Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medcon Rehab III > Oncology: Intro to Pediatric Oncology > Flashcards

Oncology: Intro to Pediatric Oncology Flashcards

1
Q

What is Cx?

A

“broad group of dis’s involving unregulated cell growth. In cx, cells divide and grow uncontrollably, forming malignant tumors, which may invade nearby parts of body.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Medical Interventions for Cx DEPENDS ON 3 THINGS:

A
  1. TYPE
  2. GRADE
  3. STAGE of Cx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PRIMARY intervention used for MOST Cx

A

Chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Chemo MAY be combined w/ what other forms of Tx?

A

Radiation tx

Sx for tumor removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chemo related terms

Adverse Effects—–

A

UNWANTED responses to Tx, may be immediate OR persistent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Chemo related terms:

Persistent Effects—–

A

relate to late term or long term effects of Cx tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Chemo/Cx related Side effects/Adverse Effects

A
  • Nausea/vom
  • dizziness/vertigo
  • PAIN
  • Fatigue–Cx related fatigue**
  • dyspnea
  • anorexia
  • coughing
  • 2* malignancies**
  • Thrombocytopenia
    • ​bed rest typ results from any of above
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PERSISTENT effects aka

A

LONG TERM EFFECTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PERSISTEN EFFECTS consist of:

7:

A
  • 2* Cx’s
  • organ damage
  • Infertility
  • chronic hepatitis
  • Alterations in growth and development
    • ​PEDS
  • impaired cognitive functioning
    • ​CNS tumors
  • Toxicity
    • ​MOST related to the medical mgmt of Primary Cx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

These 2 types of Cx acct for more than HALF of ALL CHILDHOOD CX

A
    1. Leukemias
    1. Cx of CNS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

1/3 Cx in children are…..

A

Leukemias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MOST COMMON TYPE OF Leukemia in Children

A

Acute Lymphoblastic Leukemia

ALL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common Solid tumors in children

A
  • BRAIN TUMORS
    • Gliomas
    • Meduloblastomas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Other LESS COMMON SOLID TUMORS in children

A
  • Neuroblastomas
  • Wilms tumor
  • Sarcomas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MOST COMMON TYPE OF PEDIATRIC Cx

A

ALL

Acute lymphoblastic leukemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ALL (most common pediatric cx)

Cancer of _____ and ______

A

Cx of blood and bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe ALL

Cx of blood and bone marrow

A
  • malignant proliferation of immature WBCs, beginning in bone marrow
  • Leukemia cells crowd out Norm blood cells and cause: ​
    • ​Anemia
      • ​reduced RBCs
    • Bruising
      • ​reduced plts
    • INCd infection risk
      • ​DECd norm WBCs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Possible Risk Factors/Causes for ALL

5:

A
    1. being exposed to X-rays before birth
    1. being exposed to radiation
    1. Past tx w/ chemo
    1. having certain changes in genes
    1. Genetic cond’s
      * ​Down syndrome
      * Neurofibromatosis type 1 (NF1)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

WARNING SIGNS OF ALL

A
  • Persistent (long term) fever
  • easy bruising or bleeding
  • Petechiae
    • ​flat, pinpoint, dark-red spots UNDER skin caused by bleeding
      • rash-like, internal bleeding
  • Unexplained bone or jt pain
  • Painless lumps in the neck, underarm, stomach, groin
    • ​inflamed lymph nodes
  • pain or feeling of fullness below ribs
  • weak, tired, pale
  • Loss of appetite
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Multitude of tests performed to Dx ALL

A
  • Hx and physical
  • CBC
  • Blood chem studies
  • Bone Marrow Aspiration/Biopsy
  • Cytogenic analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Prognostic Factors for ALL

# of WBCs in the blood @ Dx

A

LOWER #===POOR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Prognostic factors ALL

A
  • # Of WBCs in the blood @ Dx
    • LOWER==POOR
  • Whether there are certain changes in the chromosomes or genes of the lymphocytes w/ cx
    • ​POOR
  • whether the child has Down Syndrome
    • ​POOR
  • whether leukemia cells are found in the CSF
    • ​POOR
  • how quickly and how low the leukemia cell count drops AFTER initial Tx
    • BETTER w/ FASTER drop rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Survival rate for ALL w/ medical intervention

A

~80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

4 Modes of Tx used for ALL

A
  1. Chemo (but toxic)
  2. Radiation
  3. Stem cell transplasnt
  4. Targeted Therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Tx used for ALL

5. what is Targeted Therapy?

A
  • tx that uses drugs or other substances to ID and attack specific cx cells w/out harming NORMAL CELLS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

SIDE EFFECTS OF MEDICAL INTERVENTION

Chemo agents often associated w/ __________

A

Neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

SIDE EFFECTS OF MEDICAL INTERVENTION

Chemo agents often associated w/ Neuropathy

explain other SEs of Chemo

A
  • Vincristine== one of the drugs used
    • toxic–> causes peripheral neuropathy
  • chemo successful in killing cancer
  • chemo is toxic to body
  • Peripheral neuropathy common SE
    • ​so we will see Foot drop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

SIDE EFFECTS OF MEDICAL INTERVENTION

Another Tx other than chemo…

A

Methotrexate

  • helps to STOP GROWTH of cx cells
  • may lead to Roid rage and mood difficulties
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

SHORT and LONG-TERM complications of ALL/Medical Tx

A
  • PAIN
  • parasthesias–> distal UE/LE
  • reduced DTRs
  • mm cramps
  • learning disabilities
    • miss school
  • AVN
  • Osteopenia/osteoporosis
    • ​esp w/ long term steroid use
    • HIGH Fx RISK**
  • Impaired gross and fine motor skills
  • mm weakness
  • DECd energy expenditure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Role of PT in ALL

in general…

A
  • COMBAT 2* effects of bed rest
    • ​cx fatigue
    • chemo toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Role of PT in ALL

Research shows children w/ ALL have deficits in MULTIPLE AREAS both DURING and AFTER tx

examples?

A
  • Cardiopulm fitness
  • LOW activity lvl
  • Strength
  • ROM
  • Motor skills
  • Balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Obesity affects _______ children w/ ALL

*long term steroid use

*gain wt during medical tx and are unable to lose after tx is complete

A

11-57%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Vincristine related neuropathies

A

may also require PT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

BRAIN tumor common in children

A

Medulloblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Medulloblastoma is a form of brain tumor that arises WHERE?

A

Posterior Fossa

  • approx 40% of all post fossa tumors
  • **80% of medulloblastomas arise in the region of the 4th ventricle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Medulloblastoma warning signs

EARLY sx’s are related to what?

A

BLOCKAGE of CSF and resultant hydrocephalus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Medulloblastoma Warning Signs

commonly present w/:

A
  • relatively abrupt onset of HA’s
  • vomiting
  • lethargy
  • Unsteadiness– truncal unsteadiness
  • some degree of nystagmus
  • Papilledema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Medulloblastoma warning signs:

INFANTS–presentation is variable

A
  • NONSPECIFIC lethargy
  • psychomotor delays
  • loss of developmental milestones
  • feeding diff’s
  • Bulging of the anterior fontanel due to INCd ICP AND abnormal eye mvmts
    • ​Anterior fontanel is hole in top of skull
      • closes by 24mos
      • early as 12mos
      • look for bulging here from Hydrocephalus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Prognostic Factors for Medulloblastoma

A
  • Extent of dis @ Dx
    • LARGER tumor==poorer prognosis
  • Age @ dx
    • <3 NOT favorable
  • amt of residual disease after definitive sx
    • ​POOR prognosis if unable to resect all dis’d tissue
  • Tumor histopathology/tumor cell characteristics
  • Survival rates vary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Medical tx’s for Medulloblastoma

A
  • Sx to resect tumor
    • total or partial resection performed IF SAFE TO DO SO
  • Additional tx’s:
    • chemo + radiation
      • ​compliment the Sx
        • ​shrink tumor and attack metastatic dis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Post-op Presentation of Medulloblastoma

A
  • SIGNIFICANT neurological deficits caused by pre-op tumor related brain injury OR Sx-related brain injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Post-op Presentation of Medulloblastoma

Cerebellar Mutism Syndrome aka Posterior Fossa Syndrome

Sx’s:

A

Directly from trauma in brain– Pre-op Hydrocephalus, Sx trauma

  • delayed onset of speech
  • Suprabulbar palsies
  • Ataxia
  • Hypotonia
  • Emotional lability
43
Q

Tx Considerations for Pts w/ Brain Tumors

A
  • Tx pt as if they had sustained a TBI
  • Assess stage of Recovery (Ranchos Scale)
  • Lvl of alertness
  • Higher cognitive functioning
  • Neuro impairments MAY be main focus
44
Q

Asssessing lvl of Recovery for Medulloblastoma

TBI related

*NOTE: try to move them thru scale

A

see pics

45
Q

SOLID Bone Tumor—-

A

Osteosarcoma

46
Q

What is an Osteosarcoma aka Osteogenic sarcoma

A

EXTREMELY malignant tumor affecting BONE

47
Q

What is the MAIN CHARACTERISTIC of Osteosarcoma?

MAIN:

A

Presence of Osteoid, or immature bone

  • produced by malignant cells W/IN BONE
48
Q

Osteosarcoma can present as _____ or ______ Dx

A

PRIMARY

or

SECONDARY

49
Q

Primary Osteosarcoma

Tumor develops where?

A

PRIMARY tumor develops in Bone

50
Q

Secondary Osteosarcoma

Tumor is FROM where

A
  • Tumor is metastasis FROM ANOTHER SITE W/IN body
51
Q

Osteosarcoma is

A

RARE!!!

52
Q

Out of all bone cx dx in children, osteosarcoma accts for ________

A

50% of them

53
Q

When is Osteosarcoma dx most often?

A

Children + ado’s w/ peak incidence durng pubescent growth spurts

54
Q

Osteosarcoma more freq dx in _____

A

MALES

55
Q

OSTEOSARCOMA most often occurs @_______

A

metaphyseal portion of most actively growing bones

femur, tibia, prox humerus, pelvis

56
Q

Etiology of Osteosarcoma

A
  • exposure to ionizing radiation and chem factors
    • ​genetic mutation
  • Bone sarcomas may be induced by viruses
  • *possible genetic component
57
Q

Risk Factors for Osteosarcoma

A

*genetic disorders

*NO MODIFIABLE RISK FACTORS AT THIS TIME

58
Q

Osteosarcoma is known to originate from ______

A

poorly differentiated (immature) cells in osteoblasts

59
Q

Theorized that osteosarcoma results from ERROR that occurs in what?

A

Error in the cells responsible for development and remodeling of bones

  • DESTROYS CORTEX ===> Pathological Fx
60
Q

What do Osteosarcoma tumors look like?

A

LARGE, vicious w/ a moth-eaten pattern of destruction

  • weakens bone structure
  • Dx’d bc fx from MINOR trauma EASILY
61
Q

Clinical manifestations osteosarcoma

Often appear in BONES during what?

A

Appears in bones during active growth phases AND in ado’s @ the epiphyseal plate during growth spurts

62
Q

PRIMARY COMPLAINT OF PAIN w/ Osteosarcoma

A

Tumor growth into joint space an surrounding tissues @ tumor site

*Often mistaken for “growing pains” ****

63
Q

Osteosarcoma and PAIN

A

At first, pain is min. and intermittent, as tumor GROWS, pain intensifies in severity and duration and will eventually req. meds for pain relief

64
Q

PAIN assoc’d w/ Osteosarcoma

A

NO resolution w/ rest (Red Flag)

May cause night-time waking (Red Flag)

65
Q

PAIN and Osteosarcoma

A

pain may be present several weeks to mo’s w/ notable mass dev. prior to dx

*NOTE: diffuse pain reports prolong dx

66
Q

TUMOR GROWTH and Osteosarcoma

A

Tumor grows RAPIDLY

Swelling @ joint

ROM restricts after only a few weeks

67
Q

Integumentary manifestations and Osteosarcoma

A

Warming of the skin surrounding tumor

68
Q

Systemic symptoms and Osteosarcoma

A

RARE, but fever may occur in SEVERE cases

69
Q

HOW are osteosarcoma dx made?

A
  • Radiographs
  • MRI
    • ​more precise
  • CT
    • ​more precise
  • etc….
70
Q

POSSIBLE presentation of Osteosarcoma

Jt. Swelling

A

see pics

71
Q

Radiographys of Osteosarcoma

AP and Lateral views

A

see pics

72
Q

MRI Distal Left Femur OSTEOSARCOMA

A

SEE PICS

73
Q

MEDICAL MGMT OSTEOSARCOMA

3 MAJOR GOALS:

A
  1. Completely and permanently control the primary tumor
  2. Control and prevent micro-static and metastatic disease
  3. Preservation of FUNCTION**

*NOTE: To achieve these goals, Tx regimens typ COMBINE Sx w/ BOTH pre-and post-op chemo+radiation

74
Q

Bennies of Chemotherapy

3:

A
  • Control growth and development of tumor
  • Shrink size of primary tumor in order to INC feasibility of limb salvage proc’s OR DEC amt of amputation needed
  • Control undetected micrometastatic lesions
    • ​w/ Osteosarcoma–> we get tiny areas of Mets
      • WANT TO CONTROL THESE!!!
75
Q

Prognosis for Osteosarcoma

DEPENDS ON: 2

A
  1. Stage @ Dx

2. Excision (removal) success

76
Q

Osteosarcoma

Chemo + Sx results

A

5yr cure rates of 70-80% ***

77
Q

Osteosarcoma Prognosis

Poor prognosis assoc’d w/:

A
  • Axial lesions
  • INCd tumor size
  • Poor response to chemo
  • Presence of metastatic dis.
    • ​often to LUNGS
  • Local reoccurrence
78
Q

Talk about Sx options, types of Sx w/ Osteosarcoma

This all depends on what ?

A
  • TYPE of Sx performed depends on:
    • pts age
    • loc+size of tumor
    • extramedullary extent
    • presence of Mets
    • skeletal development
    • overall lifestyle
79
Q

Actual TYPES of Sx intervention Osteosarcoma

A
  1. Amputation
  2. Limb Salvage
  3. Rotationplasty or turnabout procedure
80
Q

Osteosarcoma Sx Interventions

Amputation

3 things to know:

A
  • surgical margin==6-7cm ABOVE most prox extent of tumor
  • allows for removal of tumor AND small lesions in the area surrounding the primary tumor site
  • affords pts w/ the greatest length of residual limb possible
81
Q

Amputation example:

Resected Left Distal Femur Osteosarcoma

A

TAKE NOTE: size of prox femur bone and condyles compared to tumor site

82
Q

Osteosarcoma Sx Intervention

Limb Salvage

A
  • involves excision of the bone tumor AND surrounding tissue w/ reconstruction of the limb in order to preserve function
  • Components:
    • allografts
    • endoprosthetic implants
  • **80-90% of pts w/ Osteosarcoma are tx’d w/ Limb Salvage Sx
83
Q

Osteosarcoma Sx Intervention

Rotationplasty

*Ankle functions as the knee one***

Indicated for WHAT pts?

A
  • indicated for those pts w/ tumor sites @ proximal tibia OR distal femur
84
Q

Osteosarcoma Sx Interventions

Rotationplasty

*Ankle functions as knee one***

A
  • tumor sites @ Prox tibia OR Dist Femur
  • Involves excision of tumor site, dist femur AND prox tibia w/ 180deg rotation of the ENTIRE LIMB including neurovascular supply***
  • AFTER rotation–the rotate ankle functions as a knee joint, thereby powering a custom-made below-knee prosthesis
  • Requires functioning hip joint and that the tumor NOT have invaded surrounding soft tissue or neurovascular supply
85
Q

POST- Rotationplasty

osteosarcoma Sx intervention

A

see pics!

86
Q

Rotationplasty

A

see pics

87
Q

Osteosarcoma Specific Tx

Phase ONE: ACUTE CARE PHASE

A
  • MOST pts referred to PT after medical mgmt initiated….but you may be FIRST healthcare worker to recognize s/s in pts w/ diffuse jt pain in outpatient
  • Tx’s vary slightly based on sx intervention
  • work closely w/ medical staff to coord. meds
  • Be aware of immune system precautions
  • Lab values should be checked for contraindications DAILY
  • be mindful of chemo SE’s
88
Q

Osteosarcoma Specific Tx

Phase ONE: ACUTE CARE PHASE

A
  • Usually referred IMMEDIATELY POST-OP:
    • early mobilization
    • prevent neg. bed rest comps
    • document skin integrity is INTEGRAL in assisting in skin healing and prevents comps
    • education regarding positioning
      • _​_In general…
        • ​avoid pos’s of COMFORT
        • promote PRONE
    • may begin desensitization programs for residual limb
  • Caution w/ WB status
  • Strengthen and maint ROM in surrounding tissues and joints
  • Chest PT indicated w/ pulm involvement
89
Q

Osteosarcoma Specific Tx

Phase ONE: ACUTE CARE PHASE

WHY would chest PT be indicated in this phase??

A
  • Post-sx
    • prolonged anasthesia predisposes us to residual fluid in lungs
  • assist w/ breathing and clearing fluid
    • ​assisted cough** BIG for post-sx
    • incentive spirometer***
90
Q

Osteosarcoma Specific Tx

Phase TWO: REHAB

A
  • cont’d strengthening of BOTH sound limb AND operative limb as well as abdomen and UEs (we don’t want overuse injuries)
  • BALANCE training (esp if COM changed from amputation)
  • Endurance building/energy conservation
  • Maximize FUNCTION w/ approp ADs
  • Pre-prosthetic and prosthetic fitting/training
  • remember to incorporate age approp play and ADLs into sessions w/ children. This also include acts needed for school ie; circle time, gym class
91
Q

Osteosarcoma Specific Tx

Phase THREE: OUTPATIENT

A
  • Cont’d adjustment and prosthetic training
  • endurance/CV training
  • INC diversity of function in diff environments
    • ex. progress AD, uneven surfs
  • sports/play/age approp activity

*NOTE: some children will not req this phase

92
Q

Gen PT Tx Considerations

Oncology overall

A
  • Med mgmt may have mult. comps
    • monitor VITALS and pt responses during tx**
  • Pt/parent/family education:
    • safety awareness
    • energy conservation
    • fall prevention
    • positioning
  • Refer pt and family members as needed to other disciplines
    • ​Cx devastating/debilitating @ any age
      • ​PSYCHOLOGY IMPORTANT!!!
93
Q

GEN ONCOLOGY TX

LAB VALUES!!!

WBC: modify when?

A
  • if severe leukopenia (neutropenia)
94
Q

GEN ONCOLOGY TX

LAB VALUES!!!

HGB: modify when?

A
  • if severe Anemia
95
Q

GEN ONCOLOGY TX

LAB VALUES!!!

Hct: modify when?

A
  • if severe anemia
96
Q

GEN ONCOLOGY TX

LAB VALUES!!!

Plts: modify when?

A
  • if Thrombocytopenia (hemorrhaging risk)
97
Q

GEN ONCOLOGY TX

BED REST SKILLS

A
  • GET Pts MOVING
    • aids in combating cx related fatigue
  • Mind and Body tx’s–> confidence, coping abilities
    • ​breathing
    • massage
    • visualization
98
Q

GEN ONCOLOGY TX

OTHER

A
  • Work to resolve clinical impairs
  • Incorporate preferred acts into tx
    • ​try to CONNECT
    • take interest in THEIR interests
99
Q

CRITICAL BLOOD COUNT GUIDELINES**

WBCS

A

NORMAL: 5-10 cells/mm^3

  • 1.0-5.0 W/OUT fever + stable or trending UP
    • ​PROCEED W/ PT
  • 1.0-5.0 w/ fever + trending DOWN
    • ​Leukopenia (neutropenia)==MODIFY PT
  • <1.0–> MODIFY for SEVERE leukopenia (neutropenia)

*Exercise is diff than low lvl mobilization

*Simple low lvl acts can be performed in bed or chair

  • ankle circles
  • quad and glute sets
  • arm circles
100
Q

CRITICAL BLOOD COUNT GUIDELINES**

HEMOGLOBIN (Hb or HgB)

A

NORMAL: Males=14-17 g/dL Females=12-16 g/dL

  • O2 carrying capacity of blood
    • Hb <7–MODIFY PT for Severe Anemia
      • ​NO EX. permitted; essential daily act only
    • Hb 7-8–MODIFY PT for anemia
      • ​light ex OK; light aerobics, lt wts
101
Q

CRITICAL BLOOD COUNT GUIDELINES**

Hematocrit (HCT)

A

NORMAL: Males=42-52% Female=37-47%

  • % of Whole blood volume which is composed of RBCs
    • ​HCT <15-20%– MODIFY PT for severe anemia
      • ​NO ex; essential ADLs only
    • HCT 20-25%–MODIFY PT for anemia
      • ​lt ex OK, lt aerobics, lt wts
102
Q

CRITICAL BLOOD COUNT GUIDELINES**

Platelets (PLT)

A

NORMAL=

  • Sm cell components involved in hemostasis
    • ​<20,000–MODIFY PT for bleeding or hemorrhage risk
      • ​NO EX; essential ADLs only
    • 20,000-50,000–MODIFY PT
      • ​lt ex OK, lt aerobics, lt wts
  • trending DOWN==thrombocytopenia
103
Q

PEDS Oncology Summary

A
  • PTs play integral role in care and mgmt of oncology pop. across all therapy settings and can make a diff in a pts overall functioning and QOL!!!
104
Q
A

Medcon Rehab III (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions