Term
| Functions of the auditory structures that need to be checked: |
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Definition
- identification of sound
- localization of sound
- interpretation of sound
- maintenance of equillibrium |
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Term
| the outside of the ear as a whole is called the __ or ___. |
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Definition
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Term
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Definition
| helix, antihelix, tragus, antitragus, external meatus, concha & lobule, intertragic incisure, anterior notch, crus of helix, cavum conchae, auricular tubercle of Darwin |
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Term
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Definition
Size- familial traits, cauliflower ear, tophi
Shape
Symmetry
Landmarks
Color
Position |
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Term
| Palpation of external ear structures: |
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Definition
Auricles & mastoid
Tenderness
Swelling
Nodules
Auricles should be firm, mobile & without nodules
Pain from lobule indicative of inflammation in canal |
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Term
| pain in lobule is indicative of inflammation in the: |
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Definition
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Term
| Preauricular pit may be normal, or it can be associated with: |
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Definition
- kidney disease
- hearing impairment |
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Term
| With trisomy 21, ears are set below the midline. |
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Definition
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Term
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Definition
- nonrandom association of specific newborn abnormalities which may include:
- vertebral dysgenesis and defect
- cardiac abnormalities
- tracheoesophageal fistula
- esophageal atresia
- radial limb and renal abnormalities |
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Term
| One of the main characteristics of Turner Syndrome? |
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Definition
- short stature ( 4ft8 is avg height for female with Turner syndrome who received growth hormone)
- also may get premature ovarian failure |
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Term
| More characteristics of Turner syndrome: |
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Definition
| Narrow, high-arched palate (roof of the mouth) Retrognathia (receding lower jaw) Low-set ears Low hairline Webbed neck Slight droop to eyes Strabismus (lazy eye) Broad chest Cubitus valgus (arms that turn out slightly at the elbows) Scoliosis (curvature of the spine) Flat feet Small, narrow fingernails and toenails that turn up Short fourth metacarpals (the ends of these bones form the knuckles) Edema of hands and feet, especially at birth |
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Term
| How is intelligence impaired in Turner Syndrome? |
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Definition
- generally intelligence is normal
- But usually do have trouble with spatial-temporal processing (imagining objects in relation to one another), nonverbal memory, and attention
- so may have trouble with math, sense of direction, manual dexterity, and social skills
- new ways of coping with this fall under category of nonverbal learning disabilities |
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Term
| Possible compilcations with Turner syndrome: |
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Definition
- heart problems
- kidney problems
- thyroid problems
- ear problems |
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Term
| Specifics about the heart problems that may develop with Turner Syndrome: |
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Definition
- 1/3 of TS pts have heart problems
- usually left sided
- may have coarction (narrowing) of arota and bicuspid aortic valve
- higher risk for hypertension
- should have EKG or MRI of heart at diagnosis and periodically to check for aortic enlargement
- pt should be aware of symptoms of aortic dissection (uncommon but very life threatening): sudden severe sharp tearing ripping chest pain, intense anxiety, rapid pulse, profuse sweating, nausea, vomitting, dizziness, fainting, or shortness of breath |
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Term
| Specifics about kidney problems associated with TS: |
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Definition
- 30% of TS patients have kidney abnormalities
- many of the abnormalities don't cause problems, but some get increased urinary tract infections and are also at increased risk for hypertension
- patient should receive a renal ultrasound at time of diagnosis |
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Term
| Specifics about thyroid problems associated with TS: |
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Definition
| - hypothyroidism due to autoimmune thyrioditis is common with TS |
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Term
| Specifics about ear problems associated with TS: |
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Definition
- otitis media very common in TS girls, especially in infancy and childhood
- majority (90%) of TS women develop early sensorineural hearing loss and may require hearing aids at an early age |
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Term
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Definition
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Term
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Definition
S-shaped pathway leading to the middle ear
About 2.5 cm in adults
Covered with very thin, sensitive skin
Protected & lubricated by cerumen
More horizontal in children |
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Term
| Examination of external auditory canal: |
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Definition
Inspect for discharge
Odor
Purulent, foul-smelling discharge associated with otitis and foreign body
Head trauma- bloody or serous discharge suggestive of skull fracture |
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Term
| tempanic membrane should be concave/convex. |
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Definition
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Term
| Tempanic membrane is pulled in at the center by the ___. |
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Definition
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Term
| dense fibrous ring surrounding tempanic memrane: |
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Definition
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Term
| Most of the tempanic membrane is tense, called the ___ ___, the superior portion is flaccid and called the ____ ____. The tempanic membrane should be ___. |
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Definition
- pars tensa
- pars flacidda
- translucent |
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Term
| handle of the mallues on the eardrum is the: |
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Definition
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Term
| nerve passing behind the ear drum? |
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Definition
| - chorda tympani nerve (branch off of the facial nerve) |
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Term
| cone of light on ear drum should be where? |
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Definition
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Term
| to get insect out of ear, what do you do? |
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Definition
| - use litochane or mineral oil to suffocate it |
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Term
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Definition
Air-filled cavity in temporal bone
Contains the malleus, incus & stapes
Continuous with mastoid area
Separated from EAC by the TM |
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Term
| Otoscopoic exam technique: |
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Definition
Inspect EAC & middle ear (thru the TM)
Use largest speculum that comfortably fits
Hold scope between thumb & index finger, supported on middle finger
Rest ulnar side of hand on patient’s head
Handle can face up or down |
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Term
| How to check for TM mobility: |
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Definition
Pneumatic attachment or valsalva maneuver
Speculum must seal canal from outer air
GENTLY apply + and - pressure
Observe change in appearance of cone of light - TM moving if normal
Improper technique = misleading results
pneumatoscopy= you have little tube attached to otoscope and you blow air into the ear to check for movement of ear drum |
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Term
| If TM doesn't move, what might be wrong? |
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Definition
| - effusion behind ear drum |
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Term
| bulging tempanic membrane means: |
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Definition
| fluid behind ear drum aka effusion |
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Term
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Definition
| eustachian tubes backed up |
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Term
| Early sign of otitis media: |
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Definition
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Term
| What is the muscle attached to the annulus ring? |
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Definition
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Term
| Cranial nerve responsible for hearing? |
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Definition
| CN VIII Vestibulocochlear nerve |
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Term
| Patient should hear softly whispered words in each ear at ___ feet ___% of time. |
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Definition
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Term
| With conductive hearing loss, Weber will lateralize to the good/bad ear? |
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Definition
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Term
| With sensorineural hearing loss, Weber will lateralize to the good/bad ear? |
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Definition
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Term
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Definition
air conductance to bone conductance ratio should be 2:1
with Rinne's test, positive is normal |
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Term
| If bone conductance is longer than air conductance with Rinne's test, what kind of hearing loss does the patient have? |
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Definition
| - conductive hearing loss |
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Term
| define conductive hearing loss: |
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Definition
| sound transmission impaired through external or middle ear |
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Term
| define sensorineural hearing loss: |
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Definition
| - defect in inner ear leading to distortion/misinterpretation of sound |
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Term
| pale mucus in nose means: |
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Definition
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Term
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Definition
| area in nose where blood nose originates |
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Term
| Nasal cavity examination: |
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Definition
Only inferior & middle turbinates visible
Pt’s head erect to examine vestibule & inferior turbinates
Tilt head back to examine meatus & middle turbinates
Carefully move speculum tip with point toward midline to examine septum |
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Term
| When examining the nasal cavity the septum should be ___ and appear thicker ___ than ____. |
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Definition
- midline
- anteriolry
- postseriorly |
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Term
| expected findings of nasal cavity: |
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Definition
Mucosa should be deep pink & glistening
Film of clear discharge often present
Hairs may be present in vestibule
Turbinates should be same color as surrounding area & should be firm
Septum should be midline, fairly straight, & appear thicker anteriorly than posteriorly |
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Term
| Sense of smell is usually tested in neuro not HEENT but may do it if there is history of trauma or it fits with the patient's chief complaint. |
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Definition
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Term
| Palpate the frontal sinuses under the ____ ___, and the maxillary sinuses under the ___ ___. |
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Definition
- bony brow
- zygomatic process |
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Term
| swelling, tenderness, or pain of sinuses indicates: |
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Definition
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Term
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Definition
Inspect frontal & maxillary for swelling
Palpate frontal sinuses- press thumbs up under bony brow
Palpate maxillary - press under zygomatic process
Percuss sinuses
Swelling, tenderness, or pain - may indicate infection or obstruction
Transilluminate ? |
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Term
| mouth and oropharynx portion of exam: |
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Definition
Inspect & palpate lips with mouth closed
Symmetry: vertical & horizontal, rest & with movement
Color - pink
Edema - infection or allergy
Should be smooth without lesions- Note any surface abnormalities
Palpate TMJ for tenderness & instability |
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Term
| How to treat a swollen/clogged Stinson's dcut: |
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Definition
warm compress and antibiotics
Note: Stinson's ducts are high on inner cheeck just behind the second molar |
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Term
| Buccal Mucosa, Teeth & Gums exam: |
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Definition
Pt clench teeth (CN V)
Observe teeth for occlusion
Upper molars should rest directly on lower molars & upper incisors slightly override lower incisors
Have pt. remove any dental appliances & open mouth !!!!!!!
CN VII (Facial nerve) – smile, show teeth (facial expressions)
Use tongue blade & light
Inspect mucosa, gums & teeth
Mucus membranes- pinkish red, smooth, & moist
Stensen ducts- whitish yellow to whitish pink protrusion at about 2nd upper molar
Gingiva- slightly stippled, pink with clearly defined, tight margins at each tooth
Gum surface should be free of inflammation, swelling, or bleeding
Palpate using gloves
Lesions, induration, thickening, or masses
Should not find tenderness
Inspect & count teeth
Probe each tooth with tongue blade - firmly anchored |
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Term
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Definition
Inspect dorsum of tongue
Note swelling, size, color, coating or ulcerations
Pt extends tongue
CN XII- tremor or deviation
Deviation= atrophy & CN XII impairment
Tongue- dull red, moist & glistening
Anterior tongue- smooth yet roughened surface with papillae & small fissures
Posterior portion smooth, slightly uneven or rugated surface with thinner mucosa
Pt touches tip of tongue to palate area
Inspect floor of mouth & ventral surface
Inspect frenulum, sublingual ridge & Wharton duct- pink & smooth with large veins between frenulum & folds
Palpate tongue, using both hands
Pt says “Ah”- evaluate movement of soft palate
May require depressing tongue
Also evaluates CN IX & X
Failure of soft palate to rise bilaterally may result from paralysis of vagus nerve. Uvula may deviate to unaffected side |
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Term
geographic tongue is same as migratory glossitis.
fissures on side of tongue are normal. runs in families. |
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Definition
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Term
| Patient saying "Ah" evaluates what cranial nerves? |
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Definition
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Term
| If soft palate does not rise bilaterally when pt. says "Ah", , this may be paralysis of the ___ nerve. The uvula may deviate to the ___ side. |
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Definition
- vagus (CN X)
- unaffected |
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Term
| what is normal to see on the posterior wall of the oropharynx? |
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Definition
| Posterior wall - smooth, glistening pink mucosa with some small irregular spots of lymphatic tissue & small blood vessels |
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Term
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Definition
- lymphoid hyperplasia seen on the posterior wall of the oropharynx
- seen with allergic conditions |
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Term
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Definition
Tonsils- usually blend into pink color of pharynx
should not project beyond limits of tonsillar pillars
Crypts may be present- may collect debris
Reddened, hypertrophic or covered with exudate may indicate infection |
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Term
| where and by what nerve is sweet and salty tasted on the tongue? |
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Definition
- anterior 2/3 of tongue
- CN VII- facial |
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Term
| where on tongue and by what nerve are bitter and sour tasted? |
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Definition
- posterior 1/3 of tongue
- CNIX- glossopharyngeal |
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Term
| If you test taste, use Qtip with taste on it and test one side of the tongue at a time. |
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Definition
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Term
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Definition
Touch posterior wall of pharynx on each side
Expect bilateral, symmetric response
Tests CN IX & X (glossopharyngeal & vagus) |
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Term
| What nerves does the gag reflex test? |
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Definition
| - CN IX and X (glossopharyngeal and vagus) |
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