Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Finals > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

(179 cards)

Start Studying
1
Q

what causes stress incontinence?

A

weakened urethral sphincter muscles mean that the detrusor pressure > urethral closing pressure which causes leakage when coughing and exervising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RF for stress incontinence

A

menopause, vaginal births, congenital weakness, pelvic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you investigate urinary incontinence?

A 
Urine stix - exclude UTI
freq/vol chart - functional capacity of the bladder
urodynamics
QoL questionaire
vaginal exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how do you manage stress incontinence?

A
  1. Conservative - 3 months of pelvic floor exercises, lose weight, stop smoking, treat a cough and constipation
  2. peri-urethral bulking agents

Medication: Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what causes overactive bladder?

A

overactive detrusor muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the RF for an overactive bladder?

A

MS/neurological/incontinence surgery/increasing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what provokes symptoms of an overactive bladder?

A

provoked by cold weather, opening the front door, coughing and sneezing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how do you manage an overactive bladder? what are the side effects of the first line medical treatment

A
  1. Lifestyle - avoid excess fluids, caffeine, carbonated drinks, alcohol

1st line = oxybutynin (anti muscarinic) - relaxes the detrusor by blocking the parasym - SE = dry mouth/constipation/nausea
2nd line = mirabegron (B3 agonist)
3rd line = botox injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is a prolapse?

A

protrusion of organs into the vagina due to weaened pelvic floor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of a prolapse (retrocele/cystocele)?

A

dragging sensation
Cystocele - urinary frequency/urgency/incomplete emptying
Retrocele - constipation/difficulty defacating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the RF for a vaginal prolapse?

A

prolonged labour, trauma and surgery to the pelvic floor, forcep delivery, chronic cough, obesity, high BMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you investigate a prolapse?

A

clench test

bimanual examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you manage a prolapse?

A
  1. pelvic floor exercises, lose weight, treat cough, stop smoking
  2. pessary (SE - discharge)
  3. surgical repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what does LH do?

A

binds to theca cells which stimulates production of androgens
induces ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what does FSH do?

A

binds to granulosa cells and converts androgens to oestrogen, and stimulates the production of inhibin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are primary and secondary amenorrhea?

A

primary - no period by the age of 16

secondary - periods stop for >6 months in women with a previous regular cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name some causes for primary amenorrhea?

A

congenital malformation of organs
Turner’s syndrome
familial
androgen insensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is Turner’s syndrome? what are the signs?

A 
45X
Coarction of aorta
spade shaped chest - wide nipples and neck
horseshoe kidney
primary amenorrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is androgen insensitivity syndrome?

A

peripheral insensitivity to testosterone despite having genotype 46XY - female phenotype but genetically male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

name some causes of secondary ameonrrhea?

A 
thyrotoxicosis
PCOS
Asherman's syndrome
Sheeshan's syndrome
prolactinoma
hypothalamic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is asherman’s syndrome?

A

scarred uterus from D&C - blood can’t leave uterus due to the scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is sheeshan’s syndrome?

A

ischaemic damage to AP (panhypopituitarism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

name some causes of raised prolactin? what are the signs?

A

prolactinoma, antipsychotics (2nd generation)

galactorrhea, reduced libido, amenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how do you investigate amenorrhea?

A

bHCG, oestrogen, progesterone
FSH and LH levels
testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is menarche? when do you investigate?
first period - need to investigate if not started by 16. also investigate if no other sex characteristics by the age of 14.
26
what is the normal order of sexual development in a female?
1. breast buds 2. pubic hair 3. axillary hair 4. menses
27
what is the role of oestrogen?
prepares endometrium for implantation. Keeps the cervical mucus thin which is good for the sperm
28
what is the role of progesterone?
maintains the endometrium and creates a hostile environment to prevent more sperm entering the uterus.
29
what is dysmenorrhea?
painful periods with/without N&V.
30
how can you manage dysmenorrhea?
``` Mefenamic acid (NSAID) Tranexamic acid (if heavy bleeding) COCP - suppresses ovulation ```
31
name some causes of dysmenorrhea?
endometriosis, adenomyosis, fibroids, polyp
32
what is endometriosis?
endometrial tissue is present outside of the uterus. Disease driven by oestrogen. RETROGRADE MENSTRUATION THEORY
33
what is the presentation of endometriosis?
``` cyclical pain with menstrual cycle severe dysmenorrhea adhesions deep dyspareunia dysuria, dyschezia reduced fertility ```
34
what do you find on examination of an endometriosis patient?
fixed and retroverted uterus uterosacral masses on ligament cervical excitation
35
Ix for endometriosis?
TVUS/MRI CA125 gold standard = laparoscopy
36
how can you manage a patient with endometriosis who wants to get pregnant?
Mefenamic acid, tranexamic acid
37
Name some treatments for endometriosis?
1. COCP + paracetamol 2. Mirena IUS 3. GnRH analogue (Goserelin) 4. surgical ablation of endometriosis lesions
38
name some complications of endometriosis?
subfertility, adhesions, chocolate cysts
39
what is a fibroid?
benign tissue of smooth muscle of the myometrium (oestrogen dependant)
40
how do fibroids present?
menorrhagia subfertility (submucosal) pain mass effect on bladder/bowel
41
How do you investigate fibroids?
TVUS | histeroscopy + biopsy
42
how do you manage fibroids?
<3cm - Mirena coil | other: GnRH analogue, myomectomy, uterine artery embolisation
43
name complications of fibroids?
subfertility | red degeneration
44
what is FGM?
any cutting/removal to external female genitalia - ILLEGAL IN THE UK
45
Acute and chronic effects of FGM?
ACUTE - blood loss, death, sepsis, pain, urinary retention | CHRONIC - dyspareunia, apareunia, UTIs, urinary retention
46
name some physiological ovarian cysts?
follicular corpus luteal
47
name some pathological ovarian cysts?
dermatoid (mature teratoma) mucinous chocolate cysts
48
how do ovarian cysts present?
``` asymptomatic chronic pain/dull ache/cyclical pain ACUTE - torsion irregular bleeding mass/ascites ```
49
IX for a ovarian cyst?
FBC, CA125, hCG, CEA TVUS MRI
50
what are the features of lichen sclerosis?
hourglass distribution of pearly white areas on the labia minora and the clitoris + regression of this tissue ITCHY!
51
What is the definition of menopause?
<50 years - no periods for 24 months | >50 years - no period for 12 months
52
what are the features of the menopause?
menstrual irregularity vasomotor - night sweats, hot flushes, palpatations atrophy of genitalia and breasts osteoporosis
53
How do you manage the menopause?
``` diet and exercise oestrogen cream for atrophic vaginitis SSRI for hot flushes HRT bisphosphonates for osteoporosis ```
54
what do you use for HRT if the woman has a uterus?
opposed oestrogen
55
name some contradictions of HRT?
oestrogen dependant cancer, undiagnosed PV bleed, previous PE
56
name some side effects of HRT?
fluid retention, bloating, acne, tender breasts
57
what annual checks do you do on a patient
BP, weight, breasts, PV bleeding
58
Risks of HRT?
increased risk of Breast cancer, VTE, stroke, MI
59
what is PID? name some causes
upper genital tract infection | chlamydia, gonorrhea, uterine instrumentation, IUCD
60
how does PID present?
abdo pain, dyspareunia, vaginal discharge
61
how do you investigate PID?
STI triple swab check | FBC/CRP/blood cultures
62
name some complications of PID?
Fitz hugh curtis syndrome recurrent/chronic PID abscess subfertility and ectopic pregnancies
63
how do you treat PID?
ceftriaxone, azithromycin, doxycycline
64
what is PCOS criteria? what does it include?
ROTTERDAM CRITERIA hyperandrogenism oligomenorrhea PCO > 12 on US
65
signs of PCOS?
subfertility, oligomenorrhea, hirtuism, acne, obesity, hyperinsulinaemia, acanthosis nigricans
66
how do you Ix PCOS?
``` TVUS LH and FSH - high LH:FSH ratio testosterone raised prolactin CA125 TFT glucose tolerance test ```
67
how do you manage PCOS?
GENERAL - weight loss, stop smoking, dietary advice metformin - for increased insulin sensitvity clomifene - induces ovulation COCP - regulates cycle cyroproterone - cream for hirsutism
68
what does PCOS increase the risk of?
endometrial cancer, T2DM, gestational diabetes
69
main feature of endometrial cancer?
POST MENOPAUSAL BLEEDING!
70
RF for endometrial cancer?
high BMI, post menopausal, HTN, PCOS, nullparity, late menopause, oestrogen only HRT, HNPCC
71
how do you investigate endometrial cancer?
TVUS - endometrial thickness >4? | hysteroscopy and biopsy --> FIGO staging
72
what is the commonest type of ovarian cancer?
serous cell
73
what is cervical screening looking for?
CIN (levels of dykaryosis)
74
what happens with the results of cervical screening?
BORDERLINE/MOD --> Test for HPV --> +ve --> colposcopy MOD --> colposcopy
75
who do we screen for cervical cancer?
25-50 screen 3 yearly | 50-70 screen 5 yearly
76
how do you manage CIN?
loop diathermy
77
symptoms of cervical cancer?
post-coital and intermenstrual bleeding, discharge, pain, ureteric and bowel disruption
78
what would you find on examination of a patient with cervical cancer?
irregular cervix surface, increased acetic acid uptake, rough and hard cervix, abnormal vessels
79
what causes thrush? symptoms? Ix? management?
cause: candida albicans signs: cottage white cheese discharge, fissures, pain and itch Ix: MC&S, micella and spores Mx: topical clotrimazole or oral fluconazole
80
what causes trinchomonas? symptoms? Ix? management?
trinchomonas vaginalis signs: strawberry cervix, thin fishy discharge wet film: motile flagellates Mx: metronidazole and contact trace
81
what causes BV? symptoms? Ix? management?
gardenerella vaginalis signs: fishy discharge, large vol, pH>4.5, positive whiff test (add KOH and there is an ammonia smell) clue cells on microscopy Mx: metronidazole
82
what causes gonorrhea? symptoms? Ix? management?
neisseria gonorrhea pres: abdo pain, discharge, post-coital bleeding Ix: swab --> NAAT --> sensitivities Mx = Ceftriaxone + azithromycin
83
what causes chlamydia? symptoms? Ix? management?
symptoms: dysuria, discharge, post coital bleeding Ix: swab --> NAAT Mx: azithromycin + contact trace
84
name some complications of chlamydia?
PID, fitz hugh curtis syndrome, Reiters
85
what strains of HPV cause genital warts?
6 and 11
86
who do we screen for breast cancer?
women aged 50-70 every 3 years with the mammogram
87
commonest type of breast cancer?
invasive ductal carcinoma
88
what are the RF for breast cancer?
BRCA 1/2, 1st degree
89
who do you refer to a breast specialist?
>30 - woman with lump/pain | >50 - nipple dischrge/retraction/abnormal changes
90
how do we medically treat breast cancer? different age groups and their actions
pre-menopause - Tamoxifen (selective oestrogen receptor modulator) post menopausal - aromatase inhibitor (anastrazole) HER2 +ve - Herceptin
91
Surgeries used for breast cancer?
mastectomy, wide local excision, radiotherapy, chemo, immune checkpoint inhibitors
92
SE of tamoxifen?
increasd risk of VTE/EC/hot flushes/PV bleeding/amenorrhea
93
name some benign breast lesions
fibroadenoma | cysts
94
Discuss the development of the placenta?
develops from trophoblastic cells which invade spiral arteries and form sinuses. Villi form at 6 weeks and forms the functional placenta units -->placenta continues to grow until 16 weeks
95
what are the functions of the placenta?
gas exchange, produces hCG/GF/oestrogen/progesterone, barrier to infection/drugs, nutrient transfer.
96
what physiological changes are there during pregnancy?
HAEM - increased blood volume - produces physiological anaemia CVS - increases in CO/SV, reduced peripheral resistance, varicose veins VENTILATION - increases by 40% reduced gut motility due to progesterone - constipation/GORD
97
what are the role of progesterone and oestrogen during pregnancy?
PROGESTERONE - produced by placenta after day 35. Reduces the smooth muscle excitability (uterus/gut/ureters) and increases the body temperature OESTROGEN - increases breast and nipple growth, water retention
98
how many days into a pregnancy will the pregnancy test test positive?
9 days post conception
99
what is the definition of infertility?
inability to conceive pregnancy after 2 years of trying with regular intercourse
100
cause of infertility?
male causes unexplained ovulation failure tubal damage (chlamydia/PID)
101
Ix for infertility? what would you be looking at?
semen sample | 21 day progesterone (low progesterone --> refer to specialist, if it is high this means that ovulation is occuring.)
102
how do you score post-natal depression?
Edinburgh post-natal depression scale
103
Features of a multiple pregnancy?
``` uterus large for date hyperremesis gravidarum polyhydramnios 2 fetal heart beats multiplicity of fetal parts ```
104
what increases the risk of a multiple pregnancy?
``` family history previous twins IVF increasing maternal age clomifene ```
105
name some complications of a twin pregnancy?
polyhydramnios pre-eclampsia increased risk of APH operatie delivery
106
what is an ectopic pregnancy?
implantation of a fertilised ovum outside of the uterus (commonly within the fallopian tube)
107
where is the most common site of ectopic pregnancy associated with rupture?
isthmus
108
what increases the risk of an ectopic pregnancy?
IUCD, PID, endometriosis, previous fallopian tube surgery
109
what is the presentation of an ectopic pregnancy?
``` 6-8 weeks amenorrhea unilateral pain (radiating to the shoulder) PV bleeding N&V signs of shock ```
110
what do you find on examination of a patient having an ectopic pregnancy? what Ix would you do?
cervical excitation tender abdomen adnexal mass bHCG - >1500 US uterus - empty
111
How do you manage an ectopic pregnancy?
EXPECTANT - unruptured, no fetal HB, falling hCG - monitor hCG for 48 hours MEDICAL - methotrexate SURGICAL - if ruptured, pain, fetal HB, bHCG>1500 - Salpingectomy
112
what is a miscarriage?
expulsion of conception products <24 weeks
113
name some causes of recurrent miscarriages?
antiphospholipid syndrome increasing maternal age bicornuate uterus fibroids
114
what are the features of the 4 types of miscarriage (inevitable, incomplete, missed, threatened)
INEVITABLE - clots, pain, blood, os open INCOMPLETE - blood, clots, pain, parts of foetus expelled MISSED - foetus dead, no expulsion yet THREATENED - painless PV bleed
115
How can you manage a missed miscarriage?
1. Expectant - wait for the foetus to be expelled spontaneously 2. MISOPROSTOL (prostaglandin - causes contractions) 3. surgical vacuum asipration
116
how do you manage an abortion?
<9 weeks - Mifepristone (anti-progesterone) + prostaglandins for contractions >9 weeks - surgical dilation and suction
117
what is the definition of labour?
regular painful contractions, effacement of cervix, rupture of membranes and release of cervical plug
118
what do you monitor during labour?
fetal - heart rate (CTG) contractions maternal - HR/BP/urine/temp
119
what problems arise during stage 1 of labour - how do you manage this
inefficient contractions - syntocinin | cephalopelvic disproportion - C section
120
what are the indications for an operative vaginal delivery?
``` prolonged 2nd stage of labour maternal exhaustion fetal distress under GP assisted delivery of preterm breech vaginal delivery cord prolapse ```
121
what is cord prolapse?
umbilical cord descends below the presenting part of the foetus. Causes cord compression and vasospasm resulting in foetal hypoxia
122
what are the RF for cord prolapse?
premature, polyhydramnios, multiple pregnancy, long cord
123
How do you manage a cord prolapse
emergency alarms try and push the cord as far inwards as [possible deliver fetus ASAP - C section or instrumental get the patient on all fours
124
complications of the PROMS?
maternal - chorioamnionitis, oligohydramnios | fetal - premature, pulm hypoplasia, infection
125
causes of PROM?
BV, gonorrhea chlamydia
126
how do you manage PROMs?
monitor temp - ensure no infection | 10 days erythromycin
127
how do you manage pre-term labour?
give corticosteroids - fetal lungs GBS - give benzylpenicillin Give an anti-oxytocin - Atosiban
128
how do you manage breech position?
at 36-37 weeks undergo extracephalic version
129
C/I to extracephalic version?
twins, placental praevia, uterine scars
130
how do you manage shoulder dystocia?
1. call for help 2. episiotomy 3. McRoberts manouvre
131
what is a hydaditiform mole?
proliferating chorionic villi resulting in raised bhCG and increased symptoms of pregnancy
132
presentation of hydatiform mole?
``` early miscarriage HG uterus large for gestational age strongly positive pregnancy tests US - snowstorm effect ```
133
what is hyperremesis gravidarum?
persistant vomiting, weight loss, ketosis
134
features of hyperremesis gravidarum?
can't keep food or drink down, lost weight, dehydration, malloryweiss tear, inability to swallow saliva
135
Ix for hyperremesis gravidarum?
urine - UTI/ketosis FBC - raised haematocrit US - exclude mole UEs - low K and Na
136
Mx of hyperremesis gravidarum?
admit - correct UE disturbances and correct hydration status Daily UEs anti-emetic - promethazine
137
RF for uterine rupture
pain during labour usually occurs on LSCS scars - previous C section obstructed labour, breech extraction
138
how to manage a uterine rupture?
category 1 CS give O2 cross match blood post op Abx
139
most common cause of puerperal infection? how do you treat this?
Endometritis | Gentamycin + clindamycin
140
what is an APH?
genital tract bleeding occuring after 24 weeks
141
name some causes of APH?
placental abruption, placenta praevia,vasa praevia
142
how do you manage a APH?
1. Admit - US - where is the placenta? | 2. IVI - fluids, O2, raise legs
143
what is abruption? Features of placenta abruption? what is it associated with?
placental detaches from uterus pain, hard uterus, PV bleed, shock out of keeping with visible losses, fetal HR distressed ASS: pre-eclampsia, smoking, cocaine, abdo trauma
144
what is placenta praevia? RF and features?
placenta lying 2.5cm from the internal OS RF - multiparity, previous C section, uterine surgery FEATURES - shock proportional to visible losses, no pain, uterus not tender, FHR normal
145
what is vasa praevia?
fetal placental vessels lie beneath the presenting parth | Rupture - painless PV bleeding, fetal distress, no pain
146
what does GBS risk to the foetus?
meningitis, pneumonia, septicaemia
147
when do you give benzylpenicillin in labour? (GBS)
preterm (<37 weeks) urine sample +ve for GBS temperature intrapartum previous child affected by GBS
148
what is pre-eclampsia?
HTN, proteinuria and oedema - occur after 20 weeks gestation due to failed trophoblastic invasion of the spiral arteries - raised BP
149
what increased your risk of pre-eclampsia?
previous pre-eclampsia, chronic HTN, SLE, anti-phospholipid, CKD
150
complications of pre-eclampsia?
HELLP, eclampsia, oedema, ARDS, placental abruption
151
what are the symptoms of pre-eclampsia/eclampsia?
asymptomatic, headache, RUQ pain, N&V, oedema, flashing lights, hyperreflexia, tonic-clonic seizure
152
how do you manage pre-eclampsia?
MONITOR: BP, URINE, UE/LFT/FBC, strict fluid balance, steroids for fetal lungs 1. Labetalol 2. Nifedipine 3. Prophylactic MgSO4
153
how do you manage eclampsia?
MEDICAL EMERGENCY - CALL FOR HELP - O2/IVI/monitor sats MgSO4 for seizure (need calcium gluconate to hand) Monitor FHR
154
what is HELLP syndrome?
haemolysis, elevated liver enzymes, low platelets
155
what is the definition of SGA?
birthweight < 2.5kg | 1 reading < 10th centile/static growth
156
how do you manage a foetus which is SGA?
1. refer for foetal US -e measure size | 2. umbilical artery doppler (26-28 weeks)
157
what are the RF for SGA?
``` maternal age > 40 smoking cocaine pre-eclampsia trisomies congenital infections ```
158
RF for gestational DM?
BMI>30, previous macrosomic baby, previous gestational DM, 1st degree relative with diabetes
159
what is the diagnostic criteria for DM?
fasting glucose > 5.6 | 2hr glucose > 7.8
160
when do you test for gestational DM?
previous gestational DM - OGTT at booking and at 24& 28 weeks any RF for gestational DM - OGTT at 24 and 28 weeks
161
how do you manage gestational diabetes?
1. Diet and exercise 2. Metformin 3. Insulin
162
what effect does gestational diabetes have on the foetus?
``` Shoulder dystocia macrosomia polyhydramnios stillborn hypoglycaemia ```
163
how do you manage chronic HTN in pregnancy?
switch the medication to labetalol
164
what is pregnancy induced HTN?
HTN > 20 weeks of pregnancy (no proteinuria or features of pre-eclampsia._)
165
when do you screen for anaemia during pregnancy?
at booking and 28 weeks
166
how do you manage a MSU +ve sample (asymptomatic bacteruria) in a pregnant woman?
Cefalexin 500mg TDS
167
what raises the risk of VTE in pregnancy?
Hx of VTE, family history, thrombophilia, SLE, sickle cell, age >35, obesity, parity >3, varicose veins, pre-eclampsia, immobility, dehydration
168
how do you manage a VTE in pregnancy?
antenatal LMWH - continue until 6 weeks postpartum
169
what are primary and secondary PPH?
primary - loss of >500mL blood in first 24hours after delivery of the baby secondary - loss of >500mL >24hours after delivery
170
name the causes of a primary PPH?
tone trauma thrombin tissue
171
name the causes of a secondary PPH?
usually due to retained placental tissue
172
How do you manage a PPH?
``` CALL FOR HELP High flow O2, assess airway 2 large bore cannulas cross match blood IV hartmaans ``` - deliver placenta, empty the uterus of clots - syntometrine (contracts the uterus) - repair any vaginal tears - rusch balloon/compression suture/uterine artery ligation
173
when do you give anti-D immunoglobunlin?
``` medical terminations spontaneous miscarriage evacuation of a mole ECV amnioscentesis ```
174
what are the contraindications for the COCP?
BMI>30, breast feeding, HTN, VTE history, migraines with aura, breast cancer
175
how does the COCP work?
inhibits ovulation due to negative feedback, inhibits proliferation of endometrium and thickened cervical mucus
176
how does the POP work?
thickens mucus in the cervixand to a degree inhibits ovulation, thins the endometrium
177
how long after unprotected sex can you take levongesterel? how does it work?
use within 72 hours | delays ovulation
178
how long after unprotected sex can you take ullipristal acetate? how does it work?
120 hours after unprotected sex | progesterone receptor modulator
179
how long after unprotected sex can you have the IUD fitted?
5 days

Finals (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions