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2024 - élo - usmle rx qbank > gastro > Flashcards

gastro Flashcards

1
Q

Slow waves determine the frequency of contractions of the gastrointestinal tract. what is their mechanism?

A

hythmic depolarizations and repolarizations of the smooth muscles cells within the muscularis propria of the stomach and intestines.
increase amplitude by parasymp

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2
Q

counteract acidity levels

A

Secretin is produced by the S cells of the duodenum in response to increased acid levels delivered to the duodenum

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3
Q

function of secretin

A

increasing pancreatic and biliary bicarbonate secretion, inhibits the effects of gastrin on acid production and growth of the gastric mucosa via increasing somatostatin and prostaglandin E2.

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4
Q

Ursodeoxycholic acid is an approved treatment for

A

primary biliary cholangitis

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5
Q

common bile duct obsrtuction treatment

A

fluid and IV antibiotics

charcots triad …. fever jaundice and pain

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6
Q

Malignancy of the bile ducts (cholangiocarcinoma) is associated with

A

primary sclerosing cholangitis

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7
Q

corhns disease on microscopy

A

non caseating granuloma

transmural inflammation

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8
Q

nd the HCO3- is increased in high flow states (during digestion)
which organ is this

A

pancreas
epithelial cells —- HCO3
acinar cells —– enzymes

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9
Q

c diff diagnosis is made by

A

toxin assay
toxin A —- enterotoxin — binds to mucosa
toxinB —- cytotoxin … disrupts cytoskeleton

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10
Q

patients with celiac disease are at risk of

A

IgA def and T cell lymphoma

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11
Q

which cell has immunologic function against C DIFF

A

paneth cells… α-defensins, lysozymes, and TNF and are identified on histology because of their eosinophilic appearance.

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12
Q

BRUCELLA

A

unpastuerized dairy
undulant fevers
intracellular gram-negative coccobacillus which, like Nocardia, stains with a modified acid-fast stain.

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13
Q

zoonotic unpasteurized dairy disease with undulant fevers joint pain, hepatomegaly, lymphadenopathy .. moldy odour

A

BRUCELLA

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14
Q

grossly elevated alkaline phosphatase, elevated bilirubin, mildly elevated or normal ALT/AST

A

choledocolithiasis

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15
Q

pt is on levofloxacin but tretment not successful
he also has history of gerd …
what drug interaction would be causing this

A

antacid use
Common antacids, such as calcium carbonate, contain polyvalent cations (Ca2+, Mg2+, and Fe2+), which directly bind levofloxacin and prevent its absorption in the gastrointestinal tract

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16
Q

barrets esophagus

A

metaplasia of squamous esophageal epithelium into intestinal columnar epithelium

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17
Q 
pt history of travel to mexico
had diarrhea 4 weeksa go 
now has right upper quad pain 
ultrasound ----  hypoechoic mass liver 
diag txt
A

amebic cyst
E.histiolytica
metronidazole

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18
Q

a periumbilical nodule (Sister Mary Joseph node) as well as left supraclavicular adenopathy (Virchow node).

A

gastric adenocarcinoma

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19
Q

mallory bodies

A

Mallory bodies are intracytoplasmic hyaline inclusions derived from cytokeratin intermediate filaments
in chronic alcohol
wilson
P biliary cirhhosis

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20
Q

acetaminophen antidote

A

n acetyl cystein

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21
Q

aspirin overdose antidote

A

remmber asprin is salysilic ACID

so treat with alkalinization of urine

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22
Q

bout of acute pancreatitis what is the complication

A

pancreatic pseudicyst
of necrotic, hemorrhagic debris with pancreatic enzymes
absence of epithelial lining … formed from fibrosis and granulation tissue

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23
Q

eturned from a trip to Africa and now reports an aching back, high fever, and black vomitus. He reports numerous mosquito bites and a yellow-tinged sclerae.

A

yellow fever
councilman bodies
Aedes and Haemagogus mosquitoes

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24
Q

dohle bodies

A

Döhle bodies are found in neutrophils, typically during infections

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25
Q

hepatomegaly and jaundice (signs of liver disease), rigidity, decreased facial expressions, impaired gait (parkinsonian features), and changes in personality

A

classic features of wilson

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26
Q

PSC

A

p ANCA
middle aged men
with IBD
intra and extrahepatic bile duct strictures

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27
Q

patient presents with traumatic injuries after a motor vehicle collision. The results of the fundoscopic exam show papilledema
nasogastric tube has BLOOD

A

cushing ulcer

ncreased intracranial pressure … increased vagal output… increased ach …. increased H+

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28
Q

new agent to treat wilson due to low side effects

A

triantrine

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29
Q

disappearance of HBsAg and appearance of HBsAb is known colloquially as

A

window period

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30
Q

window period serum markers

A

anti HBe

Anti HBc igm

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31
Q

gastric ulcers, duodenal ulcers, chronic diarrhea, epigastric pain, and even reflux or vomiting.
mass in the pancreas

A

zollinger ellison

gastrinoma

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32
Q

seemingly random episodes of self-resolving swelling.

what should this make u thnk of?

A

c1 esterase inhibitor def …. hereditary angioedema

NO ACE i

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33
Q

regenerative nodules seen on liver microscopy

what is happening at the cellular level

A

Persistent activation of stellate cells leads to transformation into myofibroblasts and collagen deposition with concomitant degradation of the normal extracellular matrix. Cirrhosis (widespread fibrosis and parenchymal nodules) results from continued collagen production and regeneration of hepatocytes. Grossly, in late-stage cirrhosis, the liver is most commonly fibrotic and shrunken.

these cells are activated by cytokines

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34
Q

Helicobacter pylori infection, nitrosamine exposure, excessive salt intake, and low intake of fresh fruits and vegetables. increases risk of which type of carcinom

A

gastric adenocarcinoma

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35
Q

patient presents with bloody diarrhea and abdominal pain after a camping trip during which he consumed undercooked food.

A

most likely camphylobacter jejuni
unpastuerized milk undercooked meat
zoonotic too — dogs cats pigs

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36
Q

giardiasis TIMELINE after consumption of the cyts

A

2 weeeeks

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37
Q

intact cell membrane, cytoplasmic shrinkage, and membrane-bound apoptotic bodies are feaatures of which type of cell death

A

apoptosis

the programmed death

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38
Q

Cellular and mitochondrial swelling
Membrane blebbing
Nuclear chromatin clumping
Ribosomal detachment

A

Reversible injury

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39
Q 
Rupture of lysosomes and autolysis
 Plasma membrane damage
 Increased mitochondrial permeability
 Nuclear pyknosis (condensation)
 Nuclear karyorrhexis (fragmentation)
 Nuclear karyolysis (fading)
A

irreversible injury

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40
Q

Duodenal ulcers are most commonly caused by

A

h pylori
NSAIDS
smoking

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41
Q

pregnant woman from india

VERY HIGH LFTs

A

hep E

SS linear RNA

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42
Q

acetyl coa carboxylase

leading to poor growth, myopathy, and muscular hypotonia

A

FA synthesis enzyme
activated by insulin
makes malonyl coA

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43
Q

lipid lowerign med linked to formation of cholestrol gall stones

A

fibrates
activate PPAR
good for reducing TGs
reducing bile acid synthesis secondary to inhibition of 7-α-hydroxylase (the key enzyme in bile acid synthesis).

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44
Q

edematous and thickened cornea

A

keratomalacia

vitamin A def

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45
Q

describe a distal tracheoesophageal fistula with atresia

A

gas in the abdomen

feeding probs

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46
Q

acetaminophen overdose affects which part of liver

A

zone 3 … certrilobular
zone 1 is mostly affected by viral heaptitis … its more peripheral and closer to portal vein and hepatic artery

zone 3 has the highest P-450 concentration and a low level of glutathione (a protective factor), and it is least oxygenated.

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47
Q

elevated levels of direct bilirubin, pale stools, dark urine, and jaundice.
elevated GGT normal AST ALT
in a 3 week old baby who was normla initially

A

biliary atresia

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48
Q

ventral bud forms

A

uncinate process and main pancreatic duct

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49
Q

bilious vomiting and a diffusely tender abdomen, a clinical picture that is most suggestive of a…
xray shows dialated loops of small intestin

A

small bowel obstruction
after surgery—- adhesions
also can be due to cnacner

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50
Q

painless jaundice, weight loss, and palpable, non-tender gallbladder (Courvoisier sign)

A

pancreatic adenocarcinoma
smoking is a RF
history of diabetes mellitus, history of chronic pancreatitis and genetic predispositions (ie, hereditary breast and ovarian cancer syndrome, familial atypical multiple mole melanoma, familial pancreatitis, hereditary non-polyposis colorectal cancer, Von Hippel-Lindau syndrome

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51
Q

infant presents with painless hematochezia and a soft nondistended abdomen. A technetium-99 scan shows increased uptake on the left upper quadrant, periumbilical area and suprapubic area.

A

meckel diverticulum

release of acid or enzymes from ectopic tissue can damage the surrounding ileum, causing painless, bright red rectal bleedin

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52
Q

mptoms that may manifest include bronchospasm, cutaneous flushing, watery diarrhea, and right-sided heart murmurs

A

carcinoid tumors

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53
Q

antidiabetic medication disulfram like reactions

A

chlopropamide

slfonylyrea first fgen

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54
Q

Sorry Pals, Can’t Go Mingle.

Sulfonylureas (first generation), Procarbazine, certain Cephalosporins, Griseofulvin, and Metronidazole

A

disulfram react

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55
Q

how does nisseria meningitidis bind to nasopharynx

A

the IgA protease and pili are especially relevant in their ability to colonize the nasopharynx via cleavage of immunoglobulin into Fab and Fc fragments

56
Q

crohns diseade and cholecystitis

A

Crohn disease often affects the terminal ileum, which decreases bile acid reabsorption and leads to increased formation of cholesterol stones due to decreased lipid emulsification

57
Q

describe the rash in dermatitis herpetiformis

A

erythematous, vesicular rash similar to herpes. I

58
Q

lynch syndrome ssoc with what other cancers

A

Additionally, there is a high risk of extracolonic cancer, including endometrial, ovarian, urinary tract, small intestinal, stomach, and biliary cancer

59
Q

Bone and soft tissue tumors are often seen in

A

gardner synd

FAP +ve colorectal cancer —- mutation ins APC gene

60
Q

Auerbach nerve plexus in the esophagus lost

A

achalasia

61
Q

enerally presents as hoarseness but may also present with dysphagia and weight loss. The most significant risk factors are smoking and alcohol use.

A

quamous cell carcinoma larynx

62
Q

blocks peptidoglycan polymerization … an antibiotic

A

vancomycin

63
Q

intermittent, colicky pain in young children who are otherwise healthy. A characteristic finding is “currant jelly” stool, which is composed of blood and mucous.

A

intussusseption

64
Q

ascending colon drained by

A

superior messenteric LN

65
Q

lab findings in obs jaundice

A

increased conj bilirubin
decreased bilirubin in urine
increased ALP

66
Q

patient presents with diarrhea, hypokalemia, and hyperchloremia, as well as CT findings consistent with a pancreatic mass.

A

vipoma
VIP include increased secretion of water and electrolytes into the intestinal lumen and relaxation of intestinal smooth muscle and sphincters.

67
Q

boerhaave synd

A

Boerhaave syndrome is a similar presentation, but there would often be crepitus heard on lung exam.
no normal xray
its a tear through the full thickness

68
Q

e coli lactose fermenters or non lactose fermenter?

A

LACTOSSE FERMENTR

69
Q

30-year-old man has a 1-month history of daily NSAID use, gnawing abdominal pain of 2 months’ duration, and duodenal ulcers on EGD
refractory to PPI

A

in the setting of red flags such as ulcers refractory to PPI or ulcers distal to the duodenum, other etiologies like duodenal neoplasm (Zollinger-Ellison syndrome) must be considered.

70
Q

RUQ pain after meals

secretion of what can cause this

A

CCK from dudoenum

stimulated by FA and AA

71
Q

somatostatin

A

Somatostatin is released by the D-cells of the duodenum, pyloric antrum, and pancreatic islets. It reduces smooth muscle contractions and inhibits the release of both insulin and glucagon from the pancreas

72
Q

with progressive bloody diarrhea, fever, and weight loss after visiting the tropics. A CT scan of his liver shows a hypodense lesion with an edge wall, indicating a liver abscess.

A

Diagnosis can be made via serology or by visualizing trophozoites with phagocytosed red blood cells in the stool. E histolytica infection is typically treated with metronidazole.

73
Q

Multinucleated trophozoites

A

giardiasis

74
Q

Oocysts on acid-fast stain

A

cryptosporidiun

75
Q

Trophozoites in blood smear characteristic of

A

malaria

76
Q

eggs in stool

A

round worm

77
Q

acute alcoholic hepatitis

A

fever, abdominal pain, and jaundice; lab values classically show an AST≥ALT ratio of 2:1.

I missed jaundice

78
Q

ailure of the maxillary processes and medial nasal processes to fuse would lead to

A

cleft lip

79
Q

Germ tube-negative fungi include

A

histoplasmosis, blastomycosis, and coccidioidomycosis,

80
Q

His insurance requires him to pay the first $1,000 of the bill and 20% of the remaining hospital expenses.

A

coinsurance

81
Q

enteropeptidase /enterokinase

A

present in the intestinal mucosa …. converts trypsinogen to trypsin ,,, which activates lipase peptidase etc

82
Q

tenofovir disoproxil fumarate

A

treatment for hep b

SE — renal failure and decrease bone density

83
Q

h nausea, dyspepsia, and paresthesias.

pt also has autoimmune thyroditis

A

suggest pernicious anemia
TYPE A gastritis … autoimmune …. involves the fundus

CD4+ (helper) T cell–mediated immunity directed against parietal cells (by destruction of H+-K+ ATPase)

84
Q

scleroderma develop dysphagia due to ?

A

smooth muscle atrophy in lower 2/3 esopphagus

85
Q

histoplasmosis treatment and side effect

A

ketoconazole

liver toxicity

86
Q

treat systemic fungal infections by interfering with formation of DNA nucleotides,
name fo drug and its SE

A

fluticosyne

bone marrow supp

87
Q

rugs that lower the seizure threshold

A

buproprion

pain medications, such as fentanyl; diphenhydramine; and venlafaxine.

88
Q

32 year old man positiive alpha fetoprotein
from asia
mum died after birth ,,,, hd jaundice

A

HBV-associated HCC may occur in the absence of cirrhosis and at an earlier age than HCV-associated HCC because HBV DNA may directly integrate into the host genome, predisposing hepatocytes to neoplastic changes.

89
Q

s psyllium or methylcellulose

A

bulk forming laxativesq

90
Q

senna mechanism

A

stimulates peristalsis

91
Q

resenting with a colonic adenoma, it is reasonable to provide preventative medication

A

yclooxygenase inhibitors can be used to decrease risk of CRC.

92
Q

potential for polyp malignancy

A

ubular adenoma ≤ Tubulovillous adenoma ≤ Villous adenoma.

93
Q

immigrant from Southeast Asia who presents with a chronic cough and serpiginous rash in the setting of eosinophilia.

A

rhabditiform larvae in stoool

strongyloides stercolis

94
Q

h pylori mechanism for ulcer

A

t causes mucosal damage through ammonia production, which promotes the survival and colonization of H. pylori.

95
Q

Gram-negative, oxidase-negative rod which does not ferment lactose (white colonies on MacConkey agar) or produce hydrogen sulfide (no blackening on TSI).

A

shigella

96
Q

for severe crohns disease what medication can be used

A

For severe Crohn disease or disease that is refractory to these treatments, an anti-TNF-α monoclonal antibody, such as infliximab or adalimumab,

97
Q

patient is a middle-aged obese G2P2 female with a likely history of biliary colic (recurrent postprandial RUQ pain) with acute epigastric pain radiating to the back in the setting of fever, hypotension, tachycardia and elevated ALT, AST and lipase. CT scan shows a diffusely edematous pancreas with fat stranding. Overall, presentation is characteristic of

A

gall stone pancreatitis

98
Q

adenocarcinoma of esophagus will stain positive for

A

Cytokeratin is expressed by cells of epithelial origin. Low-molecular-weight cytokeratin is characteristically present in adenocarcinomas of this type and can be detected by using an antibody to cytokeratin as an immunohistochemical stain.

99
Q

vimentin

A

Vimentin is an intermediate filament protein that is expressed in mesenchymal cells and connective tissue. It is used to stain for various sarcomas, endometrial carcinoma, renal cell carcinoma, and meningiomas.

100
Q

symptoms of fatigue, malaise, anorexia and nausea. plus right upper quadrant tenderness

A

hepatitis

101
Q

pt on prophylaxis with isoniazid

side effects?

A

hepatitis

impaired myocolic acid synth

102
Q

Ascending cholangitis is an infection of the gallbladder that occurs as a result of biliary stasis and bacterial overgrowth,
describe triad

A

fever
jaundice
pain

103
Q

episodic abdominal pain with nausea, vomiting, fever, and a palpable abdominal mass. However, he does not have loose or frequent stools

A

intussusception

DD acute appendicitis hs diffuse epigastric pain initially

104
Q

Painless rectal bleeding in an elderly individual (especially with a history of constipation or poor fiber intake)

A

diverticulosis

do colonscopy

105
Q

hematamesisi in alcoholic

which vein had increase pressure

A

ortal hypertension secondary to alcoholic cirrhosis, evidenced by caput medusae, led to rupture of the left gastric vein.

106
Q

in shepherds or in individuals with close contact with the animals
slow growing cyst in liver
ground glass appearance

A

ecchinococus granulosus
Albendazole is the first-line treatment; patients should be closely monitored for possible anaphylaxis if the echinococcal antigen is released from the cysts.

inhibits microtubule assembly

107
Q

Schistosoma, which is transmitted by snails and causes granulomas, fibrosis, and inflammation of the spleen and liver. It may also lead to bladder carcinoma. Although symptoms can include abdominal pain and diarrhea

txt?

A

praziquintel

108
Q

malabsorption of glucose and galactose from the intestinal lumen. Absorption of fructose is unaffected.

A

SGLT1 is a glucose and galactose transporter that enables glucose and galactose absorption across the apical membrane of enterocytes. SGLT1 achieves glucose and galactose absorption by coupling to the sodium gradient, created by the basolateral sodium-potassium pump. Since SGLT1 is not involved in fructose absorption, inhibiting its function would not affect fructose.

109
Q

GLUT 2 function

A

absrbs all glucose galactose fructose

110
Q

hepatitis E virus

A

non enveloped single stranded RNA

111
Q

enveloped circular DNA virus (hep)

A

hpe b

112
Q

vitamin A is given to apatient orally
24 hours later it is stored in ito cells
what is the route it took

A

fats and fat-soluble substances (such as vitamin A) first enter lacteals, which are small lymphatic capillaries in the villi of the intestinal epithelium.
From there, the lacteals merge, and the chyle flows into progressively larger lymphatics and ultimately the thoracic duct, which drains into the left jugular venous angle (the union of the internal jugular vein and subclavian vein).
Vitamin A is then stored in the Ito cells (the perisinusoidal cells) in the liver.

113
Q

7 year old boy

patient presents with a history of painless, bright red stools, nausea, vomiting, and an inability to pass gas.

A

meckels diverticulum
connects devp midgut lumen to yolk sac
supplied by SMA

114
Q

inferior messenteric artery supplies

A

The inferior mesenteric artery supplies the hindgut, ie, the distal one-third of the transverse colon to the upper part of the rectum.

115
Q

resistance to aminoglycosides

A

Bacterial resistance to aminoglycosides commonly occurs due to transferase enzymes. This causes drug inactivation via modification (acetylation, phosphorylation, adenylation, etc.).

116
Q

pt has pancreatitis and severe abd pain

what can be given to ease symptoms

A

somatostatin is a potent inhibitor of growth hormone secretion; it also suppresses the release of a number of digestive hormones, such as gastrin, cholecystokinin, secretin, and vasoactive intestinal peptide (VIP).

somatostatin is released from D cells in GI mucose

117
Q

venous drainage above pectinate line

A

sup rectal vein
inf mes vein
splenic vein
portal vein

118
Q

which artery can be compromised in AAA repair

A

IMA can be compromised during manipulation of the aorta in AAA repair. Sigmoid colon ischemia occurs in 1%–7% of repairs a

119
Q

entamoeba histiolytica infection course

A

Following the GI infection trophozoites may invade through the bloodstream causing necrotic abscesses, particularly of the liver. VIA THE PORTAL VEIN

120
Q

pt on treatment with phenytoin
takes acetaminophen for pain last night
presents with nausea vomitting malaise

A

Phenytoin is a known inducer of the cytochrome p450 system in the liver. Cytochrome p450–inducing drugs can increase the amount of NAPQI produced in the liver, which can cause acetaminophen toxicity even without excessive intake.

121
Q

intususseption after a diarrheal illness

what is the lead point to this?

A

peyer patch hyperplasia

M cells contained within Peyer patches take up antigens and present them to B cells

122
Q

An increased stool osmotic gap

post-lactose breath hydrogen value increase of >20 ppm compared to baseline

A

lactose intolerance

123
Q

pt takes ppi and ace i

has diarrhea that comes n goes with facial flushin

A

n the presence of liver metastasis, carcinoid tumors in the bowel present with classic symptoms including episodic diarrhea and flushing, shortness of breath, and chest tightness.

124
Q

atient with painful ulcerated skin lesions and a history of abdominal pain and intermittent diarrhea

A

Crohn disease with pyoderma gangrenosum.

125
Q

venous drainage from cecum and ileum

A

ileocecal vein which drains into SMvein

126
Q

2-day-old patient presents with green vomit and failure to pass stool since birth. He also cries when light pressure is applied to his abdomen. He was born with situs inversus (heart on the right side of his chest). Imaging shows dilated loops of bowel, loss of haustra and right lower quadrant engorgement.
imaging shows RLQ engorgement

A

malrotation with midgut volvulus

specifically of ileocecal junction

127
Q

middle colic vein drains

A

trnasverse colon

128
Q

alpha amanitin in mushrooms inhibits

A

α-Amanitin is a selective inhibitor of RNA polymerase II and III. RNA polymerase II produces heterogeneous nuclear RNA, which is processed into mRNA.

129
Q

child has a rash
mother gives a med to treat her pain
child presents with vomitting encephalopathy seizures etc

A

Reye syndrome is a rare life-threatening reaction that can occur when salicylates are administered to children who have viral infections such as influenza or chickenpox, as seems likely in this patient. Aspirin and other salicylates work by irreversibly binding to and inactivating the cyclooxygenase (COX) enzymes COX-1 and COX-2,

130
Q

baby with distended bowel
no bowel movemetns
had treatment with antidiarrheal

A

toxic megacolon post use of antidiarrheal

131
Q

patient has ulcerative colitis for 20 years and now has colon cancer
what can cause increased risk for colon cancer

A

Chronic inflammation is a major risk for all types of cancer due persistent proinflammatory cytokine and chemokine production
Colitis-associated tumors typically originate in areas that have been impacted by colitis.

132
Q

colitis assoc tumors

A

In sporadic CRC, the gene APC mutates early in the adenoma-carcinoma pathway. In contrast, APC is a late mutation in colitis-associated CRC. Colitis-associated tumors are typically flat (not polypoid), occur in the proximal colon, and have high grade histology. Additionally, patients with colitis associated colorectal cancer typically present earlier in life, often in their 30s. For this reason, patients with inflammatory bowel disease should be screened more closely than is typical. They should start screening colonoscopies 10 years after diagnosis, then every 1-2 years afterwards. A full comparison of colitis-associated vs. sporadic CRC is presented in the table below.

133
Q

long teerm side effects of ppi in gastrinoma

A

proton pump inhibitor is indicated. Proton pump inhibitors, such as omeprazole, can cause a decrease in serum magnesium with long-term usage.

134
Q

history of constipation, crampy pain, and tenderness in the left lower abdomen, diarrhea, a low fever, and blood in his stool.

A

Diverticulitis should be distinguished from diverticulosis, which simply refers to the presence of diverticula. Diverticula occur when pressure causes herniation of the colonic mucosa and submucosa through attenuated muscularis propria, creating a false diverticulum. Attenuated areas refer to those areas where the muscularis propria is thinner. These areas are most often at sites of weakening where vasa recta cross the muscularis. Since the formation of diverticula is a key step in the pathogenesis of diverticulitis, we would expect to see attenuation of the muscularis propria in all cases. Histopathology of the inflamed diverticulum itself may also reveal an inflammatory infiltrate.

135
Q

adjunct for hep c treatment to decrease teh viral load

A

Pegylated interferon can be used as an adjuvant to newer treatment regimens for hepatitis C. The use of interferon may lead to a wide range of adverse reactions, such as a flu-like sequelae and depression.

136
Q

propionic acidemia

A

Propionyl-CoA carboxylase deficiency causes propionic acidemia, an autosomal recessive disorder that results in neonatal hepatomegaly, seizures, hypotonia, vomiting, poor feeding, and metabolic acidosis with increased anion gap.

2024 - élo - usmle rx qbank (29 decks)

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