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cardio 2 Flashcards

1
Q

adult with hypertension, weak or absent femoral pulses, heart failure, left ventricular hypertrophy

A

coarctation of the aorta

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2
Q

important differential for young adults with poorly controlled hypertension

A

coarctation of the aorta

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3
Q

hallmark of coarctation of the aorta

A

narrowing of arteries

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4
Q

thickened arteries

A

atherosclerosis

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5
Q

sudden, intense chest or back pain

A

aortic aneurysm

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6
Q

rate greater than 100m bpm and QRS complex less than 120ms then

A

supraventricular tachycardia

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7
Q

management of supraventricular tachycardia if stable- vagal manoeuvres(carotid sinus massage, valsalva maneouvre)

if unstable- DC cardioversion

if physical maneouvres not successful then may try adenosine but this is contrainidicated in patients with asthma

A
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8
Q

if had raised troponin T level then you should

A

REPEAT IT if value remains roughly the same then can rule out MI but if value is further increased or reduced then MI

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9
Q

elevated serum cardiac enzymes indicate what has occured

A

MI

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10
Q

ST elevation in a few leads are typical of — due to occlusion of a coronary artery

A

Transmural infarction

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11
Q

— angina is not associated with a rise in cardiac enzymes or ST elevation

A

unstable or stable

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12
Q

subendocardial infarction affects

A

most ECG leads

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13
Q

treatment for AVNRT, a form of supraventricular tachycardia

A

Vagal manoeuvres then adenosine

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14
Q

arises from the ascending aorta, just superior to the left cusp of the aortic valve

A

Left coronary artery

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15
Q

Two main arteries arising from the ascending aorta, just superior to the cusps of the aortic valve

A

Left and right coronary artery

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16
Q

coronary sinus opens into the

A

right atrium

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17
Q

— intimately related to the coronary sulcus on the anterior surface of the heart

A

Right coronary artery

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18
Q

in 90% of patients the AV node artery arises from the right coronary artery

A
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19
Q

what supplies the AV node of the heart

A

Anterior interventricular artery, also known as LAD

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20
Q

normal pr interval length

A

0.12-0.2 ms

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21
Q

– can cause large JVP V waves

A

Tricuspid regurg

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22
Q
  • is a cause of cannon waves
A

ventricular tachycardia

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23
Q

– results in a loss of the JVP a wave

A

atrial fibrillation

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24
Q

what valve is in the left sternal border in the 4th intercostal space

A

tricuspid

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25
Q

treatment of chronic heart failure secondary to left ventricular systolic dysfunction

A

ACEi- reduced bp, increasing the ability of the heart to pump blood, increasing cardiac output

Beta blocker - relaxes the heart

Loop diuretic- relieve symptoms associated with overload

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26
Q

high BNP and anaemic indicates

A

heart failure

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27
Q

chronic heart failure symptoms

A

inceasing SOB, peripheral oedema, palpitations and cough

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28
Q

post MI with fever, elevated ESR , 2-6 weeks after

A

Dresslers sydnrome

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29
Q

complication 3-14 days post MI

A

Myomalacia cordis- softening of dead muscles

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30
Q

visual loss in a hypertensive patient can be due to

A

hypertensive retinopathy

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31
Q

common causes of hypertensive retinopathy

A

renal artery stenosis, aldosterone secreting adrenal adenoma

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32
Q

Most appropriate investigation for hypertensive patient with vision loss

A

Aldostrone to renin ratio- then CT or MRI is done

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33
Q

Troponin is found in what 2 muscles

A

cardiac and skeletal

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34
Q

Ecg changes in Non st eleveation MI

A

T wave inversion , high troponin level

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35
Q

deceleration injury (car crash) and high troponin

A

Myocardial contusion

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36
Q

raised serum troponin in suspected PE indicates

A

right ventricular strain

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37
Q

chest pain relieved sitting up, heart sounds scratchy, high troponin, bucket shaped ST elevation

A

Myopericarditis

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38
Q

first line treatment for myopericarditis

A

NSAIDS and if significant pericardial effusion may require pericardiocentesis

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39
Q

valve best heard at the apex beat

A

mitral ( 5th intercostal, mid clavicular)

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40
Q

what is diagnostic of aortic coarctation (hypertension in the upper body giving symptoms liek headache, dizziness and hypotension in lower body - claudication, recurrent pain due to ischaemia of leg muscles)

A

enlarged intercostal arteries produce notching of the inferior margins of the ribs

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41
Q

Infantile form of — is associated with patent ductus arteriosus, whereas the adult form is not)

A

aortic coarctation

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42
Q

endocarditis due to endothelial injuries promoting hypercoaguable states -SLE, antiphospholipid syndrome, malignancy, present with thrombotic events

A

Libman-sacks endocarditis

It is a thrombotic endocarditis

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43
Q

sydenham’s cholera is a manifestation of

A

rheumatic fever

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44
Q

beriberi is a form of thiamine deficiency and relates to consumption of milled – as well as alcohol

A

rice

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45
Q

elevated JVP, large V waves, pan systolic murmur at the left sternal edge, pulsatile hepatomegaly and left parasternal heave

A

tricuspid regurg

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46
Q

steady burning chest pain, post MI, friction rub is heard and heart sounds are muffled

A

Dressler sydrome which is a autoimmune phenomenon results in fibrinous pericarditis

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47
Q

patients with left ventricular failure often suffer from

A

orthopnoea- dyspnea caused by lying flat

paraoxysmal nocturnal dyspnoea- sudden attacks of dyspnoea and coughing at night

if sleeps in an armchair then indicates suffers from orthopneoa

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48
Q

Normal LVEF

left ventricular ejection fraction

A

between 50% and 70%

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49
Q

two important signs of constrictive pericarditis

A

y descent in the JVP

pericardial knock heard in early diastole

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50
Q

triad for cardiac tamponade

A

hypotension, raised JVP, muffled heart sounds

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51
Q

cardiac surgery can cause cardiac tamponade a few days later as

A

post operative bleeding

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52
Q

weight loss, anxiety, greasy skin, tremor, tachycardia

A

thyrotoxicosis

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53
Q

irrergularly irregular

A

ATrial fib

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54
Q

blood supply to the apex is by

A

anterior interventricular artery (LAD)

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55
Q

characterised by signs and symptoms of acute fibrinous pericarditis( pericardial friction rub, chest pain relieved by leaning forward, diffuse ST elevation) in additon to fever , pleuritic chest pain, leukocytosis

A

Dresslers sydrome

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56
Q

acute fibrinous pericarditis manifests how long after MI

A

2-5 days

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57
Q

On ECG, every 4th heart beat there is a non conducted P wave (P wave with no QRS complex)

A

Second degree heart block - Mobitz type II

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58
Q

treatment for symptomatic Type II heart block

A

permanent pacing

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59
Q

progressive lengthening of the PR interval, over several complexes before a non conducted P wave would occur

A

second degree heart block - mobitz type I

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60
Q

central chest pain, tachycardia, excessive sweating, admits to recently taking cocaine

A

Coronary artery vasospasm

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61
Q

tearing pain radiating to back

A

thoracic aortic dissection

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62
Q

definitve management of thoracic aortic dissection

A

open or endovascular surgical repair

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63
Q

management to reduce stress on aortic wall include blood pressure reduction with —- and sympathetic tone reduction with —

A

labetalol

morphine

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64
Q

– syndrome predisposes to recurrent thromboses

A

antiphospholipid

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65
Q

chest pain exacerbated by movement and anterior chest wall is tender to palpation

A

Costochondritis

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66
Q

pain in — is worse with movement, inspiration and coughing or sneezing

A

costochrondritis

67
Q

tenderness over costochondral joints

A

costochondritis - inflammation of the costochondral joints of the ribs

68
Q

management of malignant mesothelioma

A

mostly symptomatic , cure only possible in very localised disease where surgery can be done

69
Q

— is consistent with normal ageing

A

Reduced VO2 max

70
Q

crescendo-descendo murmur in systole is typical of an

A

ejection systolic murmur

71
Q

crescendo -descrescendo murmur and palpable thrill

A

aortic stenosis

72
Q

loud S1, low pitched grumbling noise heard during diastole at the apex

A

mitral stenosis - mid diastolic murmur

73
Q

low blowing murmur, obliterating S2, no palpable thrill

A

Mitral regurg and pan-sysolic murmur

74
Q

what is the ventricular rate like in first degrere av block

A

regular ventricular rate

75
Q

irregularly irregular rhythm, no identifiable P waves, Qrs complex is normal

A

atrial fibrillation

76
Q

polymorphic ventricular tachycardia, with rotation of the QRS complex around the isoelectric baseline

A

Torsades de pointes - associated with long QT syndrome

77
Q

pericardial effusion is between the

A

visceral pericardium and the paritetal pericardium

78
Q

central chest pain and coryzal symptoms, pain worse when lying flat and she gets some relief on sitting up and leaning forwards , pericardial rub

A

acute pericarditis

79
Q

saddle shaped concave St elevation

A

pericarditis

80
Q

presents with ischaemic stroke, PMH of Mi and ecg shows st elevation

A

LEFT VENTRICULAR ANEURYSM

  • may present as persistent ST elevation
  • thrombi can form within the aneurysm causing embolic events such as limb ischaemia or ischaemic stroke. Most common cause of ventricular aneurysm is MI
81
Q

retinal haemorrhages that can be seen in bacterial endocarditis

A

roth spots

82
Q

flushing and blanching of the nailbeds- sign of severe aortic valve insufficiency

A

quincke’s sign

83
Q

red painful lesions found on pulps of fingers

A

oslers nodes - bacterial endocarditis and thing like SLE- they are painless

84
Q

where can the transverse sinus be found

A

behind the major vessels emerging from the ventricles, but in front of the superior vena cava

85
Q

patient having MI and nearest PCI centre is 3 hours away what do you do ?

A

administer thrombolysis and transfer for PCI

(If PCI is not likely not be acieved 120 mins of when fibrinolysis could have been given, fibrinolysis prior to transfer should be strongly considered)

So if transfer time going to be greater than 2 hrs then do fibrinolysis

86
Q

ST elevation in leads V2,3,4, what artery is occluded

87
Q

first line treatment for pericarditis

88
Q

what structures pass within the femoral triangle

A

femoral vein, femoral artery, femoral nerve

89
Q

for cardiac catheterisation, catheter is inserted into

90
Q

what on ECG is associated with high potassium

A

Tall T waves , broad qrs, absent/flat p waves

91
Q

u waves could be a feature of

A

hypokalaemia

92
Q

first line medications for stable angina

A

GTN and bisoprolol

93
Q

next step management of stable angina after GTN

A

long acting nitrate- isosorbide mononitrate and arrange outpatient angiogram

94
Q

typically associated with early systolic ejection click

A

bicuspid aortic valve without calcification

95
Q

one of the most common congenital heart malformations in adults

A

bicuspid aortic valve

96
Q

in bicuspid aortic valve when there is no systolic ejection murmur we can assume there is no

A

calcifaction/stenosis

97
Q

dietary change most likely to reduce cholesterol level

A

replace saturated fats with polyunsaturated fats

  • more so than eat fruits and veg
98
Q

unsaturated fats lower your

A

cholesterol

99
Q
  • prominet right ventricular cardiac impulse, systolic ejection murmur heard best in pulmonary area and along left sternal border and fixed splitting of the second heart sound
  • dilatation of right sided chambers, delayed closure of pulmonary valve
  • creates volume overload on right side
A

atrial septal defect

100
Q

aortic stenosis is associated with

A

left ventricular hypertrophy

101
Q

pyrexia and new murmur

A

pericarditis until proven otherwise

102
Q

what valve for infective endocrditis in drug users

A

tricuspid, produce pan systolic murmur

103
Q

alongside lifestyle changes what would you prescribe to treat high cholesterol and high bp

A

atotvastatin - prevention of cardiovascular disease

bp, type 1 diabetic- calcium channel blocker

and review after 3 months

104
Q

treatent of broad complex tachycardia with adverse signs- chest pain, confusion,

105
Q

regular broad complex tachycardia without adverse signs

A

amiodarone

106
Q

new york heart association classification:

A

I- no limitation of physical activity

II- sight limitation of physical activity

III-marked limitation of physical activity

IV-unable to carry out any physical activity without discomfort- symptoms of cardiac insuffiency at rest

107
Q

Qt interval gives a rough indication of the duration of

A

ventricular systole

108
Q

first heart sounds coincides with

A

qrs complex

109
Q

second heart sound coincides with

A

same time as t wave

110
Q

chest pain relieved sitting forward and becks triad

A

cardiac tamponade sencodary to pericarditis likely caused by recent radiotherapy

-treatment urgent periocardiocentesis

need ecg to exlude MI and PE

111
Q

management of ventricular tachycardia if unstable

A

DC cardioversion

112
Q

is unstable is

A

pulseless or hypotensive

113
Q

VT if stable treatmetn

A

amiodarone or lidocaine

114
Q

St depression and tall r waves in leads — are conssitent of posterior MI

115
Q

low voltage qrs can be caused by

A

dampening effects of extra layers of fat, or air between the heart and thoracic wal- obesity, effusions, penumothorax, emphysema

116
Q

relative contraindication of thrombolysis

A

peptic ulcer, pregnancy, severe hypertension, prolonged cpr, anticoagulation

117
Q

if preseents with inferior wall MI, the most common cause of death within the first hour of symptoms is

A

an arrythmia such as ventricular fibrillation

118
Q

things occur how long after MI

pericarditis

cardiac tamponade

ruptured papillary muscle

emboli

A

3-5days

4-10 days

4-10 days

weeks to moths after

119
Q

fine bi-basal crackles, raised JVP, 3rd heart sound

A

pulmonary oedema

120
Q

pulmonary oedema is a manifestation of

A

left ventricular failure

121
Q

in tricuspid regurg there is a 3 rd heart sound and raised JVP but the hallmarks of it are

A

ascites, pulsatile liver, peripheral oedema, pansystolic murmur

122
Q

engorged jugular vein or absent heart sounds

A

cardiac tamponade

123
Q

anything that pierces fibrous pericardium and casues

A

cardiac tamponade

124
Q

aortic stenosis can be normal in

A

children, pregnacny, fever, tachycardia

125
Q

chest pain weeks after MI, worse with deep inspiration, friction rub

A

dressler sydrome

126
Q

pericardial tamponade signs

A

raised jvp, muffled heart sounds

127
Q

papillary muscle rupture has what murmur

A

mitral regurg

128
Q

low volume pusle, atrial fibrillation, normal pulse and blood pressure, Jvp -loss of a waves(AF) and large v waves (tricuspid regurg), undisplaced tapping apex, mid-diastolic murmur heard at apex

129
Q

profusely unwell and suffered Mi two days ago, low blood pressure, no murmurs, pulmonary oedema

A

cardiogenic shock secondary to MI and intra aortic balloon may be of temporary benefit

130
Q

nitrate therapy will do what to bp

131
Q

examples of things that worsens renal function

A

high dose dopamine,nitrate, nesiritide wich is a natriurtic peptide

132
Q

sinus rhythm, t wave inversion , not st changes, serum tropinin raised significantly

A

aspirin 300mg, prasugrel 60mg, fondaparinux 2.5mg

133
Q

what is seen in patients with ventricular pacing only, distended neck waves ocassional canon waves

A

pacemaker syndrome

134
Q

ventricular tachycardia with twisting electrical axis

A

Torsade de pointes

135
Q

drugs associated with qt prolongation that increase risk of developing torsades de pointes

A

erthyromycins

136
Q

drank lot of alcjol and now in a fib but otherwise fit and well treatmetn

A

amiodarone or flecainide

137
Q

drug used in the management of heart failure that can increase mortality

A

spironolactone and eplerenone

138
Q

drugs for patients who have had an MI

A

acei, beta blocker, high intensity statin, antiplatelet therapy

-atorvastatin 80mg

139
Q

what should be checked before commencement of a statin

A

liver function tests

140
Q

prolongation of pr interval is seen is

A

hyperkalaemia

141
Q

what is seen eventually in hyperkalaemia

A

ventricular tachycardia/ fibrillation

AF can occur in HypOkalaemia

142
Q

— should not be used when bp is low

A

beta blockers

143
Q

what could be prescribed if got heart failure and now AF

A

digoxin and she should be anticoagulated

144
Q

had pnemothroax, tall, pansysolic murmur at apex, loudest on expiration and radiates to axilla

A

Marfan syndrome

145
Q

learning difficulties, recurrent infections, cleft palate, central sternotomy scar suggest cardiac disease, hypocalcemia

A

DiGeorge syndrome

146
Q

digeorge syndrome affects long arm of chromosome

147
Q

kartagner syndrome is associated with

A

chronic sinusitis, bronchiectasis, infertility, dextocardia, situs invertus

148
Q

right axis deviation , positive qrs in lead avR, and dominant s waves throughout chest leads

A

kartagener syndrome

149
Q

– is secreted by the ventricles in response to stretch, levels are elevated in heart failure

150
Q

— is produced by the kidneys in response to reductions in blood pressure

151
Q

stenosis of the right coronary artery causes decreased perfusion to right atrial myocardium to

A

SA node

sa node is supplied by RCA in 60% of cases

although av node in supplied by rca in 80% of cases it is not as closely related to the right atrium as sa node

152
Q

vvi pacemaker for

A

chronic ??atrial fibrillation

153
Q

chronic af is associated with

A

bradycardia,slow irregular heart beat, lackof p waves

154
Q

AAI pacemaker for

A

atrial flutter

155
Q

bradycardia, episodic hypotension associated with syncope

A

chronic af

156
Q

– is given for rythm control. patients who have an acute presentation in teh absence of life threatening heamodynamic instability

A

amiodarone

157
Q

4th heart sound is caused by active atrial contraction and is NOT heard in

158
Q

IN —, LEFT VENTRICULAR CAVITY SIZE IS REDUCED BY SEPTAL HYPERTROPHY. ASSOCIATED WITH LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND EVENTUALLY AN ENLARGED LEFT ATRIUM

159
Q

ACEI ALSO CAUSE

A

HYPERKALAEMIA

160
Q

TYPICALLY PRESENT WITH LOUD PAN SYSTOLIC MURMUR

A

TRICUSPID REGURG

161
Q

MOST COMMON CAUSE OF TRICUSPID REGURG IS

A

HEART FAILURE

162
Q

RAISED JVP AND DISTENDED NECK VEINS IN

A

TRICUSPID REGURG

ALSO HAVE SIGNS OF RIGHT SIDED HEART FAILURE-EG PERIPHERAL OEDEMA

163
Q

MURMUR LOUDER ON INSPIRATION - MITRAL OR TRICUSPID REGURG

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