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Peds > CLIPP Main > Flashcards

CLIPP Main Flashcards

1
Q

Infants born to adolescent mothers are at greater risk for :

A
  • lower birth weight
  • vertically acquired STI
  • worse dev. outcome
  • fetal death

NOT chromsomal abnormalities though

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2
Q

How do you screen for the three leading causes of death in adolescents

A

HEEADSSS interview (home, education, eating, activity, drug/alcohol, sex, suicide, safety)

  1. Accidents
  2. Homicide
  3. Suicide
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3
Q

Effect of maternal tobacco use during pregnancy

A

risk of low birth weight in fetus

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4
Q

Effect of cocaine use during pregnancy

A

vasoconstriction = placental insufficiency and low birth weight

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5
Q

what are the components of the apgar score?

A 
Appearance (skin color)
Pulse
Grimace (reflex irritability)
Activity (mm tone)
Respiration
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6
Q

What is the Ballard score?

A

Uses neuromuscular and physical maturity to confirm gestational age (i.e. you’re not sure about dates)

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7
Q

risks for SGA newborns

A
  • Hypoglycemia
  • Hypothermia
  • Polycythemia
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8
Q

DDx for SGA newborn with Microcephaly and Purpuric Rash

A
  • TORCH
  • FAS
  • Chrom abnorm.
  • Prenatal tobacco
  • HIV
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9
Q

T/F: Erythromycin (or tertracycline,silver nitrate) admin topically to prevent gonococcal and chlamydial conjunctivitis

A

False. Only GONOCOCCAL.

–>Chlamydia more common but occurs 7-14 days later so neonatal prophylaxis doesnt help

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10
Q

brain imaging findings in congenital CMV

A
  • intracranial calcifications
  • dec # gyri/thick cortex (lissencephaly)
  • enlarged ventricles
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11
Q

T/F: CMV infected infants have progressive hearing loss

A

true

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12
Q

T/F: CMV infected infants can expect hepatosplenomegaly and rash to resolve spontaneously within few weeks

A

True

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13
Q

t/f:Treatment of symptomatic CMV for 6 months has been demonstrated to improve audiologic and neurodevelopmental outcomes at 2 years

A

true

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14
Q

Vision screening use a chart begins at age ____, and hearing with audiometry at ____

A

3; 4

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15
Q

when should toddlers be in a forward-facing car seat in the back seat?

A

> 2 years old, or have outgrown wt/ht of car seat

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16
Q

The itch that rashes

A

Atopic dermatitis (eczema)

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17
Q

antihistamines that can be used to help with eczema in kids

A

nonsedating types. Loratidine, fexofenadine, cetirizine

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18
Q

Intoeing in toddlers is caused by ____ ____, whereas intoeing in preschool/school kids by ____ ____

A

toddlers: Tibial torsion. resolves~4yo
kids: Femoral anteversion (both knees and feet turn inward). Resolves~8-12yo

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19
Q

Misalignment of the eyes

A

Strabismus

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20
Q

Anemia screening

A

@ 12 months and @preschool/KG entry

and anytime there are risk factors for anemia (poor diet)

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21
Q

4 steps toward improving a toddlers nutrition

A
  1. Stop the bottle
  2. Limit eating to 3 meals and 2 snacks, stopping food and drink grazing throughout day
  3. No bargaining (eat @ the time-limited meals)…desserts should not be an incentive for good eating
  4. Gradually change diet content (introducing new foods and reducing quantity of old favorite foods)
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22
Q

what is weight age/height age

A

time when those would plot at 50th %

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23
Q

common side effects of stimulant meds (ADHD)

A

appetite suppression, insomnia

no increases in risk of substance abuse or addiction

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24
Q

T/F: Slipped capital femoral epiphysis most commonly occurs at onset of puberty in obese patients

A

true

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25
Q

T/F: Obesity increases risk of t1dm

A

false

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26
Q

T/F: Age is generally helpful in diff. btwn T1DM and T2DM

A

False

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27
Q

Age of initiation of screening for diabetes in children at risk

A

10 years of age or onset of puberty (whichever is earlier)

–>check q3 years

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28
Q

Who gets screened for diabetes (what are criteria for “at risk”)?

A

Overweight (BMI>85%) + 2 of the following:

a. FHx of T2DM in 1st/2nd degree rel
b. Native american/african american/hispanic/asian
c. signs of insulin resistance (Acanthosis, PCOS, HTN, dyslipidemia)
d. MHx GDM or DM

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29
Q

T/F: Most elevated BP measurements in children are errors in measurement, not true HTN

A

True

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30
Q

BP %’s (don’t confuse with BMI)

A

<90th: Normal
90-95: Pre-HTN
95-99: Stage 1 HTN
>99: Stage 2 HTN

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31
Q

T/F: Adolescent with BP 130/90 has HTN

A

Depends on % for their age. if <95th, its pre-HTN

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32
Q

Why are UTI’s in childhood one of the leading causes of HTN and renal insufficiency later in life?

A

Renal scarring following infection

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33
Q

What sx of depression is more common adults than adolescents?

A

Early morning waking/difficulty falling asleep

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34
Q

Signs associated with anorexia sequelae

A
  1. Bradycardia
  2. Electrolyte abnormalities
    - ca/mg def can = arrythmias, neuro changes/increased reflex tone
    - hyponatremia from excessive H20 intake
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35
Q

T/F: A pt with a bleeding disorder would have a negative ROS unless:

  • systemic illness leading to DIC
  • neutropenia
  • thrombocytopenia
A

TRUE

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36
Q

T/F: Hypothyroidism is ass. with menorrhagia and shorter menstrual cycles

A

TRUE

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37
Q

A late-bloomer in puberty who will attain a normal adult height later than peers

A

Constitutional short stature

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38
Q

Order of puberty for girls

A

Breast buds, then pubic hair (by 10-11), growth spurt (12), menarche (12-13), attainment of adult height (15)

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39
Q

Order of puberty for boys

A

Growth of testicles, then pubic hair (12), growth of penis/scrotum (13-14), first ejaculations (13-14), Growth spurt (14), adult height (17)

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40
Q

Symptoms of vWD

A

Ecchymoses/bruising, epistaxis, menorrhagia, gingival bleeds, bleeds post dental procedures

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41
Q

Tx of vWD

A

Desmopressin (releases vWF stored in endothelium)

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42
Q

T/F: Hyperglycemia is common in LGA infants born to diabetic mothers

A

False…HYPOglycemia is common

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43
Q

clinical complications in SGA babies

A

Hypothermia, Hypoglycemia, Polycythemia, Hyperviscosity

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44
Q

path of oxygenated blood in utero

A

Placenta to umbilical vein. Some to liver, rest bypasses liver –Ductus Venosus –>IVC….crosses PFO to LA, goes to coronary/cerebral/UE circ. 10% of RV flows through pulm vasc, 90% through PDA to descending aorta.

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45
Q

What causes transient tachypnea of the newborn?

A

First breath results in replacement of lung fluid by air (uterine contractions squeeze it out + pulm lymphatics). Delay in this = TTN (persistent postnatal pulm edema)

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46
Q

How does an oxygen challenge test help differentiate btwn cardiac and respiratory causes of cyanosis?

A

Cardiac: oxygen will not sig. inc PaO2

Resp: oxygen will increase PaO2

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47
Q

T/F: Normal bilat breath sounds makes a congenital diaphragmatic hernia unlikely

A

True

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48
Q

____ is the primary anabolic hormone for fetal growth

A

Insulin

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49
Q

When should newborns be screened for hypoglycemia?

A
  • Term infants SGA or LGA
  • Late pre-term
  • DM moms

Doesn’t matter if symptoms present or not, need to screen

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50
Q

T/F: Only symptomatic infants should be screened for hypoglycemia

A

False, even asympotomatic hypoglycemia has negative conseq. for long term neurodev

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51
Q

T/F: Insulin and glucose cross the placenta

A

False, only glucose does

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52
Q

Target glucose screen value prior to routine feeds:

A

> 45 mg/dL

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53
Q

T/F: Glucometer is used to confirm hypoglycemia

A

False, its only a screening test. Confirm by lab analysis of serum or plasma glucose (draw blood)

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54
Q

Are there CXR findings in TTN?

A

Yes, lungs will look “wet” i.e. perihilar streaking/densities. but no consolidations.

Pneumonia can look similar, but clinical findings will be more concerning for sepsis

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55
Q

The breastfed infant will typically feed on demand every 2-4 hours, feeding _____ minutes on each side

A

10-15/side

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56
Q

T/F: Infants and children <2 years should not be given OTC cough and cold products (i.e. antihistamines/decongestants)

A

True

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57
Q

T/F: Allergic rhinitis presents with fever

A

False, presence of fever usually decreases suspicion of allergic rhinitis

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58
Q

T/F: Persistent URI sxs (>10days) w/day and night cough are common in sinusitis

A

True

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59
Q

Seasonal vs perennial rhinitis

A

S: environmental allergens i.e. pollen

P: Indoor allergens i.e. dust/animal/mold/tobacco

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60
Q

White, bulging, poorly mobile tympanic membranes

A

AOM

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61
Q

T/F: Otitis media with effusion = fluid in the middle ear space with acute inflammation

A

False. it is WITHOUT inflammation

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62
Q

Which viruses can increase risk for AOM?

A

RSV, influenza, rhino

alter mucosal lining

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63
Q

Amber, non/poorly mobile, opaque, and retracted TM

A

OME = Otitis Media with Effusion (not AOM)

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64
Q

T/F: Antihistamines and decongestants are helpful in clearing otitis media with effusion

A

False

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65
Q

Audiologic eval for children 6mo-2.5years

A

Visual Reinforcement Audiometry (VRA)…conventional audiometry starts at >4years

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66
Q

Tx for OME

A

Tympanostomy tube placement

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67
Q

most accurate method of determining pt’s degree of dehydration:

A

Weight prior to illness - current weight

(% dehydration)

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68
Q

recommended volume for mild-moderate rehydration

A

50-100mL/kg

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69
Q

T/F: Bilious emesis is more commonly seen in gastroenteritis than malrotation with volvulus

A

False, vice versa

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70
Q

Obstruction below ________ is typically when emesis becomes bilious

A

Ligament of Treitz

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71
Q

Study of choice for Pyloric stenosis:

A

Pyloric US (NOT CT)

…if US not available, can use Upper GI contrast study (shows String Sign)

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72
Q

T/F: As soon as pyloric stenosis is identified, corrective surgery can be performed

A

False, need to to correct metabolic status (electrolytes) first

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73
Q

What is the metabolic (electrolyte) status in Pyloric Stenosis

A

Hypochloremic, Hypokalemic metabolic alkalosis

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74
Q

Risk factors for developmental dysplasia of the hip (DDH)

A
  • breech
  • female gender
  • FHx
75
Q

T/F: Leukemia must always be considered in a kid refusing to walk

A

True –>replacement of bone marrow by leukemic cells can cause bone pain

76
Q

Acute onset of hip pain, following a URI. Low-grade fever.

A

Transient synovitis

77
Q

Children <16 years old with arthritis in at least 1 joint for >6 weeks meet the criteria for:

A

Juvenile Idiopathic Arthritis (JIA)

78
Q

Posterior displacement of the capital femoral epiphysis from teh femoral neck through the cartilage growth place

79
Q

Months of vague hip/knee sxs and limp in adolescent

A

SCFE, or Legg-Calve-Perthe

80
Q

Avascular necrosis of capital femoral epiphysis

(different than avas. nec or femoral head)

A

Legg-Calve-Perthe (Boys between 4-10)

81
Q

Hip pain secondary to an effusion (ass. with septic arthritis and transient synovitis) is relieved when patient:

A

opens hip capsule by holding hip in flexion and external rotation

82
Q

Reactive arthritis presents after what?

A

Infection outside the joint, esp GI and GU tract….2-4 weeks later

83
Q

Predictors of septic arthritis

A
  • fever
  • non wt bearing
  • ESR>40
  • wbc>12
84
Q

CRP or ESR?

Indirect measurement of fibrinogen elevation

A

ESR

higher fibrinogen = increased cohesion of rbc = faster rate of erythrocyte sedimentation

85
Q

CRP or ESR?

Direct quantification of an acute phase response

86
Q

Tx of transient synovitis

A

Rest + ibuprofen

87
Q

Dosing of Ibuprofen

A

10mg/kg q6-8hrs

comes in 100mg/5mL oral suspension

88
Q

Describe syncope/breath-holding spells in children

A
  • common ages 1-3
  • cyanotic or pallid
  • cynotic: upset child = vigorous crying and hyperventilation, then apnea, get transient hypoxia
  • quickly self-resolve
  • are benign and self-limited condition
89
Q

most common type of seizure in kids

A

Generalized tonic-clonic

90
Q

Name the seizure: Motor signs in a single extremity/side of of body

A

Simple partial

91
Q

Name the seizure: Glassy eyes, automatisms (lip-smacking, drooling), n/v, + alteration of consciousness

A

Complex partial

92
Q

How long do complex partial seizures last?

A

30 seconds-2minutes + Postictal state (confusion, sleep, headache)

93
Q

Name the seizure:

Loss of environmental awareness, automatisms (eye-flutter/lip smacking), no loss of tone/urinary continence

A

Absence seizures

94
Q

Persistent fever, nonpurulent conjunctivitis, rash, erythema/cracking of lips, strawberry tongue, cervical lymphadenopathy, swollen hands/feet

A

Kawasaki disease

95
Q

Tx of febrile seizures (fever)

A

Can treat the fear part with acetaminophen or ibuprofen…don’t usually tx the seizure

96
Q

Tx of febrile seizures (seizure)

A
  • place child on side
  • do not restrain
  • call 911 if lasts more than 5 min

only drug that helps with prevention is Phenobarbitol (primidone and valproic also do but toxic)

97
Q

Headaches that occurs with emotional stress, fatigue, lack of sleep

A

Tension headache

98
Q

Headache that is episodic, worsens through day, feels like a band around the head, can have tenderness of posterior neck muscles

A

Tension headache

99
Q

Migraines can first manifest as periodic syndromes characterized by:

A
  • cyclical vomiting
  • abdominal migraines
  • benign paroxysmal vertigo
100
Q

T/F: Tension headaches are usually accompanied by photophobia

A

False –> migraines are

101
Q

What is a classic (vs common) migraine headache?

A

Accompanied with an aura

102
Q

What is a common (vs classic) migraine headache?

A

aka migraine w/o aura.

  • Most frequent type in children
  • unilateral
  • frontal or temporal usually
103
Q

Cushings triad

A

increased ICP suggested by:

  • HTN
  • Bradycardia
  • Irregular respirations
104
Q

darkness and swelling beneath the eyes due to sinus congestion

A

Allergic shiners

105
Q

Romberg +

A

If only when eyes closed = position/vestibular f(x)

Eyes open and closed = cerebellar pathology

106
Q

Prophylactic therapy for migraines

A

Propranolol

107
Q

Hypsarrythmia pattern on EEG (high amplitude spikes that look same both ways)

A

Infantile spasms

108
Q

most common cause of acute ataxia in children

A

Post-infectious cerebellitis (aka acute cerebellar ataxia)…

autoimmune response = cerebellar demyelination few weeks after viral infection

109
Q

Organisms that can cause infectious cerebellitis

A

Mumps, enterovirus, EBV, and bacteria that cause meningitis (strep pneumo, Neisseria, H flu)

110
Q

Paraneoplastic syndrome occurring with Neuroblastoma

A

Opsoclonus-myoclonus sndrome (dancing feet-dancing eyes)

111
Q

Ataxia accompanied by intermittent jerking movements and erratic, jerky conjugate movements of the eyes

A

Opsoclonus-Myoclonus

112
Q

Worsening headaches, especially in the morning, associated with morning emesis and ataxia give concern for:

A

Increased ICP (Intracranial mass)

113
Q

Cerebellar lesions causing dysarthria, truncal ataxia, and gait abnormalities

A

in the Vermis (midline)

114
Q

Cerebellar lesions causing ipsilat limb abnormalities, nystagmus, tremor/dysmetria, and spare speech

A

Hemispheres

115
Q

Cerebellar lesions causing resting tremor, myoclonus, opsoclonus

A

Deep cerebellar nuclei

116
Q

Supra/Infra tentorial lesions present with cerebellar signs + signs of inc. ICP

A

Infratentorial

117
Q

Supra/Infra tentorial lesions present with focal motor/sensory abnormalities on side opposite to lesion

A

Supratentorial

118
Q

T/F: Cerebellar hemispheric lesions can cause changes in muscle tone and DTR, but usually lead to hypotonia/hyporeflexia

119
Q

T/F: Epidimediology:
0-2=Supratentorial tumors>Infra
3-10=Infra>Supra
>10=Supra>Infra

120
Q

4 most common childhood brain tumors

A
  • Medulloblastoma
  • Juvenile Pilocytic Astrocytoma
  • low-grade Astrocytoma
  • high grade Astrocytoma
121
Q

Where do ependymomas arise?

A

4th ventricle –> sxs related to hydrocephalus

122
Q

Tx for ependymoma

A

Surgical resection + radiation

123
Q

Which tumor in children has best prognosis?

A

Astrocytoma of cerebellum

124
Q

Most common pediatric tumor?

A

Medulloblastoma (or infratentorial PNET)

125
Q

Is medulloblastoma benign or malignant?

A

Malignant…may spread through CNS and extracranial sites

126
Q

Purpura on legs, butt, abdominal pain, joint pain after viral URI

A 
Henoch-Schonlein Purpura. 
Triad: 
-Palpable purpura
-Arthralgia
-Abdominal pain
127
Q

Asymptomatic purpura following nonspecific URI

128
Q

Bone pain is a common presentation of:

A

Leukemia in children

129
Q

Why is there petechiae in leukemia?

A

Thrombocytopenia due to marrow replacement by malignant cells

130
Q

T/F: Bacterial endocarditis presents with fever, fatigue, weight loss, petechial rash

131
Q

Supraclavicular nodes are concerning for:

132
Q

Nodes that are hard, rubbery, fixed to skin/tissue:

A

concern for malignancy

133
Q

Pain in/around a joint without signs of synovitis

A

Arthralgia

134
Q

T/F: Henoch-schonlein , ITP, and leukemia are not associated with splenomegaly

A

False. Leukemia is ass. with splenomegaly, the other 2 are not

135
Q

What labs would you order if suspecting HSP or ITP?

A
  • Platelet count (CBC with diff)
  • UA…with HSP, important to see renal involvement (can have IgA nephropathy)
  • BUN and Creatinine…if hematuria/proteinuria present, need to evaluate extent of renal disease
136
Q

the hallmark of _____ is non-thrombocytopenic purpura

A

Henoch-schonlein purpura (HSP)

137
Q

T/F: 1/3 of HSP patients will have renal involvement

A

True, usually hematuria

138
Q

Cause of ITP

A

antiplatelet antibodies leads to splenic/hepatic destruction of platelets. Tx with steroids and IVIG

139
Q

most common form of bowel obstruction in children 6 mo-6years of age

A

Intussusception (most at ileocolic j(X))

140
Q

Intussusception in HSP Is ___-____

A

ileo-ileal (not ileo-colic as normal)

141
Q

causes of altered mental status

A 
Alcohol, toxins
Epilepsy/enceph/endo/ electrolyes
Infection, insulin
OD, opiates, o2 deprived
Uremia
Trauma, temp
Insulin, infection
Psychosis
Stroke, shock, SOL

AEIOU TIPS

142
Q

Cholinergics (organophosphate)
or Anticholinergic:
Miosis, GI motility, sweating, tearing, bradycardia

A

Cholinergic

143
Q

Cholinergic (organophosphate) or Anticholinergic:

Dry as a bone, Mad as a Hatter

A

Anticholinergic

144
Q

Diphenhydramine is a _______, and Pseudoephedrine is a _______. Both cause what change to pupils ?

A

D: Anticholinergic
P: Sympathomimetic

Mydriasis

145
Q

Classic findings of TCA ingestion

A
  • cardiac (hypotension)
  • dilated pupils
  • dry, hot skin
146
Q

Profuse sweaty skin, agitation, fever, mental status changes, diarrhea, myoclonus, hyperreflexia, ataxia, shivering

A

Serotonin syndrome (OD on SSRI)

147
Q

T/F: Antihistamine ingestions present with anticholinergic effects, similar to TCA ingestions

A

True (TCA will cause cardiac manifestations uniquely)

148
Q

T/F: OD of decongestant results in a sympathomimetic syndrome

149
Q

Iron OD presents with:

A

severe abdominal sxs + signs of shock

150
Q

OD of ____ presents with agitation and tachycardia, but no mydriasis

151
Q

what evals does child with Down syndrome need during 1st 10 years life?

A
  • thyroid testing
  • vision screen
  • hearing screen
  • CBC in 1st mo (Fe def)
  • Peds cardiology ref.
  • Annual HCT/Hgb
  • early intervention
152
Q

What is one of the first sign’s of hypoalbuminemia?

A

Periorbital edema. Can also get ascites.

153
Q

Why does hepatic failure cause abdominal distention?

A

Generalized edema due to decreased production of albumin. Would also expect jaundice.

154
Q

Periorbital edema that improves when the child is upright

A

Nephrotic syndrome

155
Q

most common cause of nephrotic syndrome in children

A

minimum change disease (fusion and diffuse effacement of podocytes on EM)

156
Q

Urine Protein: Creatinine
Normal:
Suspicious for nephrotic:
Dx’ic for nephrotic:

A 
1.0 = suspicious
>2.5 = diagnostic
157
Q

tea-colored urine + skin/throat infection

158
Q

T/F: Tx’ing strep throat with antibiotics will prevent RF and PSGN

A

False, it will only prevent RF

159
Q

elevated ASO, +Streptozyme teset, Elevated anti-DNAase B antibodies, low C3

160
Q

Albumin and lipid levels in nephrotic syndrome

A

low albumin

high lipid

161
Q

Why is there a large risk of venous thrombosis in nephrotic syndrome?

A
  • Urinary loss of proteins that inhibit coagulation (AT3)
  • destabilization of platelets by hyperlipidemia
  • increased fibrinogen
  • increase viscosity
162
Q

Tx of primary nephrotic syndrome

A
  • Corticosteroids
  • Sodium restriction (to 1500-2000mg/daily)
  • Albumin + IV Furosemide if symptomatic edema (i.e. causing dyspnea/scrotal edema)
163
Q

Next step for steroid-resistant patients with nephrotic syndrome:

A

Renal biopsy

164
Q

T/F: During a nephrotic syndrome relapse with steroid use, patients are at a high risk of infection

165
Q

sickle cell = substitution of _____ for ______

A

valine for glutamic acid

166
Q

which Hgb patents associated with sickling:

  • F
  • FS
  • FAS
  • FSA
  • FSC
  • FAC
A
  • FS
  • FSA (sickle cell beta thalassemia)
  • FSC

The F is always written since its predominant hemoglobin @ birth; the letters after are listed in order of concentration

167
Q

2 most common surgeries in sickle cell kids

A
  • Tonsillectomy

- Cholecystectomy (bilirubin gallstones frequently occur in all pts with hemolytic anemias)

168
Q

Why is transcranial Doppler performed in sickle cell pts?

A

stroke occurs in 10% of children with SCD

169
Q

Which pneumococcal vaccine do sickle cell kids get

A

So 13 valent is given @ 2, 4, 6 months; SCD children also get 23-valent at 2 and 5 years

170
Q

Impairment of _____ is common in children with sickle cell disease

171
Q

What are important parts of the sickle cell physical exam?

A

Splenic palpation, observe sclera for icterus, neuro exam (stroke risk)

172
Q

T/F: Fever in children with sickle cell disease is a medical emergency

173
Q

Tachypnea and chest pain in a sickle cell kid

A

possibly Acute Chest Syndrome

174
Q

T/F: Pericariditis typically presents with tachypnea and fever

175
Q

CXR findings for Acute chest syndrome in sickle cell patients

A

Multilobar infiltrates; effusions; atelectasis

176
Q

why is an rbc transufion needed during Acute Chest Syndrome in SCD kids?

A

RBC transfusion is the only way to directly reduce/reverse the sickling process, which is the underlying cause of acute chest syndrome

177
Q

How do you calculate a corrected age (what we use for premature infants)

A

40 weeks (avg gest age) - gestational weeks of premature infant = X

Chronological age - x = corrected age

Use this CORRECTED AGE to plot growth charts until age 2

178
Q

When can a baby distinguish mother’s voice from another woman?

A

Before 7 days.

before 2 weeks for father

179
Q

When is developmental screening recommended?

A

At 9 and 18 months, and at 24 or 30 months

180
Q

Effects of anticonvulsants during pregnancy

A
  • cardiac defects
  • dysmorphic craniofacial
  • hypoplastic nails and distal phalanges
  • IUGR
  • microcephaly
181
Q

T/F: Smoking during preg = lower weight newborns at birth

182
Q

what are the features of homocystinuria?

A
  • marfanoid habitus
  • hypercoaguable state
  • dev delay
  • methionine in urine
183
Q

Why is polycythemia, seen in SGA infants, problematic?

A

Hyperviscosity = sluggish flow = respiratory distress secondary to inadequate oxygenation of end-organ tissues

Peds (3 decks)

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