the senses or mind aesthetically
beautifully
brightness
Personality disorders are long-standing, inflexible behavior patterns that persist across many situations, and they represent extreme, enduring versions of traits that most people experience occasionally and temporarily.
A person can be diagnosed with a personality disorder even if they do not feel distressed, because personality disorders often involve behavior that others find harmful while the individual views the behavior as normal.
Personality disorders can be understood as extreme variations of normal behavior or as distinct clinical categories, and the debate centers on whether these disorders represent degrees of traits or separate diagnoses.
DSM-5 groups personality disorders into three clusters: Cluster A includes paranoid, schizoid, and schizotypal disorders; Cluster B includes antisocial, borderline, histrionic, and narcissistic disorders; and Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders.
The categorical system classifies personality disorders as separate diagnoses, while the dimensional system views them as varying levels of traits, reflecting that personality disorders are often extreme forms of normal patterns.
Personality disorders usually develop gradually, often beginning with early patterns in childhood that become more rigid and pervasive by adulthood rather than having a clear point of onset.
Schizotypal personality disorder involves odd beliefs, unusual behavior, ideas of reference, magical thinking, and social isolation, and 10–20% of individuals with this disorder may later develop schizophrenia.
Paranoid personality disorder is defined by pervasive mistrust and suspicion of others, in which individuals interpret neutral or benign actions as malicious or deceptive.
Treatment outcomes for paranoid personality disorder are limited because individuals rarely seek help and mistrust therapists, requiring clinicians to first establish trust before addressing mistaken assumptions.
Cluster A disorders are odd or eccentric, Cluster B disorders are dramatic or erratic, and Cluster C disorders involve anxious or fearful behavior patterns.
Schizotypal disorder includes eccentric dress or behavior, unusual thinking, suspiciousness, and poor social relationships, and treatment often aims to reduce psychotic-like symptoms and delay schizophrenia onset.
Antisocial personality disorder involves persistent violation of rules, manipulation, disregard for others’ rights, aggression, and a lack of empathy or remorse, and it requires evidence of conduct disorder before age fifteen.
Histrionic personality disorder features dramatic, highly emotional, attention-seeking behavior, often including inappropriate intimacy, provocative dress, and exaggeration of emotions to gain short-term approval.
Narcissistic personality disorder involves grandiosity, entitlement, exploitation of others, lack of empathy, and an inflated sense of importance, often accompanied by sensitivity to evaluation and dismissal of other people’s feelings.
Avoidant personality disorder is characterized by extreme sensitivity to criticism, fear of rejection, and social avoidance despite wanting relationships, with treatment success closely tied to the strength of the therapeutic alliance.
Borderline personality disorder involves unstable and intense relationships, fear of abandonment, rapid mood shifts, impulsive behavior, self-harm or suicide attempts, and emotional volatility often linked to early trauma.
Psychopathy emphasizes traits such as superficial charm, emotional shallowness, and manipulativeness, whereas antisocial personality disorder emphasizes outward behaviors like rule-breaking and aggression; psychopaths with higher IQs may avoid detection.
The underarousal hypothesis proposes that individuals with antisocial personality disorder have unusually low levels of fear and anxiety, leading them to seek stimulation and making them less responsive to potentially threatening situations.
Dialectical Behavior Therapy is the most effective treatment for borderline personality disorder because it targets emotional instability, relationship turmoil, and suicidal or self-destructive behavior.
Dependent personality disorder involves excessive reliance on others for reassurance, submissiveness, difficulty making decisions independently, and fear of being alone or abandoned.
Dialectical Behavior Therapy prioritizes reducing self-harm behaviors by identifying the triggers behind suicidal and self-injurious actions and replacing them with safer, more effective coping strategies.
Translation is the process where the code carried by mRNA is used to build a polypeptide, and it occurs at the ribosome in the cytoplasm. The mRNA binds to the ribosome, which reads its bases in groups of threes called codons. Each codon specifies a specific amino acid. The tRNA molecules then bring amino acids to the ribosomes, with each tRNA carrying an anticodon that is complementary to a mRNA codon. Base pairing between codons and anticodons ensures that the amino acids are joined in the correct sequence by peptide bonds. When a stop codon is reached, the chain detaches and folds into a functioning protein. The precise order of amino acids determines the proteins shape and function meaning translation is essential for linking the genetic code to the correct protein.
Transcription is a process where the code for a gene on the DNA is copied complementary onto a strand of mRNA in the nucleus. In more detail, an enzyme called RNA polymerase binds to the DNA at the start of the gene code and unwinds the double helix structure of the DNA. Then, using the template strand of the DNA a complementary strand of mRNA is formed using the base pair rules except T is replaced with U (A pairs with U instead of T and G pairs with C). Once the gene is completely transcribed the mRNA and RNA polymerase detach and the DNA goes back to it’s original structure. The mRNA then exists the nucleus through nuclear pores and goes to a ribosome in the cytoplasm. The role of transcription is to produce mRNA that can carry the code for the amino acids that code for proteins. Since DNA cannot leave the nucleus, transcription provides a working copy of the genetic code that can be translated, making it an important step in ensuring the correct protein is made.
HPI (History of Present Illness)
Patient is a _- year-old M/F who presents today for further evaluation of ongoing symptoms and
follow-up on recent abnormal lab findings. The patient was referred to our clinic by Dr. [Name]
due to [abnormal findings, e.g., leukocytosis, anemia, suspected malignancy], which requires
additional assessment and management.
The patient reports a history of [relevant condition, e.g., hypertension, diabetes, GERD] and has
undergone [surgery/procedure, cholecystectomy, tumor resection] in the past. Family history is notable for [iron deficiency, breast cancer in mother at age 45, colon cancer in father at age 60].
The patient denies experiencing [e.g., fever, night sweats, significant weight loss], and denies
any history of [e.g., bleeding disorders, clotting issues, hematologic malignancy]. Additionally,
the patient has no known drug allergies and is currently compliant with prescribed medications.
Patient is a smoker/non-smoker.
Chief Complaint
I am here today to discuss my bloodwork results and for management of my ongoing symptoms.
Pt co from (SOB, fatigue, easy bruising, night sweats, unexplained weight loss)
Patient reports heavy menstrual bleeding lasting -- days, requires -- pads/day soaking with
occasional soiling of the underwear/bedding and passing of clots.
Recent lab results show that align with their proper diagnosis
ROS
Constitutional:
No fever, rigors, or chills
No night sweats or diaphoresis
No unintended weight loss or anorexia
No fatigue or malaise
No sleep disturbances
Eyes:
No blurred or double vision
No floaters or visual field deficit
No eye pain, redness, or discharge
No recent changes in vision
Ears, Nose, Throat (ENT):
No hearing loss or tinnitus
No nasal congestion, epistaxis, or sinus pain
No sore throat or dysphagia
No hoarseness or oral sores
Cardiovascular:
No chest pain or palpitations
No dyspnea on exertion
No orthopnea or paroxysmal nocturnal dyspnea
No peripheral edema
Respiratory:
No cough, hemoptysis, or wheezing
No shortness of breath at rest or exertion
Gastrointestinal:
No nausea, vomiting, or diarrhea
No abdominal pain or distention
No constipation or melena
No changes in bowel habits
Genitourinary:
No dysuria, hematuria, frequency, or urgency
No nocturia or incontinence
Musculoskeletal:
No joint pain, swelling, or stiffness
No myalgias or bone pain
Neurologic:
No headaches, dizziness, or vertigo
No numbness, tingling, or weakness
No seizures or loss of consciousness
Skin:
No new rashes, lesions, or bruising
No pruritus
No changes in mole shape or size
Hematologic/Lymphatic:
No easy bruising or bleeding
No enlarged lymph nodes
No history of blood transfusions
Endocrine:
No heat or cold intolerance
No polyuria, polydipsia, or polyphagia
Psychiatric:
No depression, anxiety, or mood swings
No sleep disturbance beyond baseline
No cognitive changes or confusion
PE
General Appearance
Well-developed / Well-nourished / Cachectic / Pale / Chronically ill-appearing
In no acute distress (NAD) / Mild distress / Appears fatigued
Vital Signs
BP:__/__ mmHg
HR: __ bpm
RR: __ breaths/min
Temp: __ °F/°C
SpO2: __ % on room air
Weight: __ lbs/kg
BMI: __ kg/m^2
HEENT (Head, Eyes, Ears, Nose, Throat)
Normocephalic, atraumatic
Pupils equally round and reactive to light (PERRL)
No scleral icterus
Mucous membranes moist, no lesions
No lymphadenopathy in cervical region
Neck
Supple, no jugular venous distension
No thyromegaly or masses
Lymphatics
No palpable cervical, axillary, or inguinal lymphadenopathy.
On physical examination at initial consultation, no palpable masses or lymph nodes noted.
No evidence of hepatosplenomegaly on abdominal palpation.
Skin examination reveals no hematomas, petechiae, or ecchymosis.
Cardiovascular
Regular rate and rhythm (RRR)
No murmurs, rubs, or gallops
Pulses intact and symmetric
Respiratory
Lungs clear to auscultation bilaterally
No wheezing, rales, or rhonchi
No respiratory distress
Abdomen
Soft, non-tender, non-distended
No hepatosplenomegaly
Bowel sounds present
Skin
No rashes, petechiae, ecchymosis, or lesions
No pallor / cyanosis / clubbing
Musculoskeletal
Full range of motion in all extremities
No joint swelling or deformities
Neurologic
Alert and oriented x3
Cranial nerves II-XII grossly intact
No focal deficits
Psychiatric
Appropriate mood and affect
Cooperative during examination
Assessment & Plan
Diagnoses:
SMOKING CESSATION Z71.6
The patient currently smokes __ cigarettes/pack(s) per day. I discussed the increased risks associated with smoking, including respiratory infections, lung disease, poor wound healing, cardiovascular complications, and various malignancies. The patient understands these risks but reports difficulty quitting. We reviewed options such as nicotine replacement therapy using patches or gum. The patient agreed to attempt smoking cessation.
THROMBOCYTOPENIA D69.6
Likely etiology includes both primary and secondary causes. We will proceed with a
comprehensive evaluation including a repeat CBC, ESR, CRP, ANA, RF, Vitamin B12, folate
levels, hepatitis panel, and peripheral blood smear. Platelet count >50K is adequate for invasive
procedures. The patient is advised to avoid alcohol and NSAIDs. Further recommendations will
be based on diagnostic findings.
IRON DEFICIENCY ANEMIA D50
Recent labs from the PCP indicate low iron stores. Treatment options were discussed, including a 6-8 month course of oral iron supplementation versus IV Feraheme in two cycles. Risks, benefits, and potential side effects were reviewed, and the patient elected to proceed with IV
Feraheme, Informed consent was obtained and documented. A pregnancy test was negative. The patient is advised to avoid MRI for three months following the last infusion due to increased iron body content. Gastroenterology referral was made to evaluate for a potential GI source of iron loss.
ANEMIA D64.9
Labs were reviewed with the PCP. The patient is currently asymptomatic. We will conduct a
standard anemia workup including iron studies, reticulocyte count, EPO level, Vitamin B12 and
folate levels, SPEP/IEP, MMA, and hemoglobin electrophoresis. Stool occult blood testing will
be obtained x3. Further recommendations will be made pending results.
BREAST CANCER
Stage__ (TN__, ER/PR__, HER2__ ). She has no family history of breast or ovarian cancer,
and BRCA1/2 genetic testing was negative. Gynecologic history is notable for menarche at age__ and last menstrual period on /20, with a history of X for __. We discussed her
diagnosis, prognosis, and treatment options in detail, including Oncotype testing to guide
adjuvant therapy. If her recurrence score is high, she will be offered adjuvant chemotherapy,
radiation therapy, and hormonal therapy; if low, she will receive adjuvant radiation therapy and
hormonal therapy. The patient was reassured that breast pain at the surgical site is a common
post-treatment symptom. Management and recommendations are aligned with NCCN guidelines. Pt will continue close follow-up with oncology, and further treatment will be determined based on Oncotype results and multidisciplinary review.
A high level of medical decision-making was utilized during this visit due to multiple co-existing
conditions requiring complex management and coordination between specialties.
Discussed risk of severe anemia progression and safety parameters for IV iron; patient consented after discussing complications and benefits.
Patient referral provided on day of visit to my specialty partner Dr. X for further evaluation
I discussed in length with patient their diagnosis, prognosis and treatment options
All questions and concerns were addressed. The patient vocalized understanding and agreement to assessment and treatment plan.
Regular CBC monitoring will be performed at every visit to track hematologic findings and
adjust care PRN
I plan to see patient P back in clinic in approximately T Day(s)/week(s)/month(s)/year for
clinical reevaluation with their ongoing symptoms after obtaining their MRI results for review if
requested. At that time, we will reassess their improvement in symptoms.
This note was documented by me, on behalf of and in the presence of Dr. X. I, Dr. X, personally performed the services described in this documentation, as scribed by me. I have reviewed the documentation; it is both accurate and complete.
HPI:
The patient is a 58-year-old female with a history of stage II invasive ductal carcinoma of the left breast, ER/PR positive, HER2 negative. She is status post lumpectomy, adjuvant chemotherapy, and radiation, completed in 2022. She presents today for her routine six-month follow-up. She reports mild fatigue but denies new breast lumps, nipple discharge, skin dimpling, or breast pain. Denies unintentional weight loss, night sweats, or fevers. She remains compliant with tamoxifen therapy and denies hot flashes, leg cramps, or thrombotic symptoms.
Chief Complaint: I came here today for fu for my left breast cancer.
Pt co from (SOB, fatigue, easy bruising, night sweats, unexplained weight loss)
Patient reports heavy menstrual bleeding lasting -- days, requires -- pads/day soaking with
occasional soiling of the underwear/bedding and passing of clots.
Recent lab results show that align with their proper diagnosis
Review of Systems:
Constitutional: Denies fevers, chills, night sweats. Reports mild fatigue.
Breast: Denies lumps, pain, discharge, or skin changes.
Respiratory: Denies cough or shortness of breath.
Cardiac: Denies chest pain or palpitations.
GI: Denies nausea, vomiting, abdominal pain, or bowel changes.
Neuro: Denies headaches, dizziness, weakness.
Medications:
Tamoxifen 20 mg daily
Past Medical History:
Breast cancer, stage II, left breast
Hyperlipidemia
Past Surgical History:
Left breast lumpectomy (2022)
Port placement and removal
Family History:
Mother: breast cancer at age 62
Father: diabetes
Social History:
Former smoker, quit 20 years ago
Drinks socially
Lives with spouse
Allergies:
NKDA
Physical Exam:
General: Alert, well-appearing, no acute distress
Breasts: No palpable masses, no skin changes, surgical scar well healed
Lymphatics: No axillary, supraclavicular, or cervical lymphadenopathy
Cardiac: Regular rate and rhythm
Lungs: Clear to auscultation bilaterally
Abdomen: Soft, non-tender, no organomegaly
Neuro: No focal deficits
Assessment:
History of stage II ER/PR+ HER2– left breast cancer, clinically stable. On endocrine therapy with good tolerance
Plan:
Continue tamoxifen 20 mg daily. Order an annual mammogram. Follow up in 6 months
Pt is also educated on the importance of maintaining a regular exercise routine, weight management, and monthly self-breast exams
Substance intoxication is a reversible state of behavioral and psychological impairment caused by recent ingestion of a psychoactive substance.
Physiological dependence occurs when the body adapts to a drug through tolerance and withdrawal, making the substance necessary for normal functioning.
Substance dependence refers to a maladaptive pattern of drug use involving tolerance, withdrawal, inability to cut down, excessive time spent around the substance, and continued use despite significant problems.
Substance use refers simply to taking a psychoactive substance, which does not itself indicate misuse, impairment, or a disorder.
According to the DSM-5, substance abuse is part of substance use disorder, defined as a problematic pattern of use causing clinically significant impairment or distress, such as hazardous use, failure to meet obligations, or continuing despite problems.
Tolerance means that increasing amounts of a substance are needed to achieve the desired effect or that the same amount produces diminished effects.
Withdrawal refers to physiological and psychological symptoms that occur when a person dependent on a substance reduces or stops using it.
Craving and drug-seeking behaviors involve powerful urges to use a substance and repeated thoughts, planning, or behaviors aimed at obtaining and consuming it.
Alcohol enhances the effects of GABA, the brain’s primary inhibitory neurotransmitter, which slows central nervous system activity and lowers inhibitions.
Dopamine plays a central role in the brain’s pleasure pathway, and many addictive drugs increase dopamine levels directly or indirectly.
About 23% of individuals in America engage in binge drinking, consuming large amounts of alcohol in short periods with elevated health and safety risks.
Opiates refer to natural derivatives of opium, whereas opioids include both natural opiates and synthetic or semisynthetic drugs with similar effects.
The initial effects of alcohol ingestion reduce inhibitions and increase sociability, but later effects impair judgment, motor coordination, reaction time, and consciousness.
Withdrawal from alcohol can cause tremors, sweating, nausea, anxiety, hallucinations, agitation, seizures, and in severe cases delirium tremens.
Long-term excessive drinking can lead to liver disease, cardiovascular problems, brain damage, cognitive impairment, Wernicke–Korsakoff syndrome, social and occupational difficulties, depression, accidents, and legal problems.
Fetal alcohol syndrome involves growth delays, characteristic facial abnormalities, and central nervous system impairment resulting from heavy drinking during pregnancy.
College students with D or F grades consume an average of 11 drinks per week, while A students typically consume 3 or fewer drinks per week.
Sedatives are substances that calm the nervous system, reducing excitement and producing relaxation or drowsiness.
Analgesics relieve pain by blocking pain signals in the nervous system and include opioid medications such as morphine and codeine.
Hypnotics are drugs used to induce sleep and are commonly prescribed for insomnia.
Benzodiazepines are anti-anxiety medications that enhance GABA activity, producing calming effects but also carrying risks of tolerance, withdrawal, and dependence.
Amphetamine overdose can cause hallucinations, delusions, confusion, sweating, nausea, and dangerous changes in blood pressure.
Cannabis intoxication can produce mood swings, ranging from euphoria and relaxation to anxiety or paranoia, along with altered perception and coordination.
The brain’s pleasure pathway is dopamine-driven, and addictive drugs stimulate this system, reinforcing continued use.
About 90% of Americans use caffeine, making it the most widely consumed psychoactive substance.
Heroin withdrawal within the first 12 hours can include anxiety, restlessness, sweating, muscle aches, runny nose, and strong cravings.
Hallucinogens alter perception dramatically, causing sensory distortions, hallucinations, and disordered thinking.
Ketamine, or “Special K,” can produce dissociation, feelings of detachment from one’s body, reduced pain sensitivity, and confusion.
Aversive treatments, such as Antabuse, pair substance use with unpleasant effects to discourage drinking or drug use.
Pyromania is an impulse-control disorder involving repeated urges to set fires for tension relief or pleasure, though it is very rare among actual arsonists.
Kleptomania involves recurrent, impulsive stealing of items not needed for personal use, accompanied by tension before and relief after the theft.
The positive-reinforcing effects of drugs refer to the pleasurable sensations they produce, which can encourage continued use even in the absence of social or cultural influences.
Alcoholics Anonymous is a 12-step, abstinence-based support program that emphasizes peer support, spirituality, and lifelong sobriety.
People addicted to nicotine smoke frequently to avoid withdrawal symptoms such as irritability, restlessness, and difficulty concentrating rather than to experience a pleasurable high.
Both anorexia nervosa and bulimia nervosa involve an overwhelming urge to be thin, which stems from distorted body image, fear of weight gain, and internalization of cultural standards that equate thinness with beauty, success, and personal worth.
Eating disorders are most prevalent in Western, industrialized countries where media and cultural norms heavily promote thinness, making Western culture the highest-risk environment for developing anorexia and bulimia.
A typical patient with anorexia nervosa is an adolescent female who is perfectionistic and high achieving, severely restricts food intake, is significantly underweight, and maintains an intense fear of gaining weight despite being emaciated.
A typical patient with bulimia nervosa is a young woman who is usually within the normal weight range, experiences episodes of large binge eating with loss of control, and engages in compensatory behaviors such as vomiting or fasting.
Purging is highly ineffective for reducing caloric intake because vomiting eliminates at most 50% of calories if done immediately, and laxatives or diuretics typically eliminate less than 10% due to delayed action.
Purging behaviors include self-induced vomiting, laxative misuse, diuretic misuse, and enemas, while non-purging compensatory behaviors include excessive exercise and extended periods of fasting.
People with anorexia nervosa experience extreme cognitive distortions, such as believing they are overweight despite severe thinness, thinking any weight gain will lead to rejection, and linking self-worth directly to body size.
Both binge-eating disorder and bulimia nervosa involve recurrent binge episodes with loss of control, but binge-eating disorder does not include compensatory behaviors, while bulimia nervosa involves purging or fasting after binges.
Binge-eating disorder is characterized by recurrent episodes of consuming unusually large amounts of food accompanied by distress and loss of control, without any purging behavior, and is commonly associated with obesity.
Males most likely to develop an eating disorder are those who participate in weight-regulated sports such as wrestling, gymnastics, or endurance running, along with gay and bisexual men, who show higher prevalence rates.
Anorexia nervosa typically begins in early adolescence around ages 13–15, whereas bulimia nervosa usually has a slightly later onset during late adolescence or early adulthood.
Anorexia nervosa involves severe restriction of food intake leading to dangerously low body weight, an intense fear of gaining weight, and a distorted perception of body shape that drives relentless pursuit of thinness.
Drug treatments are generally not effective for anorexia nervosa, as medications do not significantly improve weight restoration or correct distorted thinking, making psychological and family-based therapies the primary treatment approach.
Drug treatments for bulimia nervosa, particularly antidepressants such as SSRIs, can reduce bingeing and purging behaviors, though they work best when combined with cognitive-behavioral therapy.
According to Henderson and Brownell (2004), modern technological advancement, which reduces physical activity and increases sedentary behavior, is the largest contributor to rising obesity rates.
A polysomnographic evaluation is a comprehensive sleep study that measures brain waves, eye movements, muscle activity, breathing patterns, and sleep stages to diagnose sleep-wake disorders.
Insomnia disorder involves difficulty falling asleep, staying asleep, or waking too early, occurring at least three times per week for three months and causing significant daytime impairment or distress.
The integrative model suggests that sleep disorders arise from interacting biological factors, psychological stress or worry, and social or environmental influences such as irregular sleep schedules.
Narcolepsy is a neurological sleep disorder involving sudden, irresistible sleep attacks, rapid entry into REM sleep, and symptoms such as sleep paralysis, hypnagogic hallucinations, and cataplexy.
Individuals with hypersomnolence disorder experience excessive daytime sleepiness and prolonged nighttime sleep that still feels unrefreshing, often struggling to remain awake during normal activities.
Cataplexy is a sudden loss of muscle tone triggered by strong emotions, such as laughter or excitement, while consciousness remains intact, and is a hallmark symptom of narcolepsy.
Benzodiazepine medications can temporarily help with insomnia, but long-term use is discouraged due to risks of tolerance, dependence, and rebound insomnia once the medication is stopped.
Delaying bedtime, known as phase delay, is an effective method for resetting the biological clock in individuals with circadian rhythm sleep-wake disorders because it aligns more naturally with the body’s internal rhythms.
Sleep hygiene refers to healthy sleep practices such as maintaining a consistent sleep schedule, limiting caffeine and screen exposure before bed, and using the bedroom only for sleep.
Parasomnias involve abnormal behaviors or physiological events during sleep, such as sleepwalking or nightmares, whereas dyssomnias involve problems with sleep amount, quality, or timing, such as insomnia or sleep apnea.
Dyssomnias are sleep disorders characterized by difficulties in falling asleep, staying asleep, obtaining restorative sleep, or maintaining proper sleep-wake timing.
Sleep hygiene incorporates classical conditioning by teaching the brain to associate the bed only with sleep, preventing the learned association between bed and wakefulness that contributes to insomnia.
Sleepwalking occurs during deep non-REM sleep, usually in the first third of the night, and individuals typically have no memory of leaving the bed or performing behaviors while asleep.
Microsleeps are brief episodes of sleep lasting only a few seconds that occur during extreme sleep deprivation and can be dangerous, especially when driving or performing tasks requiring attention.
Circadian rhythm sleep-wake disorders occur when the internal biological clock becomes misaligned with external schedules, as seen in jet lag or shift work, leading to insomnia or excessive sleepiness.
Zeitgebers, such as natural light, melatonin, and social routines, are external cues that help regulate the body’s circadian rhythm and maintain a consistent sleep-wake cycle.
Obstructive sleep apnea is characterized by repeated episodes of airway blockage during sleep despite continued breathing effort, leading to loud snoring, gasping, daytime sleepiness, and morning headaches.
Adolf H is good
L_Ender's ctaclysm
Toxony
Mowzie's mobs
Fossils and archaeology revival.
Alex's caves
Adolf H fans are here! Right???
Adolf H fans are here! Right???
Adolf H fans are here! Right???
Adolf H fans are here! Right???
Adolf H fans are here! Right???
Adolf H fans are here! Right???
Adolf H fans are here! Right???
Adolf H fans are here! Right???
