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Peds Exam 1 Review
Pediatrics (Nova Southeastern University)
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Pediatrics Exam 1 Review- 40 questions
1. Physical development

Infant: 0-1 year old
i. Physical development- Birth weight doubles in 6 months and triples at 12
months.
ii. Cephalocaudal-holds head upright before walking not answer
iii. Proximal to distal- center to periphery, control trunk and fine motor skills
iv. Respirations of 30-60 are normal for infants. They are nose breathers.
Don’t want the baby to stop breathing over 20 seconds.
v. Growth: Head circumference is measured from birth until age 2 to make
sure brain has room to grow.

3 month old:
i. Psych: Smile , knows primary caregiver.
ii. Toys: mobile, mirror.

6 month old:
i. Psych: apprehension of stranger’s babbles and coos.
ii. Motor: Laughs, rolls, sits, no head lag, hand-to-hand transfer.
iii. Toys: rattles (palmar grasp), and soft toys

9 month old:
i. Psych: waves, stranger anxiety, crying, object performance, peekaboo,
ii. Motor: sits, (Pincer grasp), pulls to stand (Cruising) 1st steps of walking
using furniture for support.

Toddler 1-3 years old:
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i. Physical development: birth weight quadruples by 3 yrs. anterior fontanel
closes at 12-18 months. Sphincter control begins by age 2. (Potty training)
Potbelly appearance, bowed legs

12 month old/ 1 year old:
i. Psych: imitates, mama & dada has meaning, 2 words
ii. Motor: turns pages, walks with assistance, and stands without assistance
iii. Toys: Push toys, Nesting toys

18 month old:
i. Psych: up to 25 words & 2-3 phrases, expressive jargon, MY, separation
anxiety
ii. Motor: Walks independently by 15 months, uses spoons and shovels,
climbs, 3-4-block tower. Should be concerned if they are not walking by
15 months
iii. Toys: Push and pull toys, blocks, cause and effect.

24 month old/ 2 year old
i. Psych: negativistic behavior, transitional objects, temper tantrums, NO!
ii. Motor: can go up and down stairs, removes clothes
iii. Play: Parallel play (two toddlers playing side by side separately),
manipulation of environment

Preschool Age 3-6 year olds
i. Physical Development: weight gain + 3-5 pounds per year, vision 20/40,
20 deciduous teeth, handedness established, day time toilet training
complete, associative play.
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ii. Play- Associative play (playing together) associative and dramatic: loosely
organized groups, rules change role play: mommy, daddy, daughter,
doctor, nurse, teacher
iii. Toys: tricycle, dress up, dolls, coloring books
iv. Hospital nursing care: Give them control and choices. What juice would
you like to take with your medication apple juice or orange juice? Daddy
will be back when barney is playing on TV.

3 year olds
i. Psych: talkative, agreeable, nightmares, knows first and last name, knows
gender differences, masturbates which is normal manage with diversion,
ii. Motor: runs well, peddles a tricycle, walks on tip toe, alternative feet
going up and down, 9-10 block tower.

4-5 year olds
i. Psych: magical thinking/ fear of monsters so says you have monster spray
to kill monsters under their bed. They are concrete thinkers.
ii. Stuttering is normal, fear of body mutilation needs Band-Aid for
everything, inquisitive
iii. Motor: alternative feet on stairs, uses scissors, catches ball

School age child 6-12 year olds
i. Physical Development: permanent teeth, weight doubles between ages of 6
and 12 boys and girls close in size, 20/20 vision on Snellen chart, enuresis
and sleepwalking are common issues.
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ii. Psych: same gender friends, collections, enjoys school (competition and
cooperation), Develops morals bring schoolwork to hospital
iii. Motor- refinement of coordination and balance, two wheeler, cursive
writing

Adolescence 13-18 year olds
i. Physical Development:
1. Rapid growth rate
2. Puberty (Tanner Scale 1-5),
a. Female begins at 10-14 years old, order of girls’ secondary
development: height spurt, breast development, pubic hair,
and menarche. Menarche 12-13 years (hgt 95% of adult at
onset),
b. Male onset is 12-16 years (95% of adult height at age 15).
Order of boy’s secondary development: testes enlarge,
pubic hair, penis increases, height spurt, voice change,
facial hair.
ii. Psych: rebellious, peer pressure, body image, fearless, sneaking out,
invincible, friends are the most important thing of life, first intimate
relationship, heartbreak)
iii. Play: activities, clique formation, team sports, intimate relationships
iv. Hospitalizations: separation, body image (privacy and clothes), and
noncompliance
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2. Parallel play and associative play

Parallel play- two toddlers playing side by side separately

Associative play- Preschool aged kids playing together
3. Fontanels- physical changes at what point

Posterior Fontanel- closes at 3 months

Anterior fontanel- closes at 12-18 months
4. Safety for each age group- anticipatory guidance on each age group

Infant:
i. Car seat
ii. Breathing
iii. Sleeping
iv. Body temperature

Toddler:
i. Discipline- time outs placing the child in a safe non-stimulating area. One
minute for each year of age.
ii. Water safety- never unattended
iii. Car seats- until 4 years legally
iv. Accidental ingestions- locks and latches, original containers
v. Choking- small frequent meals, monitor feeding, all foods cut into small
pieces for young toddlers
vi.
Positioning- monitor toddler
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
Preschool:
i. Street and bike/pedestrian safety- bikes travel with traffic on the right,
pedestrian’s travel against traffic on the left.
ii. Safety around animals- never approach animals you don’t know including
wild animals.
iii. Car seat- until 4 years, and booster seats until 60 pounds.

School age:
i. Bike safety-helmets and right side of the road
ii. Home fire drills
iii. Interactions with strangers- (stranger danger)

Adolescence:
i.
Nutrition (iron and calcium)
ii. MVA
iii. Personal safety issues (sex, suicide, drug abuse)
5. Sequence is specific not the rate.

Not all children will have same patterns of growth and development however they
will all achieve their milestones. Each child is different. It’s a sequential pattern
Sequence is specific, not the rate. Rate is uneven and individual with greatest
speed during infancy and puberty.
6. Nursing interventions for children in the hospital:

Follow child’s daily routines, comfort measures, have parents present, consistent
nurses, regression explain to parents this is normal
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i. Example: In the hospital try to keep the child's daily routine from their
home. If they play, eat, and then nap do that in the hospital.
ii. Regression is normal for children after hospitalization. This is temporary.
The child will regain losses when they leave the hospital.
7. Erickson’s stages

Infant (1month-1year) Trust vs. Mistrust

Toddler (age 2-3) Autonomy vs. Shame and Doubt

Preschool (age 4-6) Initiative vs. Guilt

School (age 6-12) Industry vs. Inferiority

Adolescent (age 12-18) Identity vs. Role confusion
8. Nursing assessment on infant:

You always want to do the least invasive intervention before the more invasive
intervention.
i. Example: listen to lungs first before waking baby up. Listen to lungs
before Blood pressure. Head circumference over a blood pressure so if the
child is scared of you can do more things. All nursing interventions and
safety are geared towards growth and development
9. Cruising: 1st steps in walking they hold on to furniture. It occurs right before the baby
learns to walk independently. Usually develops at 9-13 months.
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10. Pincer grasp- developed at 9 months. You can start giving baby cheerios and table food
because they can pincer grasp it.
11. Infant nutrition- Nutrition question the answer will always be iron

BM/ Formula: Fluoride, Iron, and Vitamin D

Solids 4-6 months begin with rice. Saliva, sitting, tongue

Table food at 9 months because they can Pincer grasp

Healthy infants under 1 year are weaned onto commercially prepared iron
fortified formula. They need supplemental iron to replaced used iron stores.
12. Speak to children in ways they understand:
 Example: Mommy will be back when Barney is on.

When talking to a school aged child don’t talk about the nutrition label, talk about
how a banana is good for them so they should eat them.

When giving child medication ask if they want apple juice or orange juice with
the medication?

Never lie to the child and tell them its candy…they will never trust you again if
you lie to them.

Routine is important:
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i. When Barney is over you are going to take your medication. They don’t
have concept of time so give them things they can relate to. You are going
to play, take a nap, eat, and then daddy will be back.
13. Regression is normal after hospitalization.

While the child is in the hospital maintain routine, stick to consistent caregivers,
and expect regression. Regression is normal after hospitalization. It’s only
temporary. The child will regain losses when you leave.
14. Child’s age group-important things in hospitalization

Infant- newborn assessment, infants needs to be met including nutrition, warmth,
stimulation, sleep, and comfort. Encourage rooming in, place near the nurses
station, consistent nursing staff, hold for feedings, sucking/ pacifier use.

Toddler- separation (rooming in, transitional object), loss of control
(immobilization and isolation are major stressors, offer choices, set limits, painful
procedure should be done in the treatment room, preparation should be
immediately prior to event), and regression (reassure and educate parents this is
normal), and educate parents on choking, water, and car seat safety for all age
groups.

Preschool- rooming in, family pictures, phone calls, leaving parents belongings
behind, body mutilation- fear of intrusive procedures, band aids on everything.
Loss of control- offer choices, set limits. Example: DO you want juice or milk
with your medication? You are going to have breakfast, then you will take a nap,
and then daddy will be here.
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
School aged- separation from family and school, letters from peers, telephone
calls, tolerates separation but prefers parents close by, maintain schoolwork. Fear
of bodily/ mutilation, fear of pain, scientific explanations. Need for privacy.
Example: explain to them how bananas are good for you so you should eat them
don’t explain the nutrition label.

Adolescents- let friends visit, give them their phone. Separation, body image
(privacy and clothes) and non compliance
15. Timeline of our active vaccines
Birth- Hepatitis B

1-2 months- Hepatitis B

2 months- DTaP, Hib, IPV, PCV, Rota

4 months- DTaP, Hib, IPV, PCV, Rota

6 months- DTaP, Hib, PCV, Rota, Influenza at 6 months and then annually
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
12-15 months- HIB, PCV, IPV, MMR, Varicella

12 months- Hepatitis A and then 6 months later second dose

15 months- DTaP

6-18 months- Hepatitis B, IPV

5 years- DTaP, IPV, MMR, Varicella

9-18 years- HPV 3 doses

11-12 years- Meningococcal

Know contraindications- example: DTaP: don’t give if there has been a
neurological effect
16. Understand toddler milestones- what we expect in a toddler- speech, physical,
psychosocial development

Speech- love saying NO

Developing independence, tolerating frustration. They want to be independent.
Potty training at 2

18 month milestonesi. Psych: up to 25 words and 2-3 word phrases, expressive jargon, MY,
separation anxiety.
ii. Motor: walks independently by 15 months. Uses tools: spoons and
shovels. Climbs, 3-4 block towers.
iii. Toys: Push and Pull toys, blocks, cause and effect.

24 month/ 2 year milestones
i. Psych: negative behavior, transitional objects, temper tantrums
ii. Motor: up and down stairs, removes clothes
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iii. Play: parallel play and manipulation of environment
iv. Nutrition: Toddlers need whole milk until age 2 they need more fat to
grow. Biggest growth from brith-2 years.

3 year milestone
i. Psychosocial: talkative, agreeable, nightmares/ night terrors, knows first
and last name, knows gender differences, masturbation (normal, managed
with diversion),
ii. Motor: Runs well, peddles tricycle, walks on tiptoe, alternates feet going
up and down, 9-10 block tower.
17. Vaccines given at 2, 4, & 6 months.

2 months- DTaP, Hib, IPV, PCV, Rota

4 months- DTaP, Hib, IPV, PCV, Rota

6 months- DTaP, Hib, PCV, Rota, Influenza at 6 months and then annually

Select all that apply. DON’T PICK THE ANSWER WITH THE MMR.
Remember MMR is to be given after 1 year.
18. If you remember what is not given its easy to remember what is given. MMR
Varicella given after 1 year. 2 live vaccines MMR and Varicella given after 1 year
because the baby needs 1 year to gain immune system. So a 2-month-old SHOULD NOT
be given MMR and Varicella.
19. Major contraindications for the vaccines: anaphylaxis, & for DTAP if there is a
neurological deficit
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20. Cardiac- murmurs we talked about and what defect they come with







Congenital Heart Defects- Babies are born with this cardiac dysfunction
o 3 types
 Acyanotic (ASD, VSD, PDA)
 Obstructive (Coarctation of the Aorta)
 Cyanotic (tetralogy of Fallot) 4 types: (Ventricular septal defect,
Pulmonary stenosis, overriding aorta, right ventricular hypertrophy)
Acquired Heart Defects
o Occurs after birth (infection/autoimmune disease)
Atrial septum defect (ASD)
o Abnormal opening between the 2 atria
o Acyanotic
o S/s: difficulty breathing when feeding
o Left side has more pressure so oxygenated blood pushes to the rt. causing
pulmonary hypertension and cause right sided heart failure
Ventricular Septal Defect (VSD)
o Abnormal opening between the 2 ventricles
o Acyanotic
o S/s: same as ASD
o Murmur sounds like a loud motorcycle
o If baby is sweating while feeding baby is showing signs of distress
Patent Ductus Arterious (PDA)
o Ductus arteriosus connecting the aorta and pulmonary artery stay open (should
close at birth and turn into a ligament)
o Acyanotic
o Machinery like sound
o Management: NSAID given (Indomathacin)
o S/s: same asd, vsd, pda (all acyanotic) all can lead to congestive heart failure
because of left to right shunts
Left to right shunt common management
o Diuretics (Lasix)
o Digoxin but hold if bradycardia - infant less 100 bpm or toddler no less than 80
o Tell the parent it slows and helps pump blood better from the heart
o Soft nipple with bigger opening when feeding
o High calorie formula b/c they burn so much calories from the heart issue and
respiratory problems from this disease
o Normal urine output 1-2 ml/kg/hr
Coarctation of the aorta (COA)
o Obstructive, Acyanotic defect
o Poor perfusion
o High pressure close to the area of the aorta (like the brain)
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
o High bp in upper extremities and lower bp in lower
o Bounding brachial pulses in comparison with femoral pulses and legs (weak or
absent)
o Echo can be done first, determines structure
o Child can have leg cramps due to poor perfusion (hypoxic tissue)
o Nose bleeds
o Headaches
Catheterization – keep leg straight, and pressure in the site
21. Cardiac babies
Blood flow of the heart
 Inferior vena vena/superior vena cava right atriumright ventriclepulmonary
artery (lungs) to exchange deoxgynated blood to oxygenated bloodpulmonary
veinleft atriumleft ventricleaorta and out to the systemic area
 Left side of the heart has more pressure
22. Failure to thrive- don’t grow may be metabolic, or from neglect they are not nourished
and taken care of, or they have a cardiac defect, or cystic fibrosis. Feeding its work for
them, they are burning calories; we want to avoid malnutrition for a child with a heart
defect. Parent education is important for a child with cardiac defect Nursing intervention:
they need to give them high calorie formula, increase density, GAVAGE: if they don’t
finish their bottle you give it through OG or NG tube
23. Assessment of a child after cardiac catheterization
Keep the legs straight and put pressure on the site
24. Bacterial infection can cause valvular issues
25. Babies that don’t feed well give higher calorie formula to the baby. Because they use
calories trying to eat. Not necessarily small frequent meals but more of higher calorie
formulas.
26. Acyanotic episode- nursing intervention
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
Knees to chest

Hyper cyanosis- put them in a knee check position. It has to do with the
pressure changes to help the circulatory system them you can worry about
oxygen. Blood gets thicker Polycythemia cyanotic
27. Digoxin
Why is my baby getting Digoxin? Helps with contractility of the heart,
decreases the heart rate and increases blood flow to the heart. More effective
pump. Given to pediatric patients who have left to right shunts. Give digoxin but
hold if bradycardic- infant less then 100 bpm or toddler no less than 80 bpm
28. TET spell- Cyanotic episode

NI- knee to chest first for infants and have toddler and older children kneel
down, O2, fluids, morphine
29. Pyloric stenosis – develops in first few weeks of life (2-4 weeks) narrowing of the
pyloric sphincter of the stomach to the small intestine that occurs in infants. Results in
projectile vomiting. Palpate an olive shaped mass. Most easily palpated when child
is quiet, stomach is empty, and abdominal muscles are relaxed. Pyloric ultrasound.
Surgery is easy snip pyloric valve go home 24-48 hours.
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30. Hirschsprung Disease (Megacolon)

Disorder of Motility- Congenital anomaly. Obstruction from inadequate motility
of part of the intestine. Absence of autonomic ganglion cells in the colon-no
peristalsis. Intestinal contents accumulate and bowel distends=Megacolon

Accounts for ¼ of all cases of neonatal intestinal obstructions. 4 times more
common in males and follows a family pattern.

Clinical manifestations- failure to pass meconium, food refusal, vomiting,
intestinal obstruction, abdominal distention, FTT (failure to thrive)
i. Ribbon-like, foul smelling stool. Bloody diarrhea, fever, and severe
lethargy.

Diagnosis- barium enema

Management- surgery- removal of aganglionic portion of intestine to relieve
obstruction. Temporary colostomy in many cases, prognosis is good.
31. Intussusception- obstructive disorder occurs between the ages of 3 months to 5
years.

An invagination/telescoping of one part of the intestine into another. As a result,
the obstruction to the passage of intestinal content beyond the defect.
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Inflammation, edema, decrease blood flow-ischemia, perforation, peritonitis, and
shock can occur.

Typical behavior includes screaming and drawing the knees up to the chest.
These episodes of severe pain are characterized by intervals in which child
appears normal and comfy

Clinical manifestations: sudden onset of acute, colicky abdominal pain, currant
jellylike stool, abdominal distention/ tenderness

Diagnostic evaluation: KUB, barium enema. Management: Reduction by barium
enema or air enema
32. Urinary reflux/ Vesicoureteral Reflux- regurgitation of urine from the bladder into the
ureters due to faulty valve mechanism at the vesicoureteral junction.

Nursing Interventions: Many of them will outgrow it. Finish antibiotics, take
regularly, prevent damage, Educate parents that antibiotics are important may be
given long tern, and prevent scarring of urinary tract. Avoid UTI: cotton
underwear, stay hydrated, drink fluids, and don’t hold it in. Ecoli- is from
hygiene wiping back to front. Assist with pre-operative studies. Provide postoperative care, Monitor drains; may have one from bladder and each ureter,
Check output from all drains and record, Observe drainage from abdominal
dressing, Administer medication for bladder spasms as ordered.
33. Penis conditions

Hypospadias- urethral opening located anywhere along the ventral surface of
penis. Assessment- inability to make a straight stream of urine, urinary meatus is
misplaced.
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
Chordee- ventral curvature of the penis-often associated, causing constriction. In
extremem cases, child’s sex may be uncertain

TX- SX at 3-9 months. Circumcision has to wait they might need the extra skin to
fix the penis in a surgical repair to put the urethra in the right direction which is
straight.

Cryptorchidism- undescended testicles- must descend by 9 months of age Testes
should be palpable in scrotum may retract but still are present. If they do not drop
by 1 year of age- surgery is indicated to preserve fertility. May be in inguinal
canal, if they are present, they are not undescended, just retracted.
34. Treatment of Developmental Dysplasia of the Hip DDH

Infants under 3 months-Pavlik harness- worn for 3-6 months to ensure hip
flexion and abduction but doesn’t allow hip extension or adduction

Infants older than 3 months-skin traction (Bryant’s Traction) followed by spica
cast

Child older than 18 months- traction, operative reduction, rehabilitation
35. Clubfoot- TX related to casting

Teaching for the parents includes education about coming in every 2 weeks to get
a new cast

NI- Skin integrity, check pulses, circulation, don’t stick anything in it, make sure
they can wiggle their toes
36. Bronchiolitis- nursing care
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
NI- Noninvasive O2 monitoring, supportive care, hydration, bronchodilators,
corticosteroids, antibiotics. Oxygen, suctioning after feeding. IV fluids raise the
head of the bed. Airway is a priority in children.
37. Spinal cord defects- where, how bad, affects on patient

Spina Bifida- defect can occur at any place along the spinal canal. Degree of
disability depends on the location of the defect if the spinal nerves involved.
Children need multiple surgeries and multidisciplinary care team
i. Occulta- mildest form- no loss of function. Dimpling over lumbosacral
area. Posterior vertebral arches fail to fuse
ii. Meningocele- sac like protrusion containing meninges and CSF. No spinal
nerve involvement.
iii. Myelomeningocele- worst! Everything is out. Sac like hernia containing
CSF, meninges, and spinal nerves. Handicap 99% of the time. No nerves
so no control of bowels or urine. Incontinent! Has to get surgery right
away at risk for meningitis and sin issues
iv. Nursing care- Spina Bifida- monitor for leakage of spinal fluid, monitor
skin integrity of sac, assess for infection, position infant on side or prone
(even for feeds), Apply wet, sterile, saline dressing, do not allow sac to dry
out.
1. Home care- latex precautions, straight cath (risk for UTI), bowel
management program, monitor signs/ symptoms of hydrocephalus,
good nutrition to prevent obesity, promote safety, and independent
muscle tone.
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
Hydrocephalus- (Fluid in the brain). Body’s response to an imbalance between
the production and absorption of CSF. You can get it from: too much production
of CSF and its also reabsorbing, too much circulating and not enough reabsorbing,
or and if they have a brain tumor obstruction of the pathway of the ventricles
blocked pluming. Divert fluid out of the brain and into the right atrium or
peritoneum and gets reabsorbed by the fluid. At risk for meningitis. Shunt is in the
ventricles and they put extra tubing so when the child grows the shunt starts
uncoiling
i. NI- Teach parents to look for increase intracranial pressure: Enlarging
head size, bulging, non-pulsating fontanels, downward rotation of eyes
(sunset), poor feeding, vomiting, lethargy, irritability, high-pitched cry and
abnormal muscle tone
38. S/S of ICP for infant and child
o Infant-2 years- Enlarging head size, bulging, non-pulsating fontanels, downward
rotation of eyes (sunset), poor feeding, vomiting, lethargy, irritability, high-pitched
cry and abnormal muscle tone
o Older Children: Changes in head size less common, Signs of increased ICP:
vomiting, ataxia, headache, visual disturbances, dizziness, and change in LOC,
seizures. Alteration in consciousness and fixed and dilated pupils. Cushing’s triad
(Increased systolic BP, widened pulse pressure, bradycardia, irregular respirations
39. Diaper rash
o NI- keeps the area dry, clean, and aerated. Change dippers frequently put a
barrier on the skin. Use water instead of alcohol-based wipes, let breathe don’t
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put on dipper. Frequent diaper changes – encourage parents to use
superabsorbent disposable diapers. Plastic or rubber pants are not
recommended because they keep the wet area wet and warm. Diaper area,
buttocks, thighs, and abdomen cleansed after each diaper change Cornstarch
not recommended. Remove the diaper for short periods during the day and
place the infant on an absorbent pad
o Management- Desitin ointment, & Sitz bath
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