7622956
Pregunta 1
Pregunta
A 45 year old male patient presents with abrupt severe chest pain, flank pain, and syncope. Physical exam reveals asymmetric extremity blood pressure. Percussion of the lungs is dull and there is decreased tactile fremitus. On ausculatation you hear a decrescendo diastolic murmur best heard at the lower left sternal border. It has a blowing quality and is heard best when patient is leaning forward. CT with contrast shows a displaced trachea and pleural effusion. Which diagnosis is most likely?
Respuesta
-
Coarctation of the aorta
-
Thoracic aortic aneurysm
-
Aortic dissection
-
MI
-
PE
Pregunta 2
Pregunta
An 80 year old female presented to the emergency room with an MI. Prior medical history includes hypertension, and no prior history of angina. On the 3rd day EKG and physical exam showed abrupt pulseless electrical activity. Shortly after she died. What is the likely complication?
Respuesta
-
Free wall rupture
-
Ventricular septal defect
-
Papillary muscle rupture
-
Ventricular wall aneurysm
-
Congestive heart failure
Pregunta 3
Pregunta
What is the most common peripheral aneurysm?
Respuesta
-
Femoral artery
-
Popliteal artery
-
Carotid artery
-
Brachial artery
Pregunta 4
Pregunta
What is the most common cause of abdominal aortic aneurysm?
Respuesta
-
Marfan's syndrome
-
Bicuspid aortic valve
-
Atherosclerosis
-
Aortic stenosis
-
STEMI
Pregunta 5
Pregunta
A 35 year old female presents to the ED with dyspnea, hoarseness, hemoptysis, and lower leg edema. Clinical examination shows a loud S1 with an opening snap and rumbling mid-diastolic murmur. EKG shows left atrial enlargement and right ventricular hypertrophy. Chest x ray confirms this and shows interstitial edema. What is the likely diagnosis?
Respuesta
-
Bacterial endocarditis
-
Tricuspid stenosis
-
Mitral regurgitation
-
Aortic stenosis
-
Mitral stenosis
Pregunta 6
Pregunta
What can cause a decreased amplitude of P-waves, increase in PR interval, bradycardia in the form of AV block, and even an absence of P waves eventually leading to a "sine wave."
Respuesta
-
Hypokalemia
-
Hyperkalemia
-
Hypocalcemia
-
Hypercalcemia
Pregunta 7
Pregunta
Which of the following is the most common cause of multifocal atrial tachycardia?
Respuesta
-
Fever
-
MI
-
Valve disease
-
Lung disease
-
Low Mg/K
Pregunta 8
Pregunta
Which of the following ventricular septal defects can you expect to close spontaneously more so than the others?
Respuesta
-
Perimembranous
-
Muscular
-
Inlet
-
Supracristal
Pregunta 9
Pregunta
An EKG shows a U wave which occurs just after the T-wave and is of smaller amplitude than the T-wave. Further, there is flattening of the T-wave and ST-depression. What does this indicate?
Respuesta
-
Hypokalemia
-
Hyperkalemia
-
Hypocalcemia
-
Hypercalcemia
Pregunta 10
Pregunta
High uric acid and glucose intolerance are typical of which type of lipid disorder according to Fredrickson classification?
Respuesta
-
Type I
-
Type IIa
-
Type IIb
-
Type III
Pregunta 11
Pregunta
Electrical altercans is a finding on EKG of alternating amplitude of QRS complexes. Which of these diseases is most associated with this finding?
Respuesta
-
Atrial septal defect
-
Patent ductus arteriosus
-
Pericarditis
-
Myocarditis
-
NSTEMI
Pregunta 12
Pregunta
Which of the following is NOT a component of long term medical management of MI?
Respuesta
-
Beta blockers
-
Statins
-
Aspirin
-
Calcium channel blockers
-
P2Y12 blockers
-
ACEi
Pregunta 13
Pregunta
What is the greatest source of the biomarker CPK?
Respuesta
-
Skeletal muscle
-
Myocardial
-
Brain
-
Lungs
-
Kidneys
Pregunta 14
Pregunta
What pathology causes the greatest absolute number of ascending (thoracic) aortic dissections?
Respuesta
-
Marfan's Symdrome
-
Bicuspid aortic valve
-
Coarctation of the aorta
-
Mitral valve stenosis
Pregunta 15
Pregunta
A 70 year old female presents with ascites, edema, and jaundice. Physical exam shows JVD and hepatomegaly. Auscultation reveals a decrescendo diastolic rumble at the lower left sternal border that is louder with inspiration. What is the likely diagnosis?
Respuesta
-
Mitral stenosis
-
Mitral regurgitation
-
Mitral valve prolapse
-
Tricuspid stenosis
-
tricuspid regurgitation
Pregunta 16
Pregunta
A shortened QT interval, shortened ST segment, and Osborn waves (J waves) can be caused by?
Respuesta
-
Hypokalemia
-
Hyperkalemia
-
Hypocalcemia
-
Hypercalcemia
Pregunta 17
Pregunta
Which of the following is the most common ventricular septal defect?
Respuesta
-
Perimembranous
-
Muscular
-
Inlet/Posterior
-
Supracristal
Pregunta 18
Pregunta
Which is the most common form of lipid disorder according to the Fredrickson Lipid Classification?
Respuesta
-
Type I
-
Type IIa
-
Type IIb
-
Type III
-
Type IV
-
Type V
Pregunta 19
Pregunta
Peaked T waves best seen in the precordial leads, widening of QRS complexes, and sometimes ST depression may indicate.
Respuesta
-
Hypokalemia
-
Hyperkalemia
-
Hypocalcemia
-
Hypercalcemia
Pregunta 20
Pregunta
A 60 year old male with a prior medical history of pulmonary hypertension presents with ascites and lower extremity edema. Physical exam reveals an elevated JVP and a large pulsatile liver. Auscultation shows a holosystolic murmur at lower left sternal border that is louder with inspiration. Which of the following is most likely
Respuesta
-
Mitral regurgitation
-
Mitral valve prolapse
-
Aortic stenosis
-
Aortic regurgitation
-
Tricuspid regurgitation
Pregunta 21
Pregunta
A posterior wall MI involves which artery?
Respuesta
-
RCA
-
LAD
-
Circumflex
-
RCA and Circumflex
-
LAD and RCA
-
LAD and circumflex
Pregunta 22
Pregunta
What is the most common etiology of mitral stenosis?
Respuesta
-
Pulmonary hypertension
-
Infective endocarditis
-
Mitral annular calcification
-
Rheumatic heart disease
Pregunta 23
Pregunta
Which of the following would be first line treatment for acute AV node Reentry Tachycardia?
Respuesta
-
Adenosine
-
Lidocain
-
Amiodarone
-
Digoxin
-
Atropine
Pregunta 24
Pregunta
A 60 year old male complains of a cramping sensation in his calf after walking 50 feet or so. When he stops, the pain goes away. The pain returns upon walking. What term best describes these symptoms?
Respuesta
-
Thromangitis obliterans
-
Claudication
-
Collateralization
-
Compartment syndrome
Pregunta 25
Pregunta
What is the most common visceral aneurysm?
Respuesta
-
Splenic
-
Celiac
-
SMA
-
IMA
-
Renal
Pregunta 26
Pregunta
What is the standard antimicrobial therapy for bacterial endocarditis prophylaxis?
Respuesta
-
Penicillin
-
Amoxicillin
-
Clindamycin
-
Azithromycin
-
Ceftriaxone
Pregunta 27
Pregunta
A 35 year old patient recovering from a cold presents with dyspnea, orthopnea and edema. Physical exam shows elevated JVP, peripheral edema, and crackles. Auscultation reveals a displaced PMI and an S3 sound. EKG shows ST elevation. Chest x ray shows cardiomegaly, pulmonary congestion and thickened sub-plueral interlobular septa (Kerley B lines). Which of these diagnoses is most reasonable?
Respuesta
-
STEMI
-
Pericarditis
-
Constrictive pericarditis
-
Coarctation of the aorta
-
Myocarditis
Pregunta 28
Pregunta
Peripheral neuropathy is most often associated with which type of lipid disorder?
Respuesta
-
Type I
-
Type IIa
-
Type IIb
-
Type III
-
Type IV
-
Type V
Pregunta 29
Pregunta
A patient with a history of TB presents with peripheral edema, and ascites. Physical exam reveals hepatomegaly, elevated JVP. Kussmaul's sign (Increased JVP on inspiration) is positive but no pulsus paradoxus is noted. On auscultation a high pitched heart sound is noted during diastole. Which of the following can most reasonably explain these findings
Respuesta
-
Hypertrophic cardiomyopathy
-
Dilated cardiomyopathy
-
Myocarditis
-
Cardiac tamponade
-
Constrictive pericarditis
Pregunta 30
Pregunta
A patient presents with weakness, dyspnea and pulmonary edema. Auscultation reveals a blowing holosystolic murmur, immediately after S1 that radiates to the axilla. Based off this information alone, which of the following is most likely
Respuesta
-
Mitral stenosis
-
Mitral regurgitation
-
Mitral valve prolapse
-
Aortic stenosis
-
Aortic regurgitation
Pregunta 31
Pregunta
Which of the following presentations of cardiomyopathy is most common?
Respuesta
-
Ischemic dilated cardiomyopathy
-
Non-ischemic dilated cardiomyopathy
-
Hypertrophic non-dilated cardiomyopathy
-
Restrictive/Infiltrative cardiomyopathy
Pregunta 32
Pregunta
Which of the following Fredrickson Lipid Classification categories involved familial lipoprotein lipase (LPL) deficiency resulting in high triglycerides and chylomicrons. Signs include pancreatitis, lipemia retinalis, hepatosplenomegaly and eruptive xanthomas.
Respuesta
-
Type I
-
Type III
-
Type IV
-
Type V
Pregunta 33
Pregunta
A lateral wall MI involves which artery?
Respuesta
-
RCA
-
LAD
-
Circumflex
-
LAD and RCA
-
LAD and circumflex
Pregunta 34
Pregunta
Which of the following tests is the gold standard for diagnosing mitral regurgitation?
Respuesta
-
CXR
-
ECG
-
ECHO
-
Cardiac catheterization
-
Magnetic resonance angiogram
Pregunta 35
Pregunta
A prominent S4 and a crescendo-decrescendo murmur at LLSB (similar to AS but not as RUSB)( that does not radiate to the carotids and increases on expiration (more blood fills LV) would make you most concerned for?
Respuesta
-
Dilated Cardiomyopathy
-
Hypertrophic cardiomyopathy
-
Restrictive cardiomyopathy
-
Pericarditis
-
Myocarditis
Pregunta 36
Pregunta
A patient presents with fatigue, dyspnea and chest pain. EKG shows diffuse ST elevation. He is hypotensive with pressure varying from inspiration to expiration. In addition, physical exam reveals muffled heart sounds and elevated JVP that increases on inspiration. Chest x ray shows cardiomegaly resembling a water-bottle. Which of the following is the most likely diagnosis?
Respuesta
-
Constrictive pericarditis
-
Cardiac tamponade
-
STEMI
-
Prinzmetal's angina
-
Myocarditis
Pregunta 37
Pregunta
In western countries, what is the most common valvular heart disease?
Respuesta
-
Mitral stenosis
-
Tricuspid stenosis
-
Aortic stenosis
-
Pulmonic stenosis
Pregunta 38
Pregunta
Premature atherosclerosis, corneal arcus and tendon xanthomas are signs of which type of lipid disorder?
Respuesta
-
Type I
-
Type IIa
-
Type IIb
-
Type III
Pregunta 39
Pregunta
What is the most common cause of valvular heart disease in developing countries
Respuesta
-
Mitral stenosis
-
Mitral valve prolapse
-
Tricuspid stenosis
-
Tricuspid regurgitation
-
Aortic stenosis
Pregunta 40
Pregunta
Which class of drugs is most commonly indicated for treatment of hypertrophic cardiomyopathy?
Respuesta
-
Statins
-
Beta blockers
-
Diuretics
-
ACEi
Pregunta 41
Pregunta
A mid-systolic click followed by a late systolic murmur is virtually diagnostic for which of the following diseases?
Respuesta
-
Mitral valve stenosis
-
Mitral valve regurgitation
-
Mitral valve prolapse
-
Aortic stenosis
-
Aortic regurgitation
Pregunta 42
Pregunta
Which of the following is the most common etiology of tricuspid regurgitation?
Respuesta
-
Trauma
-
Congenital abnormalities
-
Right ventricular dilation
-
Bacterial endocarditis
Pregunta 43
Pregunta
A 60 year old male smoker with COPD and hypertension presents with abdominal pain and lower back pain. Physical exam reveals a pulsatile abdomen and "blue toes." Which of the following tests is the gold standard for evaluating and diagnosing this pathology?
Respuesta
-
EKG
-
Ultrasound
-
CXR
-
CT
-
MRI
Pregunta 44
Pregunta
Which of the following complications from acute MI is the most common cause of mortality
Respuesta
-
Arrhythmia
-
Congestive heart failure
-
Recurrent infarction
-
Septal rupture
-
Ventricular wall aneurysm
Pregunta 45
Pregunta
Which of the following is the most common congenital heart defect?
Respuesta
-
Patent ductus arteriosus
-
Atrial septal defect
-
Ventricular septal defect
-
Patent ductus venosum
Pregunta 46
Pregunta
A 58 year old female presents with dyspnea, angina and multiple cases of syncope. Auscultation reveals a systolic, high pitched, crescendo-decrescendo murmur that radiates to the carotids. Further, pulusus parvus and tardus is noted. What is the most likely diagnosis?
Respuesta
-
Aortic stenosis
-
Pulmonic stenosis
-
Tricuspid stenosis
-
Mitral stenosis
Pregunta 47
Pregunta
In an aneurysm below the inguinal ligament, what is the most common complication?
Respuesta
-
Rupture
-
Embolization
-
Thrombosis
-
Dissection
Pregunta 48
Pregunta
Which of the following would NOT be an indication for bacterial endocarditis prophylaxis?
Respuesta
-
Prosthetic heart valves
-
Hypertrophic cardiomyopathy
-
Prior history of infective endocarditis
-
Complex cyanotic congenital heart disease
Pregunta 49
Pregunta
If you suspect a patient with HIV has non-ischemic dilated cardiomyopathy myocarditis, what test would best confirm your diagnosis?
Respuesta
-
TEE
-
EKG
-
Heart biopsy
-
CT scan with contrast
-
Magnetic resonance angiogram
Pregunta 50
Pregunta
Operating on an AAA is indicated in an otherwise healthy individual when it gets larger than _______?
Respuesta
-
5cm
-
5.5cm
-
6cm
-
6.5cm
-
7cm
Pregunta 51
Pregunta
What is standard risk factor reduction therapy for asymptomatic carotid disease?
Respuesta
-
Aspirin, Statin, ACEi
-
Coumadin, Statin
-
Beta blocker, Statin, ACEi
-
Loop diuretics, Statin, ACEi
Pregunta 52
Pregunta
Which of the following arrhythmias would NOT present with a narrow QRS and irregular rhythm?
Respuesta
-
Afib
-
MAT
-
Aflutter
-
VT
Pregunta 53
Pregunta
Carotid endarterectomy surgery is indicated at what level of stenosis?
Respuesta
-
50%
-
60%
-
70%
-
80%
-
90%
Pregunta 54
Pregunta
A patient with CHF presents for further work up. Chest x ray shows cardiomegaly, pulmonary edema and rib notching. Which of the following would be a reasonable cause of his CHF?
Respuesta
-
Hypoplastic left heart syndrome
-
Aortic valve stenosis
-
Myocarditis
-
Cardiac tamponade
-
Coarctation of the aorta
Pregunta 55
Pregunta
A 39 year old male presents with claudication, Raynaud's phenomenon and digital ulceration. Which of the following would be most reasonable?
Respuesta
-
Acute arterial occlusion
-
Thromboangitis obliterans (Buerger Disease)
-
DVT
-
Chronic venous insufficiency
-
Abdominal aortic aneurysm
Pregunta 56
Pregunta
An inferior wall MI involves which artery?
Respuesta
-
RCA
-
LAD
-
Circumflex
-
RCA and circumflex
-
LAD and RCA
-
LAD and circumflex
Pregunta 57
Pregunta
A patient comes to the clinic on follow up from an acute ST segment elevation myocardial infarction (STEMI). Examination reveals a new systolic heart murmur. Which of the following is the best explanation for this finding?
Respuesta
-
Acute aortic stenosis from infarction
-
Acute tricuspid regurgitation from infarction
-
Acute mitral regurgitation from infarction
-
Acute mitral stenosis from infarction
Pregunta 58
Pregunta
A 53 yo healthy male undergoes an exercise stress test, running on a treadmill until a maximum exertion is obtained. Which of the following statements correctly describes the effects of autonomic nerve activity on the cardiovascular system in this healthy individual?
Respuesta
-
Inhibition of parasympathetic nerves decreases total peripheral resistance
-
Inhibition of parasympathetic nerves increases heart rate
-
Inhibition of parasympathetic nerves increases total peripheral resistance
-
Stimulation of parasympathetic nerves decreases the strength of cardiac contractions
-
Stimulation of sympathetic nerves decreases the strength of cardiac contractions
Pregunta 59
Pregunta
A three year old female presents for a well-child visit and was found to have rough, continuous murmur hear over the left pulmonary area. What is this murmur?
Respuesta
-
Aortic stenosis
-
Patent ductus arteriosis
-
Mitral regurgitation
-
Pulmonic stenosis
Pregunta 60
Pregunta
A 21 year old woman presents to the clinic with complaints of palpitations and a headache. On physical exam, the patient is anxious and diaphoretic with a blood pressure of 175/105 mm Hg and a heart rate of 122 b[m. ECG demonstrates sinus tachycardia. Based on this presentation, what is a likely diagnosis.
Respuesta
-
Supraventricular tachycardia
-
Acute coronary syndrome
-
Aortic dissection
-
Pheochromocytoma
Pregunta 61
Pregunta
Which of the following radiographic findings is associated with tetralogy of Fallot?
Respuesta
-
Decrease in right ventricular size
-
Rib notching
-
Increased pulmonary vascular markings
-
Boot shaped heart
Pregunta 62
Pregunta
What is the cardiac ausculatory hallmark of an atrial septal defect?
Respuesta
-
Paradoxical split S2
-
Wide, fixed split S2
-
Systolic ejection murmur second right intercostal space
-
Holosystolic murmur heard a apex that radiates to axilla
Pregunta 63
Pregunta
A 53 year old man with history of tobacco presents to the emergency department complaining of severe, ripping, substernal chest pain that radiates to his back. His blood pressure is 175/92 mm Hg. Chest X-ray reveals a widened mediastinum, What is his most likely diagnosis.
Respuesta
-
Acute coronary syndrome
-
Pneumothorax
-
Aortic dissection
-
Mitral stenosis
Pregunta 64
Pregunta
An 81 year old woman with a 10 year history of well-controlled atrial fibrillation complains of a 6-day history of fatigue, dyspnea, and a 10 pound weight gain. She denies angina or diaphoresis. Based on this history what is the most likely diagnosis?
Respuesta
-
Acute coronary syndrome
-
Heart failure
-
Sinus tachycardia
-
Cardiac tamponade
Pregunta 65
Pregunta
A 67 year old male with history of coronary artery disease with prior myocardial infarction and stable, chronic heart failure returns tot he clinic for follow up. Which of the following medication regimens is most appropriate for him?
Respuesta
-
Aspirin, metoprolol, valsartan, clopidogrel, morphine, diuretic
-
Heparin, atenolol, atorvastatin, clonidine, nitroglycerine
-
Amlodipine, Lisinopril, aspirin, valsartan, atorvastatin, diuretic, metoprolol
-
Aspirin, metoprolol, Lisinopril, atorvastatin, diuretic, nitroglycerin
Pregunta 66
Pregunta
A 37 year old diabetic patient with history of paroxysmal atrial fibrillation and hypertension presents with sudden onset of severe pain in his left arm. On physical examination, the left arm is cool and pale with nonpalpable radial and ulnar pulses. What is the most likely cause for his pain?
Respuesta
-
Atherosclerotic peripheral vascular disease
-
Venous stasis disease
-
Raynaud syndrome
-
Arterial embolization
Pregunta 67
Pregunta
Which of the following is the most likely cause of paradoxical splitting of S2?
Respuesta
-
Pulmonic stenosis
-
Left bundle branch block
-
Atrial septal defect
-
Right ventricular failure
Pregunta 68
Pregunta
Orthostatic hypotension is defined as a drop in systolic blood pressure of at least ____________ or a drop of diastolic blood pressure of at least _________________ within 3 minutes of standing from the sitting position.
Respuesta
-
10 mm Hg; 20 mm Hg
-
10 mm Hg; 5 mm Hg
-
20 mm Hg; 10 mm Hg
-
5 mm Hg; 10 mm Hg
Pregunta 69
Pregunta
A 47 year old male presents with shortness of breath. On physical examination, the patient is sitting upright with moderately labored breathing, marked jugular venous distention (JVD), bilateral pulmonary rales, and a S3 gallop. Blood pressure is 120/90 and heart rate is 110 bpm. Chest x-ray shows pulmonary congestion. ECG demonstrates sinus tachycardia with low voltage QRS. Which class of medication should be given to this patient immediately to improve symptoms.
Respuesta
-
Ace inhibitors
-
Beta blockers
-
Calcium channel blockers
-
Diuretics
Pregunta 70
Pregunta
Which of the following medications is used to control the ventricular rate during an acute event of rapid atrial fibrillation?
Respuesta
-
Beta blocker
-
Digoxin
-
Warfarin
-
Nitroglycerin
Pregunta 71
Pregunta
Which of the following is a contraindication for an exercise treadmill stress test.
Respuesta
-
Mild aortic stenosis
-
Unstable angina
-
Previous myocardial infarction
-
Nonspecific ECG changes
Pregunta 72
Pregunta
Which of the following antiarrhythmic drugs most potently blocks sodium channel current in the myocardium?
Respuesta
-
Flecainide
-
Procainamide
-
Amiodarone
-
Lidocaine
Pregunta 73
Pregunta
According to the American Diabetes Association, risk reduction for cardiovascular events in patients with diabetes can be achieved by the use of:
Respuesta
-
Beta blockers
-
Statins
-
Cholesterol absorption inhibitors
-
Aldosterone
Pregunta 74
Pregunta
A 58 year old female with history of Type 2 diabetes mellitus presents for routine follow up. Which of the following would have the LEAST impact on prevention of her risk of developing macrovascular complications from diabetes?
Respuesta
-
Strict control of blood glucose levels
-
HMG-CoA reductase inhibitor therapy
-
Estrogen/progestin combination therapy
-
ACEi to control her hypertension
Pregunta 75
Pregunta
Secondary [prevention of an St-elevation myocardial infarction should include which of the following measures?
Respuesta
-
Estrogen therapy
-
ACEi
-
Folate or Vitamin B6
-
Calcium channel blockers
Pregunta 76
Pregunta
An increase in which of the following factors is most likely to increase the preload?
Respuesta
-
Arterial vascular tone
-
Stroke volume
-
Heart rate
-
Intravascular volume
Pregunta 77
Pregunta
Which is the mechanism by which cardiac tamponade impedes cardiac output?
Respuesta
-
Decreased inflow of blood to ventricles
-
Decreased pressure in pericardium
-
Increased pressure decreases sinus rhythm
-
Increase in end-diastolic volume
Pregunta 78
Pregunta
Which of the following is used to describe diastolic dysfunction?
Respuesta
-
Increased afterload
-
Decreased preload
-
Decreased stroke volume
-
Decreased ventricular myocardial compliance
Pregunta 79
Pregunta
A 37 year old woman with a history of hypertension presents to the emergency department with complaints of shortness of breath. She was placed on a telemetry monitor. What is your diagnosis?
Respuesta
-
Normal sinus rhythm
-
Atrial fibrillation
-
Sinus tachycardia
-
Nodal rhythm
Pregunta 80
Pregunta
A 29 year old man presents with extreme fatigue and shortness of breath. What is the abnormality noted in the ECG?
Respuesta
-
Complete AV Block
-
Type II second degree AV block
-
Junctional rhythm
-
Atrial fibrillation
Pregunta 81
Pregunta
You have started your patient who has giant cell arteritis on her glucocorticoid therapy. Which of the following laboratory studies would be used to monitor her response to this therapy?
Respuesta
-
Cardiac enzymes
-
Sedimentation rate
-
Rheumatoid factor
-
Complete blood cell count
Pregunta 82
Pregunta
A 50 year old woman presents to the office with a 1 week history of substernal chest pain. The symptoms occur with climbing the stairs in her home and with moderate-paced walking. The pain is relieved with rest, She denies any current chest pain. Her physical examination and ECG are normal. What I the nest test you would order?
Respuesta
-
Exercise treadmill stress test
-
Cardiac enzymes
-
Radionuclide stress myocardial perfusion imaging
-
Echocardiogram
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