12:04 Tuesday, 5 March 2019

respiratory tract -
-
Hematemesis
Epistaxis
Massive hemoptysis -
24 400
100-150
massive 5-15% -
-

-
-

1
Viral bronchitis -

bacterial superinfection COPD

Bronchiectasis -

highly vascular

TB -

pulmonary artery aneurysm Rasmussen's aneurysm

non-TB mycobacteria Nocardia -
mycetoma -
s. Aureus necrotizing pneumonia -

Paragonimiasis -
TB

2
pink and frothy -
PE -
Pulmonary AV malformation -
Aorto-bronchial fistula -
Diffuse alveolar hemorrhage (DAH) -

ground glass opacities

SLE ▪
anti GBM GPA Pulmonary renal syndrome ▪
▪
▪

1
 ▪

3
Bronchogenic carcinoma -
Carcinoid tumors -
Small cell & squamous cell carinoma -

-
Kaposi's sarcoma -

4
Pulmonary endometriosis -
-
rupture pulmonary artery -
pulmonary vein
-
-

236

CF Clubbing
bleeding diathesis
-

pulmonary renal
-

CT
40 ▪
▪
▪
CT CT
good outcomes ▪

non bleeding lung AW -

bleeding site dependent

suction

double lumen tube

-

2
 active extravasation CT
CF 50%

AW ▪

AW ▪
Bronchial atrery embolization
▪
anterior spinal artery ▪
80% ▪
▪

15-40% ▪
▪
▪

3
 17:42 Tuesday, 5 March 2019

Alveolar gas equation -

Alveolar-arterial gradient
Aa gradient = (150- PCO2\0.8) - PaO2
Aa = age\4 + 4
R = respiratory quotient = VCO2\VO2 = normally 0.85

Aa gradient
-
high altitude -

Aa gradient
PE -
-

VQ missmatch

V=0 completely unventilated Shunt -

100%
VQ missmatch -
100%
Low V\Q
High V\Q
Q=0 Dead space -

1
2
Shunt 3
low VQ VQ missmatch 4
5

1
Inert gas dilution

TLC underestimation
Body Plethysmograph

4
 TLC RV -
TLC<80% -

2
FVL spirogram -
80-120% -
FVC -
FEV1 -
FEF 25-75% -

FEV1\FVC -

predicted actual
-
COPD -

Flow volume loops

-

IPF 1

DLCO

shift ▪
maximal expiratory flow ▪
Obesity 2

FRC
ALS 3
RV TLC
FVC FEV1
DLCO FRC

5
 -
4
Scooping
FVC RV
FEV1
DLCO
5
Scooping
FVC FEV1
RV TLC
DLCO

Airway resistance -
2

FRC 60 Muscle strength -

DLCO 3
DLCO\VA -
DLCO>80% -
-
1
2
-
DLCO -
Pulmonary fibrosis 1
2
Pulmonary HTN 3
4
DLCO -
1
Acute CHF 2
Pulmonary hemorrhage 3
4

6
 18:29 Tuesday, 5 March 2019

-
10-12% -
-

3 -
-
-
-
ICS -
-

ICS
near fatal asthma

allergic rhinitis 80%

-
-
coronavirus RSV rhinovirus
mold spores
Hygiene hypothesis
-

COX inhibitors
ACEI
-
10% -

10% Intrinsic asthma -

IgE
IgE ▪

nasal polyps

-
-
30

ICS SABA
-
-

GERD -
-

7
 Airway remodeling 1

ICS
Airway hyperresponsivness 2

-
cough variant asthma
-
-
-

8
 -
-

-
FEV1
FEV1\FVC
Peek expiratory flow
-
FEV1 200 12%
SABA 15
OCS 2-4
maximum expiratory flow peak flow FVL -
RV TLC -
-

Airway responsivness
-
FEV1 20% provocative concentration PC20

▪
▪
exercise induced asthma Exercise testing -

IgE -
-

CT
skin prick test -

Exhaled NO -
ICS

-
-

9
 -
-
Vocal cord dysfunction -
Eosinophilic pneumonia -
Churg strauss -
OCS COPD 15% COPD -

controllers bronchodilators

Bronchodilators

- SABA - albuterol SABA - Beta2 agonists

terbutaline -
- 3-6 salmetrol LABA Mast
mast Tolerance - Symptom relief formeterol

LABA -
ICS
ICS
12

- - ipratropium SAMA - - Anticholinergic

- - bromide
- LAMA -
tiotropium bromide
LAMA - glycopyrronium
ICS + LABA bromide
- - PDE - Theophylline

10 - 5-10 -
ICS
IV -
SABA

CYP450 -

Controllers

dysphonia - controllers - ICS

Oral candidiasis - T
- - mast
- transcription factors
-
-

10
 -

- 40 - OCS
- 5-10
tapering
1% -
OCS
- Montelukast Antileukotrienes
ICS - Zafirlukast
add on - cys-LT1
ICS therapy
LABA
-
-
EIA - Cromolyn Mast Cromones
- sodium
-
- Omalizumab Anti IgE
- circulating IgE

IgE
2-4 SC -
- Mepolizumab IL-5 Anti IL-5
- Reslizumab
(IV)
ICS Benralizumab

-
Bronchial thermoplasty -

-
-
-

Stepwise therapy
SABA mild intermittent -
controller therapy persistent SABA -

11
 controller therapy persistent SABA -
ICS 1
-
LABA 2
LABA -
LABA ICS 3
LAMA -
Anti IL-5 omalizumab OCS 4

-
speech dyspnea -
pulsus paradoxus -
impending respiratory failure PCO2 -

90% -
-
SABA
SAMA
IV beta2agonists -
IV Aminophylline -
IV -
-
PCO2
Halothane

-
-
IV PO

tapering 5-10 40

5% Refractory asthma
-

-
FeNO

Severe rhinosinusitis
COX inhibitors

TH1 -
-

Aspirin sensitive asthma

12
 Aspirin sensitive asthma
1-5% -
-
Rhinitis
nasal polyps

COX inhibitors -
selective COX2 inhibitors -
-

Brittle asthma
Type I -

beta agonists OCS

Type II -

-
OCS boost FEV1<80% -

Asthma-COPD overlap
-
LAMA + LABA + ICS -

13
 COPD
19:20 Friday, 8 March 2019

3 -
COPD -
Emphysema
air space enlargement ▪
GOLD 3-4 ▪
Chronic bronchitis
▪
Small airway disease
▪
GOLD 1-2 ▪
-

-
FEV1\FVC<0.7 -
-

-
goblet

resistance 2 -
-
CD8 BAL

Upper lobes Centrilobular emphysema

Superior lower lobes
Alpha1AT deficiency Lower lobes Panlobular emphysema
sparing Pleural margins Paraseptal emphysema
centrilobular emphysema

1
airflow obstruction
15%

14
 15%
2
RV\TLC RV

3
FEV1<50%
VQ missmatch ▪
▪
FEV1<25%
FEV1<25% cor pulmonale

-
dose response FEV1
FEV1 15%

Airway responsivnenss -
COPD

COPD
-

COPD
-

COPD

Alpha 1 anti-trypsin deficiency

alpha1AT protease inhibitor (PI) locus -
M allele
S allele
Z allele
Null allele
severe Alpha1AT deficiency null Z Z Piz -
early onset COPD alpha1AT COPD 1% -
COPD Piz -

COPD a1AT deficiency -

-
PI type
DNA
-
IV alpha1AT

Natural history
FEV1 -
FEV1 -
FEV1 -

15
 -

▪
▪
- ▪

Barrel chest
SCM Tripod position

blue bloater pink puffer

TNF alpha temporal wasting
Hoover's sign
cor pulmonale
COPD Clubbing
-
FEV1\FVC
TLC RV
DLCO
-
-
CT -
alpha1 AT deficiency -

16
 -

lozenge inhaler Nicotinic replacement therapy ▪

Buproprion ▪
nicotinic acid receptor agonist\antagonist Varenicline ▪
-

88% ▪
89% ▪
-
Lung volume reduction surgery (LVRS) -

Upper lobe emphysema ▪

Low post-rehabilitation exercise capacity ▪
FEV1<20%
DLCO<20% ▪

CT ▪
LAMA ICS -

17
 LAMA ICS -

SABA SAMA
LAMA
trend ▪
▪
LABA
LAMA ▪
▪
LAMA+ LABA
ICS -

Oral candidiasis

2 ▪
▪
ICS
OCS -
-

PDE4-Inhibitors - Roflumilast -

FEV<50% severe COPD ▪

▪
▪
-

former smokers
Alpha1AT IV -

Alpha1AT<11 (<50 mg\dL) null null Piz

CT

18
 -

6-12
-
COPD

▪
▪
▪

▪
FEV1 FEV1
1-3 50% ▪
CT pulmonary artery\aorta
GERD
-
50%
1/3
20-35%
PE
25% -

19
 1
anti muscarinic beta2 agonists -
-
2
moderate-severe exacerbation -
Moraxella Haemophilus Pneumococcoc -
Mycoplasma pneumonia Chlamydia pneumonia 5-10% -
3
-
outpatient 5-10 30-40 -
8 -
-
4
90 -
PCO2 minute ventilation -
-
NIPPV 5
PCO2>45 -
-
-

Craniofacial abnormalities

6
-

Respiratory arrest

expiratrory time -
auto peep -

17-30% -
60% 65 ICU -
20% -
45% 30 20% -

20
 ILD
13:23 Saturday, 9 March 2019

200 -
interstitial space

-
-
-
IPF

CTD-related ILD

-
60 IPF
20-40 PLCH LAM CTD
-
LAM
RA-ILD CTD-ILD
occuptional\exposure related IPF
-

COP drug induced CTD

IPF GPA HP eosinophilic pneumonia AIP
-

ILD LAM GPA DAH

-
TNF Rituximab AZA MTX
Nitrofurantoin

Bleomycin
5-20% -
IPF
TERT telomere MUC5B
-

End inspiratory fine crackles -

HP EGPA -
cor pulmonale clubbing -

CTD -

FVC FEV1 TLC -

DLCO -
LAM HP -
FVC -

-
standard of care HRCT -

21
 standard of care HRCT -

Upper lobe predominance

▪
▪
Hypersensitivity pneumonitis ▪
▪
RA ▪
Ankylosing spondylitis ▪
PLCH ▪

IPF HRCT

-
BAL
CD4\CD8>3.5 ▪
50% Hypersensitivity pneumonitis ▪
25% ▪
foamy macrophages milky Alveolar proteinosis ▪

HP ▪
▪
transbronchial forceps cryobiopsies yield ▪
VATS -
5%
yield

- - IPF UIP pattern UIP ILD - IPF

3-5 50% - TKi nintedanib pirfenidone fibroblast foci o -
o Honeycomb changes 5-6 -
o -
FVC alternating Honeycombing o -
o fibroblast foci traction bronchiectasis o
o temporal 1/3 -
pirfenidone & spatial heterogeneity
-
-
-

ground glass
opacities

- - - ground glass opacities - NSIP

5 - - IPF
80% - -
- subpleural sparing CTD o
Drug induced ILD o
Familial o
Infection o
-
5 -
-

honeycombing

- - pigmented macrophages - - Respiratory bronchiolitis - Smoking related

- - Centrilobular nodules - (RB-ILD)
DIP - Difuse GGO - Desqumative (DIP) -
PLCH -

40-50 -
IIP 10% -
-

relapse - 6 - Organizing pneumonia - GGO - 50-60 - COP -cryptogenic

- - - - subacute flu- - organizing
Rituximab - - like ilness pneumonia
reversed halo subpleural sparing -
\atoll sign

22
 \atoll sign -
CTD

10 20-30% - NSIP - NSIP - ILD - Systemic sclerosis

MMF - UIP - UIP - SSc
COP - COP - 50%
PPI - diffuse alveolar damage - -
- 30%
limited
40-60 -
UIP - UIP - UIP - - RA
NSIP - NSIP -
10% -
- NSIP - NSIP - 45% ILD - DM\PM
- COP - COP - anti-synthetase
UIP - UIP anti PL-12 - anti-synthetase -
DAD -
ILD

rapidly Anti JO-1 -

progressive ILD
Anti PL-12 -
-

1
o
o

HP 2
Hot tub o
o
Pneumoconiosis 3
o
coal worker's o
GPA 4
EGPA 5

LAM - lymphangioleiomyomatosis
-
-
-
-

50% - - Diffuse alveolar damage patchy GGO - Acute interstitial

- - pneumonia -
- Hamman Rich
UTRI - syndrome

85% - Diffuse alveolar damage patchy GGO 30 -

IPF - IPF
IPF -
-

23
24
 Hypersensitivity pneumonitis
19:38 Wednesday, 6 March 2019

alveoli inhalation exposure -

-
IgG innate immunity TH17 TH1 -

Offending agents
mycobacterial -
-
Farmer's lung
Bird owners

hot tub

4-8 Acute

Ground glass opacities - Sub-acute

Centrilobular nodules - ongoing

- - - Chronic
Traction bronchiectasis -
sub-pleural - clubbing
sparing -
IPF -
IPF
IPF -

offending agent -
-

DLCO
FP IgG -
BAL -
thrershold
CD4\CD8<1
-
Non caseating granulomas

Clinical prediction rule -

1
serum precipitins IgG 2
3
4-8 4
5
6

25
 6

-
ILD -
-
Organic toxic dust syndrome -

-
-
-
2-6 tapering 1-2 1
-

26
 Pneumoconiosis
11:14 Thursday, 7 March 2019

- 1 10 - Asbestosis
-
15-20 -
Opacities
- Bystander exposure -
DLCO

1-2
40

80%

TB - Acute silicosis 1 10 Acute - quartz - Silicosis

pulmonary alveolar proteinosis -
Crazy paving 15-20 - -
-
Scleroderma Whole lung lavage
Caplan syndrome Simple silicosis 2
seropositive RA Opacities
- hilar nodes
20% eggshell pattern

Complicated silicosis 3
1
Progressive massive fibrosis

COPD - Simple CWP - 15-20 - Coal worker's

- Opacities pneumoconiosis
Complicated CWP - (CWP)
1
Progressive massive fibrosis

- - Chronic beryllium
beryllium BeLPT DTH - - disease
lymphocyte proliferation test -
-

-
DLCO
non caseating -

27
non caseating -
granuloma
beryllium specific CD4

28
 20:03 Wednesday, 6 March 2019

-
BAL -

Acute eosinophilic pneumonia

20-40 -
-
-
-
-
1700 7-30
IgE
HRCT -
ground glass
PH 2/3

25% BAL -
-

-
-

relapse

Chronic eosinophlic pneumonia

29
 45 -
-
-
GI -

-
WBC 30% 90%
IgE
-
photographic negative pulmonary edema
25%
60% BAL -
COP -

-
acute -
relapse 50%

EGPA
-
17-74 48 -
9 -
-
Prodromal phase
GI Eosinophilic infiltrative phase
Vasculitic phase

2/3 -
Mononeuritis multiplex
Stroke

livedo 50% -
50% -

GI -

30
 GI -
Eosinophilic gastroenteritis

GN 25% -

-
total WBC count 75% 10%
80%
24
2/3 50% P-ANCA -
ANA RF IgE -
BAL -

bilateral ground glass opacities

-
3 50%
6 70%
relapse relapse 25% 90%
steroid sparing Anti IL-5 -
GI -

relapse
MTX AZA
Rituximab

Hypereosinophilic syndrome

1500 -

end organ damage -

-

Myeloproliferative variant -
JAK2 PDGFR
Chronic esoinophlic leukemia
B12

cellularity 80%
imatinib
Lymphocytic variant -
abnormal T cell clonal population

30-50 -
GI -
40% -
IgE -
BAL -
-

50% -
-
PDGFR Imatinib
Hydroxyurea

anti IL-5 Mepolizumab

31
 anti IL-5 Mepolizumab

Allergic bronchopulmonary aspergilossis (ABPA)

asprgillus -
-
-

bronwish plugs -
ABPA
CF
417 IgE -
-
central bronchiectasis
patchy

skin test aspergillus -

aspergillus Serum precipitins -
Specific IgG\IgE -

3-6 tapering OCS ICS -

4 Fluconazole Voriconazole -
fluconazole oral itraconazole
CF Omalizumab -

Loffler syndrome -

helminthic larevae
Ascaris ▪
hookworm ▪
W. Bancrofati filaria Tropical eosinophilia -

-
NSAIDS
nitrofurantoin

32
 -

33
 12:38 Thursday, 7 March 2019

AW Focal -
Diffuse -
-

25-50% -

Upper CF
Post radiation fibrosis
Middle • Nontuberculous mycobacteria - MAC
• Immotile cilia
• Congenital
Central ABPA
Lower Chronic recurrent aspiration (scleroderma)
fibrotic lung disease Traction bronchiectasis
Immunodeficiency

34
 -
-
-
TB -
-
granulomatous lymph node
AW Broncholithiasis
-

Infectious bronchiectasis -
poor mucocilliary clearance vicious cycle
mycoplasma pneumonia bordetella pertussis ▪
dyskinetic cilia CF ▪
AW Pseudomonas
airflow obstruction -
alpha1 antitypsin -
Traction bronchiectasis -

-
-
Clubbing -
-
-

-
tram track -
CT 1

tram track
1.5 cross section - signet ring sign
1 bronchial tapering

tree in bud

CF workup

35
 1
H. Influenza pseudomonas -
14 7-10 -
NTM -
colonizers
MAC
▪
▪

2 ▪
BAL ▪
▪
acid fast ▪

2
-
-
hyperosmolar agents -
-
-
-
CF DNAse -

3
APBA -
itraconazole ABPA
-

4
-
-

-
bronchial artery embolization -

-
pseudomonas -
20-30 50-55 FEV1 -

-
-

36
 -
-
3 -
1-2 1
Rotating oral abx 2
3
6-12 ▪
QT NTM ▪
tobramycin 4
IV 5

37
 20:37 Saturday, 9 March 2019

PE

Light criteria 1
Pleural fluid protein\serum protein>0.5
Pleural fluid LDH\serum LDH> 0.6
Pleural fluid LDH> 2\3 serum UNL
25% 2
3.1

38
39
 -
1
2
3
4
BNP>1500 -

Hepatic hydrothorax
5% -

40
 5% -
-
-

Parapneumonic effusion
-

-
grossly purulent effusion Empyema -
10 -
-

pH<7.2
Glucose< 60 mg\dL

Gross pus
-
-
deoxyribonuclease TPA 1
2
De-cortication 3

-
75% -

-
-
-

pleurodesis pleural abrasion

-
-
indwelling catheter
500 scleroting agent

-
-
shrunken hemithorax -
-

PE
-
-
Recurrent emboli

TB
primary TB -
-
interferon gamma>140 ADA>40 -

41
 interferon gamma>140 ADA>40 -
-

20% -
-

Chylothorax
thoracic duct chyle -

lymphangiogram mediastinal CT ▪
▪
110 -
-
octreotide

Percutaneous tran-abdominal thoracic duct block

thoracic duct

50% -
-
-
200

-
PMN -
Meig's syndrome -
-
s\p CABG -
1-2

TPA 1 1
deoxyribonuclease pH<7.2 2
Glucose< 60 mg\dL 3
4

Gross pus 5
6

pH<7 1
Glucose< 40 mg\dl (2.2mmol\l) 2
LDH>1000 3
4
sclerosing agent 2

octreotide 110 Chylothorax 3

50% 4

42
43
 21:13 Saturday, 9 March 2019

Primary spontaneous -
apical pleural blebs

50%
pleural abrasion blebs stapling
▪
▪

Secondary PTX -
COPD

pleural abrasion blebs stapling

sclerosing agent pleurodesis

Traumatic PTX -

hemopneumothorax
▪
▪

needle aspiration ▪
▪

Tension PTX -

CO

▪
high peak insipiratory pressure ▪
needle

44
 Sleep Apnea
10:21 Sunday, 10 March 2019

Obstructive Sleep Apnea Hypopnea Syndrome OSAHS

-

AHI hypopnea apnea 5

AHI>15 -
-
10

3%

-
40-60%
4
AHI 30% 10%
2-4 -
-
OSAHS -
Craniofacial -
3-8 Adenotonsillar hypertrophy -
-

20% 2-15% -
-

-
Gasping -
-
-
-
-
-
Epworth sleepiness score -

-
-
small orifice Oropharynx -
-
-
cor pulmonale -

overnight polysomnogram Gold standard -

FN
10 dipping pattern -
-

45
 -

deeping
CPAP
-

stroke
-
-

7-9

supine

CPAP -
50-80%

-
▪
▪
▪
EF
Oral appliance -
AHI
TMJ
CPAP mild OSA
Upper AW surgery -

oral appliance CPAP

severe OSA
CPAP mild OSA
-
Upper AW neurostimulation -
device hypoglossal nerve
CPAP moderate OSA BMI<32
-

46
 -
AHI

Central sleep apnea

pCO2 -
-

dose dependent

complex sleep apnea CPAP

-
-
-

CPAP

47
 09:36 2016 23

3 -

3-8 -
tracheobronchitis
8 -

GERD 1
PND 2
3
ACEi 4
5-30%

ACEI

chronic eosinophilic bronchitis 5

3% -
-
ICS -

-
-
CT -

reassurance CT -

narcotic cough suppressants -

Dextromethorphan -
Benzonatate -

48
 BAL
10:22 Saturday, 27 April 2019

-
CD4\CD8>3.5 -
50% - Hypersensitivity pneumonitis
CD4\CD8<1 -
25% chronic eosinophilic pneumonia
foamy macrophages milky Alveolar proteinosis

49
 12:38 Wednesday, 1 May 2019

-
-
-

-
-
shunting
PVR

1
VQ missmatch -
-
-
High altitude 2
FIO2
Right to left shunting 3
-
Areteriovenous atelectasis -
100% FiO2 -
4
PaO2
PO2
CO 5
CO

circulatory hypoxia 6
-
PO2 PaO2 -
specific organ hypoxia 7
-
8
-
PO2 -
oxygen utilization 9
-
histotoxic hypoxia PO2 -

-
COHb -
-
-
-

50
 1
4 -
-

2
methemoglobin
sulfhemoglobin
Local passive congestion 3

PVD

time of onset -

51
 time of onset -
-
clubbing -
PaO2 -

52
 9:57 Saturday, 16 March 2019

baseline

vareniciline bupropion

20-30%
-
radon -
TB COPD -
2-3 1 -

20% KRAS - 40%

15-20% EGFR -
ALK -
ROS -
RET -
-
Central 20% Squamous
RB1 TP53 90% Central 15% Small cell
5% Large cell

Screening
-
low dose chest CT -
15 30 55-74

20%
FP NNT 320

-
Post obstructive pneumonia -
-

Regional spread
-
recurrent laryngeal nerve paralysis -
-
brachial plexus superior sulcus tumor pancost tumor -
T2 T1 C8

Horner's syndrome
-
SVC syndrome -
lymphangitis spread -

53
 lymphangitis spread -
1/3 -

SCLC SIADH ADH

1-4 -
SCLC ACTH
Squamous PTHrP
NSCLC Clubbing Skeletal
Hypertrophic pulmonary osteoarthropathy

SCLC Lambert Eaton

SCLC anti Yo, anti Hu Cerebellar degeneration

migratory venous thrombophlebitis Trousseau's syndrome
DIC
Marantic endocarditis

Tissue diagnosis -
tissue confirmation
core biopsy
squamous SCLC
transthoracic biopsy large cell
100% 70%
Cell block

Staging
CT PET CT -
FN
▪
8 ▪
▪

well differentiated adenocarcinoma

confirmation with biopsy FP
MRI -
SCLC
NSCLC
lymph node status -

▪
▪
▪

Staging
-
FEV1>2 L
lobectomy FEV1>1.5 L
VO2max<15 mL cardio-pulmonary Borderline PFT

54
VO2max<15 mL cardio-pulmonary Borderline PFT

-
MI

FEV1<1 L
45 CO2
DLCO<40%

SCLC Staging
Limited disease -
radiation port
supra-clavicular laryngeal nerve SVC
Extensive disease -
radiation port

NSCLC Staging

NSCLC curtaive
-

55
 -
SVC -
-
phrenic nerve -
-
-
2 -
-
main pulmonary artery -

stage III Pancost tumor -

N2 -

56
 SCLC

57
58
 solitary pulmonary nodule
18:43 Saturday, 16 March 2019

-
Patterns of calcifications -
bulls eye
popcorn ball
dense central nidus
multiple punctuate foci

-
-
-
-
-
PET -

7-8 PET CT

59
60
 CF
12:03 Sunday, 2 June 2019

CFTR -
F508del
W1282X mutation

-
-

30%
15% -
Meconium ileus -
-
-
vas deference 99%

CFTR mutation analysis -

-
CF
nasal airway ion transport -
CFTR -

-
D DNAse
-

-
-
Ivacaftor
CFTR potentiator ▪
G551D ▪
▪
Lumacaftor
F508del Corrector ▪
Ivacaftor ▪

CYP ▪
▪

61