Usmle Step 2 Last Minute Cram

Front 1

what does dermatitis pellagra look like

Back 1

sunburn

Front 2

riboflavin deficiency clue

Back 2

cheilosis

Front 3

RA + Enlarged Liver + Palpable Kidneys

Back 3

---> think Amyloidosis

Front 4

Tx for GBSro

Back 4

IVIG and plasmapheresis

Front 5

pseudotumor cerebri vs normal pressure hydrocephalus

Back 5

PTC = young obese females with headaches; shrunken ventricles on MRI
NPH = Elderly, incontinence, dementia, ataxia; dilated ventricles on MRI

Front 6

Chemotheraputic pt with non-colicky burning pain that radiates to back

Back 6

think VZV

Front 7

Gallstones on CG

Back 7

cannot see gallstones because they are isodense with bile

Front 8

Fanconi's Anemia:

Back 8

XL loss of DNA repair genes --> chromosomal breaks
Bones: aplastic anemia or progressive failure
Appearance: short, microcpehalic, abnormal thumbs, hypogonadal
Skin: dark or light spotting, cafe au laits, large freckles
Eyes: stabismus, low set ears, middle ear abnormalities (hemorrhage, infxns, deafnesss)

Front 9

Contrads to breast Feeding:

Back 9

Inborn Metabolic Errors;
Herpes simplex, TB, and HIV
mom is taking radioactive meds, antimetabolites, or chemotheraputics, or drugs

Front 10

Types of Shock vs Normal:

Back 10

Hypovolemic Shock: Systemic Vascular Resistance is Up, Mixed Venous O2 is down, preload and PCWP are down
Cardiogenic Shock: Systemic Vascualr Resistance is Up, Mixed O2 sat is down, preload and PCWP are up
Septic: Systemic Vascualr Resistance is DOWN, Mixed O2 venous sat is UP

Front 11

Overal Probabiliyt of CAD: (Pretest)
what next?1

Back 11

Low: aSx, atypical chest pain in women <50 yo
Intermeediate: atpyical pain in all men, or atypical pain in women >50, typical pain in women 30-50
High: Typical Pain ina ll men >40, all women >60
Pretest prob is low: no further test
Pretest prob is high: start tx & get angio
Pretest prob is intermediate: Stress test or Rx Test if they can't, if positive get angio

Front 12

Post-URI nephropathy

Back 12

IgA or post-streptococcal;
IgA is most common cause of glomerulonephritis in adults
NB latent period for step --> nephritis is 20 days with pharyngitis and 20 days with impetigo
latent period with IgA is 5d

Front 13

MCC: colonic hemorrhage

Back 13

diverticulosis
angiodysplasia causes bleeding, not MCC for hemorrhage

Front 14

pasturella multocida`
source, org, tx

Back 14

is cat bites is anaerobe responds to augmentin

Front 15

mild grade hepatitis C,
tx

Back 15

monotherapy of interferon is okay

Front 16

cardiogenic shock:

Back 16

not just heart, but implies specifically the contractility of the LV
ie afib is not cardiogenic shock, you wouln't have cardiogenic shock just because you have diastolic failure.

Front 17

Thrombocytopenia + Eczema + Hx Multiple Bacterial Infx

Back 17

= Wiskott Aldrick Sro:
Step pneumo, N meninigitidis, H influ;
MCManifestation = Thrmobocytopenia <50k, with small low volume platelets
XL disorder

Front 18

Woman complains of bloating, HA, fatigue, decreased libido for a week each month

Back 18

--> keep a menstrual diary because you need at least 3 cycles to confirm dx of PMS
Tx: reduce caffeine, exercise, if fail --> SSRI's; failure --> alprazolam
do not initiate tx until dx has been made

Front 19

Complex Partial Seizure vs Absance Sz

Back 19

Any ictal --> CPSz
inability to procude 3Hz spike on EEG with hyperventilation --> Absance
Juvenile myoclonic epislepsy: myoclonic jerks which occur in morning precipitated by sleep deprivation

Front 20

Lennox Gastaut sro

Back 20

childhood szs, impaired cognition, slow wpike & wave activity on EEG

Front 21

cause of alkalotic carpopedal spasm:

Back 21

calcium dissociates from albumin in high pH to become ionized & active

Front 22

Otherwise healthy pt with anasarca: blood not proteins in urine

Back 22

think decreased GFR from glomerulonephritis --> volume overload

Front 23

gestational diabetes babies: metabolic disturbances

Back 23

hypoglycemia, hypocalcemia (parathyroid hormone suppression)
hyperviscocity of polycythemia 2/2 increased metabolic demands induced by hyperglycemia
hypoplastic lungs
cariomypoathy/CHF

Front 24

Lady with HSV is in Labor

Back 24

Lady with HSV is in Labor

Front 25

Pregger with HSV is not in Labor

Back 25

--> Tx with antivirals

Front 26

+FTA-ABS pregger is allergic to PCNs

Back 26

skin test to see if they actually do ---> PCN desensitization
Nothing else both works & crosses the placenta & is not harmful to baby

Front 27

Non-anion gap met acidosis think RTA

Back 27

Type4 = aldosterone defeiicency/insensitivity; often seen in diabetics

Front 28

Retinitis of HIV

Back 28

caused by HIV or VZV reactivation assoc with keratitis/conjuncitvitis
HSV is rapidly progressive and painful - fundoscopically central necrosis of retina
CMV retinitis is painless; fluffy granular retinal lesions & hemorrhages; not asscated with conjuncitivits or keratitis

Front 29

important causes of Rx induced interstitial nephritis:

Back 29

Sulfas, PCNs, Cephalosporins, Rifampin, Trimethorprim, NSAIDs, Diruetics, Captopril

Front 30

Most common site of Axial spine involvement in RA

Back 30

Axial spine involvement is rare, but most likely in C1-C2 instability & subluxation

Front 31

difference between Renin Secreting Tumor & Bartter Sro:

Back 31

[Na], high in tumor, normal in Bartter

Front 32

polyarthralgia, fever, discrete pustules on extensor surfaces

Back 32

disseminated gonococci; arthralgias are not septic necessarily

Front 33

abdominal pain, neuropsych abnormalities

Back 33

think acute intermittent porphyria
exacerbated by barbituates & etoh (primidone is an anticonvulsant which metz into a barbituate)

Front 34

asbestosis is far more likely to cause

Back 34

bronchogenic carcinoma than mesothelioma
but asbestos is the only known risk factor for mesothelioma

Front 35

expected weight gain from OCPs

Back 35

none

Front 36

contras to beta blockers from actute MI

Back 36

contraindicated if pulmonary edema

Front 37

MI with Pulm Edema

Back 37

Aspirin, Morphine, O2, and FUROSEMIDE
Beta Blockers are conrad if Pulm Edema
Furosemide reduces preload & venodilates

Front 38

diabetic loses vision over course of 1 week

Back 38

think HHSro with hyperosmolarity of glucose in lens

Front 39

monotherapy for acute migrain attacks

Back 39

IV antiimetics can be used as monotherapy for acute migrain attacks:
chlorpromazine, prochlorpromazine, metoclopramide

Front 40

intrahepatic cholestasis of pregnancy:

Back 40

south american women, intesne pruritis esp on palms & soles
dx of exclusion
resolves with delivery, risks for fetus (meconium stained amniotic fluid, intrauterine demise)
tx: ursodeoxycholic acid (increases bile flow); early delivery for fetus

Front 41

7MCC: 2* Amenorrhea

Back 41

MCCPregnancy
Ovarian: PCOS, Ovarian Failure
Hypothalamic: Stress, Ca, GnRH deficiency
Pti: prolactinoma, empty sella sro
Endocrine: hypo/hyperthyroid, DM
Uterine: asherman sro (intrauterine adhesions)

Front 42

Rubella vs Measels

Back 42

Rubella looks just like Measles except for the posterior auricular lymphadenomathy
Infecious: 1 week before rash, 2 weeks after onset of rash.

Front 43

Triacylglyceride levels & Tx:

Back 43

Tx dictated by total cardiovascular risk
<500 & risk --> statin
>500 & risk --> fibrate

Front 44

pt with back pain cannot urinate, has good sphincter tone

Back 44

severe pain --> unable to perform vaslava to overcome BPH

Front 45

GI bleed + Cirrhosis

Back 45

--> blood in intestine preciptiates hepatic encphealopathy, not necessarily chronic

Front 46

what is
methylphenidate

Back 46

methamphatamine

Front 47

what is
pimozide

Back 47

traditional antipsychotic

Front 48

Tourette Sro: which antipsychotics

Back 48

tpyical, like pimozide

Front 49

Definitively diagnosing DJ vs Rotor

Back 49

urinary coproporphyrin #1 increased >50% in DJ, normally #3 is majority.
DJ will tend to be Jewish.

Front 50

placental abruption mom or baby is unstable

Back 50

get the baby out fast as possible.

Front 51

wencheback =

Back 51

mobitz type 1 = progressively extending pr intervalwith dropped beats = AV node dysfnx

Front 52

DPL is reserved for

Back 52

stable patients with blunt trauma
skip it in unstable pts and penetrating trauma pts.

Front 53

trastuzumab use & toxicity

Back 53

use: HER2/neu Breast Ca
toxicity: cardiac

Front 54

Rx: cachectic pt with anorexia

Back 54

megestrol or medroxyprogesterone (progestins)
corticosteroids also helpful, but progestins have milder side effects

Front 55

hospitalized pt with PID

Back 55

cefoxitin, cefotetan/doxycycline, or clind/gent.

Front 56

no improvement 72 h after starting organism susceptible antibiotic for pyelo

Back 56

--> US for complixn/pathology (stone, abscess)

Front 57

Tension Pneumo:

Back 57

NEEDLE first, then tube

Front 58

hyperemesis gravidum:

Back 58

could be molar always -->test bHCG in molar will be >100k
should resolve on own by mid-pregnancy

Front 59

pre-eclamptic pt in labor has depressed DTRs

Back 59

Mg toxicity, followed by respiratory depression
tx: dc Mg, admin Ca2+ gluconate

Front 60

painless oral ulcers, arthritis, hematologic abnormalities (thrombocytopenia, anemia, leukopenia), proteinuria, RBC casts

Back 60

RA will not have oral ulcers or renal dz

Front 61

Type of Nephropathy which leads to renal vein thrombosis:

Back 61

membranous glomerulonephritis most associaed with RVT

Front 62

Oral Tx for Endocarditis

Back 62

You cannot treat endocarditis with ORALs

Front 63

water bottle heart

Back 63

pericardial effusion

Front 64

Tx regiment: Chronic HepC with normal liver enzymes

Back 64

no tx, yearly liver tests.

Front 65

Fight Bite Infx Tx

Back 65

Augmentin

Front 66

when doi you use octerotide for liver failure

Back 66

with midodrine in hepatorenal sro
SLE

Front 67

Hereditary Spherocytosis Pts get

Back 67

Folate supplements

Front 68

baclofen:

Back 68

muscle relaxant for UMN sx

Front 69

CHF vs COPD exacerbations

Back 69

CHF will be crackles and alkalosis
COPD exacerbation will be wheezes and acidosis

Front 70

dilute urine in presence of high serum osmols

Back 70

--> DI

Front 71

hypothyroid myopathy

Back 71

is a thing

Front 72

hepatic vein thrombosis + hemolytic anemia

Back 72

Think paroxysmal nocturnal dyspnea

Front 73

clind hits

Back 73

positives & anaerobes

Front 74

multiple nontender lesions on penis turn white with acetic acid

Back 74

?

Front 75

variable endothoracic upper airway obstruction

Back 75

tx for meningococcal meningitis is ceftriaxone

Front 76

donepazil is for what?

Back 76

d

Front 77

linear atelectasis on CXR suggests

Back 77

bronchiectasis

Front 78

MCC: Congenital hypothyroidism

Back 78

thyroid dysgenesis

Front 79

Start Ganciclovir at what CD4 count

Back 79

Ganciclovir not currently recommended for prophlaxis in HIV
at <50 you prophylact vs MAC

Front 80

at <50 you prophylact vs

Back 80

at <50 you prophylact vs MAC
Ganciclovir not currently recommended for prophlaxis in HIV

Front 81

Trauma Pt
Elevated PCWP 2/2 NS Bolus with Hypotension

Back 81

Think Myocardial Contusion

Front 82

ABO incompatibility with baby

Back 82

--> mild hemolytic disease of newborns;

Front 83

Medial Medullary Lesion

Back 83

occlusion of vertebral artery;
contralateral paralysis, contralateral loss of tactile, vibratory ^& positional sense, tongue deviated to injured side.

Front 84

Lateral Midpontine Lesion

Back 84

impaired sensory & motor function of CNV with limb ataxia

Front 85

Medial Pontine Lesion:

Back 85

Ipsilateral Limb Ataxia & Contralateral Eye deviation, paralysis of face, arm & leg +/- imparied touch & position sense

Front 86

Lateral Medullary Lesion

Back 86

: Wallenberg Sero: ipsilateral horner sro, loss of pain & temp to face, weakness of palate, pharynx & vocal cords, cerebellar ataxia; loss of pain & temp from contralateral side

Front 87

Central Midbraine Lesion

Back 87

Oculomotor paresis & other CN3, cerebellar ataxia & contralateral hemiplegaia.

Front 88

Weber's sro, Benedikit's Sro, Claude's Ssro, Nothnagel's Sro, parinaud's Sro.

Back 88

?

Front 89

MCC: left sided subacute infective endocarditis

Back 89

mitral valve PROLAPSE.
MITRAL STENOSIS IS NOT ASSOCIATED WITH ENDOCARDITIS.

Front 90

DOC: gonococcal vs chlamydial conjunctivitis

Back 90

gonococcal: ceftriaxone, chlamydiral: oral erythromycin

Front 91

Most influential factor for reducing limb amputation with Chorionic Villous Sampling:

Back 91

Gestational Age of Fetus

Front 92

Cauda Equina Sro is compression of the

Back 92

NERVE ROOTS not spinal cord. It's a ton of LMN sx.

Front 93

nitrates vs Leukocyte esterase

Back 93

Nitrates: enterobacteriaceae
LE: PMN's

Front 94

Recent Unilateral Vision Loss, You Suspect Temporal Arteritis, Course of Action:

Back 94

High Dose Prednisone. You can definitively dx later.

Front 95

What is the main problem you can run into with post-term pregnancies:

Back 95

oligohydramnios; defined as no vertical pocket of fluid >2cm or an AFI of 5cm or less

Front 96

The 3 types of Renal Tubular Acidosis

Back 96

have fun with that

Front 97

Tx Thalassemias

Back 97

Thalasemias Do not Respond to Iron Treatment

Front 98

Beta vs Alpha Thals

Back 98

only real difference is that beta thalassemia has elevated HgA2 on electrophoresis, whereas alpha looks normal

Front 99

Abdominal Trauma Pt sent home, cleared by CT, returns in fever, chills, & abdominal pain

Back 99

--> missed pancreatic lac--> pseudocyst --> abscess

Front 100

lichen sclorisis et atrophicus
course of action

Back 100

any lady with lichen sclorisis et atrophicus has a higher risk of cancer so you punch bx that **** vs squamous cell carcinoma
non-Ca tx = topical corticosteroid (it's autoimmune)

Front 101

Empiric Tx for Endometritis

Back 101

Clind + Gent
Clind vs anaerobes & positives, Gent vs negs.

Front 102

Steatorrhea + 1/2 h of pain with every meal

Back 102

--> sounds like chronic pancreatitis

Front 103

WPW + Afib-->

Back 103

convert to sinus with procainamide; do not slow AV Node
slow AV node --> accessory pathway --> vfib

Front 104

Of all the pulmonary renal sros which requires emergent plasmapheresis

Back 104

goodpasture requires emergent plasmapheresis
wegeners is treated with cyclophosphamide & steroids

Front 105

Young risk-less pt has a fluid filled cyst which you aspirate & completely collapse
course of action

Back 105

foul smelling or bloodly -> cytology
clear fluid --> observe for 4 weeks

Front 106

Rx for CLL
Rx for NHL:
Rx for Hairy Cell:

Back 106

Rx for CLL
Chlorambucil
Rx for NHL: CHOP
Rx for Hairy Cell: CLadribine

Front 107

MCC Constrictive Carditis in Mexico

Back 107

TB

Front 108

Step 1 in aSx SIADH:

Back 108

fluid restriction

Front 109

DOC: impetigo:

Back 109

mild: topical mupirocin or erythromycin
severe: diclox, amox, cephalexin

Front 110

Anteiror, Middle, Posterior MEdiastinum

Back 110

Broncogenic cysts occur in middle mediastinum
thymomoa usually found in anterior mediastinum
neurogenic tumors all in posterior mediastinum

Front 111

baby has noisy breathing (inspiratory only) when on back, improves when sitting up, chin up

Back 111

laryngomalacia
epiglottis rolls from side to side on direct laryngoscopy is diagnostic
most children improve gradually, healty by 2 years old
in the mean time, child should be in upright postiion for 30 min after each feeding & never fed lying down.

Front 112

Neoadjuvant vs Salvage vs Consolidation vs maintenance cancer intervention

Back 112

Maintenence: keep cancer in remissino
neoadjuvant: given before standard therapy for a disease, ie radiation to reduce size
Induction: rapidly kill tumor cells & send pt into remission (=<5% tumor buburden)
cosolidation: after induction to further reduce burden
adjuvent: given in addition to standard therapy at same time as standard therapy
salvage: given in addition to standard therapy when standard therapy has failed

Front 113

actinomycies israeli response to

Back 113

IV PCN

Front 114

diagnostic requirement of schizoaffective disorder:

Back 114

psychosis + mood disturbances, with at least 2 weeks of psychotic sx without mood sx

Front 115

greatest risk factor for variant angina, tx

Back 115

ie prinzmetal = smoking
tx: CCBs & Nitrates to prevent vasoconstrixn

Front 116

SCID vs Common Varibale ID vs Brutons vs WAS

Back 116

SCID: absent LNS & tonsils, lymphopenia, absent thymic shadow, few NK's, Ts & Bs'
CVID: acquired hypogammagloulinemia: young adults with decreases in Ig's & no change in T's or # of B's
Brutons is few #B's & almost no Ig's
Wisckott Ladrich: XLR, bleeding, atopy & low Ig's.

Front 117

Sarcoid CXR

Back 117

they may not say "hilar lymphadenopathy" with sarcoid, could just be "diffuse interstitial infiltrates"

Front 118

CIN2 Lesion sp LEEP

Back 118

Pap + Cytology q6mo until 3 negatives, then to normal cancer screening

Front 119

MM Tetrad:

Back 119

CRAB: Hypercalcemia, Renal Impairment, Anemia, Bone problems,

Front 120

Beckwith-Widemann Sro:

Back 120

hypotonia, macrosomia, microcephaly with Macroglossia, Visceromegaly (Omphalocele), Hyperinulinemia/Hypoglycemia
11p duplication, IGF2 overexpression
prominent occipute & eyes
Risks: Wilms' tumor, hepatoblastoma, gonadopblastoma

Front 121

Beckwith Widermann S vs Congenital Hypothyroidism:

Back 121

appear very similar:
hypotonia, macroglossia, ; no hypoglycemia/hyperinsulinemia; umbilical hernia instead of omphalocele
macrocephaly not microcephaly

Front 122

Infant of a Diabetic Mother Risk

Back 122

Caudal Regression, Transposition of Greats, Duodenal Atresia, Small Left Colon, Anencephaly/NTDs

Front 123

WAGR:

Back 123

Wilm's Tumor, Aniridia, Genitourinary Anomaly, mental Retardation; Chrom 11 deletion, incl WT1 & PAX6

Front 124

Denys-Drash:

Back 124

Male pseudohermaphrodism, early onset renal failure 2/2 mesangial sclerosis

Front 125

EKG signs of paroxysmal bradyarrhymias:

Back 125

prolonged PR, prolonged QRS (BBB)

Front 126

TX: SCFE

Back 126

= Immediate Surgical Screw Fixation

Front 127

elyte imbalance with SAH:

Back 127

"Cerebral Salt Wasting" Hyponatremia: combination of SIADH & increased Brain Natriuretic Peptide

Front 128

Empiric Tx of Meningitis:

Back 128

community acquired bacterial: Vanc + Ceftriaxone = S pneumonia, H influ, N meningitidis
add Amp to cover Listeria in over 55, immunocomped
IV cefotaxime + amp = <3yo.
Cefotaxime covers the 3 community acquired & amp covers Listeria (replaced with Van & ceftriaxone in older because of biliary sludging)
IV ceftazidime + vanc for Hospital Acuired to cover Staph & Pseudomonas

Front 129

Amantadine

Back 129

Amantadine is for Parkinsons

Front 130

inhibin and Downs

Back 130

?

Front 131

coup kiddo needs in respiratory failure

Back 131

always give a trial of epi in croup before intubation

Front 132

pre-schooler with unilteral fluctuant cervical lymphadenopathy

Back 132

--> staph aureus

Front 133

nephrotic sro: dense C3 deposits within basement membrane, no Ig's

Back 133

--> membranoproliferative glomerulonephritis type 2 "dense deposit dz" caused by IgG antibodies directed against C3 convertase --> lead to persistent activation of complement & C3 deposition.

Front 134

pt has weight loss, hyperglycemia, & rash

Back 134

rash is necrotiszing dermatitis, this is classic triad of glycacongoma
dx: CT, fasting glucose& glucagon, tx: surgical excision

Front 135

how long before veganism catches up to your B12 stores

Back 135

5 years
the shiny tongue of b12 deficiency is because of the atrophic gastritis not the deficiency?

Front 136

pregnant urine culture when

Back 136

pregnant urine culture only btw 12 & 16 wks

Front 137

Parkinsons Rx's which cause
what SE's

Back 137

hallucinations - DA agonists
choreiform dyskinesa: COMT inhibitors (entacapone, tolcapone)
Levido reticularis: amantadine
urinary retention: anticholinergics (benztropine)

Front 138

systolic crescendo decrescendo murmur at left sternal border without carotid radiation

Back 138

HCOM

Front 139

glasgow coma scale

Back 139

x

Front 140

estrogen replacement & thyroid fnx

Back 140

increases thyroid hormone metzm rate

Front 141

alpha naphtyl esterase positive

Back 141

acute monocytic leukemia (FABM5) - gingival hyperplasia & bleeding gums

Front 142

alcohol abuse --> megaloblastic anemia

Back 142

folate

Front 143

what does renin actually do (molecularly)

Back 143

cleaves angiotensinogen into angiotensin 1

Front 144

neonate has a hydrocele:

Back 144

most will resolve spontaneously by 1 year; surgical intervention thereafter to prevent inguinal hernia.

Front 145

Pt has MGUS

Back 145

do a skeletal bone radiorgaphy survey

Front 146

confirm the dx of aortic dissection:

Back 146

esophageal echo

Front 147

lgsil:

Back 147

premenopausal: colp & bx
post: choices

Front 148

hypothalamic - pituitary failure (hypothyroidism) can occur with cirrhosis

Back 148

yep

Front 149

2 risk factors for CAD

Back 149

goal is 130 initiate therapy for >160 if 10%, for >130 if 10-20%

Front 150

why is NaHCO3 good for TCA OD?

Back 150

Na load alleviates action of TCA on Na channels, alkalinization of serum decreases TCA affinity for Na Channels
should admin if QRS>0.10

Front 151

All torchs

Back 151

Toxoplasma, Rubeela, CMV, HSV, Syphillis
create HSM, microcephaly, chorioretinitis, thrombocytopenia, deafness

Front 152

Things which prevent confounding

Back 152

randomization vs confounding
restriction & matching also vs confounding

Front 153

when to give ca gluconate

Back 153

K>6.5, EKG changes, muscular paralysis
else just stop offending causes

Front 154

HIV retinitis vs CMV retinitis

Back 154

CMV: yellow, HIV: cotton wool

Front 155

MCC: metal contact dermatitis

Back 155

nickel

Front 156

HIV pt with lung infx CD4 at 400:

Back 156

Pneumoccocus is most common for typical pneumonia
PCP: dry cough & dyspnea

Front 157

Tx: Social Phobia

Back 157

Assertiveness Training & SSRI (apparently not Beta Blocker)

Front 158

3 beta hydroxylase deficiency

Back 158

decreased testosterone & mineralcorticoids --> DHEA-S excess

Front 159

21 beta hydroxylase deficiency vs 11

Back 159

21 beta hydroxylase deficiency more common than 11;
21 can be complete (neonatal) or incomplete (puberty)

Front 160

Thyroid Panel in Pregnancy

Back 160

in pregnancy an increase in estrogen leads to an increase in TBG, results in an increase in T3 and T4 with normal activity and normal TSH

Front 161

to diagnose endometriosis

Back 161

you need to go in laproscopically
no imaging method can adequately distinguish soft ts vs soft ts.

Front 162

anti-smooth muscle antibodies

Back 162

autoimmune hepatitis

Front 163

qid 2285 for awesome neurologic dysnfx

Back 163

indeed