Hip (PTA) Flash Cards

 
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True/False

Extracapsular fractures will cause a vascular disruption to the head of the femur?
FALSE

INTRACAPSULAR WILL CAUSE A DISRUPTION, BUT NONUNION MAY OCCUR WITH EXTRACAPSULAR AS THE RESULT OF FIXATION FAILURE
0 MichaelMorano Tue, 05 Oct 2010 04:53:59 GMT view revision history
Recommendatins vary from partial weight bearing for at least 6 weeks to wbat immediately after surgery? CEMENTLESS AND HYBRID 0 MichaelMorano Tue, 05 Oct 2010 03:03:49 GMT view revision history
Immediate postoperative weight bearing as tolerated? CEMENTED 0 MichaelMorano Tue, 05 Oct 2010 03:03:49 GMT view revision history
What is the rationale for a minimally invasive THA? USE OF SMALLER INCISIONS POTENTIALLY LESSONS SOFT TISSUE TRAUMA DURING SURGERY AND THEREFORE SHOULD IMPROVE AND ACCELERATE A PATIENT'S POSTOPERATIVE RECOVERY 0 MichaelMorano Tue, 05 Oct 2010 03:03:49 GMT view revision history
What form of THA offers the best stability? ANTEROLATERAL APPROACH 0 MichaelMorano Tue, 05 Oct 2010 02:38:50 GMT view revision history
This for of THA can give a positive trandelenberg sign. Why? DIRECT LATERAL APPROACH
-DISRUPTION OF THE ABDUCTOR MECHANISM IS ASSOCIATED WITH POSTOPERATIVE WEAKNESS AND GAIT ABNORMALITIES.
0 MichaelMorano Tue, 05 Oct 2010 02:38:50 GMT view revision history
Cementless fixation is typically used for? PATIENTS UNDER AGE 60 AND ARE PHYSICALLY ACTIVE AND GOOD BONE QUALITY 0 MichaelMorano Tue, 05 Oct 2010 02:38:50 GMT view revision history
Cement fixation is typically used for? PATIENTS WITH OSTEOPOROSIS AND POOR BONE STOCK AND TYPICALLY WITH ELDERLY PATIENTS 0 MichaelMorano Tue, 05 Oct 2010 02:38:50 GMT view revision history
Characteristics of a flat back posture? -DECREASED LUMBOSACRAL ANGLE
-DECREASED LUMBAR LORDOSIS
-HIP EXTESION
-POSTERIOR PELVIC TILT
0 MichaelMorano Mon, 04 Oct 2010 20:43:48 GMT view revision history
This procedure replaces the damaged femoral head with a bipolar prosthesis? HEMIARTHROPLASTY 0 MichaelMorano Mon, 04 Oct 2010 19:18:30 GMT view revision history
What does a hemiarthroplasty require? A NORMAL ACETABULAR SURFACE (RARELY USED FOR ARTHRITIS) 0 MichaelMorano Mon, 04 Oct 2010 19:18:30 GMT view revision history
What are the mobility impairments of a sway back? IN THE UPPER ABDONMIANS
-RECTUS FEMORIS AND OBLIQUES
-INTERNAL INTERCOSTAL
-HIP EXTENSOR
-LOWER LUMBAR EXTENSOR

IMPAIRED MUSCLE PERFORMANCE DUE TO STRETCHED AND WEAK LOWER ABDOMINAL MUSCLES
0 MichaelMorano Mon, 04 Oct 2010 19:04:03 GMT view revision history
What is the result of a sway back? AN INCREASED LORDOSIS AND INCREASES KYPHOSIS IN THE THORACIC REGION, AND A FORWARD HEAD 0 MichaelMorano Mon, 04 Oct 2010 19:04:03 GMT view revision history
The relaxed or slouched posture is AKA? SWAY BACK 0 MichaelMorano Mon, 04 Oct 2010 19:04:03 GMT view revision history
When are patients typically discharged from therapy? 8-12 WEEKS 0 MichaelMorano Mon, 04 Oct 2010 04:38:00 GMT view revision history
When are soft tissues normally healed by? 6 WEEKS 0 MichaelMorano Mon, 04 Oct 2010 04:38:00 GMT view revision history
What are the goals for the initial phase of postoperative rehabilitation? -PREVENT VASCULAR AND PULMONARY COMPLICATIONS
-IMPROVE STRENGTH IN THE UPPER AND SOUND LOWER EXTREMITIES
-PREVENT POSTOPERATIVE REFLEX INHIBITION OF HIP AND KNEE MUSCULATURE
-RESTORE ACTIVE MOBILITY AND DYNAMIC CONTROL OF THE INVOLVED HIP AND ADJACENT JOINTS
0 MichaelMorano Mon, 04 Oct 2010 04:38:00 GMT view revision history
Low intensity resistance exercises of the operated hip often are delayed for how long postoperatively? 4-6 WEEKS 0 MichaelMorano Mon, 04 Oct 2010 04:27:45 GMT view revision history
After hip surgery it is expected to see _____ to _____ of active hip flexion (with knee flexed) by _____ to _____ weeks postop. 80-90 DEGREES
2-4 WEEKS
0 MichaelMorano Mon, 04 Oct 2010 04:27:45 GMT view revision history
When do exercises begin after hip surgery? THE FIRST POSTOPERATIVE DAY TO PREVENT POSTOPERATIVE COMPLICATIONS AND TO RESTORE A PATIENT'S CONTROL OF THE OPERATED HIP DURING FUNCTIONAL ACTIVITIES 0 MichaelMorano Mon, 04 Oct 2010 04:27:45 GMT view revision history
What are some signs and symptoms of possible failure of the internal fixation mechansim? -SEVERE, PERSISTENT GROIN, THIGH, OR KNEE PAIN THAT INCREASES WITH LIMB MOVEMENT OR WEIGHT BEARING.
-PROGRESSIVE LIMB LENGTH INEQUALITY (SHORTENING OF THE INVOLVED LOWER EXTREMITY) THAT WAS NOT PRESENT IMMEDIATELY AFTER SURGERY
-PERSISTENT ER OF THE OPERATED LIMB
-A POSITIVE TRENDELENBURG SIGN DURING WB ON THE INVOLVED LIMB THAT DOES NOT RESOLVE WITH STRENGTHENING EXERCISES
0 MichaelMorano Mon, 04 Oct 2010 04:27:45 GMT view revision history
What are some considerations to consider for wb status aften hip fx surgery? -PATIENT'S AGE
-BONE QUALITY
-FX LOCATION
-TYPE OF FIXATION
-DEGREE OF INTRAOPERATIVE STABILITY ACHIEVED
0 MichaelMorano Mon, 04 Oct 2010 04:14:54 GMT view revision history
What is an important thing to do immediately after hip surgery? GET THE PATIENT UP AND MOVING AS QUICKLY AS POSSIBLE TO PREVENT OR MINIMIZE THE ADVERSE EFFECTS OF PROLONGED BED REST, INCLUDING THROMBOEMBOLI AND PULMONARY COMPLICATIONS WHICH PROTECTING THE FX SITE. 0 MichaelMorano Mon, 04 Oct 2010 04:14:54 GMT view revision history
What is bad about femoral neck fractures? THERE IS A HIGH RISK OF DISRUPTION OF THE VASCULAR SUPPLY TO THE HEAD OF THE FEMUR. 0 MichaelMorano Mon, 04 Oct 2010 04:14:54 GMT view revision history
When is surgery indicated after a hip fx? 24-48 HOURS AFTER INJURY 0 MichaelMorano Mon, 04 Oct 2010 04:14:54 GMT view revision history
What is the goal of surgery after a hip fx? ACHIEVE MAXIMUM STABILITY AND RESTORE ALIGNMENT OF BONY STRUCTURES OF THE HIP 0 MichaelMorano Mon, 04 Oct 2010 04:06:36 GMT view revision history
Where is pain felt for ischiogluteal bursitis? AROUND THE ISCHIAL TUBEROSITIES 0 MichaelMorano Mon, 04 Oct 2010 04:06:36 GMT view revision history
Ischiogluteal bursitis is AKA?A TAILOR'S OR WEAVERS BOTTOM 0 MichaelMorano Mon, 04 Oct 2010 04:06:36 GMT view revision history
Where is pain felt for a psoas bursitis? PAIN IN THE GROIN OR ANTERIOR THIGH AND POSSIBLY INTO THE PATELLAR AREA

(AGGRAVATED DURING ACTIVITIES OF EXCESSIVE HIP FLEXION)
0 MichaelMorano Mon, 04 Oct 2010 04:06:36 GMT view revision history
A patient with an anterverted hip with have? EXCESSIVE IR AND DECREASED ER 0 MichaelMorano Mon, 04 Oct 2010 01:37:59 GMT view revision history
True/False

A patient with a coxa vera will have more abduction than adduction?
FALSE

MORE ADDUCTION
0 MichaelMorano Mon, 04 Oct 2010 01:37:59 GMT view revision history
A patient with a coxa vara will have what kind of contracture? HIP ADDUCTOR CONTRACTURE 0 MichaelMorano Mon, 04 Oct 2010 01:37:59 GMT view revision history
Femoral nerve injuries will affect what muscle group? QUADS 0 MichaelMorano Sun, 03 Oct 2010 00:46:56 GMT view revision history
Obturator nerve injuries will affect what muscle group? ADDUCTOR GROUP 0 MichaelMorano Sun, 03 Oct 2010 00:46:56 GMT view revision history
Sciatic nerve injuries will affect what muscle group? HAMSTRINGS 0 MichaelMorano Sun, 03 Oct 2010 00:46:56 GMT view revision history
Hip end feels? FLEXION: SOFT

ALL OTHER END FEELS ARE FIRM
0 MichaelMorano Sun, 03 Oct 2010 00:46:56 GMT view revision history
Capsular pattern of the hip? FLEXION>ABD>IR 0 MichaelMorano Sun, 03 Oct 2010 00:45:25 GMT view revision history
Actual differences exists between the length of a patient's two lower limbs? TRUE LLG 0 MichaelMorano Sun, 03 Oct 2010 00:45:25 GMT view revision history
The actual length of the patient's two lower limbs is identical, but other factors such as joint or muscle contractures cause one of the limbs to function or appear as if it were shorter or longer than the other? FUNCTIONAL/APPARENT LLG 0 MichaelMorano Sun, 03 Oct 2010 00:45:25 GMT view revision history
Functional is synonimous with? APPARENT 0 MichaelMorano Sun, 03 Oct 2010 00:45:25 GMT view revision history
Signs and symptoms of rheumatoid arthritis? -CHRONIC SWELLING
-PAIN
-DEFORMITY OF THE JOINTS
0 MichaelMorano Sun, 03 Oct 2010 00:41:40 GMT view revision history
Autoimmune degeneraive condition? RHEUMATOID ARTHRITIS 0 MichaelMorano Sun, 03 Oct 2010 00:41:40 GMT view revision history
Primary causes of osteoarthritis? -AGING
-MECHANICAL
-CHEMICAL (STEROID INJECTIONS)
-STRUCTURAL
-GENETIC
-SECONDARY (KNEE PROBLEMS)
-REFERRED PAIN
0 MichaelMorano Sun, 03 Oct 2010 00:41:40 GMT view revision history
Wear and tear? OSTEOARTHRITIS 0 MichaelMorano Sun, 03 Oct 2010 00:41:40 GMT view revision history
Avascular necrosis of the hip is associated with? -FEMORAL NECK FX
-HIP DISLOCATIONS
-SLIPPED CAPITAL EPIFITHES
-LUPUS
-ERYTHEMATOSUS
-ALCOHLISM
-PROLONGED USE OF CATABOLIC STEROIDS
0 MichaelMorano Sun, 03 Oct 2010 00:39:04 GMT view revision history
Many options are available when treating hip fractures which are? -PATIENT'S AGE
-LOCATION OF FX
-QUALITY OF BONE
-SEVERITY OF FX (SIMPLE VS. DISPLACED)
-ACTIVITY LEVEL OF PT
-ASSOCIATED SOFT TISSUE INJURIES
-SPECIFIC GOALS FOR THE PATIENTS RETURN TO ACTIVITY
0 MichaelMorano Sun, 03 Oct 2010 00:39:04 GMT view revision history
Causes of iliopectineal bursitis? -CONTRACTURE OF ILIOPSOAS SECONDARY TO DJD 0 MichaelMorano Sun, 03 Oct 2010 00:39:04 GMT view revision history
Causes of ischial bursitis? -SITTING FOR LONG PERIODS OF TIME
-FALL
0 MichaelMorano Sun, 03 Oct 2010 00:39:04 GMT view revision history
Causes of a greater trochanter bursitis? -SHORTENED ITB
-LEG LENGTH DISCREPENCY
-BANKED SURFACES
-ANTERVERSION
0 MichaelMorano Sun, 03 Oct 2010 00:17:14 GMT view revision history
The most common contusion affecting the hip and pelvis involves the ____________ ___________ of the iliac crest and is commonly termed a _____ _________? -SUBCUTANEOUS TISSUES
-HIP POINTER
0 MichaelMorano Sun, 03 Oct 2010 00:17:14 GMT view revision history
An adductor muscle strain usually involves what muscle? ADDUCTOR LONGUS 0 MichaelMorano Sun, 03 Oct 2010 00:17:14 GMT view revision history
Most acute injuries affecting the hip are? MUSCULOTENDINOUS STRAINS OF
-HAMSTRINGS
-ILIOPSOAS
-ADDUCTORS
-RECTUS FEMORIS
0 MichaelMorano Sun, 03 Oct 2010 00:17:14 GMT view revision history
Characterized by either local tenderness over the iliopsoas muscle and tendon or diffuse radiating pain into the anterior thigh? ILIOPECTINEAL BURSITIS 0 MichaelMorano Sat, 02 Oct 2010 23:46:48 GMT view revision history
An ischial bursitis can exhibit what kind of injury? HAMSTRING STRAIN 0 MichaelMorano Sat, 02 Oct 2010 23:46:48 GMT view revision history
This will result from a direct contusion of the ischial tuberosity or extended periods of sitting? ISCHIAL BURSITIS 0 MichaelMorano Sat, 02 Oct 2010 23:46:48 GMT view revision history
Bursitis' commonly affecting the hip? -TROCHANTERIC BURSITIS
-ISCHIAL BURSITIS
-ILIOPECTINEAL BURSITIS
0 MichaelMorano Sat, 02 Oct 2010 23:46:48 GMT view revision history
What modalities may be helpful in the acute phase of a greater trochanter bursitis? -ULTRASOUND
-HYDROTHERAPY
0 MichaelMorano Sat, 02 Oct 2010 23:41:12 GMT view revision history
Tx of greater trochanteric bursitis? -CENTERED ON RELIEVING PAIN AND INFLAMMATION
-ADDRESSING THE UNDERLYING CAUSE OF THE CONDITION
0 MichaelMorano Sat, 02 Oct 2010 23:41:12 GMT view revision history
What is the tx for soft tissue disorders of the hip? -CORRECT MALALIGNMENT
-STRETCHING AND STRENGTHENING
0 MichaelMorano Sat, 02 Oct 2010 23:41:12 GMT view revision history
How do you diagnose a soft tissue disorder of the hip? ACTIVE CONTRACTIONS/PASSIVE STRETCHING SHOULD REPRODUCE SYMPTOMS 0 MichaelMorano Sat, 02 Oct 2010 23:41:12 GMT view revision history
What muscles are typically involved with soft tissue disorders of the hip? -RECTUS FEMORIS
-TFL/IT BAND
-HIP ER
0 MichaelMorano Sat, 02 Oct 2010 23:31:40 GMT view revision history
A femoral neck fx is an example of what kind of hip fx? INTRACAPSULAR 0 MichaelMorano Sat, 02 Oct 2010 23:31:40 GMT view revision history
An intertrochanteric hip fx is an example of what kind of hip fx? EXTRACAPSULAR OR TROCHANTERIC 0 MichaelMorano Sat, 02 Oct 2010 23:31:40 GMT view revision history
What are the classifications of hip fx's? -INTRACAPSULAR
-EXTRACAPSULAR
0 MichaelMorano Sat, 02 Oct 2010 23:31:40 GMT view revision history
What are the risk factors of hip fx's? -ELDERLY
-FEMALE
-WHITE
-SEDENTARY
-HX OF PRIOR FX
-PSYCHOTROPIC DRUGS (PROZAC) WEAKENS BONES
-ALCOHOLISM
-DEMENTIA
0 MichaelMorano Sat, 02 Oct 2010 22:47:02 GMT view revision history
What is likely to occur from a posterior hip dislocation? OSTERNECROSIS 0 MichaelMorano Sat, 02 Oct 2010 22:47:02 GMT view revision history
What is the most common type of hip dislocation? POSTERIORLY (80%) 0 MichaelMorano Sat, 02 Oct 2010 22:47:02 GMT view revision history
High energy Fx's and are normally seen in young patients? -FEMORAL SHAFT FX
-HIP DISLOCATIONS
0 MichaelMorano Sat, 02 Oct 2010 22:47:02 GMT view revision history
Tx of a femoral shaft fx? INTRAMEDULLARY ROD 0 MichaelMorano Sat, 02 Oct 2010 21:51:32 GMT view revision history
Nonsurgical tx of the acetabulum or pelvis, when is wb permitted? 9 WEEKS 0 MichaelMorano Sat, 02 Oct 2010 21:51:32 GMT view revision history
Surgical tx of a fx pelvis or acetabulum involves how many weeks of a protected wb? 8-10 0 MichaelMorano Sat, 02 Oct 2010 21:51:32 GMT view revision history
What is the most significant clinical feature associated with pelvic fx's? THE POTENTIALLY LIFE-THREATENING COMPLICATIONS 0 MichaelMorano Sat, 02 Oct 2010 21:51:32 GMT view revision history
Because of the fragile hemodynamic nature of the significant pelvic fx, wb of any kind is deferred for how long? 8 WEEKS OR LONGER 0 MichaelMorano Sat, 02 Oct 2010 21:42:07 GMT view revision history
How can unstable pelvic fx's be defined? -ROTATIONALLY UNSTABLE BUT VERTICALLY STABLE
-ROTATIONALLY AND VERTICALLY UNSTABLE
0 MichaelMorano Sat, 02 Oct 2010 21:42:07 GMT view revision history
How are stable fx's of the pelvis treated? -NONSURGICALLY
-PROTECTION
-BED REST (2-3 WEEKS)
-PROGRESSIVE MOTION AND EXERCISE ONCE STABLE BONE UNION HAS BEEN CONFIRMED
0 MichaelMorano Sat, 02 Oct 2010 21:42:07 GMT view revision history
When can strengthening exercises be added after a hip avulsion fx? WHEN THE PHYSICAN CONFIRMS RADIOGRAPHIC EVIDENCE OF SECURE UNION OF THE AVULSION 0 MichaelMorano Sat, 02 Oct 2010 21:42:07 GMT view revision history
How can avulsion fx's of the pelvis be treated? -CONSERVATIVELY WITH REST
-PROTECTED WB
-CRUTCHES
-AVOIDANCE OF PREMATURE STRETCHING AND RESISTIVE EXERCISES.
0 MichaelMorano Sat, 02 Oct 2010 21:24:14 GMT view revision history
The most basic classification of pelvic fx's refers to the injury as either? STABLE/UNSTABLE 0 MichaelMorano Sat, 02 Oct 2010 21:24:14 GMT view revision history
Acetabular fractures? -HIGH-VELOCITY INJURY
-YOUNG ADULTS
-MAYBE ASSOCIATED WITH HIP DISLOCATION
-ABDOMINAL VISCERA AND SCIATIC NERVE INJURY
-USUALLY REQUIRES ORIF
0 MichaelMorano Sat, 02 Oct 2010 21:24:14 GMT view revision history
Treatment of SCFE? SURGERY 0 MichaelMorano Sat, 02 Oct 2010 21:24:14 GMT view revision history
MOI of SCFE? SUDDEN TRAUMA OR ATRAUMATIC AND SLOW 0 MichaelMorano Sat, 02 Oct 2010 21:13:38 GMT view revision history
SCFE affects what gender/age? BOYS (10-16) 0 MichaelMorano Sat, 02 Oct 2010 21:13:38 GMT view revision history
Shearing forces displace the head of the femur inferiorly and posteriorly relative to the neck of the femur SLIPPED CAPITAL FEMORAL EPIPHYSIS 0 MichaelMorano Sat, 02 Oct 2010 21:13:38 GMT view revision history
What is the treatment for LCP? BRACING IN ABD & IR 0 MichaelMorano Sat, 02 Oct 2010 21:13:38 GMT view revision history
What are the signs and symptoms of LCP? -LIMP
-IPSILATERAL MEDIAL THIGH PAIN
-LIMITED IR AND ABD
0 MichaelMorano Sat, 02 Oct 2010 21:06:49 GMT view revision history
What is the etiology (cause) of LCP? UNKNOWN 0 MichaelMorano Sat, 02 Oct 2010 21:06:49 GMT view revision history
LCP typically involves? MALES 3-12 YEARS OF AGE 0 MichaelMorano Sat, 02 Oct 2010 21:06:49 GMT view revision history
What is the treatment for excessive femoral anterversion? FOOT ORTHODICS 0 MichaelMorano Sat, 02 Oct 2010 21:06:49 GMT view revision history
What are the signs and symptoms of excessive femoral anterversion? -EXHIBIT A TOE IN GAIT
-MALALIGNMENT OF THE LOWER LIMB
-EXHIBITS GREATER IR ROM OF THE HIP
0 MichaelMorano Sat, 02 Oct 2010 21:04:02 GMT view revision history
With anterversion, the ipsilateral lower limb will be in what position? IR 0 MichaelMorano Sat, 02 Oct 2010 21:04:02 GMT view revision history
Angle between the femoral neck and femoral shaft on the transverse plane is ________ in adults? 15 DEGREES 0 MichaelMorano Sat, 02 Oct 2010 21:04:02 GMT view revision history
Anterversion will often result in what? -GENU VALGUM
-PES PLANUS
0 MichaelMorano Sat, 02 Oct 2010 21:04:02 GMT view revision history
Retroversion? -A DECREASE IN THE TORSION OF THE FEMORAL NECK
-CAUSES THE SHAFT OF THE FEMUR TO BE ROTATED LATERALLY
0 MichaelMorano Sat, 02 Oct 2010 21:00:37 GMT view revision history
A decrease in the torsion of the femoral neck is called? RETROVERSION 0 MichaelMorano Sat, 02 Oct 2010 21:00:37 GMT view revision history
Anterversion? -AN INCREASE IN THE FEMORAL NECK
-CAUSES THE SHAFT OF THE FEMUR TO BE ROTATED MEDIALLY
0 MichaelMorano Sat, 02 Oct 2010 21:00:37 GMT view revision history
An increase in the torsion of the femoral neck is called? ANTERVERSION 0 MichaelMorano Sat, 02 Oct 2010 21:00:37 GMT view revision history
What is the primary focus of LCP? -MAINTAINING THE FEMORAL HEAD WITHING THE ACETABULUM
-REGAINING MOTION
-REDUCING PAIN AND DYSFUNCTION
0 MichaelMorano Sat, 02 Oct 2010 02:41:59 GMT view revision history
What is the cause of LCP? AVN 0 MichaelMorano Sat, 02 Oct 2010 02:24:58 GMT view revision history
How is LCP characterized? NONINFLAMMATORY, SELF LIMITING (CAN HEAL SPONTANEOUSLY WITH OR WITHOUT SPECIFIC TX), SYNDROME IN WHICH THE FEMORAL HEAD FLATTENED AT THE WEIGHT BEARING SURFACE. 0 MichaelMorano Sat, 02 Oct 2010 02:24:58 GMT view revision history
Legg-Calve-Perthes disease is AKA? COXA PLANA 0 MichaelMorano Sat, 02 Oct 2010 02:24:58 GMT view revision history
Usually affects children between 4-8 years old? LEGG-CALVE-PERTHES DISEASE (LCP) 0 MichaelMorano Sat, 02 Oct 2010 02:24:58 GMT view revision history
Diseases that can lead to degenerative changes in the hip joint? -OSTEOARTHRITIS (DJD)
-RHEUMATOID ARTHRISIS
-CONGENITAL DEOFOMITIES
0 MichaelMorano Sat, 02 Oct 2010 01:56:42 GMT view revision history
This is the most common arthritic disease of the hip joint? OSTEOARTHRITIS 0 MichaelMorano Sat, 02 Oct 2010 01:56:42 GMT view revision history
What is the function of the hip abductors during gait? CONTROL THE LATERAL PELVIC TILT DURING SWINGING OF THE OPPOSITE LEG 0 MichaelMorano Sat, 02 Oct 2010 01:56:42 GMT view revision history
How will someone compensate if they have tight hip flexors? INCREASED LUMBAR LORDOSIS OR WALKS WITH THE TRUNK BENT FORWARD 0 MichaelMorano Sat, 02 Oct 2010 01:56:42 GMT view revision history

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