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Bridge Physiology > FInal Exam > Flashcards

FInal Exam Flashcards

Endocrine and Reproductive

1
Q

Gametes (sperm and egg) are formed by

A

testis and ovaries

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2
Q

Fertilization produces one cell ______ with one set of chromosomes from each parent

A

Zygotes

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3
Q

Gonads produce ____ and secrete

A

gametes and secrete sex hormones

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4
Q

List the different structures in the male reproductive system

A
  1. Testis: sperm formation
  2. Epidiymis: sperm maturation
  3. Vas (ductus) deferens: sperm duct
  4. Seminal vesicle: semen
  5. Prostate: prostatic fluid; semen
  6. Urethra: urine
  7. Scrotum: cools testis
  8. Penis
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5
Q

______ is a sac of loose skin, fascia and SM divided into two pouches by a septum. It is involved in temperature regulation of the testes

A

Scrotum

  • sperm survive: 2-3o lower temp than core body temp
  • Muscle: elevates testes on exposure to cold and arousal
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6
Q

______ are paired, oval glands measuring 2in by 1 inch. They are surrounded by a dense white capsule

A

Testes

  • Septa: 200-300 compartments (lobules)
  • Lobules: filled with 2 or 3 semniferous tubules (sperm formation)
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7
Q

Inside the testis are specific cells located either between the lobules, or inside the semniferous tubules (within lobules). What are these cells?

A
  1. Leydog: Cells in interstitial space between lobules (testosterone);
  2. Sertoli: inside the semniferous tubules (in lobules)
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8
Q

Semniferous tubules contain

A
  1. sperm forming cells
  2. Sertoli (supporting cells)
  3. Interstitial cells in between tubules secrete testosterone
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9
Q

Sertoli cells extend from the basement membrane to the lumen inside Semnifrerous tubules. What are the functions of these cells?

A
  1. Androgen binding protein
    - -bind testosterone (Leydig cells)
    - -influences dev. of male gonads
  2. Inhibin (slow sperm production)
    - dec. testosterone
  3. blood-testis barrier
  4. supports developing sperm
  5. secrete fluid and controls sperm release /movement into lumen
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10
Q

Spermatogenesis: Sperm forming cells go through 2 meiotic divisions. Describe the steps

A
  1. Mitosis
    - spermatogonium (2n)
  2. Primary spermatocyte (2n)
  3. Meiosis I
    - 2 secondary spermatocytes (1n)
  4. Meiosis II
    - 4 spermatids
    - 1n
  5. Sperm
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11
Q

Sperm are adapted for reaching and fertilizing the egg. Describe sperm morphology

A
  1. Head:
    - -DNA, nucleus, acrosomes with enzymes
  2. Midpiece: mitochondria
  3. Tail: flagella
    * final maturation: epidiymus; regulated by testosterone
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12
Q

Describe hormonal control of male physiology

A
  1. GnRH (Hypothalamus)
  2. FSH and LH (Ant. pit.)
  3. FSH – Sertoli cells secrete androgen binding protein and inhibin
    - -conversion of cholesterol to pregnenolone
  4. LH – Leydig (interstitial) to secrete testosterone
    * ABP and testosterone inc. spermatogenesis
    * Regulation: Neg. feedback by inc. testosterone and inhibin
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13
Q

There are three main exocrine glands in the male reproductive system: Seminal vesicles, Prostate, and Cowper’s glands (bulbourethral).

Describe seminal vesicles

A

60% of clear, alkaline seminal fluid

major secretions fructose (nutrition) and prostaglandins (passage of semen)

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14
Q

There are three main exocrine glands in the male reproductive system: Seminal vesicles, Prostate, and Cowper’s glands (bulbourethral).

Describe prostate gland secretions

A

30% of milky, slightly acidic

*antibiotics

Semen: fibrinogen, fibrinolysin

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15
Q

Semen is a mixture of

A

fluid + seminal fluid

Normal sperm count: 50 to 150 million/mL

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16
Q

Erection is sexual stimulation caused by _______ nervous system

*point n shoot

A

Parasympathetic

  1. arterioles dilate: supply arterioles
  2. blood enters penis - compress veinous outflow
  3. blood sinuses of penis engorge with blood
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17
Q

Emission is the next step following erection. It stops at the ejaculatory duct (before ejaculation).

During emission, Muscle contractions ____ the sphincter at the base of the bladder.

Fluids are propelled through the ____, _____ and _____ to the bulb of the penis

A

Muscle contractions: close sphincter

Fluids propelled: ductus deferens, seminal vesicle and ejaculatory ducts into bulb

Prostatic fluid: secreted into urethra

*controlled by sympathetic

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18
Q

EJaculation is the final step in male sex reflex. Ejaculation is controlled by ______ nervous system.

A

Sympathetic

-skeletal muscle (bulbospong…) squeeze semen out through urethra

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19
Q

Erectile dysfunction

A

unable to have an erection

-viagra (vasodilator)

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20
Q

Determine between genetic sex, gonadal sex and phenotypic sex

A
  1. Genetic sex: determine by sperm (XX, XY)
  2. Gonadal sex: testis vs. ovary
    Males: testis determining factor - Sertoli and Leydig cells produce anti-mullerian hormone and testosterone (respectively)

Females: absence of testis determining, anti-mullerian and testosterone forms female

  1. Phenotypic sex: gential tract, external genitalia
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21
Q

List the external parts of the female reproductive system

A

Externa:

  1. Vulva:
    - pubis
    - labia majora
    - labia minora
    - clitoris
  2. Vestibule
    - urethral opening
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22
Q

List the internal reproductive structures in females

A

Internal:

  1. Ovaries: egg (oocyte) production and hormones
  2. Uterine tubes: transport eggs
  3. uterus: fetal development
  4. Vagina (birth canal)
  5. External genitalia (vulva)
  6. Mammary glands: milk
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23
Q

True/False: Before birth females already produce oogonia

A

True

Puberty: 400,000
Geriatric/Menopause: death

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24
Q

List the steps of sperm development

A
  1. germ cell
  2. spermatogonium
    DNA replication/S phase
  3. Primary spermatocyte
    Meiosis I
  4. Secondary spermatocyte
    Meiosis II
  5. Spermatid
    Spermiogenesis (lose cytosplasm, gain flagella, acrosome)
  6. Spermatozoa
    capacitation - increase motility, change in cell surface proteins and acrosome
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25
Q

List the steps in gestation

A 
1. germ cell
gestation
2. Oogonium
S phase/DNA rep.
3. Primary oocyte
meiosis I
meiotic arrest until LH, FSH surge at puberty
4. Secondary oocyte + 1 polar body (may degenerate)
Meiosis II
Meiosis II arrest until fertilization
5. Ovum + up to 3 polar bodies
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26
Q

List the steps in gestation

A
  1. germ cell
    gestation
  2. Oogonium
    S phase/DNA rep.
    (Mitosis)
  3. Primary oocyte
    meiosis I
    meiotic arrest until LH, FSH surge at puberty
  4. Secondary oocyte + 1 polar body (may degenerate)
    Meiosis II (metaphase II)
    Meiosis II arrest until fertilization
  5. Ovum (graafian follicle) + up to 3 polar bodies
    * longest stage between prophase I and metaphase II
    * eggs contained in follicles
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27
Q

FSH acts mainly on

A

granulosa cells

-aromatase: converts androgens from theca to estrogen

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28
Q

granulosa cells (inner) and theca (outer) cells surround the oocyte and secrete mainly

A

estrogen

  • growth/repair of uterine lining
  • regulate female cycle
  • sex characteristics
  • maintain bone and muscle
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29
Q

A mature, graafian follicle reases an oocyte each month during

A

ovulation

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30
Q

Oocytes develop within

A

follicles

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31
Q

List the stages of follicular development

A
  1. Primordial follicle: single layer of sq. cells around oocyte
  2. Primary follicle:
    - layers of cuboidal granulosa cells around oocyte
    - -secrete estrogens
  3. Secondary follicle
    - antral cavity forms
    - granulosa cells
    - theca cells
  4. Graafian follicle
    - follicle mature
    - ready to ovulate oocyte
    * *antrum
    * *theca and granulosa
  5. Ovulation
    - follicle ruptures releasing oocyte
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32
Q

After ovulation, the empty follicle becomes the Corpus luteum secretes:

A
  1. Progesterone – completes the preparation of uterine lining
  2. Estrogens – work with progesterone
  3. Relaxin – relaxes uterine muscles and pubic symphysis
  4. Inhibin – decreases secretion of FSH and LH
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33
Q

When the egg is released, it enters the fimbria end of the fallopian tube.

Describe anatomy of the uterine/fallopian tubes?

A

-extends from ovary to uterus

  1. enters infundibulum (fimbraie)
    - -cilia sweep
  2. ampulla (central region)
    - site of fertilization
    - -24 hrs/after ovulation
  3. Isthmus: narrowest portion joins uterus
    * zygote reaches uterus about 7 days after ovulation
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34
Q

The female reproductive cycle is controlled by monthly hormonal cycle from the hypothalamus, anterior pituitary and ovary.

List the two cycles

A
  1. Ovarian cycle:
    - changes in ovary during and after maturation of the follicle and oocyte
  2. Uterine cycle (menstrual)
    - prep. uterus to receive fertilized ovum

*if implantation does not occur, functional layer of endometrium is shed during menstruation

  • If implantation occurs: continue progesterone
  • -zygote release hcG
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35
Q

Non-classical endocrine organs

A

Heart, Skin

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36
Q

Endocrine system: True/False: Glands that work together to maintain homeostasis

A

True

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37
Q

______ is a signalling molecule that is released into the bloodstream and modulates an aspect of physiology from a distant location

A

Hormone

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38
Q

Protein/Peptide hormones

water soluble

A
  • pre-prohormone form in ER
  • cleaved to pro-hormone
  • cleaved in TGolgi
  • hormone packaged into vesicles

ex: oxytocin, all hormones of hypothalamus and ant. pituitary

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39
Q

Steroid hormones

lipid soluble

A

cholesterl precursor

ex: testosterone, progesterone
- reproductive tract and adrenal cortex

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40
Q

Amine hormones

water soluble

A

Made from tyrosine

ex: norepinephrine, thyroid

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41
Q

Which two hormones require carrier proteins?

A

Steroid hormones and thyroid hormone

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42
Q

Hormone effects are mainly due to ____

A

receptor

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43
Q

3 requirements for hormone receptor:

A
  1. high affinity
  2. high specificity
  3. signal amplification within the target cell
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44
Q

Types of Hormone receptors

A
  1. GPCR (Gs, Gi, Gq)
  2. Steroid hormone receptors (nucleus)
  3. Guanylyl cyclase (cGMP)
  4. Receptor tyrosine kinase (autophosphorylation)
  5. Tyrosine-kinase associated receptor
    (linked to tyrosine kinase that can phosphorylate)
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45
Q

Insulin binds what receptors?

A

Receptor tyrosine kinase

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46
Q

Modulation of hormones

A
  • positive FB (oxytocin)
  • negative FB
  • up/downregulate receptors
  • change gene expression
  • carrier proteins (steroie/thyroid)
47
Q

How does the Hypothalamus communicate with the anterior pituitary?

A
  1. Anterior pituitary

- -hypothalamohypophyseal portal system

48
Q

How does the Hypothalamus communicate with the posterior pituitary?

A

*Hormones synthesized in hypothalamus; stored in Herring bodies in posterior pituitary

  1. Supraoptic nucleus (ADH)
  2. Paraventricular nucleus (oxytocin)
49
Q

Dopamine inhibits _______

A

prolactin

50
Q

TRH stimulates

A

prolactin and TSH

51
Q

Somatostatin inhibits

A

GI system, insulin, glucagon, GH

*octreotide (analog) used for acromegaly; vasoconstrictor

52
Q

Melanocyte Stimulating Hormone is produced by

A

Intermediate pituitary/anterior pituitary

53
Q

FSH acts on ______

A

Males: Sertoli cells

  • sperm production
  • inhibin
  • androgen binding protein
  • anti-mullerian hormone

Females: Granulosa cells
–convert androgens to estradiol
(aromatase)

54
Q

LH acts on _____

A

Males: Leydig cells

  • -testosterone
  • -androstenedione, DHEA

Females: Theca interna
–androgens

55
Q

ACTH acts on the ______

A

ZF and ZR of adrenal cortex

56
Q

The zona glomerulosa of the adrenal cortex is regulated by the

A

Renin-angiotensin-aldosterone system

*not affected by pituitary adenoma

57
Q

Prolactin acts on the mammary gland and the hypothalamus to stimulate milk production. What does it inhibit?

A

GnRH

58
Q

Anti-psychotics have what effect on dopamine?

A

block dopamine – inc. prolactin and dec. GnRH

59
Q

GH acts on the liver to increase ______ which causes cellular growth

A

IGF-1

  • muscles, bones,
  • alters blood glucose
  • high GH dec. tissue sensitivity to insulin
60
Q

High blood glucose level has what effect on growth hormone?

A

Inhibits GH

61
Q

GH-secreting pituitary adenoma can cause

A

Adults: acromegaly
Kids: Gigantism

62
Q

Melanocyte stimulating hormone (M SH) is produced from the precursor molecule

A

POMC

  • stimulates melanocytes
  • melanin
63
Q

POMC is synthesized in the _______ with at least 4 different cleavage sites. Where are these sites?

A

Synthesis: anterior pituitary

Cleavage: ACTH, B-endorphin, enkaphilin, MSH

64
Q

Oxytocin (post. pituitary) acts on the uterus and mammary glands to cause

A

contractions and milk let down

65
Q

ADH acts on ____ receptors in SM cells and on _____ receptors on principal cells of CD.

A

SM cells: V1

  • -vasoconstriction
  • -Gq (IP3)

CD: V2
–aquaporins to cell membrane

66
Q

SIADH occurs from hypersecretion of ADH. What results?

  • SSRI’s
  • Carbemazepine
  • Small cell carcinoma
A

-Urine is concentrated

-Hyponatremia
(<125mEq)

-Dangerous and dilutional
(retain too much fluid)

*personality changes, seizures, cerebral edema

67
Q

Diabetes insipidus is the opposite of SIADH due to low levels of ADH. What happens in DI

A

excessive loss of diluted urine (lose too much fluid)

  • hypernatremia
  • psychogenic (mind), central (lack of ADH; idiopathic; trauma) nephrogenic (ADH receptor issue; drug-induced; Lithium)
68
Q

ANP in the heart causes ______ of Na+

A

inhibition of Na2+ reabsorption

*vasodilator

69
Q

Classification of Endocrine disorders occurs by

A

Location

Primary: organ
Secondary: anterior pituitary
Tertiary: Hypothalamus

70
Q

True/False: Negative feedback axis describes that the final hormone or hormones produced at the level of the pituitary being able to inhibit additional further release of hormones from the Hypothalamus/pituitary

A

True

71
Q

The Hypothalamic-Pituitary - Adrenal (HPA) Axis involves signalling from the hypothalamus that results in Cortisol release from the adrenal cortex. Disruption of the HPA axis can result in Cushing Syndrome

Describe Cushing Syndrome

A

High Cortisol levels in blood – inhibit CRH and ACTH

Loss of ACTH from anterior pituitary

Atrophy of adrenal glands

Symptoms: hypertension (alpha-1 receptors); immunosuppression

72
Q

Addison’s disease is Adrenal destruction that results in

A

low cortisol, low aldosterone

  • autoimmune
  • no negative feedback
  • high CRH, ACTH
  • Crisis!
  • Hyponatremia, hypglycemia, hyperpigmentation (gums, palmar surface)
73
Q

Cosyntropin Stimulation test

A

distinguishes whether low cortisol is primary (adrenal gland) or secondary (ant. pituitary)

  • Primary: Low cortisol, high ACTH
  • Secondary/Tertiary: Low cortisol, low ACTH
74
Q

True/False: Klinefelter’s syndrome

(47, XXY) is inherited disorder of males in which males have an extra X and don’t develop normal sexual characteristics

A
  • -dec. testes

- -inc. GnRH

75
Q

Hypothalamic - Pituitary Axis in the Liver Muscle involves GH and IGF-1 release. What inhibits GH?

A

Somatostatin

76
Q

Insulin is secreted from the endocrine pancreas Beta cells along with C-peptide. It is the major anabolic hormone of the body.

What are its functions?

A
  • dec. blood glucose (GLUT-4; SK and adipose)
  • dec. blood aa’s
  • dec. blood fa’s
  • inc. K+ uptake

(inc. lipogenesis; glycolysis; protein synthesis)

77
Q

List the counter-regulatory hormones of Insulin

A

Glucagon
GH
Cortisol
Epinephrine

78
Q

Diabetes Mellitus Types

A
  1. Type I
    - -Type IV hypersensitivity
    - -destroy beta cells

*DKA

  1. Type II
    - -receptor downregulation
    - -end organ resistance
  2. Gestational
    - -pregnancy
    - -high blood glucose crosses placenta
    - -produce insulin
    * hypoglycemia eventually
79
Q

Effects of T3

A

6 B’s

  1. brain maturation
  2. bone growth (w/GH)
  3. B-adrenergic (inc. beta receptors in heart)
    * beta blockers
  4. Basal metabolic rate
  5. blood sugar
  6. break down lipids
80
Q

TSH binds, initiating formation of T3, T4. What pathway does it use?

A

Gs, GPCR/cAMP

81
Q

5-deiodinase converts ____ to _____ in peripheral target tissues.

A

T4 to T3

82
Q

True/False: Free t3/T4 are the only ones that perform negative feedback

A

True

83
Q

Hyperthyroidism is caused by high thyroid (T3/T4) and low TSH.

What is the most common disease of hyperthyroidism?

A

Graves disease

TSH Ab’s that act like TSH

  • pre-tibial myxedema
  • opthalmopathy
84
Q

Hypothyroidism results from low thyroid hormone (T3/T4) but high TSH.

What is a common disese of hypothyroidism?

A

Hashimoto’s thyroiditis

  • autoimmune destruction
  • TPO antibodies
85
Q

Chief cells of the parathyroid hormone secrete

A

PTH

–inc. serum calcium

86
Q

Parafollicular C cells of Thyroid gland secrete

A

Calcitonin

-reduce calcium serum

87
Q

PTH functions

  1. inc. bone resorption of ______ and ______
  2. inc. kidney reabsorption of Ca2+ in _______
  3. dec. reabsorption of phosphate in ______
  4. inc. Vit. D3 (calcitriol) production in ______
A
  1. Ca2+ and PO4
    - RANKL (osteoblasts)
    - RANK (osteoclasts)
  2. Reabsorbs Calcium at DCT
  3. Trashes phosphate at PCT
  4. Vit. D3 at PCT
    - -activates 1-alpha hydroxylase
88
Q

High Calcium levels results in what actions?

A
  1. Calcium sensing receptors
  2. Vit. D. inhibits PTH
    (mRNA level)
  3. Calcitonin (parafollicular cells of thyroid)
89
Q

Forms of Plasma Calcium

A
  1. bound to albumin
  2. complexed w/citrate and phosphate
  3. free ions
  • free ions = active
  • inc. pH = inc. affinity of albumin for Ca2+
90
Q

True/False: Hypocalcemia makes neurons more excitable

A

True

91
Q

Layers of Adrenal Cortex

“The deeper you go, the sweeter it gets….salt, sugar, sex. “

A
  1. Z. glomerulosa
    - -Aldosterone
  2. Z. fasciculata
    - -Cortisol
  3. Z. reticularis
    - -weak androgens (precursors)
    - -DHEA/ androstenedione
92
Q

The female reproductive cycle is controlled by what hormones?

A

GnRH: hypothalamus
FSH and LH: Ant. Pit.

FSH/LH: target ovaries and drive ovarian cycle

Estrogen & progesterone: drive uterine cycle

93
Q

List the phases of the Ovarian Cycle

A
  1. Follicular phase
    (inc. estrogen)
  • FSH stimulates follicle growth
  • Growth into Graafian
  • Granulosa cells: estrogen and inhibin
  • inhibition of FSH

*estrogen inc. LH

  1. Ovulation
    - -LH surge
    - -rupture of Graafian and release oocyte
    - -uterine tube
  2. Luteal Phase
    - -Corpus luteum (via LH)
    - -Progesterone, some estrogen
    - -prepares endometrium
94
Q

List the phases of the Uterine Cycle

A
  1. Proliferative phase
    - -rising estrogen levels
    - -develop uterine walls
    - -endometrial thickening
  2. Secretory phase
    - -Corpus luteum secretes progesterone
    - -inc. thickening of functional layer
    - -blood supply
    - -glands
  3. Menstruation phase
    - -dec. progesterone
    - -discharge of functional layer
    - -beginning of next cycle
95
Q

What happens to the corpus luteum if fertilization does not occur?

A
  1. atrophy – corpus albicans
  2. progesterne and estrogen levels decline
  3. functional layer shed (1st five days)

*inhibition of LH, FSH, and GnRH is lifted

96
Q

The ______ is the site of menstruation and development of the fetus

A

Uterus

-fundus, body and cervix

97
Q

List the layers of the Uterus

A
  1. Endometrium
    - simple columnar
    - Stroma

A. functional layer
B. Basal layer

  1. Myometrium
    - 3 layers SM
  2. Perimetrieum
    - Visceral peritoneum
98
Q

The ______ is a 4 inch long, fibromuscular organ ending at the cervix. It acts as the passageway for birth, menstrual flow and intercourse.

A

Vagina

  • between urinary bladder and rectum
  • orifice partially closed w/ hymen
99
Q

The ________ are modified sweat glands that produce milk (lactate). The amount of adipose determines the size of the breast.

A

Mammary glands

100
Q

Milk-secreting mammary glands alveoli open by _______ ducts at the nipple

A

lactiferous ducts

*areola: pigmented area around nipple

101
Q

The breasts are suspended from deep fascia of the pectroal muscles via the _____ ligaments

A

Suspensory (cooper’s) ligaments

102
Q
  1. _______ develop the ducts system in the breasts
  2. develop the milk-secreting glands which are called alveoli
  3. _______ stimulates milk synthesis in the alveoli
  4. ______ stimulates milk ejection from the alveoli
A
  1. Estrogens
  2. Progesterone
  3. Prolactin
  4. Oxytocin
103
Q

What stimulates milk ejection?

A
  1. Nursing, suckiling, crying releases oxytocin
  • SM of alveoli contract
    • lactiferous ducts — lactiferous sinuses – nipple

-sensory impulses from nipple

  • positive feedback
  • suppresses ovulation
104
Q

What happens to the corpus luteum if fertilization occurs?

A
  1. embryo implants in endometrium
  2. Progesterone levels maintained
    - -dec. LH
  3. hcG (embryo; outer part of blastocyst)
    - -similar to LH
105
Q

After about 3-4 months of pregnancy, the corpus luteum degenerates. What takes over production estrogen and progesterone?

A

Placenta

*progesterone: inhibits prolactin until baby is delivered

106
Q

Labor should normally occur at 40 weeks of gestation. It is divided into 3 stages:

A
  1. 1st stage (3-24 hrs)
    - -contractions (oxytocin; progesterone)
    - -until full cervical dilation (8-10cm)
    - -longest
  2. 2nd stage (30-120min)
    - -full cervical dilatation to birth
    - -nulliparous: 2 hours
    - -multiparous: 1 hour
  3. 3rd stage (15-30 min)
    - -delivery of placenta
107
Q

During the 1st phase of labor Relaxin is released. What is the function of relaxin?

A
  • soften CT

- ease passage of baby

108
Q

During lactation:

  1. _____- Stimulates duct growth
  2. ______ - Promotes lobule growth
  3. __________ - Stimulate the synthesis of enzymes necessary for milk production
A
  1. Oestrogen
  2. Progesterone
  3. Prolactin & Human Chorionic Somatomammotropin
109
Q

Suckling stimulates milk production via the release of ______ from ant. pit.

Milk is ejected via contraction of myoepithelial cells and release of ______ from post. pit

A

Milk production: PRL
Milk ejection: Oxytocin

PRL: contraceptive role

110
Q

List methods of contraception

A
  1. abstinence
  2. vasectomy
    - -vas deferens
  3. tubule ligation
    - -uterine tubes
  4. birth control pills
  5. IUD’s
    - cervix
  6. Condom
  7. Diaphragm
  8. Withdrawal
  9. Rhythm method
111
Q

Describe the process of fertilization

A
  1. acrosome
    - attach to corona radiata (outer coating of ovum)
    - acrosin
  2. hydrolysis reaction
    - reach inner coating (zona pellucida)
  3. 1 sperm penetrates
    - -fuses w/ cell membrane
  4. Rapid depolarization
112
Q

The following symptoms describe:

HTN, hypokalemia, Metabolic alkalosis (loss of H+ ions), hypernatremi

A

Primary hyperaldosteronism

*adrenal adenoma

113
Q

Aldosterone acts on the _____ to reabsorb Na and water (inc. blood volume and pressure)

A

Collecting duct

*secrete K+ and H+

114
Q

Cortisol:

BIG FIB

A

inhibits phospholipase A2
inhibits WBC adhesion
blocks IL-2

Bridge Physiology (4 decks)

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