Green book 3 Flashcards by B M

Which of the following statements is/are true regarding Hepatitis B infection:

a) Infection results in jaundice in greater than 50% of all cases
b) The incubation period ranges from 14-60 days
c) Chronic disease is strongly linked to the development of liver cancer
d) Less that half of children infected per-natally develop chronic disease
e) Most of those infected as adults will become chronic carriers of HBV

Chronic disease is strongly linked to the development of liver cancer

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Hepatitis B vaccines:

a) Are not effective in patients with acute hepatitis B
b) Are live attenuated vaccines
c) Fewer than 10% of adults fail to respond to hep B vaccines adequately
d) Are very effective if used for post-exposure prophylaxis
e) Work best in those aged over 40 years

Are not effective in patients with acute hepatitis B

Fewer than 10% of adults fail to respond to hep B vaccines adequately

Are very effective if used for post-exposure prophylaxis

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Hepatitis B vaccines:
a) Contain hepatitis B core antigen prepared from yeast cells
b) All contain the same dosage
c) Should not be given to a person who may already have been exposed to Hepatitis B
without checking for markers of past infection
d) Should not be administered into the buttock
e) Induce anti-HBs specific antibodies

Are interchangeable (different vaccines can be used to complete a primary course)

Should not be administered into the buttock

Induce anti-HBs specific antibodies

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Which of the following people should receive pre-exposure Hepatitis B vaccine:

a) Healthcare workers (including students/trainees) working in the UK
b) Staff working in residential accommodation for people with learning difficulties
c) Embalmers
d) Prison officers
e) Laboratory staff handling materials which may contain the virus

Healthcare workers (including students/trainees) working in the UK

Staff work at residential accommodation for people with learning difficulties

Embalmers

Prison officers

Laboratory staff handling materials which may contain the virus

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Which of the following should receive pre-exposure Hepatitis B vaccine:

a) Short term foster carers
b) Sewage workers
c) People receiving regular blood transfusions
d) People with chronic liver disease
e) People with chronic renal disease

Short term foster carers

People receiving regular blood transfusions

People with chronic liver disease

People with chronic renal disease

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Which of the following should receive pre-exposure Hepatitis B vaccine:

a) People living in residential accommodation with learning disabilities
b) Prison inmates
c) Intra-venous drug users
d) Household contacts of people who inject drugs
e) People who work with primates

People living in residential accommodation with learning disabilities

Prison in mates

Intravenous drug users

Household contacts of people who inject drugs

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Post-exposure prophylaxis with HBIG is recommended for:
a) Non-responders to hep B vaccine who have had a needle stick injury from a patient
with acute hepatitis B
b) People who have had unprotected sexual intercourse with a case of acute of
hepatitis B seen within one week of last contact
c) Babies born to women with chronic hepatitis B infection who are e antigen positive
d) People who have had unprotected sexual intercourse with a recently diagnosed case
of chronic hepatitis B 2 weeks ago
e) Babies born to women who have developed acute hepatitis B infection during
pregnancy

Non-responders to hep B vaccine who have had a needle stick injury from a patient with acute hepatitis B

People who have had unprotected sexual intercourse with a case of acute of hepatitis B seen within one week of last contact

Babies born to women with chronic hepatitis B infection who are e antigen positive

Babies born to women who have developed acute hepatitis B infection during pregnancy

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Available pre-exposure hepatitis B immunisation schedules for high risk
exposure in adults include:
a) 0, 1 month, 2 months and 12 months
b) 0, 7 days, 21 days and 12 months
c) 0, 1 month, 6 months and 12 months
d) 0, 2 months, 6 months and 12 months
e) 0, 2 months, 3 months and 4 months

0, 1 month, 2 months and 12 months

0, 7 days, 21 days and 12 months

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An immunocompetent healthcare worker is found to have an anti-HBs level of 10
– 100 mIU/ml after a course of hepatitis B vaccine. Which of the following is/are
true?
a) They need no further doses of hep B vaccine as satisfactory protection has been
achieved
b) They should have 1 further dose of hep B vaccine
c) They should have 1 further course of hep B vaccine
d) They should have single booster dose of hep B vaccine after 5 years
e) They should receive a booster dose of hep B vaccine every 5 years

They should have 1 further dose of hep B vaccine

They should have single booster dose of hep B vaccine after 5 years

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The following is/are true of babies born to hep B positive mothers:
a) If the mother is HBsAg positive and HBeAg the baby should receive a dose of HBIG
at birth
b) If the mother is HBsAg positive, HBeAg negative and the baby weighs 1800g the
baby should receive HBIG
c) The first dose of hep B vaccine should be given within 24 hours of birth
d) They should be tested for HBsAg at 6 months of age
e) They should be tested for HBsAg at 12 months of age

If the mother is HBsAg positive and HBeAg the baby should receive a dose of HBIG at birth

The first dose of hep B vaccine should be given within 24 hours of birth

They should be tested for HBsAg at 12 months of age

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Babies born after the 1st August 2017 in the UK whose mothers are NOT known to
be hep B carriers should receive:
a) Three doses of Hexavalent vaccine at 8, 12 and 16 weeks
b) A booster dose of Hexavalent vaccine at 1 year
c) A blood test for HBsAg at 1 year
d) A pre-school booster dose of Hexavalent vaccine
e) A blood test to measure response to the hep B vaccine 2 months after completion of
the Hexavalent vaccine schedule

Three doses of Hexavalent vaccine at 8, 12 and 16 weeks

A booster dose of Hexavalent vaccine at 1 year

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Babies born after 1st August 2017 in the UK to hep B carrier mothers should
receive:
a) Doses of monovalent hep B vaccine at birth and 4 weeks
b) Three doses of Hexavalent vaccine at 8, 12 and 16 weeks
c) A dose of Hexavalent vaccine at 1 year
d) A dose of monovalent hep B vaccine at 1 year
e) A pre-school booster dose of monovalent vaccine at 3 years 4 months

Doses of monovalent hep B vaccine at birth and 4 weeks

Three doses of Hexavalent vaccine at 8, 12 and 16 weeks

A dose of monovalent hep B vaccine at 1 year

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Which of the following should NOT be given Hepatitis B vaccine:
a) Those with a confirmed anaphylactic reaction to a previous dose of Hepatitis B
vaccine
b) Immunosuppressed individuals
c) Pregnant women
d) HIV positive people
e) Premature infants

Those with a confirmed anaphylactic reaction to a previous dose of Hepatitis B vaccine

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The following is/are true about Human Papillomavirus (HPV) infection:

a) HPV 18 is responsible for more than 50 % of all cervical cancers in Europe
b) HPV types 6 and 11 cause the majority of genital warts
c) 90 % of new HPV infections clear within 2 years
d) Approximately 100 types of HPV infect the genital tract
e) HPV can be transmitted from mother to newborn baby

HPV types 6 and 11 cause the majority of genital warts

90 % of new HPV infections clear within 2 years

HPV can be transmitted from mother to new-born baby

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The following is/are true about HPV vaccines:
a) They are contraindicated in yeast allergy
b) A 2-dose schedule should be given to those who are HIV infected or known to be
immunocompromised
c) They are given intramuscularly
d) Males and females in cohorts eligible for vaccination in the National Programme
remain so until their 25th birthday
e) If a course of HPV infection is interrupted it should be repeated

They are given intramuscularly

Males and females in cohorts eligible for vaccination in the National Programme remain so until their 25th birthday

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The following is/are true about Gardasil:
a) It contains thiomersal
b) It contains HPV types 6,11,16 and 18
c) The minimum interval between 2 doses of Gardasil for children and adolescents
aged between 9 and below 15 years of age is 6 months
d) There is evidence on the interchangeability of Gardasil and Cervarix
e) If Gardasil is given at the same time as dTaP both vaccines can be given at the
same site

It contains HPV types 6,11,16 and 18

The minimum interval between 2 doses of Gardasil for children and adolescents aged between 9 and below 15 years of age is 6 months

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The following is/are true about Cervarix:

a) It will provide protection against genital warts
b) If the 3-dose course is interrupted it should be resumed but not repeated
c) It is supplied as a suspension of virus-like particles(VLPs) in a pre-filled syringe
d) The risk of local reactions is less if given intramuscularly rather than subcutaneously
e) It contains HPV types 11 and 16

If the 3-dose course is interrupted it should be resumed but not repeated

It is supplied as a suspension of virus-like particles(VLPs) in a pre-filled syringe

It should be given by the intramuscular route

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. In the UK, the groups recommended to receive HPV vaccine include(s):

a) Children aged 9-11 years
b) Adolescents aged 11-14 years
c) Older adolescents and adults aged 15-30 years
d) MSM aged up to and including 45 years
e) MSM aged 50 with no previous history of HPV vaccine

Adolescents aged 11-14 years

MSM aged up to and including 45 years

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In the UK programme the following patient groups should not be routinely
advised to receive HPV vaccine:
a) Patients with immunosuppression
b) Patients with HIV infection
c) Patients who are pregnant
d) Males aged 11-18 years
e) Females coming to the UK from overseas under the age of 18 years with an
uncertain immunisation history

Patients who are pregnant

Males aged 11-18 years

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Which of the following is/are true:

a) Influenza is caused by type A, B or C viruses
b) Influenza A is the usual cause of epidemics
c) Minor changes in the surface antigens of influenza A occur every year
d) “Antigenic shift” means a major change in the influenza A virus has occurred
e) The burden of influenza B disease is mostly in adults

Influenza is caused by type A, B or C viruses

Influenza A is the usual cause of epidemics

Minor changes in the surface antigens of influenza A occur every year

“Antigenic shift” means a major change in the influenza A virus has occurred

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Which of the following is/are true about Influenza vaccines:
a) They must be given annually
b) Current trivalent vaccines have 2 influenza A subtypes and one B subtype in them
c) Quadrivalent vaccines with an additional influenza A virus have become routinely
available
d) Most of the vaccines are prepared from viruses grown in embryonated hens’ eggs
e) They may cause influenza in some individuals

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They must be given annually

Current trivalent vaccines have 2 influenza A subtypes and one B subtype in them

Most of the vaccines are prepared from viruses grown in embryonated hens’ eggs

Influenza vaccine should be offered to the following:

a) The main carer of a disabled person
b) Residential care home staff
c) All the inmates of a Young Offenders Institution
d) A pregnant woman
e) A Midwife

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The main carer of a disabled person

Residential care home staff

A pregnant woman

A midwife

Patients with the following conditions should have seasonal influenza vaccine:

a) Class III obesity
b) Stage 2 chronic renal disease
c) Diabetes controlled by diet
d) Cystic Fibrosis
e) Severe learning disability

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Class III obesity

Diabetes controlled by diet

Cystic Fibrosis

Severe learning disability

The following is/are true about flu vaccine in pregnancy:
a) Influenza vaccine is contraindicated in the first trimester of pregnancy
b) The vaccine of choice for pregnant women is LAIV
c) Pregnant women are more likely to suffer side affects from the vaccine
d) Pregnant women who have received influenza vaccine are at slightly increase risk of
miscarriage
e) Influenza vaccine given to the mother may provide passive immunity to the infant in
the first few months of life

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Influenza vaccine given to the mother may provide passive immunity to the infant in the first few months of life

The following is/are contraindications to children receiving LAIV: a) Lymphoma b) Taking salicylate therapy c) Taking inhaled corticosteroids d) Asthma with increased wheezing in the previous 72-hours e) HIV infection on HAART

Lymphoma Taking salicylate therapy Asthma with increased wheezing in the previous 72-hours

Adverse reactions to inactivated flu vaccine may include: a) Pain and swelling at the injection site b) High grade fever c) Myalgia d) Shivering e) Clinical influenza

Pain and swelling at the injection site Myalgia Shivering

Which of the following is/are true about LAIV Fluenz Tetra®: a) Cannot be given at the same time as other live vaccines b) When LAIV Fluenz Tetra® is being administered, the dose should be repeated if the patient sneezes or blows their nose c) It may be left out of the refrigerator for a maximum of 48 hours at a temperature not above 25°C d) It should not be administered within 48 hours of antiviral drugs e) It is administered as a dose of 0.2 ml into each nostril

It should not be administered within 48 hours of antiviral drugs

The following is/are true about LAIV Fluenz Tetra®: a) It contains live attenuated virus b) It is recommended for children with egg allergy c) It is contraindicated in patients receiving low dose inhaled corticosteroids d) If influenza vaccine has not been received previously a 3-year-old child having LAIV Fluenz Tetra® should receive 2 doses e) Can be administered by health care workers who are pregnant

It contains live attenuated virus Can be administered by health care workers who are pregnant

A child aged 3 in a clinical risk group who has never received any influenza vaccine before, should have: a) A dose of inactivated quadrivalent vaccine, followed by a dose of LAIV 4 weeks later b) A dose of LAIV followed by a dose of inactivated quadrivalent vaccine 4 weeks later c) One dose of LAIV d) Two doses of LAIV at least 4 weeks apart e) Two doses of LAIV at least 8 weeks apart

Two doses of LAIV at least 4 weeks apart

The following is/are true: a) If not given at the same time, a 4-week interval should be observed between LAIV and other live vaccines b) Quadrivalent Cell Cultured Inactivated (QVIC) vaccine is an inactivated vaccine made from influenza virus grown in chicken cells c) Inactivated vaccines should be given using an 18-guage needle d) Standard flu vaccines have low effectiveness against A(H3N2) in the elderly e) Children in clinical risk groups can receive flu vaccine from 6 months of age

Quadrivalent Cell Cultured Inactivated (QVIC) vaccine is an inactivated vaccine made from influenza virus grown in chicken cells Inactivated vaccines should be given using an 18-guage needle Standard flu vaccines have low effectiveness against A(H3N2) in the elderly Children in clinical risk groups can receive flu vaccine from 6 months of age

Japanese encephalitis: a) Is a tick borne viral encephalitis b) Highest transmission rates occur during and just after dry seasons c) Has an incubation period of 5-15 days d) Is associated with a rate of approximately 10 % of neurological sequelae in survivors e) Is not transmitted from person to person

Has an incubation period of 5-15 days Is not transmitted from person to person

JE vaccine should: a) Be given to those who are going to an endemic or epidemic area b) Be given to laboratory staff who have potential exposure to the virus c) Not be given to those who have had a confirmed anaphylactic or serious systemic reaction to a previous dose of JE vaccine d) Not be given to those who have had a confirmed anaphylactic reaction to any component of the vaccine e) Not be given during pregnancy and breast-feeding

Be given to those who are going to an endemic or epidemic area Be given to laboratory staff who have potential exposure to the virus Not be given to those who have had a confirmed anaphylactic or serious systemic reaction to a previous dose of JE vaccine Not be given to those who have had a confirmed anaphylactic reaction to any component of the vaccine

Which of the following is true about JE vaccines? a) They contain no live organisms b) They should be given by subcutaneous injection c) There is currently only one licensed vaccine recommended for use in the UK - IXIARO d) They can be given at the same time as other travel or routine vaccines e) They are not usually recommended in children under 1 year of age

They contain no live organisms There is currently only one licensed vaccine recommended for use in the UK – IXIARO They can be given at the same time as other travel or routine vaccines They are not usually recommended in children under 1 year of age

Which of the following is/are true: a) IXIARO is licensed for individuals aged 2 months and older b) For children aged 24 months of age the recommended vaccine schedule is 2 x 0.5 ml doses of IXIARO vaccine on days 0 and 28 c) The recommended primary schedule for IXIARO comprises 3 doses d) Primary vaccination should be completed ideally at least one week prior to potential exposure to JE virus e) A rapid schedule administered at days 0 and 14 is also licensed for adults aged 18 to 65

For children aged 24 months of age the recommended vaccine schedule is 2 x 0.5 ml doses of IXIARO vaccine on days 0 and 28 Primary vaccination should be completed ideally at least one week prior to potential exposure to JE virus

Recognised complications of infection with measles virus include: a) Otitis media b) Convulsions c) Pneumonia d) Constipation e) Joint pains

Otitis media Convulsions Pneumonia

Sub-acute sclerosing pan-encephalitis (SSPE): a) Is a fatal late complication of measles infection b) Occurs in every 25,000 measles infections c) Has increased in rate since the introduction of MMR vaccine d) The risk of developing SSPE is greater if the child has measles infection after the age of one year e) May take 20-30 years to develop post measles infection

Is a fatal late complication of measles infection Occurs in every 25,000 measles infections May take 20-30 years to develop post measles infection

If a child has received a dose of MMR vaccine before the age of 12 months: a) They need only one further dose of MMR given at the same time as the pre-school booster immunisations b) The child needs to receive 2 further doses of MMR vaccine given at 12-13 months and at the same time as the pre-school boosters c) The response to a dose given before 12 months may be suboptimal due to persistence of maternal antibodies in the baby d) This may increase the risk of an adverse reaction to any subsequent dose e) It is worth checking for measles antibodies before deciding to give a further dose

The child needs to receive 2 further doses of MMR vaccine given at 12-13 months and at the same time as the pre-school boosters The response to a dose given before 12 months may be suboptimal due to persistence of maternal antibodies in the baby

Which of the following is/are true about MMR vaccine: a) It is a live attenuated vaccine b) It should not be given to children with autism c) It should not be given in pregnancy d) It is better not to give it if a person has a previous history of either measles, mumps or rubella e) If the vaccine course is started after the age of 18 months a child needs 2 doses separated by 3 months

It is a live attenuated vaccine It should not be given in pregnancy

Which of the following is/are true: a) A single dose of MMR vaccine confers protection against measles in about 80% of individuals b) There is a link between Guillain-Barré syndrome (GBS) and MMR vaccine c) A mild measles-like rash may develop 3 weeks after MMR vaccine d) Allergy to egg is not an absolute contra-indication to MMR e) There is no evidence of measles vaccine virus being found in breast milk

Allergy to egg is not an absolute contra-indication to MMR There is no evidence of measles vaccine virus being found in breast milk

Which of the following is/are true about managing contacts of measles: a) Advice should be sought from the local HPU or microbiologist b) HNIG may be indicated in non-immune contacts who are pregnant, immunocompromised or under 9 months of age c) In susceptible immunocompetent contacts in whom MMR is not contra-indicated a dose of MMR may protect them if given within 3 days of exposure d) Where HNIG is given, an interval of at least 3 months must be allowed before subsequent MMR immunisation e) Measles infection in pregnancy can lead to congenital malformation

Advice should be sought from the local HPU or microbiologist HNIG may be indicated in non-immune contacts who are pregnant, immunocompromised or under 9 months of age In susceptible immunocompetent contacts in whom MMR is not contra-indicated a dose of MMR may protect them if given within 3 days of exposure Where HNIG is given, an interval of at least 3 months must be allowed before subsequent MMR immunisation

A diagnosis of meningococcal infection requires the following to be present: a) Headache b) Neck stiffness c) Photophobia d) Drowsiness e) Pyrexia

None of the answers listed are required to give a diagnosis of meningococcal infection, although any of the symptoms may be present

Meningococcal infection in young infants: a) Rarely presents with an insidious onset b) Will usually present with the classical signs of meningitis c) Should be considered if the child has a raised anterior fontanelle, if still patent d) Is likely to be present in an apyrexial child e) Should be considered where a child is irritable

Should be considered if the child has a raised anterior fontanelle, if still patent Should be considered where a child is irritable

3. Meningococci: a) Are most often harmless commensals colonising the nasopharynx b) Are carried by about a quarter of adolescents, who show no signs of disease c) Are transmitted by aerosol d) Are usually transmitted with minimal contact e) Cause infection most frequently in teenagers

Are most often harmless commensals colonising the nasopharynx Are carried by about a quarter of adolescents, who show no signs of disease Are transmitted by aerosol

Meningococcal C conjugate (MenC) vaccine: a) Was introduced to the UK routine immunisation programme in 1999 b) The first dose is given in the UK primary vaccination schedule to children at 3 months c) Should be offered as a single dose to anyone over the age of 10 years who has not completed the primary childhood schedule up to the age of 50 d) Is given as Hib/Men C vaccine between 12 and 13 months of age and as a component of ACWY vaccine in adolescence in the UK primary vaccination schedule e) Children over the age of 1 and under the age of 10 who have not received any Men C vaccine should be offered a single dose of Hib/Men C vaccine

Was introduced to the UK routine immunisation programme in 1999 Is given as Hib/Men C vaccine between 12 and 13 months of age and as a component of ACWY vaccine in adolescence in the UK primary vaccination schedule Children over the age of 1 and under the age of 10 who have not received any Men C vaccine should be offered a single dose of Hib/Men C vaccine

Which of the following is/are true about children and adults with asplenia and splenic dysfunction: a) Children under one year of age should receive 2 doses of Men ACWY vaccine one month apart b) Children presenting over 2 years of age and under 10 should be given one dose of Hib/Men C vaccine, one dose of PPV23 and one dose of Men ACWY conjugate vaccine 1 year later c) Adults who develop splenic dysfunction should be offered Men B vaccine d) If travelling to a country at increased risk of A, W135 or Y disease children under 5 should be offered Men ACWY polysaccharide vaccine e) Conjugate Men ACWY vaccine gives a poorer response than polysaccharide Men ACWY vaccine

Children under one year of age should receive 2 doses of Men ACWY vaccine one month apart Adults who develop splenic dysfunction should be offered Men B vaccine

Meningococcal vaccines are contra-indicated in the following: a) Pregnant women b) HIV positive people c) Other people with severe immuno-compromising conditions d) Premature infants e) Breast feeding mothers

There are no correct answers, all the following could receive meningococcal vaccine

Which of the following is/are true quadrivalent ACWY conjugate vaccines: a) They are live vaccines b) They are conjugated to other CRM 197 or tetanus toxoid carrier proteins c) They can provide limited cross protection against group B meningococcal disease d) They provide longer lasting immunity than polysaccharide meningococcal vaccine e) They are given intramuscularly

They are conjugated to other CRM 197 or tetanus toxoid carrier proteins They provide longer lasting immunity than polysaccharide meningococcal vaccine They are given intramuscularly

Which of the following is/are recognised adverse reactions to meningococcal vaccines: a) Fever > 39.5°C with Hib/Men C conjugate vaccine b) Atopic dermatitis occurring after MenC/Hib combined vaccine c) Impaired sleep following MenC conjugate vaccine d) Diarrhoea in infants and toddlers following MenC vaccine e) Fever > 38°C and irritability in children under 10 with 4CMenB vaccine Bexsero

Fever > 39.5°C with Hib/Men C conjugate vaccine Atopic dermatitis occurring after Men C/Hib combined vaccine Impaired sleep following Men C conjugate vaccine Diarrhoea in infants and toddlers following MenC vaccine Fever > 38°C and irritability in children under 10 with 4CMenB vaccine Bexsero

The following is/are true about quadrivalent ACWY vaccines for travel: a) Immunisation with ACWY vaccine is recommended for long stay visitors to subSaharan Africa b) Children under 1 need one dose of Menveo® c) Children aged between 5 and 10 need 2 doses of Menveo® or Nimenrix® d) A dose of 4CMenB vaccine should routinely be given in conjunction with the ACWY vaccine to those travelling abroad e) If an infant has already had Men C vaccination, then Men ACWY should also be given

Immunisation with ACWY vaccine is recommended for long stay visitors to sub-Saharan Africa If an infant has already had Men C vaccination, then Men ACWY should also be given

The following is/are true about 4C Men B protein vaccine (Bexsero®): a) Bexsero® may protect up to 98% of circulating Men B strains in England and Wales b) Bexsero® may also protect against infection by other capsular groups of meningococcus c) Is currently recommended for all household contacts of an index case of invasive group B meningococcal disease d) Is licensed for use from 2 months of age e) Is made from one N. meningitidis protein

Bexsero® may also protect against infection by other capsular groups of meningococcus

The following is/are true about 4C Men B protein vaccine (Bexsero®): a) It is supplied as a vial of white powder with a separate diluent b) In the routine immunisation schedule is given at 2 and 4 months with a booster at 12 – 13 months c) In the routine immunisation schedule is given at 2, 3 and 4 months d) It should be offered as a single dose to students attending university for the first time e) Is now routinely recommended for individuals who are travelling or going to reside abroad

In the routine immunisation schedule is given at 2 and 4 months with a booster at 12 – 13 months

Regarding the 4C Men B protein vaccine (Bexsero®): a) Post vaccination fever peaks at around 2 hours and has usually gone by 24 hours after vaccination b) Three doses of paracetamol given prophylactically at the time of vaccination then at 4-6 hourly intervals reduces the fever c) Ibuprofen has been found to be as effective as paracetamol in reducing the fever d) The immunogenicity of other routine vaccines in infants co-administered with 4C MenB is not affected by giving paracetamol e) Fever of ≥40°C in a child following a dose of Bexsero® is a contraindication to the child receiving a further dose of the vaccine

Three doses of paracetamol given prophylactically at the time of vaccination then at 4 – 6 hourly intervals reduces the fever The immunogenicity of other routine vaccines in infants co-administered with 4C MenB is not affected by giving paracetamol

Green book 3 Flashcards

(52 cards)