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Pediatrics > Pedia Topnotch > Flashcards

Pedia Topnotch Flashcards

0
Q

Immediate goal of immunization

A

Prevention of disease

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1
Q

Ultimate goal of immunization

A

Eradication of disease

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2
Q

Two types of immunization

A

Active and passive

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3
Q

Types of antigen for active immunization

A
  1. Live attenuated

2. Inactivated

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4
Q

What are the live vaccines? List 7.

A 
BCG
Measles
MMR
Varicella
Rotavirus
Influenza intranasal
Typhoid fever
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5
Q

Peak of passive immunization for IM injections

A

48-72 hrs

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6
Q

System for ensuring the potency of a vaccine from the time of manufacture to the time it is given to a child

A

Cold chain

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7
Q

When can combination vaccines be given simultaneously?

A
  1. Equal or >2 inactivated vaccines

2. Inactivated and live vaccines

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8
Q

What is the rule in giving live vaccines in combination?

A

28-day minimum interval if not given simultaneously

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9
Q

What is the principle in lapsed immunization?

A

does not require reinstitution of the entire series. subsequent immunizations should be given at the next visit as if the usual interval has elapsed.

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10
Q

Only vaccine given intradermally

A

BCG

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11
Q

When is BCG usually given?

A

earliest possible age after birth preferrably within the first 2 months

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12
Q

If BCG is not given in the first 2 months what do we do?

A

PPD vaccination is NOT recommended prior to vaccination.

PPD is however required if the following conditions are present:

  1. suspected congenital TB
  2. history of close contact to know TB case
  3. clinical findings suggestive of TB or xray suggestive of TB
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13
Q

What is a positive PPD test in those requiring PPD before vaccination?

A

> 5mm induration

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14
Q

What is the dose of BCG?

A

12 mos - 0.1 ml

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15
Q

Measles vaccine is given through what route

A

SQ

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16
Q

Measles vaccine is given at

A

9 months

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17
Q

Measles vaccine can be given as early as ___ in cases of outbreaks as declared by PH officials

A

6 months

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18
Q

Common adverse effects of BCG vaccine

A

Abscess or ulcers at site

Axillary Lymphadenopathy

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19
Q

Dose of measles vaccine

A

0.5ml

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20
Q

Common adverse effect of measles vaccine

A

fever 5-12 days after vaccination

rash

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21
Q

A 14 year old male presents with joint pains and morning stiffness for the past 3 months. The joint pain is present in both hands and feet bilaterally. On PE, joints are tender to palpation, warm, and swollen. What is the most likely diagnosis?

A

Juvenile Rheumatoid Arthritis

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22
Q

3 prinicipal types of onset of JRA

A
  1. Oligoarthritis (pauciarticular)
  2. Polyarthritis
  3. Systemic-onset disease
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23
Q

HLA subtypes in JRA

A 
HLA DR4 (Polyarticular)
HLA DR8 and DR5 (Pauciarticular)
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24
Q

Criteria of classification of JRA

A

Age <16years
Arthritis (2 or more of the following) limitation of ROM, tenderness or pain on motion, increased heat in one or more joints

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25
Q

Onset type of JRA is defined by disease characteristic in the first _months

A

6 mos

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26
Q

JRA classifications, differentiate each:

A
  1. Polyarthritis - 5 or more inflamed joints
  2. Oligoarthritis: <5 inflamed joints
  3. Systemic arthritis: with characteristic fever
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27
Q

Characteristic of fever in systemic onset JRA

A

quotidian fever with daily high spikes and rapid return to baseline usually associated with a faint red macular rash (salmon pink rash)

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28
Q

Treatment of JRA

A

NSAIDs
Methotrexate and immunosuppresive agents
Steroids for overwhelming systemic illness
Physical and occupational therapy

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29
Q

Inflammation if the joints of the axial skeleton and limbs, presence of enthesitis (inflammation of the sites of attachments of ligaments, tendons, fascia, and capsule to bone), absence of Rheumatoid factor

A

Ankylosing spondylitis

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30
Q

Demographic of people with ankylosing spondylitis

A

older boys, adolescents, young adults

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31
Q

HLA type found in >90% of people with ankylosing spondylitis

A

HLA-B27

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32
Q

Forms of ankylosing spondylitis (3)

A
  1. Juvenile (oligoarthritis legs>arms, enthesitis, hip joint arthritis, back pain, loss of spinal flexibility
  2. Psoriatic (oligoarthritis, asymmetric, nail pitting, dactylitis, FH of psoriasis)
  3. Reactive (Reiter syndrome: arthritis, conjunctivitis, urethritis), lower limb arthritis
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33
Q

Eye complication of ankylosing spondylosis

A

Anterior uveitis (Iridocyclitis) 25%

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34
Q

Treatment for ankylosing spondylosis

A

NSAID and may add sulfasalazine

Intraacrticular triamcinolone

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35
Q

Criteria for diagnosis of SLE

A

4 out of 11

SOAP BRAIN MD

Serositis (Pleuritis, Carditis)
Oral Ulcers (painless)
Arthritis (2 or more joints)
Photosensitivity

Blood Changes (anemia, leukopenia, thrombocytopenia)
Renal Disorder (persistent proteinuria,cellular casts)
ANA abnormal titer
Immunological Changes (anti dna, Ab, Anti Sm)
Neurologic signs (seizures, frank psychosis)

Malar rash
Discoid rash

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36
Q

screening for SLE

A

ANA

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37
Q

more specific marker for lupus and reflects degree of disease activity

A

anti dsdna

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38
Q

Complement low in lupus

A

low C3, C4

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39
Q

marker only found in SLE

A

anti Smith Ab

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40
Q

Route of rotavirus vaccine

A

oral

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41
Q

RV1 and RV5 number of doses, schedule, interval between doses and brands

A

RV1 (monovalent) Rotarix 2 doses
RV5 (pentavalent) RotaTeq 3 doses

between 6 weeks and 32 weeks (8mos)
interval between doses: 4 weeks

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42
Q

MMRV:

Route?
How many doses?
Schedule between ?
Minimum interval between doses?

A

Route? SQ
How many doses? 2 doses
Schedule between ? 12 mos-12 years
Minimum interval between doses? 3 mos

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43
Q

Definition of hematuria

A

More than 5 rbcs/hpf

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44
Q

Dipstick test for hematuria is based on what chemical reaction?

A

Peroxidase reaction with hemoglobin

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46
Q

Is cloudy urine always abnormal?

A

No. It can be due to crystal formation at room temp.

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47
Q

Tea colored urine usually points out to a ___ problem

A

Glomerular

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48
Q

Normal specific gravity

A

1.015-1.025

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49
Q

What crytals form in acidic urine?

A

Uric acid

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50
Q

What crystals form in basic urine?

A

Phosphate crystals

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51
Q

Positive dipstick but absent rbcs in urine. What is the usual cause?

A

Myoglobinuria from rhabdomyolysis

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52
Q

Primary treatment in SLE

A

Prednisone 1-2mg/kg/day

Severely ill: Pulse IV steroids (30 mg/kg/dose max 1 gm over 60mins OD for 3 days)

Severely ill: pulse IV cyclophosphamide to maintain renal function and prevent progression

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53
Q

Most common of the pediatric inflammatory myopathies

A

Dermatomyositis

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54
Q

HLA subtype association in Dermatomyositis in >80%

A

HLA Ag DQA1*0501

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55
Q

Systemic vasculopathy with cutaneous findings and focal areas of myositis resulting in progressive muscular weakness that is responsive to immunosuppressive therapy

A

Dermatomyositis

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56
Q

Usual risk factor and infection triggers of Dermatomyositis

A

Sun exposure

Enterovirus (Coxsackievirus B) and GABHS

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57
Q

Periorbital violaceous erythema common in Dermatomyositis

A

Heliotrope rash

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58
Q

Skin finding over the metacarpal and proximal interphalangeal joints that is hypertrophic and pale red with a papular, alligator-skin like appearance seen in dermatomyositis

A

Gottron papules

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59
Q

Severe prognostic sign in dermatomyositis

A

Dysphagia

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60
Q

A chronic disease characterized by fibrosis affecting the dermis and arteries of the lungs, kidney, and GIT

A

Scleroderma

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61
Q

Pathophysio of Scleroderma

A

Injury of vascular endothelium leading to fibrosis

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62
Q

Earliest manifestation of scleroderma and may precede skin and internal organ involvement by months or years.

this is not however limited to scleroderma but can also herald other diseases such as connective tissue disorders, rheumatic disorders and other immunologic conditions

A

Raynaud phenomenon

excessively reduced blood flow in response to cold or emotional stress, causing discoloration of the fingers, toes, and occasionally other areas

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63
Q

Components of CREST Syndrome

A

Calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia.

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64
Q

Is a systemic connective tissue disease.

Characteristics include essential vasomotor disturbances; fibrosis; subsequent atrophy of the skin, subcutaneous tissue, muscles, and internal organs (eg, alimentary tract, lungs, heart, kidney, CNS); and immunologic disturbances accompany these findings.

A

Systemic sclerosis (SSc)

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65
Q

Diagnostic Criteria of Systemic Sclerosis

A

Major criterion or 2 of the 3 Minor criteria

Major Criteria:
1. Proximal scleroderma: typical skin changes (tightness, thickening, non-pitting induration excluding localized forms) involving areas proximal to the MCP or MTP joints

Minor Criteria

  1. Sclerodactyly
  2. Digital pitting scars from digital ischemia
  3. Bibasilar pulmonary fibrosis not attributable to primary lung disease
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66
Q

Antibody finding mostly suggestive for scleroderma

A

Anti-SCL70 specific for topoisomerase 1 and anticentromere autoantibodies

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67
Q

Drug used that may prevent ulcerations in scleroderma

A

ACE inhibitors

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68
Q

Imunosuppresive agents used in scleroderma

A

Methotrexate and steroids

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69
Q

How many percent of coronary aneurysms in Kawasaki disease resolve after 1-2 years?

A

50%

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70
Q

IgA mediated vasculitis of the small vessels

A

HSP

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71
Q

Typical Prodrome of HSP

A

typically follows after an URTI

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72
Q

Pathophysio of HSP

A

IgA deposition in blood vessels that cause leaking –> purpura and petechiae

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73
Q

HLA subtype common in HSP

A

HLA-DRB1*07

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74
Q

Organ systems primarily affected in HSP

A

Skin, GI, Kidney

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75
Q

Hallmark rash of HSP

A

palpable petechiae or purpura that evolve from red to brown that last from 3-10 days

usually found on dependent areas

76
Q

Renal involvement in HSP is seen in __%

77
Q

Odynophagia vs. dysphagia

A

Odynophagia - pain during swallowing

Dysphagia - difficulty swallowing

78
Q

Most common type of TEF (Nelsons)

A

Type A (EA and distal fistula)

For Robbins, Type B

79
Q

50% of those who have TEF have associated syndrome of anomalies called

A

VATER/VACTERL

Vertebral, anorectal, trachea, esophagus, cardiac, renal, radial limb syndrome

80
Q

Most common esophageal disorder in children of all ages

81
Q

Major mechanism of GERD

A

Transient LES Relaxation

82
Q

Main stimulus for transient relaxation of LES in GERD

A

Gastric distention

83
Q

Surgical management for intractable GERD

A

Nissen Fundoplication

“gastric fundus (upper part) of the stomach is wrapped, or plicated, around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter”

84
Q

Most common esophageal foreign body in 6 months to 3 years old

85
Q

What is the management in cases of asymptomatic esophageal foreign bodies (blunt objects)?

A

May be observed up to 24 hrs in anticipation of passage in the stomach.

86
Q

Indication for urgent endoscopy in esophageal foreign bodies

A

Sharp objects

Failure to visualize+symptomatic patient

87
Q

True or False. Absent oral lesions mean that there is no significant esophagogastric injury.

88
Q

Liquid alkali in caustic ingestion causes what type of necrosis?

A

Liquefaction necrosis

89
Q

Most common cause of non-bilous vomiting in children

A

Pyloric stenosis

90
Q

Physical exam finding in pyloric stenosis

A

Firm, movable, olive shaped mass

91
Q

Ultrasound findings in pyloric stenosis

A

pyloric thickness >4mm or length >14mm

92
Q

Barium enema signs in pyloric stenosis

A

shoulder sign- bulge of the pyloric muscle in the antrum

double tract sign - streaks of barium in the narrowed channel

93
Q

Atresia vs. Stenosis

A

Atresia - complete obstruction

Stenosis - partial block of luminal contents

94
Q

Triad of Volvulus

A

S-I-R Volvulus

  1. Sudden onset severe epigastric pain
  2. Inability to pass tube in the stomach
  3. retching with emesis
95
Q

X ray findings in volvulus

A

Bird’s beak sign
Inverted U sign
Coffee bean sign (midline crease corresponding to mesenteric root)

96
Q

Management of volvulus

A

Decompression and derotation using a rectal tube or colonsocope if with no signs of bowel ischemia or perforation.

Lap derotation +/- bowel resection

97
Q

48 hr old boy at 34 weeks AOG noted to vomit greenish material after feeding. PE revealed non-distended abdomen with hyperactive bowel sounds. Diagnosis?

A

Duodenal atresia

98
Q

Incomplete rotation of the intestine during fetal development

A

Malrotation

99
Q

Most common type of malrotation

A

failure of the cecum to move into the RLQ

100
Q

Diagnostic and sign seen in duodenal atresia

A

Xray abdomen

Double bubble sign

101
Q

Remnant of the omphalomesenteric duct which connects the yolk sac to the gut in the embryo and provides nutrition

A

Meckel Diverticulum

102
Q

Most frequent GI congenital anomaly

A

Meckel Diverticulum

103
Q

Most common cause of lower GI obstruction in neonates

A

Hirschprung’s Disease

104
Q

Pathophysio of Hirschprung’s

A

arrest of neuroblast migration from proximal to distal bowel

absence of ganglion cells in the bowel wall beginning in the internal anal sphincter

105
Q

The Currarino syndrome (also Currarino triad) is

A

iInherited congenital disorder where

(1) the sacrum (the fused vertebrae forming the back of the pelvis) is not formed properly,
(2) there is a mass in the presacral space in front of the sacrum, and
(3) there are malformations of the anus or rectum.

It can also cause an anterior meningocele or a presacral teratoma.

106
Q

Diagnostic of choice for Hirschprung’s

A

Rectal suction biopsy

107
Q

Portion of the alimentary tract is telescoped into an adjacent segment

A

Intussusception

108
Q

Most common cause of intestinal obstruction between 3 months to 6 years old

A

Intussusception

109
Q

Most common risk factors in intussusception

A

Rotavirus vaccine after 8 mos, adenovirus

110
Q

Intussusception happens usually in what segments?

A

Ileocolic and Ileoileocolic

111
Q

Characteristic of stool in intussusception

A

Currant Jelly Stools

112
Q

Abdominal PE findings of intussusception

A

sausage-sahped mass in the RUQ which may increase in size and firmness during paroxysms of pain

113
Q

Imaging findings in intussusception?

Xray, Barium enema, ultrasound

A

Xray - increased density
Barium enema - coiled spring pattern
Ultrasound - tubular mass, donut shaped, or target sign

114
Q

Diagnostic of choice of peptic ulcer disease

115
Q

Test done to determine the presence of H. pylori

A

Rapid urease test

116
Q

Treatment of H. pylori

A

PPI + Clarithromycin + Amox/Metronidazole

117
Q

Definition of diarrhea

A

> 3 episodes in 24 hours

118
Q

2 types of acute infectious diarrhea

A

Inflammatory and Non-inflammatory

119
Q

Mechanisms of diarrhea

A 
Secretory
Osmotic
Reduction in surface area
Alteration in motility
Mutations in apical membrane transport proteins
120
Q

Fluid deficit in SOME Dehydration

A

50-100ml/kg

121
Q

Parameters to classify a patient with some signs of dehydration

A 
General condition: iriitable
Eyes: Sunken
Thirst: Thirsty, drinks eagerly
Skin turgor: slow
Weight loss %: 5-10%
Fluid deficit: 50-100ml/kg
122
Q

Treatment for patients with no signs of dehydration

A

give ORS after every loose stool

123
Q

Treatment for patients with some dehydration

A

75ml/kg ORS over 4 hrs

124
Q

Treatment for patients with severe dehydration

A

give a total of 100cc/kg pLR IV

  • first 30cc/kg over 1 hr for infants, 30 mins for children
  • next 70cc/kg over 5 hrs for infants, 2.5 hrs in children
125
Q

Chronic or persistent diarrhea definition

A

> 14 days duration

126
Q

Reduced osmolarity ORS components and total osmolarity

A 
Glucose 75
Na 75
Cl 65
K 20
Citrate 10
TOTAL OSMOLARITY 245
127
Q

Cornerstone in the management of AGE

A

Management of dehydration

128
Q

Give the causative organism of AGE:

Presentation: watery diarrhea 7-10days
Treatment: supportive

129
Q

Give the causative organism of AGE:

Presentation: from nurseries and daycare
Treatment: TMP-SMZ

A

Enteropathogenic E. coli

130
Q

Give the causative organism of AGE:

Presentation: hemorrhagic colitis HUS
Treatment: TMP-SMZ

131
Q

Give the causative organism of AGE:

Presentation: eggs milk and poultry
Treatment: ?

A

Salmonella

Treatment: treat only if <3mos old

132
Q

Give the causative organism of AGE:

Presentation: person to person contact through contaminated food
Treatment: Cefixime, Erythromycin

A

Shigella and Campylobacter

133
Q

Give the causative organism of AGE:

Presentation: Hx of antibiotic use
Treatment: ?

A

C. difficile

Metronidazole or Vancomycin

134
Q

Give the causative organism of AGE:

Presentation: within 12 hours due to a preformed toxin with a common food source
Treatment: ?

A

S. aureus

no treatment

135
Q

Give the causative organism of AGE:

Presentation: infects the colon, acute bloody diarrhea
Treatment: ?

A

E. histolytica

Metronidazole

136
Q

Give the causative organism of AGE:

Presentation: cysts are ingested from contaminated food and water; watery diarrhea
Treatment: ?

A

G. lamblia

Metronidazole

137
Q

Give the causative organism of AGE:

Presentation: profuse watery diarrhea; rice water consistency of stool with fishy odor; Washer woman’s hands
Treatment: ?

A

Cholera

Tetracycline

138
Q

Amylase and lipase levels in acute pancreatitis (days elevated)

A

Serum amylase- elevated up to 4 days

Serum lipase - rises by 4-8 hrs, peaks at 24-48 hrs, elevated 8-14 days longer than amylase

139
Q

Criteria for acute pancreatitis used in adults

A

Ranson’s criteria and APACHE

not suitable for children

140
Q

In EINC, the significance of delayed cord clamping is to

A

decrease the incidence of anemia

141
Q

Series of time bound chronologically-ordered standard procedures that the baby receives after birth

A

Essential Newborn Care

142
Q

Most important component of the APGAR

143
Q

The best description of the APGAR Score is that it

A

assesses neonates in need of resuscitation

5 min - initial resuscitation

144
Q

Components of newborn screening

A 
CH
CAH
Galactosemia
Phenylketonuria
G6PD
145
Q

Cheese like material that covers the normal term infant in varying amounts

A

Vernix caseosa

146
Q

purplish reticulated pattern noted on the neonate when exposed to cold

A

cutis marmorata

147
Q

Newborn PE: small white occasionally vesicopustular papules on an erythematous base develop after 1-3 days. Contains eosinophils

A

erythema toxicum

148
Q

Newborn PE: vesiculopustular eruption over a dark macular base around the chin, neck, back, and soles, contains PMNs

A

pustular melanosis

149
Q

Newborn PE: cysts appearing on the hard palate composed of accumulations of epithelial cells

A

Epstein pearls

150
Q

Newborn PE: pearly white papules mostly seen on the chins and around the cheeks

151
Q

Term infant with severe respiratory distress and a scaphoid abdomen on PE. Diagnosis?

A

Congenital diaphragmatic hernia

152
Q

Most common type of congenital diaphragmatic hernia

153
Q

Term infant born with extrusion of abdominal viscera. Initial management?

A

Decompression and wrapping

154
Q

Which is associated with more congenital anomalies? Omphalocoele or gastroschisis?

A

Omphalocoele

155
Q

Gastroschisis is common on which side of the umbilicus

A

Right side

156
Q

A preterm baby won’t stop crying. Baby has abdominal distention with abdominal erythema. Baby cries more when touched. Diagnosis?

A

Necrotizing enterocolitis

157
Q

Xray of a newborn showed thickened bowel walls and air in the bowel wall. This is called? Intervention?

A

pneumatosis intestinale

supportive - hydrate and antibiotics

158
Q

On CXR of a newborn, findings of “bubbly lungs” (cystic lucencies) with irreular denses strands and aearation. Diagnosis?

A

Bronchopulmonary dysplasia

159
Q

CXR differences between TTN and RDS

A

RDS or HMD: finely granular lungs, ground glass appearance, air bronchograms, air filled esophagus

TTN: prominent pulmonary vacular markings
fluid lines in fissure, overaeration

160
Q

On CXR of a newborn, coarse streaking granular pattern on both lungs is usually suggestive of what?

A

Meconium aspiration syndrome

161
Q

Most common cause of jaundice in neonates?

A

Physiologic

162
Q

Most serious complication of hyperbilirubinemia in newborns

A

Kernicterus

163
Q

Amount of serum bilirubin on physiologic vs pathologic jaundice

A

Physiologic: peaks at 5-6mg/dl on 2-4 days
Pathologic: rate is rising faster than 5mg/dl/24hrs

164
Q

Chart used for fast assessment of Jaundice?

A

Kramer’s chart

165
Q

Fast serum bilirubin levels based on Kramer’s chart

A

head 6-8mg/dl
chest 9-12mg/dl
abdomen 12-14mg/dl
whole body >18 mg/dl

166
Q

Most likely etiology of jaundice in the first 24 hrs.

Key clue: first born child

A

ABO incompatibility

167
Q

Most likely etiology of jaundice in the first 24 hrs.

Key clue: second born child

A

Rh incompatibility

168
Q

Most likely etiology of jaundice in the first 24 hrs.

Key clue: history of prolonged second stage of labor, no prenatal check up

169
Q

Most likely etiology of jaundice in the first 24 hrs.

Key clue: history of maternal infection during pregnancy

A

TORCH infection

170
Q

Most likely etiology of jaundice after the first 24 hrs.
Onset of jaundice: 2-3 days
Key clue: baby otherwise normal

A

Physiologic

171
Q

Most likely etiology of jaundice after the first 24 hrs.
Onset of jaundice: 3-4 days
Key clue: mother supplements breastfeeding with sugar water

A

Breastfeeding jaundice

172
Q

Most likely etiology of jaundice after the first 24 hrs.
Onset of jaundice: >1 week
Key clue: baby purely breastfed

A

breastmilk jaundice

173
Q

Breastmilk versus breastfeeding jaundice?

A

Breastfeeding jaundice - “lack of breastfeeding jaundice,” is caused by insufficient breast milk intake resulting in inadequate quantities of bowel movements to remove bilirubin from the body.

This can usually be ameliorated by frequent breastfeeding sessions of sufficient duration to stimulate adequate milk production.

Breastmilk jaundice - breast milk jaundice is a biochemical occurrence and due to a lot of factors, there is inefficiency in bilirubin removal by gut bacteria or liver enzymes.

174
Q

Staining in kernicterus usually occurs in the

A

basal ganglia and brainstem

175
Q

Kernicterus is rare in infants with serum levels that are ___?

A

below 25mg/dl

176
Q

Phases of kernicterus

A

Phase 1 - poor sucking, stupor, hypotonia
Phase 2 - hypertonia, opisthotonus, fever
Phase 3 - hypertonia

177
Q

The most important risk factor that predisposes a neonate to sepsis

A

Prematurity

178
Q

TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy

Key clue: vesicular lesions on the face and mouth

179
Q

TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy

Key clue: Purpuric hemorrhagic lesions all over the body

180
Q

TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy

Key clue: maculopapular rash, periostitis of the bone

181
Q

TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy

Key clue: chorioretinitis, periventricular calcifications

182
Q

TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy

Key clue: chorioretinitis, microcephaly, hepatosplenomegaly, imaging: intracerebral calcifications

A

Toxoplasmosis

183
Q

TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy

Key clue: cutaneous scars, cortical atrophy

184
Q

Colostrum is produced over the first few days of lactation. This is rich in what immunoglobulin?

185
Q

Whey to casein ratio of mature human milk?

Pediatrics (2 decks)

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