pharm interventions to prevent recurrence

129
Q

BREAST CA risk factors:

A

age, fam hx, ETOH, smoking, denser breast tissue

130
Q

BREAST CA screening tool?

A

*GAIL calculator (breast cancer risk assessment)

131
Q

SERMS stands for? and what are the two we care about?

A

selective estrogen receptor modifiers (SERMS)

*tamoxifen & raloxifene

132
Q

COLORECTAL CA risk factors:

A

certain diets (fill in if you know), smoking, ETOH, obesity, lack of physical exercise, hx of polyps/adenomas or fam hx, hx of IBS

133
Q

colorectal CA screening tools:

A

guiaic, colonoscopy

134
Q

colorectal CA primary prevention:

A

change modifiable rf:

diet, exercise, no smoking, no ETOH

135
Q

colorectal CA secondary prevention:

A

detection: guiaic, colonoscopy

136
Q

colorectal CA tertiary prevention:

A

chemo, surgery, surveillance

137
Q

cervical CA risk factors:

A

multiple partners, HPV, infection, smoking

138
Q

cervical CA screening:

A

PAP, HPV testing

139
Q

cervical CA primary prevention:

A
  • change modifiable RF: no smoking

* prevent transmission: limit partners, abstinence, condoms

140
Q

lung CA risk factors:

A

smoking, environmental exposure (asbestos/radon)

141
Q

lung CA screen:

A

CXR, low dose CT scan

142
Q

lung CA primary prevention:

A
  • change modifiable risk factors: NO smoking

* minimize environmental exposure (radon leaks into basement

143
Q

lung CA secondary prevention:

A

CXR, low dose CT scan

144
Q

lung CA tertiary prevention:

A

chemo/radiation/surgery

145
Q

osteoporosis risk factors:

A

age, female, ETOH 3+/d, personal hx of fracture, fam hx of hip fx, low BMI, use of oral corticosteroids, smoking

146
Q

osteoporosis screening tools:

A

FRAX, BMD, determining adult functional history?

147
Q

osteoporosis tertiary prevention:

A
  • prevent falls w mobility aids

* meds: biphosphonates

148
Q

osteoporosis primary prevention:

A

change modifiable RF: reduce ETOH, no smoking, weight train 2x/week, dietary CA++ and Vitamin D (check levels), get off glucocorticoids if possible

149
Q

osteoporosis secondary prevention:

A

BMD (T Score)

150
Q

what does the FRAX tool assess? results are in terms of?

A

*a woman’s 10-yr risk of osteoporotic fracture AND
10yr risk HIP fracture
*results are T-score
*PRO: good at determining women in osteopenia range that may benefit from treatment

151
Q

_____ & ______ fractures are associated with premature mortality

A

hip & vertebral

152
Q

osteopenia is defined as a T-score of:

A

-1 to -2.5

153
Q

osteoporosis is defined as a T-score of:

A

< -2.5

154
Q

severe osteoporosis is defined as a T-score of _____ OR _______

A

below -3.5 OR below -2.5 WITH A FRACTURE

155
Q

normal T score is?

A

-1 to 1

156
Q

must the FRAX tool be used with or without BMD score?

A

FRAX does NOT required BMD for assessment

157
Q

treatment for osteoporosis begins when ____+ 10yHIPfx risk OR _____+ 10yOPfx

A

3%, 20%

158
Q

true or false? calcium supplements helped reduce fx risk in healthy postmenopausal women

A

FALSE

159
Q

recommended calcium intake for women < 50?

> 50?

A

1000mg/d <50

1200mg/d for 51+

160
Q

dietary calcium is the preferred route but calcium may be supplemented in what way?

A
  • calcium citrate OR calcium bicarbonate

* should be combined w vitamin D

161
Q

USPSTF recc’s vitamin D suppl to prevent _____ in community-dwelling older women at high risk for ______

A

falls

162
Q

Vitamin D dose for fall prevention: women <71

A

600iu/day

163
Q

vitamin D dose for fall prevention: women 71+

A

800 iu/day

164
Q

vitamin D deficiency is defined as level less than

A

20

165
Q

main risk factor for developing osteoporosis =

A

increasing age

166
Q

USPSTF screening reccs for OP =

A
  • women 65+

* women UNDER 65 ONLY if their risk is = to or > the risk of a 65yo white lady w no additional risk factors

167
Q

TREATMENT for OP is recc’d for WHO &/or when?

A
  • T score < -2.5 W FRAX HX

* T score -1 to -2.5 AT HIGH RF FRAX

168
Q

true or false? calcium & vitamin D supplementation are recc’d for PREVENTION of FRAX?

A

FALSE. no evidence in men or premenopausal women

169
Q

Vitamin D/calcium supplement dose for noninstututionalized postmenopausal women

A

1000mgCA++/400iuD PER DAY. no more no less.

170
Q

USPSTF rec’s regular assessment of global CVD risk in adults aged ________

A

40-79 even without known CVD

171
Q

USPSTF screening recs for AAA

A
  • MEN aged 65-75 WITHOUT smoking history: selective
  • MEN 65-75yo WITH smoking history: 1 time US
  • women dont’ get screened
172
Q

USPSTF serum lipid screening reccs:

A

ALL MEN 35+ AND men 20-35 at increased risk

WOMEN 20+ only at increased risk (eye roll)

173
Q

USPSTF recs statin use for CVD prevention: pts must meet what 3 criteria?

A
  • 40-75yo
  • 1+ CVD rf (lipids, DM, HTN, smoking)
  • 10%+ 10yr risk CV event
174
Q

most important prevalent cause of morbidity and mortality? cause 1 in every ___ deaths?

A

cigarette smoking, 1 in 5

175
Q

smoking increases risk for:

A

premature death, fatal heart disease, lung CA, other cancers (mouth/throat/esoph/pancreas/kidneys/bladder/cervix), CVA, PUD, Hip/wrist/vertebrae frax, cataracts, AAA

USA-FNP: CMN 571 (5 decks)

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